1. 11 Non-dischargeable Mentally Disordered Offenders in a German Hospital Order Institution Paper presented to the 3 rd Annual IAFMHS Conference, April 9 th – 11 th, 2003, Miami Sabine Eucker & Dieter Jöckel, Forensic Psychiatric Hospital Haina, D-35114 Haina

2. 12 High Risk forensic hospitalcommunity lifelong

3. 13 Low Risk Forensic Psychiatric Hospital Haina community after 4 years

4. 14 What about insane offenders for whom the door remains closed? ?????

5. 15 Non-dischargeable Mentally Disordered Offenders 1 increasing interest in expert discussion limited to high risk personality disordered offenders headline „untreatable insane offenders“ developments: - Germany: placement in correctional system? - Great Britain: DSPDs - Netherlands, Germany: long stay units

6. 16 Non-dischargeable Mentally Disordered Offenders 2 but no research no definition

7. 17 Non-dischargeable Mentally Disordered Offenders in the Haina Forensic Psychiatric Hospital 1 definition: hospital inmates who are not expected to be discharged to the community in the foreseeable future

8. 18 Non-dischargeable Mentally Disordered Offenders in the Haina Forensic Psychiatric Hospital 2 October 2000: 102 „non-dischargeable“ inmates 29% of all inmates October 2002: 1 „non-dischargeable“ inmate was discharged to the community

9. 19 Compiled Data personal data criminal data diagnostic data risk assessment data clinical judgment data

10. 110 Sample (N=102) mean age:43 years (23 - 79) women: 8% mean treatment term:6,6 years (0-33) longstay wards:25%

11. 111 Level of Security (N =102) pass:57 % a) with accompany:29 % b) without accompany:28 % totally under lock and key:43 %

12. 112 Index Offenses and Main Diagnoses (N = 102) Offenses sex offenses 34% assault 19% murder 11% attempted murder 10% arson 10% robbery 8% other 5% Main Diagnoses no mmD50% a) PD30% b) paraphilia20% schizophrenia etc.30% (only paranoid) organic mental d. 12% mental retardation 6%

13. 113 Significant Differences Between Non-dischargeable and Dischargeable Inmates (N=343) Non-dischargeable inmates: older more sexual offenses more personality disorders more paraphilia more mental defiency (IQ < 85)

14. 114 No Significant Differences Between Non-Dischargeable and Dischargeable Inmates (N=343) substance abuse APD (DSM-III-R) acute psychotic symptoms

15. 115 Risk Markers 1: PCl-SV (N=102)

16. 116 Risk Markers 2: HCR-20, H-Score (N=102)

17. 117 Factor Analysis (N=102) all variables which occur more often than 4 times main axis analysis exclusion of variables with a low selfvalue selfvalue criterion, scree test: 3 – 9 factors varimax rotation best interpretation: 5 – factor –solution s 2 : 54%

18. 118 5-Factor-Solution (N=102) 1.Antisocial lifestyle (s 2 : 21%) PCL- SV 7-10 H-Score (HCR-20) APD (DSM-III-R) substance abuse prior convictions robbery 2.Placement in hospital order institutions (s 2 : 12%) diminished responsibility placement in prison possible no schizophrenia personality disorder admission questionable

19. 119 5-Factor-Solution (N=102) 3. Sexual violence ( s 2 : 8%) sex offence paraphilia mental defiency (IQ<85) no organic mental disorder no attempted murder 4. Low motivation for treatment (s 2 : 7%) no motivation from first day on non- discharge ability obvious no arson

20. 120 5-Factor-Solution (N=102) 5. Psychotic violence (s 2 : 6%) first hospital order chronic psychotic assault no murder

21. 121 Conclusions 1.Non-dischargeable insane offenders are scarcely noticed by forensic research. 2.The proportion of non-dischargeable insane offenders seems to be striking high. 3.The research of non-dischargeable insane offenders should not be reserved to the „DSPs“. 4.Up to 35% cannot be identified by common risk markers. 5.The term „non-dischargeable“ seems to be more appropriate than „non-treatable“.

22. 122 Further Research forensic hospitalcommunity