Criminal recidivism and mortality among patients discharged from a forensic medium secure hospital

Abstract

Background: One of the goals in forensic psychiatric care is to reduce the risk of recidivism, but current knowledge about the general outcome of forensic psychiatric treatment is limited. Aims: To analyse the rate of criminal recidivism and mortality after discharge in a sample of patients sentenced to forensic psychiatric treatment in a Swedish county. Methods: All offenders in Örebro County, Sweden, sentenced to forensic psychiatric treatment and discharged during 1992–2007 were included: 80 males and eight females. Follow-up data was retrieved from the Swedish National Council for Crime Prevention, the National Cause-of-Death register and clinical files. Mean follow-up time was 9.4 years. Results: The mean age at discharge was 40 years. Schizophrenia, other psychoses and personality disorders were the most prevalent diagnoses. Thirty-eight percent of those still alive and still living in the country re-offended and were sentenced to a new period of forensic psychiatric treatment or incarceration during follow-up. Four male re-offenders committed serious violent crimes. Substance-related diagnosis was significantly associated with risk of recidivism and after adjustment for diagnoses, age and history of serious violent crime, the Hazard Ratio was 4.04 (95% CI 1.51–10.86, P = 0.006). Of all included patients, 23% had died at the end of follow-up (standardized mortality rate 10.4). Conclusions: Since repetition of serious violent crimes was unusual, results indicate a positive development subsequent to treatment for those alive at follow-up. Clinical implications: The high mortality rate suggests that more attention should be paid in evaluation of the patients’ somatic and psychiatric health during and after care in order to prevent premature death.

• Forensic psychiatric treatment
• Mortality
• Recidivism

Acknowledgement

—We are indebted to Anna-Karin Cornelius for collecting clinical data, Jana Villem for gathering causes of death data, and to Anders Magnusson and Ole Brus for statistical support.

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

Notes

1 The forensic Psychiatric Care Act: SFS 1991:1129.

2 Aggravated means that the act constituted a mortal danger or the offender inflicted grievous bodily harm or severe illness or otherwise displayed particular ruthlessness or brutality.