Court-ordered inpatient psychiatric care in Switzerland: determinants of length of stay and treatment outcome

Frontiers in Psychiatry

Psychiatry

Philippe Bertschy¹  Christophe Menu¹  François R. Herrmann²  Sandrine Morier³  Lise Lesaffre³  Panteleimon Giannakopoulos⁴  Kerstin Weber⁴ 

[1] Department of Institutions and Information Technology, Republic and State of Geneva, Geneva, Switzerland;Department of Rehabilitation and Geriatrics, Geneva University Hospitals and University of Geneva, Geneva, Switzerland;Division of Institutional Measures, Medical Direction, Geneva University Hospitals, Geneva, Switzerland;Division of Institutional Measures, Medical Direction, Geneva University Hospitals, Geneva, Switzerland;Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland;

关键词: mentally disordered offenders;    court-ordered treatments;    forensic psychiatry;    prison;    length of stay;   

DOI  :  10.3389/fpsyt.2023.1222337

 received in 2023-05-14, accepted in 2023-09-18,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionIn several European countries, offenders with decreased or abolished responsibility and high risk of recidivism due to long-lasting mental disorders are compulsory admitted for court-ordered treatments (COT) that take place in high and medium-security hospitals. As a rule, length of stay in these structures is very long implying major restrictions for the inmate and high societal cost. Despite intensive research, the predictors of length of stay and treatment outcome in long stay forensic services is still matter of debate.MethodsWe report here a detailed analysis of the demographic, psychiatric and offense predictors of length of stay and discharge locations of 204 mentally disordered offenders convicted to COT in a new medium-security forensic psychiatry clinic in Geneva, Switzerland. Kaplan-Meier survival estimates were performed to determine time to release. Length of stay was predicted by Cox regressions, and discharge locations were predicted by multinomial logistic regressions.ResultsThe typical inpatient was a 35-age single male re-offender, submitted to COT after a conviction for physical violence (78.9%) or property violation (64.2%), with drug trafficking (52.9%), in relation to psychotic (67.2%), antisocial or borderline personality disorder (35.8%) with comorbid substance use disorders (60.3%). Sex offenses were found in 24.5% of cases and were associated with Cluster B personality disorders. The median length of stay was of 2.5 years and was independent of demographic variables, severity of crime recidivism and psychiatric diagnosis. Longer COT at admission, and type of offense (in particular drug traffic and sexual violence) predicted longer stays. At discharge, 32.8% of cases were transferred to sheltered educational housing, 23.1% to open low-security wards, while 30.6% returned to regular prisons and 9.7% to their country of origin.DiscussionYounger age and conviction for property violation rather than physical violence increased the chances to be discharged to sheltered educational housing. Longer COT at admission, personality disorders, and conviction for sexual offense increased the risk to return to prison. These data suggest that sex offenses determine not only longer stays under COT but also drastically decreases the chance of freedom for inmates with Cluster B personality disorders.

【 授权许可】

Unknown   
Copyright © 2023 Weber, Morier, Lesaffre, Menu, Bertschy, Herrmann and Giannakopoulos.