Prisoners with reduced criminal responsibility stand out based on their rates of hospitalisation during their sentences.

PURPOSE: Globally, health problems are very common among prisoners. A mental state examination aims to help in recognising psychiatric problems among offenders and the possible association of these psychiatric issues with their committed crime. The legal-medical term "reduced criminal responsibility" refers to a weakened sense of reality and the ability to control one's behaviour because of compromised mental health and without an evaluated need for forensic psychiatric hospitalisation. However, little is known about the actual need for the health care of prisoners with reduced criminal responsibility (PRCR). The purpose of this study was to explore treatment-related visits to prison by PRCR in Finland. DESIGN/METHODOLOGY/APPROACH: The research data comprise information on PRCR's treatment-related visits and that of a matched control group (n = 222). Descriptive cross-tabulation with X²- and nonparametric Mann-Whitney U-tests and Cox regression analyses are applied. FINDINGS: The results show that almost every PRCR had at least one treatment-related visit during their sentences. Visits to a psychiatric hospital for prisoners, to the prison hospital and especially to a civil hospital are more common among PRCR. The need for treatment appears significantly earlier in their sentences. ORIGINALITY/VALUE: These findings demonstrate the PRCR's greater need for access to health services and the need for further development between the Health Care Services for Prisoners, Prison and Probation Service of Finland and public health and social services in Finland. More exploration of the medical reasons and locational distribution of the vast amount of civil hospitalisation is needed.

Partners in crime: A 21-year cohort comparison of people who commit serious crimes together with those who act alone.

BACKGROUND: Perpetrators who act together violently occur frequently in police and media discussions, but are rarely the focus of forensic psychiatric research. AIMS: We aimed to characterise people who act together when committing a serious crime and to map the frequency of such crimes over 21 years in Finland. METHODS: Data for the study were retrieved from the national database of forensic psychiatric examinations for the period 2000-2020, with reports on file for nearly all people charged with serious criminal offences in the country. Index cases were defined as those with two or more perpetrators attacking a single victim; people who acted alone were comparison cases. Sex and age at the time of the crime were extracted together with all diagnoses listed in the reports. RESULTS: Seventy-five multiple perpetrator groups (MPG) were identified, accounting for 165 individuals whose reports were compared with 2494 single-perpetrator (SPR) reports. Most group and solitary offenders were male (87%: 86%, respectively). The index offence was more likely to be homicide among the group perpetrators (mean 1.12) than the solitary offenders (mean 0.83). Proportionately more of the group offenders had personality disorder or substance use disorders (antisocial personality disorder MPG 49%: SPR 32%; any personality disorder MPG 89%: SPR 76%); alcohol (MPG 79%: SPR 69%; cannabis MPG 15%: SPR 9%). By contrast, psychosis was about twice as common among the solitary offenders (MPG 12%; SPR 26%). CONCLUSIONS: The number of group-perpetrated crimes has not increased, according to these Finnish forensic psychiatric report data of 2000-2020, but the relatively high prevalence among them of personality and substance use disorders is a constant. Understanding psychiatric disorders as factors in both leading to and avoiding violent conflicts may help plan new approaches to further diminish group violence.

Imprisonment and diagnostic delay among male offenders with schizophrenia.

BACKGROUND: Psychotic symptoms are common among prisoners, a diagnosis of schizophrenia probably more likely than in the general population; however, less is known about the extent to which prisoners may show a different course of illness. AIMS: The aims of the study were to characterise schizophrenic male offenders and to compare their age at diagnosis with that of people with schizophrenia in general mental health services in Finland. METHODS: The study population comprised all the male offenders in Finland who left the national psychiatric prison hospital between 1 January 2003 and 31 December 2006 with an International Classification of Diseases, Tenth Edition, diagnosis of schizophrenia. The comparison group was drawn from 9992 Finnish people screened at random for psychotic illnesses. RESULTS: There was no overall difference in age of diagnosis between prisoners and their community peers, but three-quarters of the offenders had received their diagnosis of schizophrenia in the prison hospital rather than in the community, and for them, the median age at diagnosis (30) was significantly older than that (27) in the community comparison group. CONCLUSIONS: Our findings show that men with schizophrenia who have to serve prison sentences are not a homogenous group, but that for a majority, complex presentations are likely to delay diagnosis and appropriate treatment. If replicated, the findings raise concerns that psychiatry is failing such men who can only access treatment for a severe illness through the penal system.