Co-operation between the Probation Serviceand

the Psychiatric Service

(and a little about the treatment of the forensic psychiatric patients)

Peter KrampFormer head

Clinic of Forensic PsychiatryCopenhagen

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)

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.

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.

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

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.

Co-operation PS and psychiatry (and a little about the treatment of the forensic patients)

Validity and RealiabilityControl

Final material

Factual errors ~ 5 %(Dates, criminality, diagnoses etc.) Do not affect the results’ conclusions.Estimates of co-operation problems: Too low

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.

Co-operation PS and psychiatry (and a little about the treatment of the forensic patients)

The same distribution of sex all over the country

Sex n %

Men 879 85

Women 153 15

Total 1.032 100

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

Co-operation PS and psychiatry (and a little about the treatment of the forensic patients)

Diagnoses; n= 1.032

All

n %

F00-09 57 6

F10-19 24 2

F20-29 653 63

F30-39 92 9

F40-49 20 2

F60-69 112 11

F70-79 4 0

F84 (Asperger) 24 2

ADHD 48 5

Total 1.032 100p= 0.001

Region Midt

n %

17 7

8 3

134 51

24 9

6 2

35 14

1 0

9 4

26 10

260 100

Co-operation PS and psychiatry (and a little about the treatment of the forensic patients)

Criminality n %

Violence 625 61

Arson 78 8

Sex 51 5

Robbery 72 7

Offences against property (burglary, theft, etc.) 126 12

Serious drug dealing 32 3

Other 48 5

Total 1.032 100

Violence + arson + sex + robbery: 81 %

No major differences between the regions

Co-operation PS and psychiatry (and a little about the treatment of the forensic patients)

Region Relative probability

Syddanmark 1

Midtjylland 1.5

Hovedstaden 3.4

Sjælland 4.9

Nordjylland 5.3

Relative probability being a forensic patient in the five regions; n= 1.032

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

Region Average 95 % CI

Hovedstaden 89 [81; 97]

Sjælland 107 [93;121]

Syddanmark 62 [51;72]

Midtjylland 50 [41;59]

Nordjylland 43 [26;60]

p<0.000

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 unit n %

Community psychiatry 1.141 55

Forensic Psychiatry 608 29

General psychiatry 338 16

Total 2.087 100

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

Yes No

n % n %

348 33 684 67

(but the real figures are higher ~ 50 %)

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

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.)

Co-operation PS and psychiatry (and a little about the treatment of the forensic patients)

Regions and problems; n= 1.032

Region At least one problem

n %

Hovedstaden 131 35

Sjælland 43 35

Syddanmark 56 28

Midtjylland 100 38

Nordjylland 19 24

Total 349 34

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.

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.

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.