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.