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”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
Gitte Ahle 1
The § 69-study
§ 69-studyThe aim:
• To provide greater knowledge about the group of offenders covered by § 69 of the Danish Penal Code
Gitte Ahle 2
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 3
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
Gitte Ahle 4
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
Gitte Ahle 5
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 6
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 7
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
Gitte Ahle 8
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
Gitte Ahle 9
Results
n = 660 forensic psychiatric evaluations
Gitte Ahle 10
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
Gitte Ahle 11
Gender and diagnosis(%)
Gitte Ahle 12
Gender and offense (%)
Gitte Ahle 13
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 14
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
Gitte Ahle 15
Gitte Ahle 16
Possible increase in treatment sanctions (%)
Offense and diagnosis
Gitte Ahle 17
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)
Gitte Ahle 18
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
Gitte Ahle 19
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
Gitte Ahle 20
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)
Gitte Ahle 21
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
Gitte Ahle 22
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.
Gitte Ahle 24
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
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