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Dangerous or merely ‘difficult’? The new population of forensic mental hospitals

Published online by Cambridge University Press:  16 April 2020

H. Schanda ,
T. Stompe  and
G. Ortwein-Swoboda
H. Schanda*
Affiliation:
Justizanstalt Göllersdorf, 17, Schlossgasse, 2013Göllersdorf, Austria
T. Stompe
Affiliation:
Justizanstalt Göllersdorf, 17, Schlossgasse, 2013Göllersdorf, Austria
G. Ortwein-Swoboda
Affiliation:
Justizanstalt Göllersdorf, 17, Schlossgasse, 2013Göllersdorf, Austria
*
*Corresponding author. Tel.: +43 2954 2411 305; fax: +43 2954 2411 206. E-mail address: hans.schanda@meduniwien.ac.at (H. Schanda).
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Abstract

Background

During recent decades, there has been a substantial increase in admissions to forensic mental hospitals in several European countries. It is not known if reforms implemented in mental health policies and practices are responsible for this development.

Objective

Our study examined the development of mental health care in Austria and the incidence and prevalence of mentally disordered offenders judged not guilty by reason of insanity (NGRI).

Methods

We analysed data on service provision and data from criminal statistics between 1970 and 2008 from several national sources.

Results

During the first decade when reforms to mental health practice were implemented, the incidence and prevalence of offenders judged NGRI remained unchanged, despite a reduction of mental hospital beds by nearly 50% and little outpatient care. Surprisingly, the enormous increase in admissions to forensic inpatient treatment began in Austria only after community mental health services were rolled out across the country in the 1990s. This increase was primarily due to admissions of patients who had committed less severe offences, while rates of those who had committed homicide remained unchanged.

Conclusion

Our results cannot be explained by details of the reforms such as the downsizing of mental hospitals or a lack of outpatient facilities, nor by changes to criminal sentencing. Rather, the results provide evidence of an increasingly inadequate provision of comprehensive care for “difficult” but not extremely dangerous psychotic patients living in the community. This may result from the attitudes of mental health professionals who have become less inclined to integrate aggressive behaviour into their understanding of psychosis. As a consequence, increasing numbers of “difficult” patients end up in forensic psychiatric institutions. This development, which can be observed in nearly all European countries, raises concerns with regard to efforts to destigmatize both patients and psychiatry.

Keywords

Schizophrenia and psychosisViolenceEpidemiologyForensic psychiatryPsychiatry in Europe
Type
Original article
Information
European Psychiatry , Volume 24 , Issue 6 , September 2009 , pp. 365 - 372
Copyright
Copyright © Elsevier Masson SAS 2009

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References

Aderibigbe, X.A.Deinstitutionalisation and criminalisation: tinkering in the interstices. Forensic Sci Int 1997;85:127–134Google Scholar
Almond, S.Knapp, M.Francois, C.Toumi, M.Brugha, T.Relapse in schizophrenia: costs, clinical outcomes and quality of life. Br J Psychiatry 2004;184:346–351CrossRefGoogle ScholarPubMed
Arboleda-Florez, J.Mental illness in jails and prisons. Curr Opin Psychiatry 1999;12:677–682Google Scholar
Arboleda-Florez, J.On the evolution of mental health systems. Curr Opin Psychiatry 2004;17:377–380CrossRefGoogle Scholar
Becker, T.Hülsmann, S.Knudsen, H.C.Martiny, K.Amaddeo, F.Herran, A.et al.Provision of services for people with schizophrenia in five European regions. Soc Psychiatry Psychiatr Epidemiol 2002;37:465–474CrossRefGoogle ScholarPubMed
Belfrage, H.A ten-year follow-up of criminality in Stockholm mental patients: New evidence for a relation between mental disorder and crime. Br J Criminol 1998;38:148–155CrossRefGoogle Scholar
Böker, W, Häfner, H. Gewalttaten Geistesgestörter. Eine psychiatrisch-epidemiologische Untersuchung in der Bundesrepublik Deutschland Berlin, Heidelberg, New York: Springer; 1973.Google Scholar
Brennan, P.A.Mednick, S.A.Hodgins, S.Major mental disorders and criminal violence in a Danish birth cohort. Arch Gen Psychiatry 2000;57:494–500CrossRefGoogle Scholar
Brown, St.Excess mortality of schizophrenia. A meta-analysis. Br J Psychiatry 1997;171:502–508CrossRefGoogle ScholarPubMed
Bundesministerium für Justiz. Vollzugsdaten 1976–2008. Wien: Bundesministerium für Justiz; 2009.Google Scholar
Carta, M.G.Kovess, V.Hardoy, M.C.Brugha, T.Fryers, T.Lehtinen, V.et al.Psychosocial well-being and psychiatric care in the European Communities: analysis of macro indicators. Soc Psychiatry Psychiatr Epidemiol 2004;39:883–892CrossRefGoogle ScholarPubMed
Danzer D, Hagleitner J, Lehner M. Statistische Informationen zur Vollziehung des Unterbringungsgesetzes Teil 6: 2003–2005. Wien: Österreichisches Bundesinstitut für Gesundheitswesen (ÖBIG); 2006.Google Scholar
Eikelmann, B.Reker, T.Richter, D.Zur sozialen Exklusion psychisch Kranker - Kritische Bilanz und Ausblick der Gemeindepsychiatrie zu Beginn des 21. Jahrhunderts. Fortschr Neurol Psychiat 2005;73:664–673CrossRefGoogle Scholar
Erb, M.Hodgins, S.Freese, R.Müller-Isberner, R.Jöckel, D.Homicide and schizophrenia: Maybe treatment does have a preventive effect. Crim Behav Ment Health 2001;11:6–26CrossRefGoogle ScholarPubMed
Fazel, S.Danesh, J.Serious mental disorder in 23,000 prisoners: a systematic review of 62 surveys. Lancet 2002;359:545–550CrossRefGoogle Scholar
Fazel, S.Grann, M.The population impact of severe mental illness on violent crime. Am J Psychiatry 2006;163:1397–1403CrossRefGoogle ScholarPubMed
Fichter, M.Quadflieg, N.Three-year course and outcome of mental illness in homeless men. A prospective longitudinal study based on a representative sample. Eur Arch Psychiatry Clin Neurosci 2005;255:111–120CrossRefGoogle Scholar
Forster, R.Die Praxis des Anhalteverfahrens. Ergebnisse einer soziologischen Untersuchung. Österreichische Juristenzeitung 1988;43:257–268Google Scholar
Forster R. Psychiatrie/4. Statistische Informationen zur Vollziehung des Unterbringungsgesetzes. Wien: Ludwig Boltzmann-Institut für Medizin- und Gesundheitssoziologie; 1993.Google Scholar
Forster, R.Kandolf, S.Laburda, E.Mixa, E.Entwicklung und status quo der allgemein-psychiatrischen Versorgungsangebote in Österreich. Gemeindenahe Psychiatrie 1994;49:5–17Google Scholar
Forster R, Kinzl H. (2002). Statistische Informationen zur Vollziehung des Unterbringungsgesetzes Teil 4: 2000. Wien: Institut für Rechts- und Kriminalsoziologie; 2002.Google Scholar
Fuchs, H.Maleczky, O.Kodex des österreichischen Rechts WienLexisNexis 2003Google Scholar
Geller, J.L.The last half-century of psychiatric services as reflected in Psychiatric Services. Psychiatr Serv 2000;51:41–67CrossRefGoogle ScholarPubMed
Geller, J.L.Morrissey, J.Asylum within and without asylums. Psychiatr Serv 2004;5:1128–1130CrossRefGoogle Scholar
Gilligan, J.The last mental hospital. Psychiatr Q 2001;72:45–61CrossRefGoogle ScholarPubMed
Hagleitner, J.Nepp, B.Statistische Informationen zur Vollziehung des Unterbringungsgesetzes 2006/2007 WienÖsterreichisches Bundesinstitut für Gesundheitswesen (ÖBIG) 2008Google Scholar
Hansson, L.Muus, S.Saarento, O.Vinding, H.R.Göstas, G.Sandlund, M.et al.The Nordic comparative study on sectorized psychiatry: rates of compulsory care and use of compulsory admissions during a 1-year follow-up. Soc Psychiatry Psychiatr Epidemiol 1999;34:99–104CrossRefGoogle ScholarPubMed
Hodgins, S.Mednick, S.A.Brennan, P.A.Schulsinger, F.Engberg, M.Mental disorder and crime: Evidence from a Danish birth cohort. Arch Gen Psychiatry 1996;53:486–496CrossRefGoogle ScholarPubMed
Hodgins, S.Müller-Isberner, R.Allaire, J.F.Attempting to understand the increase in the numbers of forensic beds in Europe: a multi-site study of patients in forensic and general psychiatric services. Int J For Ment Health 2006;5:173–184Google Scholar
Hodgins, S.Alderton, J.Cree, A.Aboud, A.Mak, T.Aggressive behaviour, victimisation and crime among severely mentally ill patients requiring hospitalisation. Br J Psychiatry 2007;191:343–350CrossRefGoogle Scholar
Janzarik, W.Themen und Tendenzen der deutschsprachigen Psychiatrie Berlin, Heidelberg, New YorkSpringer 1974CrossRefGoogle Scholar
Katschnig H, Grumiller I, Strobl R. Daten zur stationären psychiatrischen Versorgung Österreichs. Teil 1: Inzidenz, Teil 2: Prävalenz. Wien: ÖBIG; 1975.Google Scholar
Katschnig, H.Ladinser, E.Scherer, M.Sonneck, G.Wancata, J.Österreichischer Psychiatriebericht 2001. Teil 1Daten zur psychiatrischen und psychosozialen Versorgung der österreichischen Bevölkerung WienLudwig-Boltzmann-Institut für Sozialpsychiatrie 2001Google Scholar
Katschnig, H.Denk, P.Scherer, M.Österreichischer Psychiatriebericht 2004: Analysen und Daten zur psychiatrischen Versorgung der österreichischen Bevölkerung WienLudwig Boltzmann Institut für Sozialpsychiatrie 2004Google Scholar
Knapp, M.King, D.Pugner, K.Lapuerta, P.Non-adherence to antipsychotic medication regimens: associations with resource use and costs. Br J Psychiatry 2004;184:509–516CrossRefGoogle ScholarPubMed
Kramp, P.Schizophrenia and crime in Denmark. Crim Behav Ment Health 2004;14:231–237CrossRefGoogle ScholarPubMed
Kutscher, S.-U.Schiffer, B.Seifert, D.Schizophrene Patienten im psychiatrischen Maßregelvollzug § 63 StGB Nordrhein-Westfalens. Entwicklungen und Patientencharakteristika. Fortschr Neurol Psychiat 2009;77:91–96CrossRefGoogle Scholar
Längle, G.Egerter, B.Albrecht, F.Petrasch, M.Buchkremer, G.Prevalence of mental illness among homeless men in the community. Soc Psychiatry Psychiatric Epidemiol 2005;40:382–390CrossRefGoogle Scholar
Large, M.Smith, G.Swinson, N.Shaw, J.Nielssen, O.Homicide due to mental disorder in England and Wales over 50 years. Br J Psychiatry 2008;193:130–133CrossRefGoogle ScholarPubMed
Lögdberg, B.Nilsson, L.-L.Levander, M.T.Levander, S.Schizophrenia, neighbourhood, and crime. Acta Psychiatr Scand 2004;110:92–97CrossRefGoogle Scholar
Meise, U.Hinterhuber, H.Leistungsorientierte Krankenhausfinanzierung - verliert die Psychiatrie?. Neuropsychiatrie 1998;12:177–186Google Scholar
Munk-Jørgensen, P.Has deinstitutionalization gone too far?. Eur Arch Psychiatry Clinical Neurosci 1999;249:136–143CrossRefGoogle ScholarPubMed
Ortwein-Swoboda G, Brandlhofer B. Prävalenz im österreichischen Maßregelvollzug nach § 21/1 StGB. Paper presented at the 23. Münchner Herbsttagung der Arbeitsgemeinschaft für Methodik und Dokumentation in der Forensischen Psychiatrie, October 9th–11th 2008, Munich, Germany.Google Scholar
Ösby, U.Correia, N.Brandt, L.Ekblom, A.Sparen, P.Mortality and causes of death in schizophrenia in Stockholm County, Sweden. Schizophr Res 2000;45:21–28CrossRefGoogle ScholarPubMed
Pichot, P.Ein Jahrhundert Psychiatrie ParisÉd. Roger Dacosta 1983Google Scholar
Priebe, S.Badesconyi, A.Fioritti, A.Hansson, L.Kilian, R.Torres-Gonzales, F.Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries. BMJ 2005;330:123–126CrossRefGoogle ScholarPubMed
Prunnlechner-Neumann R, Blecha H-G, Kemmler G. Zwischen UbG und Maßnahmenvollzug: Ein spezielles Angebot für eine Risikoklientel? Paper presented at the 4. Jahrestagung der Österreichischen Gesellschaft für Psychiatrie und Psychotherapie, April 21st–24th 2004, Gmunden, Austria.Google Scholar
Rothwell, P.M.Funding for practice-oriented clinical research. Lancet 2006;368:262–266CrossRefGoogle ScholarPubMed
Saha, S.Chant, D.McGrath, J.A systematic review of mortality in schizophrenia. Arch Gen Psychiatry 2007;64:1123–1131CrossRefGoogle Scholar
Salize, H.J.Dreßing, H.Epidemiology of involuntary placement of mentally ill people across the European Union. Br J Psychiatry 2004;184:163–168CrossRefGoogle ScholarPubMed
Sanders, J.Milne, S.Brown, P.Bell, A.J.Assessment of aggression in psychiatric admissions: semi structured interview and case note survey. BMJ 2000;320:1112CrossRefGoogle Scholar
Schanda, H.The Ashenputtel principle in modern mental health care. Crim Behav Ment Health 1999;9:199–204CrossRefGoogle Scholar
Schanda, H.Psychiatry reforms and illegal behaviour of the severely mentally ill. Lancet 2005;365:367–369CrossRefGoogle ScholarPubMed
Schanda, H.Die aktuelle Psychiatriegesetzgebung in Österreich: Zivil- und Strafrecht aus psychiatrischer Sicht. R&P 2005;23:159–165Google Scholar
Schanda, H.Untersuchungen zur Frage des Zusammenhangs zwischen Psychosen und Kriminalität/Gewalttätigkeit: Studiendesigns, methodische Probleme, Ergebnisse. Fortschr Neurol Psychiatr 2006;74:85–100CrossRefGoogle Scholar
Schanda, H.Knecht, G.Schreinzer, D.Stompe, T.Ortwein-Swoboda, G.Waldhoer, T.Homicide and major mental disorders: A twenty-five year study. Acta Psychiatr Scand 2004;110:98–107CrossRefGoogle Scholar
Schanda, H.Stompe, T.Ortwein-Swoboda, G.Psychisch Kranke zwischen Psychiatriereform und Justiz: Die Zukunft des österreichischen Maßnahmenvollzugs nach § 21/1 StGB. Neuropsychiatrie 2006;20:40–49Google Scholar
Schande H, Stompe T, Ortwein-Swoboda G. Psychiatry reforms and increasing criminal behaviour of the severely mentally ill: Any link? Int J For Ment Health;doi:10.1080/14999010903199290.CrossRefGoogle Scholar
Spießl, H.Binder, H.Mache, W.Osterheider, M.Cording, C.Psychiatrische Regelversorgung und Maßregelvollzug: Gibt es Wechselwirkungen?. Nervenarzt (Suppl. 1) 2005; 294Google Scholar
Statistik Austria. Gerichtliche Kriminalstatistik Österreichs 1975–2007. Wien: Statistik Austria; 2008.Google Scholar
Talbott, J.A.Lessons learned about the chronically mentally ill since 1955Ancill, R.J.Holliday, S.Higenbottom, J.Schizophrenia: Exploring the spectrum of psychosis LondonWiley & Sons 1994 1–20 [Reprint in Psychiatr Serv 2004;55:1152–9]Google Scholar
Taylor, P.J.Damage, disease and danger. Crim Behav Ment Health 1997;7:19–48CrossRefGoogle Scholar
Tiihonen, J.Wahlbeck, K.Lönnqvist, J.Klaukka, T.Ioannidis, J.P.A.Volavka, J.Haukka, J.Effectiveness of antipsychotic treatments in a nationwide cohort of patients in community care after first hospitalisation due to schizophrenia and schizoaffective disorder: observational follow-up study. BMJ 2006;333:224 doi:10.1016/10.1136/bmj.38881.382755.2F"CrossRefGoogle Scholar
Torrey, E.F.Jails and prisons - America's new mental hospitals. Am J Public Health 1995;85:1611–1613CrossRefGoogle ScholarPubMed
Torrey, EF. Out of the shadowsConfronting America's mental illness crisis. New York, Chichester, Brisbane: Wiley and Sons; 1997.Google Scholar
Walsh, E.Gilvarry, C.Samele Ch, Harvey, K.Manley, C.Tyrer, P.et al.Reducing violence in severe mental illness: randomized controlled trial of intensive case management compared with standard care. BMJ 2001;323:1–5CrossRefGoogle ScholarPubMed
Weithmann, G.Traub, H.-J.Die psychiatrische Vorgeschichte schizophrener Maßregelpatienten - Rahmenbedingungen der Deliktprävention durch die Allgemeinpsychiatrie. Forens Psychiatr Psychol Kriminol 2008;2:112–119CrossRefGoogle Scholar
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