1. Co-operation between the Probation Service and the Psychiatric Service (and a little about the treatment of the forensic psychiatric patients) Peter Kramp Former head Clinic of Forensic Psychiatry Copenhagen

2. Co-operation PS and psychiatry (and a little about the treatment of the forensic patients) Material All new forensic patients under supervision of the Probation Service 01.07.2007-30.06.2009. n= 1.032 (90% of all forensic patients)

3. Co-operation PS and psychiatry (and a little about the treatment of the forensic patients) Methode The probation officer (a socialworker) completed a registration form with 29 items every six month concerning all new clients (n= 1.032) in the research periode (01.07.2007-30.06.2009). In total 2.101 registration forms.

4. Co-operation PS and psychiatry (and a little about the treatment of the forensic patients) The 29 items covered factual data, e.g. diagnosis, criminality, admissions, unit responsible for the treatment (community psychiatry, general psychiatric ward, forensic psychiatry) and the probation of- ficers judgement of the co-operation with psychiatry, e.g. admissions and discharge, contact with psychiatry, quality of treatment.

5. Co-operation PS and psychiatry (and a little about the treatment of the forensic patients) Validity and Realiability Errors in roughly 35 % of the registration forms Returned and corrected

6. Co-operation PS and psychiatry (and a little about the treatment of the forensic patients) Validity and Realiability Control Around 250 randomly selected Probation Service records concerning forensic patients (i.e. 25 % of all) were looked through and compared with the registration forms.

7. Co-operation PS and psychiatry (and a little about the treatment of the forensic patients) Validity and Realiability Control Final material Factual errors ~ 5 % (Dates, criminality, diagnoses etc.) Do not affect the results’ conclusions. Estimates of co-operation problems: Too low

8. Co-operation PS and psychiatry (and a little about the treatment of the forensic patients) Denmark divided into I: Five regions each responsible for the whole psychiatric service within the region. II: 14 probation service districts responsible for supervision of all clients within the district. The Probation Service registers in which region the client is living.

9. Co-operation PS and psychiatry (and a little about the treatment of the forensic patients) The same distribution of sex all over the country Sexn% Men87985 Women15315 Total1.032100

10. Co-operation PS and psychiatry (and a little about the treatment of the forensic patients) Age, mean (n=1.013) Men: 35.2 years (95% CI: 34.4; 35.9) Women: 39.8 years (95% CI: 37.8; 41.7) p<0.0001

11. Co-operation PS and psychiatry (and a little about the treatment of the forensic patients) Diagnoses; n= 1.032 All n% F00-09576 F10-19242 F20-2965363 F30-39929 F40-49202 F60-6911211 F70-7940 F84 (Asperger)242 ADHD485 Total1.032100 p= 0.001 Region Midt n% 177 83 13451 249 62 3514 10 94 2610 260100

12. Co-operation PS and psychiatry (and a little about the treatment of the forensic patients) Criminalityn% Violence62561 Arson788 Sex515 Robbery727 Offences against property (burglary, theft, etc.)12612 Serious drug dealing323 Other485 Total1.032100 Violence + arson + sex + robbery: 81 % No major differences between the regions

13. Co-operation PS and psychiatry (and a little about the treatment of the forensic patients) RegionRelative probability Syddanmark1 Midtjylland1.5 Hovedstaden3.4 Sjælland4.9 Nordjylland5.3 Relative probability being a forensic patient in the five regions; n= 1.032

14. Co-operation PS and psychiatry (and a little about the treatment of the forensic patients) Duration (days) between conviction and first contact with psychiatry, regions, n= 1.032 RegionAverage95 % CI Hovedstaden89[81; 97] Sjælland107[93;121] Syddanmark62[51;72] Midtjylland50[41;59] Nordjylland43[26;60] p<0.000

15. Co-operation PS and psychiatry (and a little about the treatment of the forensic patients) Treatment units responsible for the treatment; n=2.087 Responsible unitn% Community psychiatry1.14155 Forensic Psychiatry60829 General psychiatry33816 Total2.087100

16. Co-operation PS and psychiatry (and a little about the treatment of the forensic patients) Problems in the co-operation with psychiatry, the probation officers’ judgement; n= 1.032 YesNo n%n% 3483368467 (but the real figures are higher ~ 50 %)

17. Co-operation PS and psychiatry (and a little about the treatment of the forensic patients) Problems in the co-operation with psychiatry, the probation officers’ judgement Poor communication - no information about admissions or discharge - impossible to get in contact with the psychiatrist responsible for the treatment Insufficient treatment - difficulties to establish treatment - too scanty and too poor contact with psychiatrists (and others) - insufficient knowledge

18. Co-operation PS and psychiatry (and a little about the treatment of the forensic patients) Treatment units and problems Community psychiatry - significantly fewer admissions compared to forensic and general psychiatry (p< 0.000) - significantly more problems compared to forensic and general psychiatry (p< 0.000) (no differences in diagnoses, criminality, sex etc.)

19. Co-operation PS and psychiatry (and a little about the treatment of the forensic patients) Regions and problems; n= 1.032 RegionAt least one problem n% Hovedstaden13135 Sjælland4335 Syddanmark5628 Midtjylland10038 Nordjylland1924 Total34934

20. Co-operation PS and psychiatry (and a little about the treatment of the forensic patients) Conclusion I The probation service do not have an organization that enable the service to collect data in a systematic and correct way.

21. Co-operation PS and psychiatry (and a little about the treatment of the forensic patients) Conclusion II The large differences between the regions concerning assessment and treatment of forensic psychiatric patients is a violation of the rule of law.

22. Co-operation PS and psychiatry (and a little about the treatment of the forensic patients) Conclusion III The treatment of many forensic patients is insufficient. Many (general) psychiatrists do not know – or do not care – about the requirements and responsibilities connected with treatment of forensic patients.