Compulsory treatment of dangerous offenders with severe personality disorders: a comparison of the English DSPD and Dutch TBS systems

Abstract

British society has come to see itself as at risk from violent and antisocial behaviour from people with mental disorders. One manifestation of this is the DSPD programme for offenders with severe personality disorders, inspired by the Dutch TBS system. The TBS legislation was introduced to combat the frequent reoffending of “psychopaths”. The number of TBS hospital beds has increased rapidly, from 400 in 1975 to more than 1,600 in 2006. This is mainly due to the growing confidence of Dutch courts that the order protects the public and minimises recidivism. Five-year recidivism rates among discharged TBS patients have fallen from 52% in 1974 to 17% in 1998. In this article, we describe the main differences between the two systems in terms of philosophy, treatment programmes, outcomes and costs. The DSPD programme has deviated substantially from the TBS model in ways that may prevent it being as effective. It has not, in our opinion. properly implemented the patient responsibility, the rehabilitation focus, or the clear care pathways of the Dutch system. We are concerned that unless these issues are addressed, DSPD services will not live up to expectations and a chance to help personality disordered offenders will be lost.