The impact of the Danish Medico-Legal Council on the choice between treatment and punishment for non-psychotic offenders.

BACKGROUND: The Danish Medico-Legal Council provides the court with statements based on available psychiatric assessment reports to assist the law in the use of the Penal Code sections on mentally disordered offenders. AIMS: To analyse the impact of the Council on the courts' choice between punishment and treatment in cases of offenders falling under §69 of the Penal Code, i.e. mentally disordered, although not psychotic offenders. METHODS: In 298 cases of defendants who according to the Medico-Legal Council might fall under §69 the recommendations of the assessment reports, the recommendations of the Council and the final verdicts are compared; and assessment reports from forensic psychiatric centres are compared with those from other psychiatrists. RESULTS: The recommendations of the Medico-Legal Council were often, but not blindly followed by the courts. The probability for the Council to recommend some measure of treatment was about 50% for adult males, and higher for adolescents and for females. In court, however, the two genders as well as adolescents and adults alike all had the same probability, approximately 50%, of being sentenced with treatment instead of punishment. When measured by the final verdict, the Medico-Legal Council is of higher quality than the assessment reports, especially those from outside forensic psychiatry. CONCLUSION: The Council serves as a quality assurance of Danish forensic psychiatric assessments, and the Council's statements are by the court considered to represent the state of the art of these assessments.

Mentally disordered non-psychotic criminal offenders--treatment instead of punishment.

BACKGROUND: By including §69 into the Danish Penal Code, it has since 1975 been possible to use psychiatric measures as legal sanctions for even non-psychotic offenders-if the measure is believed to be preventive of future crime. To be able to decide on the applicability of treatment measures as sanctions in criminal cases, the court will request a psychiatric report. They may furthermore ask a medical expert consultation board, the Danish Medico-Legal Council, for an opinion on the mental status of the defendant. AIMS: To describe a sample of offenders falling under §69 and the use of the section in sentencing offenders to treatment instead of punishment. METHODS: All 298 opinions given by the Medico-Legal Council between April 1, 2005 and December 31, 2007 of defendants definitely or possibly falling under §69 of the Danish Penal Code were rated together with the psychiatric assessment reports and the final verdicts on socio-demographic, health and criminal items, and the data were computerized. RESULTS: The sample was characterized by severe criminality and mental disorder. Forty-six percent (138/298) were sentenced by the court to a psychiatric measure instead of punishment. CONCLUSIONS: The results document that §69 of the Danish Penal Code is used as intended by the law.

Forensic psychiatric patients among immigrants in Denmark--diagnoses and criminality.

The purpose of this study is to analyse a sample of immigrant forensic psychiatric patients and to compare them with Danish patients. Of the 326 forensic patients in Copenhagen, 111 were immigrants or descendants of immigrants. The sample was broken down according to area of origin, age, gender and ethnic status. The data have been analysed by Poisson regression with the background population as an offset variable. Of the patients of non-Danish ethnicity, a significantly higher ratio was diagnosed with schizophrenia and a lower ratio was diagnosed with personality disorders compared with Danes. Iranians accounted for a higher ratio than did other minority groups, whereas patients from Western Europe/USA were not different from Danes. The higher ratio of forensic schizophrenic patients of non-Danish ethnicity cannot be explained by social factors or substance abuse. Migration increases the age-adjusted risk (ARR) of becoming schizophrenic (ARR=2.7). We found the ARR of becoming a male forensic schizophrenic patient among immigrants/descendants to be 2.8, i.e. the same as that caused by migration as such. Violence and schizophrenia are associated, and this explains the fact that the ratio of immigrants/descendants having committed violence exceeds that of Danes. Non-violent crimes are more equally distributed among ethnic groups and seem to be associated with common criminogenic factors. Arson is mainly committed by older schizophrenic patients of Danish ethnicity. The risk of an individual immigrant and Danish schizophrenic patient exhibiting criminal behaviour is the same. Schizophrenia is a criminogenic factor in violence, but not in non-violent crimes. The differences between the various ethnic groups could be related to selection caused by both immigration and emigration.

The impact of sensory quality of pork on consumer preference.

Danish consumers from Roskilde, a town near the Danish capital Copenhagen (n=213), and from Holstebro, a provincial town in the north-western part of Jutland (n=162), rated nine different samples of pork on an unstructured hedonic scale from "do not like at all" to "like very much". The samples represented variation in raw meat quality (pH, IMF and carcass weight), muscle (LD and BF), origin (Danish/French Pay Basque), cooking method (pan/oven) and end point temperature (65°C/75°C). The meat was described by sensory profiling and chemical and physical analysis (pH, fat, water, colour, fatty acid composition). All the consumers preferred tender, juicy meat with a fried flavour and no off-flavours. However, within this description there were differences. The consumers from Holstebro put more emphasis on tenderness and the absence of off-flavours, while the consumers in Roskilde preferred the fried flavour. The young consumers put less emphasis on tenderness, compared with consumers aged over 30 years, but preferred instead some crumbliness in the meat. A segmentation of the consumers showed that about 6% of the consumers were only influenced by flavour attributes in their preference. In contrast, 12% of the consumers were mainly influenced by texture irrespective of flavour attributes other than sour-like taste. Most of the consumers were, however, influenced by both flavour and texture as well as appearance.

Mental disorders and charges of violent offences. A study of male adolescent remand prisoners.

This study describes associations between mental disorders and charges of violence among remanded adolescents. 100 15-17 year old boys from East Denmark, consecutively remanded during one year, were interviewed with SCAN, K-SADS and SCID-II to obtain past year ICD-10 diagnoses. There was no statistically significant association between the occurrence of a violent charge and mental disorders in general (OR=1.02, 95% confidence interval (CI) [0.24; 4.38]). An association was found between violent charge and non-Danish ethnicity (OR=7.58, [1.60; 35.92]). Previously reported association between violence and mental disorder among adults were not replicated in this male adolescent remand population. A developmental hypothesis is proposed.

Violence of young criminals predicts schizophrenia: a 9-year register-based followup of 15- to 19-year-old criminals.

Violent and aggressive behavior in preschizophrenia adolescents has been described in several studies. Our aim was to investigate the extent to which violent conviction in late adolescence predicted later schizophrenia in a cohort of young criminals. We performed a 9-year register-based followup of a complete national cohort of young convicted criminals. A total of 780, 15- to 19-year-old subjects identified in 1992 were followed up in 2001 with register linkage of the Danish Psychiatric Central Register, the Danish National Criminal Register, and the Danish National Cause of Death Register. Analyses with Cox regression were performed to identify predictors of later schizophrenia. We found at followup that 3.3 percent of the cohort had been diagnosed with schizophrenia and 4.5 percent with any psychosis. Conviction of violence in late adolescence was significantly associated (odds ratio = 4.59 [95% confidence interval (1.54; 13.74)]) with future diagnosis of schizophrenia. Violent behavior can thus be seen as part of the preschizophrenia phase of young criminals.

[Crimes committed by mentally ill persons in the years 1977-1999. Development, number and causes]. / Kriminalitet begået af psykisk syge 1977-1999. Udvikling, antal og årsager.

INTRODUCTION: In line with many other countries, Denmark has reorganised psychiatric care with closure of 50% of the psychiatric beds in favour of community mental health. Parallel to this reorganisation the number of forensic patients has increased. MATERIAL AND METHODS: In Denmark, the majority of forensic patients are under supervision by a probation officer. As from 1977, The Department of Prison and Probation has registered the monthly prevalence of forensic patients, from 1989 also the monthly incidence and decrease. These data have been used to analyse the trends in the number of forensic patients. RESULTS: The number of forensic patients increased from 297 in 1980 to 1134 in 1999, the increase in prevalence being exponential with an annual growth rate of 6.79%. The incidence figures showed an exponential increase with an annual growth rate of 5.96% (95% confidence interval 4.76%-7.27%). The annual growth rate for the decrease is 6.18%. Thus, the three growth rates do not differ, meaning that the increasing number of forensic patients is the result of an increasing intake. DISCUSSION: The growing number of mentally ill offenders cannot be explained by changes of the Danish penal law concerning mentally abnormal offenders nor by changes in administrative or diagnostic practice. The number of reported crimes in Denmark has remained unchanged from 1987. The main reason for the exponential growth rate is an increasing number of schizophrenic patients committing crimes. It is concluded that deinstitutionalisation is the main reason for this development.

Psychiatric diagnosis and criminal record determine the courts' decisions.

INTRODUCTION: Section 69 of the Danish Penal Code implies the possibility of sentencing also non-psychotic offenders to treatment when this is considered expedient. The aim of this study was to analyse which factors influence the courts' decisions to sentence offenders to psychiatric treatment instead of punishment. MATERIAL AND METHODS: The psychiatric statements of the Danish Medico-Legal Council from 1 April 2005 to 31 December 2007 were screened retrospectively to sample all cases processing non-psychotic offenders under Section 69. Analyses were performed using logistic regression with a verdict of a measure of psychiatric treatment as the response variable as opposed to punishment; the following reference variables were used as the main explanatory variables: demographic data, diagnosis, prior and present charges, and psychiatric history. The selection of the material thus ensures diagnostic validity. RESULTS: A psychiatric diagnosis is clearly the most decisive factor associated with a psychiatric treatment measure, but also psychiatric history and prior offences have a significant impact. The present charge only has limited influence. CONCLUSION: Section 69 of the Danish Penal Code is still used as intended, i.e, treatment measures are given according to psychiatric needs and take into consideration the offender's criminal behaviour. FUNDING: This study received funding from the Ministry of Health and the Health Foundation (Helsefonden). TRIAL REGISTRATION: The Danish Data Protection Agency has approved the study. Approval from the Danish Data Protection Agency was obtained (file no. 2012-41-1272).

[Forensic patients in Denmark--2000-2004]. / Retspsykiatriske patienter--udvikling 2000-2004.

INTRODUCTION: In Denmark the number of forensic patients increased exponentially from 1980 to 1999, with an annual growth rate of 6.8%. In 2000 some psychiatric orders became time-limited. This study maps out the development from 2000 to 2004. MATERIALS AND METHODS: The material includes forensic patients under supervision by a probation officer. Since 1977, the Department of Prisons and Probation has registered their prevalence and, since 1989, also the incidence and the lifting of previously established orders. The material is representative and has been corrected according to new legislation. The monthly prevalence is analysed 1980-2004, the monthly incidence 1989-2004. RESULTS: The incidence increased exponentially from 1989 to 1999, with an annual growth rate of 6.2%, the annual growth rate from 2002 to 2004 being 12.8% (p=0.078). The whole period 1989-2004 showed a constantly increasing growth rate (p<0.001). The prevalence decreased from 2000 to 2001, as many orders were lifted due to new legislation. The prevalence in 2002-2004 shows an annual growth rate of 11.0%. The difference between the growth rates of incidence and prevalence 2002-2004 is not significant. Thus the number of forensic patients is now increasing exponentially, with an annual growth rate of 11% CONCLUSION: Increasing criminality among schizophrenic patients has been established in many countries. The main reason is supposed to be deinstitutionalization, which probably applies to Denmark as well. Today forensic patients occupy about 20% of the total number of psychiatric beds in Denmark, and whatever the reasons for the growing number are, this fact, in combination with the decreasing number of available beds, points towards a disastrous development for the mentally ill.