1. Danish forensic psychiatry Peter Kramp Former head Clinic of Forensic Psychiatry Copenhagen

2. PK/CO Danish forensic psychiatry Central concepts The Danish penal code § 16 (1): “Persons who, at the time of the act, were irresponsible owing to mental illness or similar conditions or a pronounced mental retardation are not punishable. eDoc 8479

3. Danish forensic psychiatry Central concepts “Mental illness” = psychosis The current psychiatric definition of psychotic conditions. PK/CO

4. Danish forensic psychiatry Central concepts “Mental illness or similar conditions” Examples: Hypoglucemia Epileptic confusion Severe dissociative disorders …

5. Danish forensic psychiatry Central concepts Irresponsible (in Danish ”utilregnelig”, in latin ”non compos (mentis)) Other possibilities: Mentally incompetent Not attributable to But - the word is ”without meaning” The court - never the psychiatrist - decide whether the defendant is “irresponsible” owing to a psychotic condi- tion/mental retardation. PK/CO

6. Danish forensic psychiatry Central concepts “Not punishable” The court decide whether the defendant is guilty/not guilty independent of the mental state of the person in question. Psychotics and mentally retarded are thus “responsible”. PK/CO

7. Danish forensic psychiatry Central concepts If “non punishable” the court will pass a treatment sanction Court decision: a  b Treatment continues until the sanction is lifted by the court. a: Placement in a psychiatric ward b: Psychiatric treatment c: Outpatient psychiatric treatment PK/CO

8. Danish forensic psychiatry The main Problem The increasing number of forensic patients

9. Forensic patients in Denmark Monthly prevalence 1977-2004 … Observed monthly prevalence Estimated monthly prevalence 1980-2004 ooo Reported annual number of offences against the penal law (in 1.000) Reported number of offences in 2004 is an estimate based on the first six months of the year Annual growth rate 1980-1999: 6.8% 2000-2001: - 1.50% 2002-2004: 10.96% Kramp P, Gabrielsen G. Ugeskr Læger, accepteret.

10. -2.5 0 2.5 5 7.5 10 12.5 15 17.5 -10-9-8-7-6-5-4-3-201 Growth rates of consumed psychiatric beds Growth rates of incidences of forensic patients The (positive) growth rates of incidences inversely correlate to the (negative) growth rates of consumed beds: r = -0.553, p=0.040 Danish counties 1980-1997 Plot of growth rates of incidences of forensic patients and growth rates of consumed psychiatric beds; (n=14)

11. Danish forensic psychiatry The main Problem Danish Regions – (responsible for the total health care in the region, including (forensic) psychiatry: Forensic psychiatry is a cuckoo in the nest

12. Danish forensic psychiatry The main Problem Another problem Too long waiting time for reports for the court – up to six month or even more.