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PLACEMENT AND TREATMENT OF MENTALLY ILL OFFENDERS
LEGISLATION AND PRACTICE IN EU-MEMBER STATES
Hans Joachim Salize & Harald Dressing
Central Institute of Mental Health Mannheim, Germany
Central Institute of Mental HealthEuropean Commission - Health & Consumer Protection Directorate-General
Powpoint/Vorträge-2002/Bukarest-2002 (Compulsory).ppt
• Civil Detention: Involuntary Placement and Treatment of Mentally Ill –Legislation and Practice in European Union MemberStates (1999-2002)
• Forensic Care: Placement and Treatment of Mentally Ill Offenders –Legislation and Practice in European Union MemberStates (2002-2004)
• Mental Health in Prison: Treatment of Mentally Ill or Disordered Persons in European Prison Systems EUPRIS
(2005-2007)
Studies on Law and Coercion in European Psychiatry
Study conducted from: December 2002 - October 2004Study included: 15 Member States (before extension in 2004)
Neth
Por
Ire
Aus
AustriaBelgiumDenmarkFinlandFrance GermanyGreeceIrelandItalyLuxembourgNetherlandsPortugalSpainSwedenUnited KingdomEsp
Ita
Gree
Swe
LuxBel Ger
Fr
Fin
UK Dan
Study Aims
• Provide a standardized description of legal frameworksproceduresroutine practiceservice provisionepidemiology
• Describe similarities or differences in Member States
• To draw conclusions for potential harmonization on an European level
Legal Tradition
AustriaBelgium
DenmarkFinland
France GermanyGreeceItaly LuxembourgThe NetherlandsPortugal Spain
Sweden
Roman Law
Ireland United Kingdom
Common Law
9
3 3
graded concept
dichotomicconcept
concept notapplied
Basic Concept: Criminal Responsibility
FinlandFranceGermanyGreeceItalyLuxembourgNetherlandsPortugalSpain Austria
BelgiumDenmark
Engl. & WalesIrelandSweden
Assessment of correlation required
AustriaFinlandFranceGermany GreeceItalyNetherlandsPortugal SpainSweden
Correlation of Mental Disorder and Crime
Assessment of correlation not required
Belgium DenmarkEngland & Wales IrelandLuxembourg
Available
England & Wales (3 years)Finland (6 years)Germany (1 year)Portugal (6 month)
Specialist Training in Forensic Psychiatry
Not provided
AustriaBelgium DenmarkFranceGreeceIrelandItalyLuxembourg NetherlandsSpainSweden
12 months
12 months
6 months
106 days
28 days
0 2 4 6 8 10 12 14
IRELAND
NETHERLANDS
GREECE
GERMANY
PORTUGAL
month
Maximum Time Frames for Pre-trial Placement
Not specified
AustriaBelgiumDenmarkEngland & WalesFinlandFranceItalyLuxembourgSpainSweden
66
241212
624
12666
126
12
0 6 12 18 24
AUSTRIA *
BELGIUM
DENMARK *
ENGLAND & WALES *
FINLAND
FRANCE
GERMANY *
GREECE
IRELAND
ITALY
LUXEMBOURG
NETHERLANDS
PORTUGAL
SPAIN
SWEDEN
month
Time Frames for (post-trial) Reassessment
not legally defined
theoretically possible
AustriaBelgium DenmarkEngland & Wales FinlandFranceGreeceItalyNetherlandsSweden
Lifelong Placement in Forensic Care
not possible
Portugal Spain
legal option
Belgium DenmarkGermany
Preventive Detention / Secure Custody
concept not known
AustriaEngland & Wales *FinlandFranceGreeceIrelandItalythe NetherlandsPortugal SpainSweden
* Currently proposed by government for extremely dangerous persons with personality disorders
Number of specified Beds in Forensic Care (1998-2003)
no. of additional capacity prison placementbeds in general psychiatry due to shortage
Austria 384 yes (incl.) noBelgium 1,061 yes (not incl.) yesDenmark 250 yes (not incl.) unknownEngland & Wales 3,200 yes (not incl.) noFinland 360 yes (incl.) unknownFrance 486 yes (not incl.) yesGermany 7,123 yes (not incl.) yesGreece 250 – 330 yes (incl.) yesItaly 1,282 no noIreland 80 yes (not incl.) unknownThe Netherlands 1,304 yes (not incl.) yesPortugal 189 no noSpain 593 yes (not incl.) noSweden 713 yes (incl.) unknown
4,7
10,3
6,66,1
6,9
0,8
8,6
2,4 2,2 2,1
8,1
1,81,4
8
0
4
8
12
Austria
Belg
iumDen
mark
Englan
d & W...
Finland
France
Germ
any
Greece Italy
Irelan
dNeth
erlan
dsPort
ugalSpa
inSwed
en
Specified Beds in Forensic Care (per 100.000 population, 1998-2002)
Availability of Forensic Outpatient Facilities
available in
AustriaBelgium GermanyThe Netherlands
not availablein 11 Member States
5,710,4
2,29,4
2,22,12
7,5
6,121,7
6,33,4
0 5 10 15 20 25
Austria 2002
Belgium 2002
Denmark 1999
Finland 2002
France
Germany 2003
Greece 1996
Ireland 2001
Italy 2001
Luxembourg
Netherlands 2001
Portugal 2002
Spain
Sweden 2002
England & Wales 2001
mentally ill offenders per 100.000 population (prevalence-rate)
0
5
10
15
20
25
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
Austria BelgiumDenmark FinlandGermany GreeceItaly IrelandNetherlands PortugalSweden England&Wales
number
FIN
mentally ill offenders in forensic care per 100.000 population (rates)
SWEIRE
NETH
AUSPOR
DEN
GER
ITA
BEL
GREENG
Disorders of patients in forensic care (most recent year available)
0%
25%
50%
75%
100%
Sweden 2002
Ireland 2001Italy 2001
Austria 1992
Denmark 2000
Netherlands 2000
Schizophrenia Substance Abuse
Affective Disorder Personality
Sex. Disorder Others
85,7 14,3
90,1 9,9
94,4 5,6
94,9 5,1
90,4 9,6
87,5 12,5
83,7 16,3
0 50 100
Austria 2001
Sweden 2002
Belgium 1999
The Netherlands 2000
Germany 2001
England 2002
Finland 2002
Gender of mentally ill offenders in forensic care
%
male female
• Legal traditions, legal frameworks, routine procedures or key concepts of forensic care are varying remarkably across the EU, as do the pathways to the two major sanction systems – prison or specialised forensic care
• Forensic service provision is extremely varying (in quality or quantity), although hard to evaluate and compare -under-provision with specialized services is common
• Clear definitions for forensic cases or capacities are lacking standardized European indicators are not provided - which is a serious obstacle for international comparison of efficacy or effectiveness of forensic approaches
• Available data suggests an overall slow increase of forensic prevalence during the last decade
• Harmonizing legal frameworks or agreeing on basic standards for forensic care on an EU-level seems hard to achieve in the near future
Conclusions
• to increase research on interdependencies and influencing factors on procedures and outcomes
• to stimulate an international debate among experts and the scientific community
• to ensure basic human rights and contemporary standards of mental health care for civilly detained mentally ill and mentally ill offenders
• to develop a common set of European indicators on the issue and and propose the inclusion into national health/justice reporting systems
• to support efforts for a harmonized training program for forensic psychiatrists and propose/promote adoption by all Member States
Major Concern
Forensic Legislation Final report
available soon from Pabst Scientific Publishers
European Commission - Health & Consumer Protection Directorate-General
EUROPEAN COMMISSION
Research Project
Placement and Treatment of Mentally Ill Offenders –
Legislation and Practice in EU Member States Final Report – February 15, 2005
___________________________________________________________________________
Hans Joachim Salize & Harald Dreßing Central Institute of Mental Health J5 D-68159 Mannheim Germany ____________________________________________________________________________________
Central Institute of Mental Health
Treatment of Mentally Ill or DisorderedPersons in European Prison Systems (EUPRIS)
- Service Provision and Outcomes
Hans Joachim Salize & Harald Dressing
Central Institute of Mental Health Mannheim, Germany
Central Institute of Mental HealthEuropean Commission - Health & Consumer Protection Directorate-General
Selected for funding: July 22, 2004
Method: expert evaluation assessment by questionnaire analysis of data by study centrefeedbackexpert meetingfinal report
Probable start : September 1, 2005 - April 1, 2007
EUPRIS Study - Details
to set up network of experts on mental illness and mental health care in the prison systems of included countries
to explore and describe the availability of information on mentally ill or disordered prison inmates and onmental health care provision or treatment programmes (health or justice reporting systems)
to describe and analyse the structure and size of the prison systems of the included countries(structure, capacity, health care provision, number, rates, gender, ethnicity, age groups, crimes of inmates etc.) description of information gaps and shortages
to describe and analyse prevalence and incidence of mental disorders in prison inmates of included countries (diagnostic groups, rates, quotas, time series, information shortages)
to describe and analyse mental health care capacities within the prison-system (assessment procedures, treatments, programmes for mentally disordered inmates)
- overall psychiatric service provision in prison - trained staff: number of physicians, psychiatrists, psychologists, nurses in prison - rates: trained mental health care staff per 10,000 prisoners- annual budget for psychiatric service provision in prison- available treatments, specific programmes- aftercare
to describe the collaboration with general health care, mental health care or forensic psychiatry
to describe and analyse the outcome of mental health care provision or the determinants of mental ill health in prisons
to identify and propose appropriate outcome indicators (e.g. suicidal behaviour, suicide rates in prisons)
to describe national research activities in the field and outline major findings on mental illness in prison systems
EUPRIS Study - Overall Aims
27 countries included
Austria H. SchandaBelgium P. CosynsBulgaria T. TomovCyprus E. AnastasiouCzech Rep. J. Raboch Denmark P. Kramp Estonia A. ToumaaFinland R. Kaltiala-HeinoFrance P. LamotheGermany N. KonradGreece G. AlevizopoulosHungary L. LajtavariIceland J.F. SigurdssonIreland E. DooleyItaly A. FiorittiLithuania A. Avramenko
EUPRIS Study - Collaborators
Luxembourg J.M. Spautzthe Netherlands C.H. de KogelNorway E. KjelsbergPoland A. KjenaPortugal M. XavierRomania M. MunteanuSlovakia P. NawkaSlovenia A. MarusicSpain F. Torres-GonzálezSweden O. HoffmannUnited Kingdom D. James
missing countriesLatviaLiechtensteinMaltaTurkey
EUPRIS Study - Other Studies in the field
Health in Prison Project - WHO / European Commission
Collaboration is agreed
This paper was produced for a meeting organized by Health & Consumer Protection DG and represents the views of its author on the subject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the data included in this paper, nor does it accept responsibility for any use made thereof.