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Stockholm 2011

The § 69-study. ” Forensic psychiatric evaluations concerning mentally ill, non-psychotic offenders* in 2003 and 2008 at 4 regional centers in Denmark – development, differences and similarities" * §69 in the Danish Penal Cod e. Stockholm 2011. § 69-study. The aim:

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Stockholm 2011

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  1. The § 69-study ”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 2011 Gitte Ahle

  2. § 69-study The aim: • To provide greater knowledge about the group of offenders covered by § 69 of the Danish Penal Code Gitte Ahle

  3. 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… Gitte Ahle

  4. Forensic patients 1990-2006Prevalence Number Year 2010: 2638 forensic patients in Denmark Gitte Ahle

  5. 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 Gitte Ahle

  6. 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? Gitte Ahle

  7. 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 Gitte Ahle

  8. Selected data • Age • Gender • Ethnicity • Diagnosis • Offense • Substanceabuse • Suggestion to legal outcome • Occationallyreview from the PsychiatricSection of the Danish Medico-LegalCouncil • Final legal outcome Gitte Ahle

  9. Results • 2003: 583 forensic psychiatric evaluations • of these 294 were § 69-cases - (50 %) • 2008: 720forensic psychiatric evaluations • of these 366 were § 69-cases – (51 %) An increase of 24 % in actual number in 5 years Gitte Ahle

  10. Results n = 660 forensic psychiatric evaluations • 103 females (16 %) • mean age 33,9 years (15 – 71) • 557 males (84 %) • mean age 36,1 years (15 – 80) Gitte Ahle

  11. Gender (n = 611) • Females (n = 91) • 47% treatment sanction • 53% ordinary punishment • Males (n = 520) • 22%treatment sanction • 78% ordinary punishment Gitte Ahle

  12. Gender and diagnosis(%) Gitte Ahle

  13. Gender and offense (%) Gitte Ahle

  14. 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 % Gitte Ahle

  15. Legal outcome:Sentenced to psychiatric treatment 26 % of all § 69-cases (n=611, 2003 plus 2008) The majority were sentenced to outpatient treatment, supervised by theProbation Services and the possibility of compulsory admission Gitte Ahle

  16. Possibleincreasein treatmentsanctions (%) Gitte Ahle

  17. Offense and diagnosis Gitte Ahle

  18. Offense and diagnosisPersonality disorders (F6) Gitte Ahle

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

  20. Diagnosticcategories ICD-10 (%) Gitte Ahle

  21. 17 % (110) bornoutside Denmark(n = 660) Gitte Ahle

  22. 98 (16%) § 69-cases were reviewed bythe Danish Medico-Legal Council In 76 (78 %) cases: • Agreement between the examiner, the Medico-Legal Council and the court's conclusion Gitte Ahle

  23. Preliminary conclusions from the § 69-study • The total number of forensicpsychiatricevaluations given onsection 69-cases is increasing (24 % over 5 years) • The percentage of section 69-cases of the total number of forensicpsychiatricevaluationsseemsunchanged • 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 disorderspresented the majority is dyssocial • Femalesare more likely to gettreatmentorderthan males • The pattern of alcohol- and substanceabuseseemsunchanged • 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 diagnosticpractice? Thankyou for your attention!!! Gitte Ahle

  24. Corresponding author: • Gitte Ahle, MD, Ministry of Justice, Clinic of forensic psychiatry - gahle@mail.dk Co-authors: • Mette Brandt­Christensen, 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. Gitte Ahle

  25. 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

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