Danish forensic psychiatry Peter Kramp Former head Clinic of Forensic Psychiatry Copenhagen 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 PK/CO Danish forensic psychiatry Central concepts “Mental illness” = psychosis The current psychiatric definition of psychotic conditions. PK/CO Danish forensic psychiatry Central concepts “Mental illness or similar conditions” Examples: Hypoglucemia Epileptic confusion Severe dissociative disorders … … PK/CO 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 condition/mental retardation. PK/CO 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 Danish forensic psychiatry Central concepts If “non punishable” the court will pass a treatment sanction a: Placement in a psychiatric ward b: Psychiatric treatment c: Outpatient psychiatric treatment Court decision: a b Treatment continues until the sanction is lifted by the court. Danish forensic psychiatry The main Problem The increasing number of forensic patients Forensic patients in Denmark Monthly prevalence 1977-2004 Number 1500 1000 500 1975 1980 1985 1990 1995 2000 Reported number of offences in 2004 is an estimate based on the first six months of the year 2005 … Observed monthly prevalence Estimated monthly prevalence 1980-2004 ooo Reported annual number of offences against the penal law (in 1.000) Annual growth rate 1980-1999: 6.8% 2000-2001: - 1.50% 2002-2004: 10.96% Year Kramp P, Gabrielsen G. Ugeskr Læger, accepteret. Danish counties 1980-1997 Plot of growth rates of incidences of forensic patients and growth rates of consumed psychiatric beds; (n=14) Growth rates of incidences of forensic patients 17.5 15 12.5 10 7.5 5 2.5 0 -2.5 -10 -9 -8 -7 -6 -5 -4 -3 -2 -1 Growth rates of consumed psychiatric beds 0 1 The (positive) growth rates of incidences inversely correlate to the (negative) growth rates of consumed beds: r = -0.553, p=0.040 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 Danish forensic psychiatry The main Problem Another problem Too long waiting time for reports for the court – up to six month or even more.