Michael G

The role of the Dutch addiction services in the approach of addicted repeat offenders drs. Chris van der MeerMan. Director Palier

EFTC conference June 4th 2009Eyes on the Future

EFTC conference 4 june 2009

Overview of presentation

Introduction•The Repeat Offender Project (ROP)• The project participants • Characteristics of top 500 group (demogr., MH, crim.)

• Role of Addiction Services and MH Probation• Treatment modalities and subgroups• Reintegration modalities• Results of TX

• Results of the ROP• Conclusions


The Hague, demographic data

Offenders:15.800 / yr• < 10 crim. rec.: 13.800• ≥ 10 crim. rec.: 2.000• “top 500”

Drug addicts: 2.900 /yr • (opiates / cocaine)• prevalence

– 1% of 15-54yr– 0,6-3% in ethnic minorities (>1% av.)– 0-2,4% in central. districts

Criminal drug addicts: 2.000 / yr• > 10 crim. records :1.600

Inhabitants: 475.000 (3rd city)• 47% ethnic minorities

patients > 100 000 employees > 8.000 beds 2.700 locations > 180

Expert – Respectful - Optimistic

SOV

The Hague addict. psych. probation Patients 4000 25.000 2.000 Employees 500 2500 90 Beds 200 1100 -

Parnassia Bavo Groep 2008


Repeat Offender Project (ROP)

• 2002 Public Safety Policy of Government

• ROP’s: intensive cooperation of• Community• Public prosecutor • Police• Probation• MH & Addiction.

• RO: top 1% of offenders is responsible for • >10% court sessions• 37% of short detentions (<3 mnth)


Role of Central Government

ISD order (Oct. 2004) / extra prison cells (>800)• 2 year court order for most active RO• Partly in prison, partly outside (conditional)• Successor of (experimental) SOV order (2002)

Additional funding ROP• Larger cities (GSB) • Probation offices (Justice Dpt)

Forensic MH & Add. under control Justice Dpt. (2007)• Extra funding MH&A

Role community The Hague

• RO Project structure (leading role of the Mayor!)• chain continuity• case register “top 500”, web based• performance contracts with• Police ( adoption structure; top 10!)• Public Prosecutor (super fast justice)• PBG (MH & Add; MH Probation: 300 trajectories)

• extra funding for necessary links in chain• program evaluation


Top 500 definition and demography (The Hague)

definition: • > 10 offenses in the last 5 years, at least 1 in the

index year• n=1536 (2000-2006)• Per year 600 -700 in contact with police• 100 -150 new in top 500demography: • mean age 36 yr• 93 % male • 57 % ethnic minority• 8 % employed• 70 % single / homeless


Top 500 criminal careers (The Hague)

criminal career:• criminal career 42% > 15 yr, mean 14 yr• start 57% < 18th yr; mean 19th • av. 44 offenses / 68 registered crimes• 100% property, 67% violence


Top 500: mental health aspects

• 86% addicted – mostly poly drug; – 39% (also) alcohol; – 10% only alcohol or cannabis

• 50% psychiatric diagnosis – 13% schizophrenia– personality disorders, ADHD, ASS, mental

deficits)• 67% known at PBG (MH or Add.S.)• NB multi problem with many other

criminogenic factors!


Judicial modalities on entry(300 trajectories)

Voluntary treatment (20%)• preventive approach• after expiration of title

Mandatory treatment / Diversion (60%)• (partly) conditional sentences• probational supervision

ISD order (20%) (‘ultimum refugium’)• 2 years court order• modular treatment in prison (limited!)• addiction and MH treatment in 2nd (extramural) phase


Different strokes for different folks

Treatment matching factors:• motivation / risks / needs (what works)• psychiatric possibilities and limitations• conditions of the sentence

4 subgroups• complete rehabilitation (40%)• rehabilitation with enduring substitution / support (30%)• severe dual diagnosis / chronic care (20%)• severe behavioral disturbances / outreach (10%)

Subgroups from treatment perspective Recov

40%

Subst

30%

DD

20%

MP

10%

Treatment in prison• Modular treatment on DFU and ISD unit

• Prison TC??

+

!

+

!

+ +

Inpatient / residential treatment• TX (modified TC criminal addicts)

• EH (regular TC)

• Motivational Center (3mnth; low thresh.)

• Center Dual Diagnosis (CDP)

• Forensic psychiatric ward (FPA)

+

+

+

+

+

(+)

(+)

Outpatient / outreaching treatment• Outpatient drug free

• Substitution programmes

• Forensic outpatient

• CDP outpatient

• F-ACT

+

+

+

+

+

+

+

+

+

+

+

+


Treatment modalities: inpatient / residential treatment (n=50 PO’s / moment)

Emiliehoeve TC (40) Triple-Ex modified TC (crim. add.)(40)

Forensic psychiatric ward (46) Motivational Centre (low threshold)(24)


Treatment modalities: outpatient / outreaching treatment (n=120 / moment)

forensic outpatient treatment in prison substitution program

forensic ACT outpatient drug free


Forensic outpatient (25 FTE/ 800 cl) PO: 109• Psychiatric and addiction

diagnosis and treatment• Forensic Outreach Team (F-

ACT)• Prison team

MH Probation (90 FTE/ 2000 cl) PO: 205

• Forensic reports• diversion / indications• supervision and case management• behavioral training in prison

Reintegration modules, e.g.Mat. Soc. Service (MJD) (32 FTE/ 1800 cl) PO 100 • budget help• juridical advise, • help with housing, insurance, • ID, permits

Forensic ambulatory, a comprehensive outpatient chain

Forensic outpatient treatment(25 FTE/ 800 cl) PO: 109Psychiatric and addiction treatment

forensic ACT

Subgroups from reintegration perspective

Recov

40%

Subst

30%

DD

20%

MP

10%

Material help (MJD)• budget and debts

• insurance / ID / etc

+

+

+

+

+

+

+

+

Housing projects• Remise (guided living RO’s)

• Re entry after Emiliehoeve and Triple-Ex

• Shelter Center Dual Diagnosis (CDP)

• Mi Casa / Woodstock

• Turnaround houses

+

+

+

+

+

+

+

+

(+)

(+)

(+)

Day care / work• Vocational training (‘t Filiaal) / job coach (BV)

• Day wages RO’s (Reflex)

• Regular day wages (Clean River; Schoon&Zn))

• Day care

• Walk in programme

+

+

+

+

+

+

+

+

+

+

+

+

NB Intensive MH probation !! + + + +


Remise 25 drugfree places (for RO’s) Re-Entry (TX & EH) 30 drugfree places

Remise 26 plaatsen

Reintegration 2: housing projects

MiCasa 47 places De overloop 15 places Woodstock 30 places


Vocational training ‘t Filiaal en job coach BV

Reintegration 3a: vocational skills

technics - health care - catering / restaurant – cleaning - roadman / gardening - technics - health care - catering / restaurant – cleaning - roadman / gardening - individual programmesindividual programmes 70-100 pupils / wk70-100 pupils / wk


Schoon & Zn Clean River

Kringloopwinkel

Rehabilitation 3b: day care / day wages

Reflex (for RO’s) Recycle-shop

EFTC conference 4 june 2009Triple-Ex: ex-addict, ex-criminal en ex-unemployed

40 places


Outcome study: results SOV vs. regular detention and coercion projects (TX)

part of a larger quasi-experimental pre-post study

t baseline t follow-up

intervention12 monthspre-treatment phase

12 monthspost-treatment phase

SOV (compulsory stay detention with treatment 18 months

with 6 months community based aftercare)

Compared to

TX (modified TC; 9-12 months; coercion / voluntary; plus RE)

FVK (inpatient treatment, non TC)

Thanks to: Amsterdam Inst. Addiction Research (Maarten Koeter) and Parnassia Addiction Research Center

(Peter Blanken)


Client characteristics TX at admission

Background:- male 100 %- age 33 yrs- lower education * 88 %- non-western ethn. 39 %

Social situation:- never any work 8.1%- recent work 16%- welfare 25.8%- paid labour 11.3%

* LO/ LBO/ MVO

Drug abuse:- poly drug 98%- start at 22 yr Cocaine 89 % Heroin 58 %

- euro/month €1505

Criminality:- property 74%- violence 48%- drugs dealing 40%


Criminality during FU (>1 yr) (police & self-report)

24

9

37

45

23

7

31

14

46

53

43

9

0

10

20

30

40

50

60

TX coerc. TX-c short TX-c long TX volunt SOV reg. det.

no crim. during FU

reduction during FU

Reduction = > 50% red. & <5 crimes

TIP:SOV 24 mTX-c 6.5 mTX-v 6.8 mShort =<3m

n=SOV 154TX-c 50TX-v 51


Substance abuse at FU (>1 yr) (self-report)

40

17

5045

35

10

48

30

63

49 49

10

0

10

20

30

40

50

60

70

TX coerc. TX-c short TX-c long TX volunt SOV reg. det.

no subst. use last 30d

reduction last 30d

Reduction = > 50% red. & <6d dr/alc

TIP:SOV 24 mTX-c 6.5 mTX-v 6.8 mShort =<3m



Combined success on FU (SU & crim.)

20

25

18

4

0

5

10

15

20

25

30

TX coerc. TX volunt SOV reg. det.

no recidivism & abstinent

TIP:SOV 24 mTX-c 6.5 mTX-v 6.8 m


Results ROP: community level

0

20

40

60

80

100

120

2002 2003 2004 2005

theft of bikes

theft of cars

theft from cars

theft from homes

theft from firms

2002 73.5002002 73.5002005 50.5002005 50.500

Analyse & Research Politie Haaglanden 2007

Results ROP: RO group level

Recidive-indicator = part that relapses in index year x av. number of arrests that year

428375

313

212 209 223

0

50

100

150

200

250

300

350

400

450

2002 2006200520042003 2007

Analyse & Research Politie Haaglanden 2008


Conclusions

1. Addiction Services & MH play a very important role in local safety policy (Repeat Offender Project)

2. The complex group of RO’s is characterized by addiction with much co-morbidity

3. A differentiated and comprehensive response is needed:– Residential / outpatient / outreaching / in prison treatment– Rehabilitation modules (finance, housing, work, education)– MH probation (specialized)

4. PBG: in this integrated service package (incl. harm reduction) TC’s flourish. The total results are very promising.

5. Future: better treatment in detention (prison TC!!) and modalities for clients with mental deficits.


Thank you !

Michael G

Health & Medicine

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