Long-Term Violent Reoffending Following Forensic Psychiatric Treatment: Comparing Forensic Psychiatric Examinees and General Offender Controls

Abstract

Background: Long-term violent re-offending in forensic psychiatric (FP) patients vs. non-FP offenders is largely unknown. Methods: We studied rates and facets of long-term violent reoffending among 1,062 violent forensic psychiatric examinees (FPE) consecutively undergoing pre-trial, forensic psychiatric examination (FPE) in Denmark during 1980–1992. Altogether, 392 were sentenced to FP treatment (FPE+T); the remaining 670 examinees received ordinary non-FP sanctions (FPE-T). FPE+T were compared to 392 contemporary matched violent general offenders (GEN) without FPE or other psychiatric contacts and sentenced to ordinary non-FP sanctions. FPE data were linked to population-based registers with sociodemographic, psychiatric, and crime information, and we estimated relative risks controlling for birth year, sex, educational and marital status, and previous violent crime. Results: During follow-up (mean = 18.0–19.5 years), FPE+T and GEN had any violent recidivism rates of 43% vs. 29% [adjusted hazard ratio (aHR) = 1.5; 95% CI, 1.1–1.9], respectively. Corresponding findings for severe violence (21% vs. 14%; aHR = 1.3; 95% CI, 0.9–1.9) and recurrent violence (3+ violent convictions; 16% vs. 6%; adjusted odds ratio [aOR] = 2.5; 95% CI, 1.5–4.4) also suggested weakly to moderately increased risks in FPE+T, albeit non-significantly for the former. Comparing FPE+T to FPE-T suggested decreased risk of any violence (43% vs. 51%; aHR = 0.8; 95% CI, 0.6–1.1), severe (21% vs. 34%; aHR = 0.6; 95% CI, 0.4–0.8), and recurrent violence [16% vs. 22%; adjusted odds ratio (aOR) = 0.7; 95% CI, 0.5–1.0] in FP patients, though non-significantly for any violence and recurrent violence. Among all FPE examinees, violent reoffending was independently predicted by male sex, younger age, pre-index violent crime, personality disorder (vs. schizophrenia spectrum and other psychiatric disorder), substance use disorder, and 5+ hospital admissions. Conclusion: FPE examinees, untreated followed by treated, reoffend violently more often than GENs. Similar trends are suggested also for severe and recurrent violence suggesting a need for continua of services for FPE examinees, independently of medico-legal status (i.e., sentencing to treatment or not).

Prison inmates with court-ordered treatments: are they really different?

“…One recent study reported that single status is a strong risk factor for criminal recidivism in community settings [ 25 ]. In the same line, the analysis of offenders with COT in Denmark during 1980–1992 revealed that they are predominantly single compared to regular prison inmates [ 26 ].…”

The curse of experiencing and committing violence as a criminal recidivism predictor: A comparison between female forensic psychiatric patients with severe mental disorders and substance use disorder

“…However, our current findings suggest that physical abuse during childhood and youth adds very little to no prognostic value regarding violent reoffending or the duration until criminal recidivism in both female patient populations. Surprisingly, similar findings were observed when looking at violence during their hospital confinement and violence as an index crime in patients with other mental illnesses than SUD, thereby contradicting findings on male patients [27]. Also, a codiagnosis of antisocial/dissocial personality disorder in either group did not impact the time interval to a first reoffence or overall violent recidivism rates, further indicating possible gender differences regarding personality disorders and violent crimes [28].…”

Longer than prison? A comparison of length of stay in a medium security hospital and prison for perpetrators of violent crimes other than homicide or attempted homicide

“…Possible justification for the caution and longer lengths of stay may come from findings that reoffending rates for mentally disordered offenders may be higher than for people convicted of comparable offences who were sentenced to imprisonment (Bengtson et al., 2019), although a systematic review of 35 other studies from 10 countries of outcomes after secure hospitalisation (Fazel et al., 2016) suggested that patients with comparable offending were less likely to reoffend after release. That said, most of the studies included in the Fazel group had not directly compared outcomes with prisoner outcomes and so their patient‐prisoner comparison summary may be less robust than the other findings.…”

“…It is very surprising that few authors have tried to address this question. (Harris, Rice & Cormier, 1991) in Canada, compared length of institutional stay of matched groups of 280 male insanity acquittees sent to hospital and 238 convicted offenders sent to prison and found that the former were in locked facilities for significantly longer than the prisoners. Results of other studies were inconsistent (Braff, Arvanites & Steadman, 1983; Draine et al., 2010; Metraux, 2008; Pasewark, Pantle & Steadman, 1979; Pasewark, Pantle & Steadman, 1982).…”