1. ”Forensic psychiatric evaluations concerning mentally ill, non-psychotic offenders* in 2003 and 2008 at 4 regional centers in Denmark – development, differences and similarities" * §69 in the Danish Penal Cod e Stockholm 2011 Gitte Ahle1 The § 69-study

2. § 69-study The aim: To provide greater knowledge about the group of offenders covered by § 69 of the Danish Penal Code Gitte Ahle2

3. 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 Ahle3

4. Forensic patients 1990-2006 Prevalence Gitte Ahle4 Number Year 2010: 2638 forensic patients in Denmark

5. 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 Ahle5

6. 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 Ahle6

7. 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 Ahle7

8. 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 Ahle8

9. 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 Ahle9

10. Results n = 660 forensic psychiatric evaluations Gitte Ahle10 103 females (16 %) mean age 33,9 years (15 – 71) 557 males (84 %) mean age 36,1 years (15 – 80)

11. Gender (n = 611) Females (n = 91) – 47% treatment sanction – 53% ordinary punishment Males (n = 520) – 22% treatment sanction – 78% ordinary punishment Gitte Ahle11

12. Gender and diagnosis (%) Gitte Ahle12

13. Gender and offense (%) Gitte Ahle13

14. 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 Ahle14

15. Legal outcome: Sentenced to psychiatric treatment 26 % 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 Ahle15

16. Gitte Ahle16 Possible increase in treatment sanctions (%)

17. Offense and diagnosis Gitte Ahle17 F0F1F2F3F4F5F6F7F8F9 Homicide, fatal violence and attempts 39012088003 Arson42013041014 Severe violence22334057027 Violence5022100550014 Violence and threats against public servants 52113022005 Rape and attempts00001119010 Sexual offense, excl. rape 52221062124 Offense against property 8769511082012 Total 322414192924523649

18. Offense and diagnosis Personality disorders (F6) Gitte Ahle18 F60.0F60.1F60.2F60.30F60.31F60.6F60.7F60.8F60.9F61.0 Homicide, fatal violence and att. 2031253261911 Arson 01142524174 Severe violence 00286211077 Violence 021652222183 Violence and threats against public servants 1142510132 Rape and attempts 0090011143 Sexual offense, excl. rape 101201637147 Offense against property 2349762131113 6716324261814218350

19. Gitte Ahle19 ADHD 2003 and 2008 in the 4 regional centers F90 - % of all § 69-diagnoses

20. Gitte Ahle20 Diagnostic categories ICD-10 (%)

21. 17 % (110) born outside Denmark (n = 660) Gitte Ahle21

22. 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 Ahle22

23. 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 Ahle23

24. Corresponding author: Gitte Ahle, MD, Ministry of Justice, Clinic of forensic psychiatry - gahle@mail.dkgahle@mail.dk Co-authors: Mette Brandt­Christensen, 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 Ahle24

25. 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 Ahle25