Previous forensic mental examination is a useful marker indicating effective violence relapse prevention among psychotic patients

Abstract

Background: Patients with schizophrenia have an increased risk of violent behavior. Aims: The aim of this study was to find predictive indicators of high risk of violent behavior among outpatients with psychosis. Methods: A total of 206 individuals were involuntarily ordered to hospital treatment as forensic patients after a forensic mental examination in Finland from 1995–1999. The information was collected from the registers of the National Authority for Medicolegal Affairs, and was obtained from 194 persons of which 184 had been accused of a violent crime. Results: Twenty percent (22/110) of those forensic patients, who had received a psychosis diagnosis before the index crime, had previously undergone a forensic examination. This subgroup was 12% of the total study population (22/184), which is about 300 times higher than expected (i.e. if no risk increase assumed). Ten of the 22 persons in this subgroup had been committed in forensic psychiatric inpatient care and later discharged. The same number of persons had been sentenced to prison and subsequently released after the previous forensic mental examination. Conclusions: While primary prevention of crime for the larger population of all patients with psychosis is not feasible, secondary prevention (prevention of reoffending) might be possible by focusing on the small subgroup, which had undergone a previous forensic mental examination. Obligatory follow-up and treatment in outpatient care would probably decrease recidivistic offending among discharged forensic psychiatric patients and among those offenders found not guilty by reason of insanity but not considered to fulfill criteria for involuntary hospital treatment.

• Forensic psychiatry
• Mental examination
• Prevention
• Violence

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.