Hostname: page-component-848d4c4894-hfldf Total loading time: 0 Render date: 2024-05-21T15:19:37.846Z Has data issue: false hasContentIssue false
  • English
  • Français

The organization of the psychiatric service and criminality committed by the mentally ill

Published online by Cambridge University Press:  16 April 2020

P. Kramp  and
G. Gabrielsen
P. Kramp*
Affiliation:
Clinic of Forensic Psychiatry, Blegdamsvej 6B, 2, DK-2200Copenhagen N, Denmark
G. Gabrielsen
Affiliation:
Unit of Statistics, Copenhagen Business School, Solbjerg Plads 3, DK-2000Frederiksberg C, Denmark
*
*Corresponding author. Tel.: +45 35360366; fax: +45 35201488. E-mail address: pk001@retspsykiatriskklinik.dk
Get access

Abstract

Introduction

Over the past 40 years, a marked deinstitutionalisation in favour of social and community psychiatry has taken place in many countries. During this same period of time, there has been an increase in the number of mentally ill criminals. The purpose of this study is to analyse the correlations between the reorganization of the psychiatric treatment system, the growing number of forensic patients and the increase in serious crime, homicide, arson and violence associated with the mentally ill.

Materials and methods

Using registers and other data sources, we estimated the annual positive or negative growth rate of consumed psychiatric beds and in social and community psychiatry (explanatory variables) and in prevalence and incidence of forensic patients, homicide, arson and violence (response variables) from 1980 to 1997 for each of the Danish counties. We analysed the immediate effect of the changing treatment structure by relating response variables to explanatory variables. The long-term effect was analysed in the form of between county analysis with both single and multiple regressions.

Results

Bed closure had no immediate effect on either the number of forensic patients or serious criminality. The between county analysis shows, however, that over time the (negative) growth rate in number of consumed beds is significantly correlated with the (positive) growth rates for forensic patients, homicide and arson. Social and community psychiatry have little effect, if any.

Discussion

The study is based on historical data, but the results are still valid. We have used two sets of data firstly the number of forensic patients and, secondly the reported number of crimes associated with the mentally ill. The uniformity of the results leads us to consider them for certain: That the decreasing effort invested in inpatient treatment is causing an increase in the crime rate among the mentally ill.

Conclusion

Many forensic patients suffer from schizophrenia. These patients are not only offenders, but also the victims of an inadequate treatment system. Modern inpatient treatment facilities should be established.

Keywords

DeinstitutionalisationOutpatient treatmentForensic patientsSerious crimes
Type
Original article
Information
European Psychiatry , Volume 24 , Issue 6 , September 2009 , pp. 401 - 411
Copyright
Copyright © Elsevier Masson SAS 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Amtsrådsforeningen, Amterne og psykiatrien. København: Amtsrådsforeningen, 1991 [The Association of County Councils, the counties and psychiatric services. In Danish].Google Scholar
Amtsrådsforeningen. Psykiatrien i tal. Udviklingen i det samlede amtskommunale tilbud til sindslidende: kapacitet, aktivitet og økonomi 1992–1995. København: Amtsrådsforeningen, 1996 [The Association of County Councils, Psychiatry in figures. In Danish].Google Scholar
Belfrage, H.Criminality and mortality among a cohort of former mental patients in Sweden. Nord J Psychiatry 1994;48(5):343–347CrossRefGoogle Scholar
Coid, J.Kahtan, N.Cook, A.Gault, S.Jarman, B.Predicting admission rates to secure forensic psychiatry services. Psychol Med 2001;31(3):531–539Google ScholarPubMed
Coid, J.Lewis, S.W.Reveley, A.M.A twin study of psychosis and criminality. Br J Psychiatry 1993;162:87–92CrossRefGoogle ScholarPubMed
Conway, M.Care-management for mental illness. Lancet 1995;345(8954):926–927CrossRefGoogle ScholarPubMed
Davidson, M.Humphreys, M.S.Johnstone, E.C.Owens, D.G.Prevalence of psychiatric morbidity among remand prisoners in Scotland. Br J Psychiatry 1995;167(4):545–548CrossRefGoogle ScholarPubMed
Gabrielsen, G.Kramp, P.Det stigende antal retspsykiatriske patienter [The increasing number of forensic psychiatric patients]. Nord Tidskr Kriminalvidenskab 2007;94(3):389–398 [In Danish with an English summary]Google Scholar
Gabrielsen, G.Kramp, P.Forensic psychiatric patients among immigrants in Denmark– diagnoses and criminality. Nord J Psychiatry 2009;63:140–147CrossRefGoogle ScholarPubMed
Gottlieb, P.Gabrielsen, G.Kramp, P.Increasing rates of homicide in Copenhagen from 1959 to 1983. Acta Psychiatr Scand 1988;77(3):301–308CrossRefGoogle ScholarPubMed
Hodgins, S.Lalonde, N.Major mental disorders and crime: Changes over time?Cohen, P.Slomkowski, C.Robins, L.N.Historical and geographical influences on psychopathology LondonErlbaum 1999 57–84Google Scholar
Hodgins, S.Mednick, S.A.Brennan, P.A.et al.Mental disorder and crime. Evidence from a Danish birth cohort. Arch Gen Psychiatry 1996;53(6):489–496CrossRefGoogle ScholarPubMed
Hodgins, S.Müller-Isberner, R.Allaire, J.-F.Attempting to understand the increase in the number of forensic beds in Europe: a multiside study of patients in forensic and general psychiatric services. Int J Forensic Ment Health 2006;5(2):173–184Google Scholar
Kramp, P.Gabrielsen, G.Kriminalitet begået af psykisk syge 1977–1999 [Crimes committed by mentally ill persons in 1977–1999. Development, number and causes]. Ugeskr Laeger 2003;165(25):2553–2556 [In Danish with an English summary]Google Scholar
Kramp, P, Gabrielsen, G. Retspsykiatri i H:S, rapport [Forensic psychiatry in the Copenhagen Hospital Corporation, report]. København: H:S Sundhedsfagligt råd for psykiatri 2001 [In Danish].Google Scholar
Kramp, P.Gabrielsen, G.Retspsykiatriske patienter i H:S. Diagnoser, misbrug og kriminalitet. [Forensic psychiatric patients. Diagnoses, substance abuse, and criminal activity]. Ugeskr Laeger 2004;166(34):2890–2894 [In Danish with an English summary]Google Scholar
Kramp, P. Denmark. In: Salize HJ, Dressing H, editors. Placement and treatment of mentally disordered offenders: legislation and practice in the European Union. Lengerich: Pabst science publishers; 2005, p. 152–177.Google Scholar
Laajasalo, T.Hakkanen, H.Excessive violence and psychotic symptomatology among homicide offenders with schizophrenia. Crim Behav Ment Health 2006;16:242–253CrossRefGoogle ScholarPubMed
Marshall, M.Lockwood, A.Gath, D.Social services case-management for long-term mental disorders: a randomised controlled trial. Lancet 1995;345(8947):409–412CrossRefGoogle ScholarPubMed
Martinsen, E.W.Ruud, T.Borge, L.Watne, O.Friis, S.The fate of chronic in-patients after closure of psychiatric nursing homes in Norway: a personal follow-up 6 years later. Acta Psychiatr Scand 1998;98(5):360–365CrossRefGoogle ScholarPubMed
Munetz, M.R.Grande, T.P.Chambers, M.R.The incarceration of individuals with severe mental disorders. Community Ment Health J 2001;37(4):361–372Google ScholarPubMed
Munk-Jørgensen, P.Kastrup, M.Mortensen, P.B.The Danish psychiatric register as a tool in epidemiology. Acta Psychiatr Scand Suppl 1993;370:27–32CrossRefGoogle ScholarPubMed
Munk-Jørgensen, P.Mortensen, P.B.The Danish psychiatric central register. Dan Med Bull 1997;44(1):82–84Google ScholarPubMed
Munk-Jørgensen P, Perto G. De farlige psykiatriske tal [The dangerous psychiatric numbers] København: Munksgaard 2000 [In Danish].Google Scholar
O’Neill, C.Kelly, A.Sinclair, H.Kennedy, H.Deprivation: different implications for forensic psychiatric need in urban and rural areas. Soc Psychiatry Psychiatr Epidemiol 2005;40(7):551–556CrossRefGoogle ScholarPubMed
O’Neill, C.Sinclair, H.Kelly, A.Kennedy, H.Interaction of forensic and general psychiatric services in Ireland: learning the lessons or repeating the mistakes?. Ir J Psychol Med 2002;19(2):48–54CrossRefGoogle ScholarPubMed
Politiets årsberetninger 1980–1996 [Annual reports 1980–1996 from the Danish National Police]. København: Rigspolitiet; 1981–1997 [In Danish with English summaries].Google Scholar
Priebe, S.Frottier, P.Gaddini, A.Kilian, R.et al.Mental health care institutions in nine European countries, 2002 to 2006. Psychiatr Serv 2008;59:570–573CrossRefGoogle ScholarPubMed
Reiss, A.J.Miczek, K.A.Roth, J.A.Understanding and preventing violence Washington DCNational Academy Press 1994Google Scholar
Repo, E.Virkkunen, M.Rawlings, R.Linnoila, M.Criminal and psychiatric histories of Finnish arsonists. Acta Psychiatr Scand 1997;95(4):318–323Google ScholarPubMed
Rigsadvokaten. Behandling af straffesager vedrørende psykisk afvigende kriminelle og personer omfattet af straffelovens § 70 Meddelelse nr. 5/2007 [Director of Public Prosecutions’ instructions to the prosecution on handling cases involving mentally abnormal criminals]. København: Rigsadvokaten; 2007 [In Danish].Google Scholar
Robertson, G.Arrest patterns among mentally disordered offenders. Br J Psychiatry 1988;153:313–316CrossRefGoogle ScholarPubMed
Schanda, H.Psychiatry reforms and illegal behaviour of the severely mentally ill. Lancet 2005;365(9457):367–369CrossRefGoogle ScholarPubMed
Socialministeriet og Sundhedsministeriet [Ministry of Social Affairs and Ministry of Health]. Regeringens statusrapport om tilbuddene til sindslidende 1995 [The Government's annual status report on service offerings for the mentally ill for 1995]. København: Socialministeriet, Sundhedsministeriet; 1995 [In Danish].Google Scholar
Socialministeriet, Indenrigs- og Sundhedsministeriet [Ministry of Social Affairs and Ministry of Health]. Regeringens statusrapport om tilbuddene til de sindslidende 2000 [The Government's annual status report on service offerings for the mentally ill for 2000]. København: Socialministeriet; 2002 [In Danish].Google Scholar
Søgaard, H.J.Godt, H.H.Blinkenberg, S.Trends in psychiatric hospitalization and changes in admission patterns in two counties in Denmark from 1977 to 1989. Soc Psychiatry Psychiatr Epidemiol 1992;27(6):263–269Google ScholarPubMed
Soyka, M.Substance misuse, psychiatric disorder and violent and disturbed behaviour. Br J Psychiatry 2000;176:345–350CrossRefGoogle ScholarPubMed
Sugarman, P.Home Office Statistical Bulletin 22/01: statistics of mentally disordered offenders 2000. J Forensic Psychiatry Psychol 2002;13(2):385–390CrossRefGoogle Scholar
Trieman, N.Leff, J.Glover, G.Outcome of long stay psychiatric patients resettled in the community: prospective cohort study. BMJ 1999;319(720):13–16CrossRefGoogle ScholarPubMed
Vevera, J.Hubbard, A.Veselý, A.Papežová, H.Violent behaviour in schizophrenia. Retrospective study of four independent samples from Prague, 1949 to 2000. Br J Psychiatry 2005;187:426–430Google ScholarPubMed
Wallace, C.Mullen, P.E.Burgess, P.Criminal offending in schizophrenia over a 25-year period marked by deinstitutionalization and increasing prevalence of comorbid substance use disorders. Am J Psychiatry 2004;161(4):716–727CrossRefGoogle Scholar
Walsh, E.Gilvarry, C.Samele, C.Harvey, K.Manley, C.Tyrer, P.et al.Reducing violence in severe mental illness: randomised controlled trial of intensive case management compared with standard care. BMJ 2001;323(7321):1093–1096CrossRefGoogle ScholarPubMed
WHO ICD-10. Psykiske lidelser og adfærdsmæssige forstyrrelser: Klassifikation og diagnostiske kriterier [based on the International Statistical Classification of Diseases and Related Health Problems]. København: Munksgaard; 1998.Google Scholar
Submit a response

Comments

No Comments have been published for this article.