“You’re stuck in the system, aren’t you. The court has already said that.” The judge looks understandingly at the huge screen directly in front of him on which 37-year-old Noël can be seen. Noël has been in compulsory care for sixteen years with interruptions. Now he is in front of a camera, in the forensic psychiatric clinic De Rooyse Wissel in Venray. Next to the screen is his chief practitioner, as an expert witness. And his lawyer, Joe de Goeij.
Everyone in the room seems to be upset with this case, from judge and officer to expert. His last TBS clinic has also run out of treatment options. But where to now, with Noel? And above all: will he be able to handle an alternative? Few successes have been achieved in sixteen years of treatment.
In Alkmaar they already knew Noël before his conviction in 2007 as a minor frequent offender – constantly stealing, not accepting help. He was born mentally handicapped due to lack of oxygen. Followed by a childhood of surveillance, quarrels, boarding schools, behavioral problems, crime and detentions. Father alcoholic, mother mentally retarded. “Extremely vulnerable, structure dependent and suggestible person for whom life is and will remain too difficult.” The psychologists already wrote him off as an independent citizen when he was convicted. Someone with a tendency to see everything in black and white, who is fiercely opposed to authorities and behaves antisocially. But dangerous enough for sixteen years behind a fence?
In 2006 Noël threatened a woman in a village in North Holland with a knife. He needed money again, for weed. He took her 60 euros and two telephones. It was eleven months in prison – extortion and attempted murder was the verdict. And also tbs with compulsory nursing. That knife came very close. And she had her baby with her, in the pram, that didn’t help either.
Two years waiting for treatment
Never before had a client of lawyer De Goeij been hospitalized for so long for a relatively minor offense that happened so long ago. Also rare: his client had been living outside the clinic for about seven months, under probation supervision. But was later locked in again, because he turned out to be ‘unaccompanied’. After that, all TBS clinics were full and he had to wait two years in prison for a treatment place. And now, a year after placement, this clinic is also finished.
The waiting times for admission to TBS have now decreased to approximately six months. Of the TBS treatments in the clinic, 80 percent was terminated within eight years, often under conditions of supervision by the probation service or the clinic itself. But not with Noel. He belongs to roughly 3 to 5 percent of ‘stalled’ patients in whom therapy does not work and who cannot be accommodated elsewhere. A little known group. A week after the hearing, it is explained to me by Michiel Verhees, deputy director of treatment and care at De Rooyse Wissel. The problem in tbs is throughput: other agencies convince other institutions that a tbs’er is ‘just a psychiatric patient’, whose risks are manageable.
The lawyer thinks that Noël with ‘a benefit and money for a smoke’ won’t be a nuisance
But mayors are wary of consternation, institutions are afraid of risks. And all for a fuss in media and politics. Tbs’ers have a bad reputation, while the relapse rate is much lower than among detainees. After the punishment, nobody cares about them. “We don’t dare to be proud of tbs,” says Verhees.
There are still a few patients like Noël in his institution, for whom the high security level is no longer necessary. It is especially difficult to find places to stay in enclosed areas. Sometimes it is possible to purchase places from regular mental healthcare elsewhere. Or to start this “care” yourself, on your own property. But then again – where do you find the staff for the guidance?
Noël has also proved untreatable, being mentally retarded, rigid, anxious, suspicious, frustrated and threatening. He can only be used if there is consistently one practitioner or one department for a long time where all the choices have been made and he can feel confident – at least, that is stated in a behavioral report. But they were never available to him.
His tbs has been extended regularly in the Alkmaar court since 2007. The question is always whether conditional termination, under the control of the court, is already possible. Which then carries more weight – safety and the risk of recidivism or the re-socialization of the offender? This is often preceded by a ‘care conference’, a hearing with the patient, lawyer and many experts. Three have already been devoted to Noël – always without success.
De Goeij has never experienced that before either. In forty years of legal practice, he helped dozens of clients out of the TBS clinic fairly quietly. Usually with reports from new experts, who assess the person slightly differently. After which the door can be left ajar, via step-by-step leave and then more and more freedom “with conditions”. But that won’t work here.
Risk management
The consensus in the Alkmaar courtroom is that Noël’s aggression is now a reaction to life in the TBS itself. And that he would be better off in a regular institution. But how to get there? The court previously ruled thatout of the boxmust be thought. Today looks like that. An ‘indication’ has been granted on the basis of the Care and Coercion Act, with which ‘ordinary’ psychiatric patients or people with dementia can be admitted involuntarily.
That could be a breakthrough. Now to get another setting to place Noël. Noël is therefore incapable of a successful trial leave alone. He sets too high standards, for example on his living space. Tends to overestimate – and is seen as dangerous. A care farm was previously thought of as the final destination. But the clinic is not getting the “risk management” done. Which makes Noel angry again.
And is he really dangerous, or is he mainly venting his frustrations, as the reporters suggest? Joe de Goeij thinks that Noël will not cause any nuisance with “a benefit and enough money for a smoke”. But will that be the case? The session ends with an extension of the TBS – that alternative institution outside the TBS now really has to be found.
You have the last word, says the chairman. “I don’t agree that I should be in here,” says Noël. Thank you, says the chairman. The screen goes black.
A version of this article also appeared in the newspaper of May 3, 2022
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