National Database for Risk Assessment TBS

"Placement under a hospital order" (TBS) is a treatment measure that Dutch courts can impose to prevent recidivism. The idea underlying this measure is that risk and protective factors must be the focus of treatment to reduce risk if psychiatric illness has contributed to the criminal behavior. These factors are not only the starting point for treatment, but also the main criteria for:

• assessing change,
• deciding about leave taking,
• managing risk during leave taking (as an integral part of treatment),
• deciding about ending the measure.

The enforcement of the measure is an integrated effort of different disciplines and institutions, which perform a balancing act between resocialisation (controlled risk) and public safety (controlling risk). This demands the management of information from various sources, where decision making based on (scientific) evidence is paramount.

The national database for risk assessment, established by Dutch Forensic Psychiatric Clinics (FPCs) and the Expertisecentre Forensic Psychiatry, is a response to this demand. The database contains the data of all mandatory (once yearly) risk assessments for all high security (tbs) patients from 2005 onwards.
The database, coupled with visual data mining techniques will be able to contribute to:

• insight into risk assessment data,
• refinement of the involved instruments,
• differentiated risk profiles usable in clinical practice.

The database makes it possible to gather larger cohorts and thus foster more detailed research. This then enables the forensic psychiatric sector to learn from the today's system of risk management and thus improve it for tomorrow. Analysis of (statistically) large enough groups and databases will lead to a more accurate use and also further development of existing risk assessment instruments. This will improve the way risk and protective factors of patients are predicted and controlled, which should in turn eventually improve public safety.

The basis for the National Database consists of the mandatory structured risk assessment in high security FPCs. The data are uploaded to the database by the FPCs via a trusted third party (Zorg TTP). The TTP double pseudonimizes the data so that patients and clinics are not recognizable.