Why was the apparently deranged shoplifter Kenzo K. not safely locked up in an institution after his pre-trial detention? And so he had not the chance to murder his two downstairs neighbors in a psychotic fit? After every tragedy there is a need for interpretation in view of repetition. The reconstruction in NRC last weekend more than provided for the circumstances surrounding the double murder that the ‘crossbowman’ K. committed in 2021. The shortest, least satisfactory summary was that he was actually too dangerous to be admitted. And ‘so’ they let him go, mainly because there was no alternative. But why ‘so’?
For shoplifting of cat treats, the possibilities for longer detention are limited under criminal law. Rightly so. This puts the ball in the court of public health care, which must protect both the patient and those around him. That ‘meddling concern’ with citizens like K., who do not recognize their serious problems and shut themselves off, has been inadequate for years.
With that, the Kenzo K. case can be included in the series of welfare state debacles that made the news this week. The Council for Public Health & Society assessed mental health care as weak, shaky and vulnerable. Too little is being invested in it, it is too focused on the short term and arranged too non-committal and fragmented. The 2015 Youth Act, according to the Court of Audit, can even be regarded as a failure. The decentralization has led to a “cluttered and unworkable situation for municipal officials and aid workers”. Vulnerable children end up in a situation of ‘organized impotence’.
The care for people with psychiatric problems in the Netherlands is deteriorating, it seems. The problem of seriously confused people on the loose without proper care is visibly growing. The police counted between 2017 and 2021 886,000 incidents between police officers and so-called confused persons, with a clear upward trend.
In summary, the cause of the K. issue lies in the decentralization and associated impoverishment of this form of expensive and complex care. It has been taking place since roughly 2008, according to the reconstruction. And is now so advanced that it can be completely absent at the crucial moment. Many shelters have now closed, mainly because the tight funding means it is no longer worthwhile to specialize in ‘difficult cases’. The responsibility has been placed with the health insurers by the past cabinets, which keep the reins tight. Especially because they receive insufficient financial support from the Ministry of Health, Welfare and Sport. Psychiatric problems are said to be too unpredictable, which means that insurers’ institutions do not dare to accept complex – because ‘expensive’ patients.
In daily practice, the outpatient teams of the GGZ or Buurtzorg are sent to the complex cases. They may then call through the letterbox whether Mr. or Mrs. wants to open the door. Which they rarely want.
It is even more painful that the murder of Minister of State Els Borst by the seriously psychotic Bart van U. in 2014 already led to an in-depth investigation and mea culpa from, at the time, especially the Public Prosecution Service. This care avoider knew even more blatantly than Kenzo K. by remaining free through the cracks of the system. At the time, the conclusion that it is cheese with holes led to good intentions and new laws about better cooperation between the police, the Public Prosecution Service and healthcare, the results of which were then disappointing.
The responsible ministers in Rutte IV do not get much further than acknowledging that confused people are a tough and complex social problem. Indeed – and it has been for years. Seen in this way, this theme fits seamlessly into the series of Postponed Issues (asylum, nitrogen, climate, housing, recovery benefits and gas) that characterizes the legacy of the Rutte cabinets. The fact that Rutte IV has entered a dissolution phase after the CDA announcement to renegotiate the coalition agreement does not make it optimistic. Yet the ball is in the cabinet’s court and nowhere else. He must take the lead and ensure a financial balance between the insurer and the government that makes ‘expensive beds’ possible again. And the route to it becomes passable again. Now two people are dead and Kenzo K. is in TBS with compulsory treatment – which is not exactly free either.
A version of this article also appeared in the newspaper of April 22, 2023.