”Forensic psychiatric evaluationsconcerning mentally ill, non-

psychotic offenders* in 2003 and 2008

at 4 regional centers in Denmark – development, differences and

similarities" * §69 in the Danish Penal Code

Stockholm 2011Stockholm 2011

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The § 69-study

§ 69-studyThe aim:

• To provide greater knowledge about the group of offenders covered by § 69 of the Danish Penal Code

 

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The Danish Penal Code

• § 16:… psychotic and mentally retarded (regarded irresponsible) offenders are not punishable, but will be sentenced to psychiatric treatment.…

• § 69:.. non-psychotic or mentally retarded, but otherwise mentally disturbed offenders may be sentenced to treatment rather than punishment – when treatment is considered the more appropriate sanction in order to prevent relapse into crime…

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Forensic patients 1990-2006Prevalence

0

1000

2000

Ant

al

1975 1980 1985 1990 1995 2000 2005 2010

tid

Growth rate 1989 – 1999 : 6.7 % per year Growth rate 2000 – 2001 : -1.5 % per year Growth rate 2002 – 2006 : 11.4 % per year

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Number

Year

2010: 2638 forensic patients in Denmark

Developement in the numbers of forensic patients

• The number of forensic patients has increased dramatically in Denmark as well as in many other countries during the last three decades.

• The patients primarily suffer from schizophrenia.

• The offenses committed by the patients are often violent offenses.

• Journal of the Danish medical association: Kramp et al. 2008;170(46):3768

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The § 69-study Research questions

• Is the number of § 69-cases increasing?

• Has the diagnostic pattern changed?• Has the crime pattern changed?• Has the nature of alcohol and

substance abuse changed?• Were there regional differences?

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The § 69-study

• Forensic psychiatric evaluations from four regional centers, where the offender was assigned to § 69

• 2003 and 2008• Study design comparative, retrospective,

based on file-data• All evaluations scrutinized by

experienced forensic psychiatrists and selected data registered

• Covering app. 80% of the total § 69-cases in DK performed in 2003 and 2008

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Selected data

• Age• Gender• Ethnicity• Diagnosis• Offense• Substance abuse• Suggestion to legal outcome• Occationally review from the Psychiatric

Section of the Danish Medico-Legal Council• Final legal outcome

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Results• 2003:

583 forensic psychiatric evaluations – of these 294 were § 69-cases - (50 %)

• 2008:720 forensic psychiatric evaluations – of these 366 were § 69-cases – (51 %)

An increase of 24 % in actual number in 5 years

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Results

n = 660 forensic psychiatric evaluations

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103 females (16 %) mean age 33,9 years (15 – 71)

557 males (84 %)mean age 36,1 years (15 – 80)

Gender (n = 611)

• Females (n = 91)– 47% treatment sanction– 53% ordinary punishment

• Males (n = 520)– 22% treatment sanction– 78% ordinary punishment

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Gender and diagnosis(%)

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Gender and offense (%)

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Reported alcohol– and substance abuse during the offense

• Under influence of alcohol (only):– 2003: 28,8 %– 2008: 29,4 %

• Under influence of alcohol and/or other substances:– 2003: 56,7 %– 2008: 57,0 %

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Legal outcome:Sentenced to psychiatric

treatment26 % of all § 69-cases

(n=611, 2003 plus 2008)

The majority were sentenced to outpatient treatment,

supervised by the Probation Services and

the possibility of compulsory admission

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Possible increase in treatment sanctions (%)

Offense and diagnosis

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F0 F1 F2 F3 F4 F5 F6 F7 F8 F9Homicide, fatal violence and attempts

3 9 0 1 2 0 88 0 0 3

Arson 4 2 0 1 3 0 41 0 1 4

Severe violence 2 2 3 3 4 0 57 0 2 7

Violence 5 0 2 2 10 0 55 0 0 14

Violence and threats against public servants

5 2 1 1 3 0 22 0 0 5

Rape and attempts 0 0 0 0 1 1 19 0 1 0

Sexual offense, excl. rape

5 2 2 2 1 0 62 1 2 4

Offense against property

8 7 6 9 5 1 108 2 0 12

Total 32 24 14 19 29 2 452 3 6 49

Offense and diagnosis Personality disorders (F6)

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F60.0 F60.1 F60.2 F60.30 F60.31 F60.6 F60.7 F60.8 F60.9 F61.0

Homicide, fatal violence and att.

2 0 31 2 5 3 2 6 19 11

Arson 0 1 14 2 5 2 4 1 7 4

Severe violence 0 0 28 6 2 1 1 0 7 7

Violence 0 2 16 5 2 2 2 2 18 3

Violence and threats against public servants

1 1 4 2 5 1 0 1 3 2

Rape and attempts 0 0 9 0 0 1 1 1 4 3

Sexual offense, excl. rape

1 0 12 0 1 6 3 7 14 7

Offense against property

2 3 49 7 6 2 1 3 11 13

6 7 163 24 26 18 14 21 83 50

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ADHD 2003 and 2008 in the 4 regional centersF90 - % of all § 69-diagnoses

0

2

4

6

8

10

12

14

16

Aalborg Aarhus Middelfart København

%

2003

2008

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Diagnostic categories ICD-10 (%)

0

10

20

30

40

50

60

70

80

90

100

Aal 2003 Aal 2008 Aar 2003 Aar 2008 Mid 2003 Mid 2008 Kbh 2003 Kbh 2008

F0

F1

F2

F3

F4

F5

F6

F7

F8

F9

17 % (110) born outside Denmark(n = 660)

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98 (16%) § 69-cases were reviewed by

the Danish Medico-Legal Council

In 76 (78 %) cases: • Agreement between the examiner,

the Medico-Legal Council and the court's conclusion

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Preliminary conclusions from the § 69-study

• The total number of forensic psychiatric evaluations given on section 69-cases is increasing (24 % over 5 years)

• The percentage of section 69-cases of the total number of forensic psychiatric evaluations seems unchanged

• There appears to be a trend towards more often recommending treatment sentence

• The majority (84%) of the section 69-offenders are males• Of the personality disorders presented the majority is dyssocial• Females are more likely to get treatment order than males• The pattern of alcohol- and substance abuse seems unchanged• 17 % of section 69-cases were born outside Denmark• 16% of section 69-cases were reviewed by the Danish Medico-

Legal Council• There is a difference between the regional centers in the number

of ADHD-diagnoses given• Less F6, more F9 (ADHD) in all centers from 2003 to 2008. Change

in diagnostic practice?

Thank you for your attention!!!Gitte Ahle 23

Corresponding author:

• Gitte Ahle, MD, Ministry of Justice, Clinic of forensic psychiatry - gahle@mail.dk

Co-authors:• Mette Brandt Christensen, MD, Ph.d., Forensic

Psychiatric Centre Glostrup, Copenhagen University Hospital.

• Peter Fristed, MD, Forensic Psychiatric Centre, Odense University Hospital.

• Tina Gram Larsen, MD, Forensic Psychiatric Dep., Aalborg University Hospital.

• Kirsten Nitschke, MD, Forensic Psychiatric Dep., Aaarhus University Hospital.

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Forensic psychiatric reports

• Are requested… if there are reasons to assume, that the

offender suffers from any of the conditions comprised in § 16 or § 69, as well as if offenders are charged with a seriously violent crime, in order

• … to describe the offender’s mental state at the time of the offense and at the time of the evaluation and

• … to offer suggestion to legal outcome Gitte Ahle 25