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Non-dischargeable Mentally Disordered Offenders in a German

Hospital Order Institution

Paper presented to the 3rd Annual IAFMHS Conference, April 9th – 11th,

2003, Miami

Sabine Eucker & Dieter Jöckel, Forensic Psychiatric Hospital Haina, D-35114 Haina

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High Risk

forensic hospital community

lifelong

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Low Risk

Forensic Psychiatric Hospital Haina

community

after 4 years

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What about insane offenders for whom the door remains closed?

?????

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Non-dischargeable Mentally Disordered Offenders 1

• increasing interest in expert discussion• limited to high risk personality disordered

offenders• headline „untreatable insane offenders“• developments:

- Germany: placement in correctional system?

- Great Britain: DSPDs

- Netherlands, Germany: long stay units

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Non-dischargeable Mentally Disordered Offenders 2

but

no research

no definition

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Non-dischargeable Mentally Disordered Offenders in the Haina

Forensic Psychiatric Hospital 1

definition: hospital inmates who are not expected to be discharged to the community in theforeseeable future

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Non-dischargeable Mentally Disordered Offenders in the Haina

Forensic Psychiatric Hospital 2

• October 2000: 102 „non-dischargeable“ inmates

29% of all inmates

• October 2002: 1 „non-dischargeable“ inmate was discharged to the community

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Compiled Data

• personal data

• criminal data

• diagnostic data

• risk assessment data

• clinical judgment data

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Sample (N=102)

• mean age: 43 years (23 - 79)

• women: 8%

• mean treatment term: 6,6 years (0-33)

• longstay wards: 25%

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Level of Security (N =102)

• pass: 57 %

a) with accompany: 29 %

b) without accompany: 28 %

• totally under lock and key: 43 %

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Index Offenses and Main Diagnoses (N = 102)

Offenses

• sex offenses 34%• assault 19%• murder 11%• attempted murder 10%• arson 10%• robbery 8%• other 5%

Main Diagnoses

• no mmD 50% a) PD 30% b) paraphilia 20%• schizophrenia etc. 30% (only paranoid)• organic mental d. 12%• mental retardation 6%

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Significant Differences Between Non-dischargeable and

Dischargeable Inmates (N=343)

Non-dischargeable inmates:• older• more sexual offenses• more personality disorders• more paraphilia• more mental defiency (IQ < 85)

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No Significant Differences Between Non-Dischargeable and Dischargeable Inmates (N=343)

• substance abuse

• APD (DSM-III-R)

• acute psychotic symptoms

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Risk Markers 1: PCl-SV (N=102)

37%

35%

28%psychopathictraits

no psychopath

psychopath

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Risk Markers 2: HCR-20, H-Score (N=102)

25%

75%

H-Score <11

H-Score >10

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Factor Analysis (N=102)

• all variables which occur more often than 4 times

• main axis analysis• exclusion of variables with a low selfvalue• selfvalue criterion, scree test: 3 – 9 factors• varimax rotation• best interpretation: 5 – factor –solution• s2: 54%

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5-Factor-Solution (N=102)

1. Antisocial lifestyle

(s2: 21%)

• PCL- SV 7-10

• H-Score (HCR-20)

• APD (DSM-III-R)

• substance abuse

• prior convictions

• robbery

2. Placement in hospital

order institutions

(s2: 12%)• diminished

responsibility• placement in prison

possible• no schizophrenia• personality disorder• admission questionable

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5-Factor-Solution (N=102)

3. Sexual violence ( s2: 8%)

• sex offence• paraphilia• mental defiency

(IQ<85)• no organic mental

disorder• no attempted murder

4. Low motivation for treatment (s2: 7%)

• no motivation• from first day on non-

discharge ability obvious

• no arson

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5-Factor-Solution (N=102)

5. Psychotic violence

(s2: 6%)

• first hospital order

• chronic psychotic

• assault

• no murder

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Conclusions

1. Non-dischargeable insane offenders are scarcely noticed by forensic research.

2. The proportion of non-dischargeable insane offenders seems to be striking high.

3. The research of non-dischargeable insane offenders should not be reserved to the „DSPs“.

4. Up to 35% cannot be identified by common risk markers.

5. The term „non-dischargeable“ seems to be more appropriate than „non-treatable“.

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Further Research

forensic hospital community