danish forensic psychiatry peter kramp former head clinic of forensic psychiatry copenhagen
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Danish forensic psychiatry
Peter KrampFormer head
Clinic of Forensic Psychiatry
Copenhagen
PK/CO
Danish forensic psychiatryCentral 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
Danish forensic psychiatryCentral concepts
“Mental illness” = psychosis
The current psychiatric definition of psychotic conditions.
PK/CO
PK/CO
Danish forensic psychiatryCentral concepts
“Mental illness or similar conditions”
Examples: Hypoglucemia
Epileptic confusion
Severe dissociative disorders
… …
Danish forensic psychiatryCentral 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
Danish forensic psychiatryCentral 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 psychiatryCentral 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
Danish forensic psychiatry
The main Problem
The increasing number of forensic patients
Forensic patients in DenmarkMonthly prevalence 1977-2004
1975 1980 1985 1990 1995 2000 2005 Year
500
1000
1500
Number
… 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 estimatebased 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.
-2.5
0
2.5
5
7.5
10
12.5
15
17.5
-10 -9 -8 -7 -6 -5 -4 -3 -2 -1 0 1Growth 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 1980-1997Plot of growth rates of incidences of forensic patients and
growth rates of consumed psychiatric beds; (n=14)
Danish forensic psychiatryThe 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 psychiatryThe main Problem
Another problem
Too long waiting time for reports for the court – up to six month or even more.