Characteristics of mentally ill offenders from 100

psychiatric court reports

1,2
Yasser A Elsayed, Mohamed Al-Zahrani,2 and Mahmoud M Rashad2,3

Abstract

Background

There is an increasing probability that the psychiatrist will,

willingly or not, come into contact with mentally ill offenders
in the course of their practice. There are increasing rates of
violence, substance abuse and other psychiatric disorders that
are of legal importance. Therefore, the aim of this work was to
investigate the rates of different mental disorders in 100
court reports and to investigate the characteristics of
mentally ill offenders.

Methods

All cases referred from different departments of the legal

system to the forensic committee for assessment of legal
accountability over 13-months duration were included. A
specially designed form was prepared for data collection. Cases
were classified into five groups: murder, robbery, financial
offences, violent and simple offences and a group for other
offences. Data were subjected to statistical analysis and
comparisons between different groups of subjects were performed
by analysis of variance (ANOVA).

Results

Men constituted 93% of cases. In all, 73% of offenders were

younger than 40 years old. Schizophrenia cases made up 13% of
the total, substance related cases constituted 56% and
amphetamine cases alone made up 21%; 10% of cases were
antisocial personality disorders, and 51% of cases were
classified as having a low education level. Unemployment was
found in 34% of cases. The final decision of the forensic
committee was full responsibility in 46% of cases and partial
responsibility in 11% of cases, with 33% considered non-
responsible. A total of 58% of cases had had contact with
psychiatric healthcare prior to the offence and in 9% of cases
contact had been in the previous 12 weeks. A history of similar
offences was found in 32% of cases. In all, 14% of the offences
were murders, 8% were sexual crimes, and 31% were
violent/simple crimes.
Conclusions
The ability of the legal system to detect cases was good, while
the ability of the healthcare system to predict crimes and
offences was weak, as 58% of cases had had previous contact
with the healthcare system previously. Substance abuse,
especially amphetamine abuse, played an important role.

Reference:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2820027/?
tool=pmcentrez

Reaction:

The relationship between substance abuse and crime has

been well known for some time, but according to the current
study the depth of this relationship is alarming, and serves to
justify a sense of urgency for intervention as the rate of
substance abuse was 56%. If this problem can be stop or just be
controlled maybe the population of mentally ill patients due to
any kind of abuse can be minimize. Also Primary prevention,
treatment and rehabilitation of patients with substance abuse
and dependence have a strong relationship with crime rates, and
should be a focus of attention for service planners. The role
of the psychiatrist as an expert witness in the court is still
weak, and in need of further delineation. The training of
mental health professionals in this key area of psychiatry is
also weak and in need of strong support.

How does mental health care perform in respect to

service users' expectations? Evaluating inpatient and
outpatient care in Germany with the WHO
responsiveness concept
Anke Bramesfeld*1, Felix Wedegärtner2, Hermann Elgeti3 and
Susanne Bisson1

Abstract

Background

Health systems increasingly try to make their services more

responsive to users' expectations. In the context of the World
Health Report 2000, WHO developed the concept of health system
responsiveness as a performance parameter. Responsiveness
relates to the system's ability to respond to service users'
legitimate expectations of non-medical aspects. We used this
concept in an effort to evaluate the performance of mental
health care in a catchment area in Germany.

Methods

In accordance with the method WHO used for its responsiveness

survey, responsiveness for inpatient and outpatient mental
health care was evaluated by a standardised questionnaire.
Responsiveness was assessed in the following domains:
attention, dignity, clear communication, autonomy,
confidentiality, basic amenities, choice of health care
provider, continuity, and access to social support. Users with
complex mental health care needs (i.e., requiring social and
medical services or inpatient care) were recruited
consecutively within the mental health services provided in the
catchment area of the Hanover Medical School.

Results

221 persons were recruited in outpatient care and 91 in

inpatient care. Inpatient service users reported poor
responsiveness (22%) more often than outpatients did (15%);
however this was significant only for the domains dignity and
communication. The best performing domains were
confidentiality and dignity; the worst performing were choice,
autonomy and basic amenities (only inpatient care). Autonomy
was rated as the most important domain, followed by attention
and communication. Responsiveness within outpatient care was
rated worse by people who had less money and were less well
educated. Inpatient responsiveness was rated better by those
with a higher level of education and also by those who were not
so well educated. 23% of participants reported having been
discriminated against in mental health care during the past 6
months.
The results are similar to prior responsiveness surveys with
regard to the overall better performance of outpatient care.
Where results differ, this can best be explained by certain
characteristics that are applicable to mental health care and
also by the users with complex needs. The expectations of
attention and autonomy, including participation in the
treatment process, are not met satisfactorily in inpatient and
outpatient care.

Conclusion

Responsiveness as a health system performance parameter

provides a refined picture of inpatient and outpatient mental
health care. Reforms to the services provided should be
orientated around domains that are high in importance, but low
in performance. Measuring responsiveness could provide well-
grounded guidance for further development of mental health care
systems towards becoming better patient-orientated and
providing patients with more respect.

Reference:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1931438/

Reaction:

In this study they tried to measure the responsiveness of

mental health care by the example of a regional mental health
care system in a larger German city. The study group can be
considered representative of service users in psychiatric
inpatient care and of service users using complex services in
urban areas of Germany.
It is interesting to compare the ratings of responsiveness
in mental health care with data on general health care
responsiveness. There are many things to consider in taking
care of mentally ill patients that is why health care workers
should see all circumstances that is needed by the patients.
Patients should also see if the hospital has all the facilities
that could help them with all their needs.