Psychiatric antecedents of forensic patients with schizophrenia - Framework conditions of crime prevention by General Psychiatry

Background. People suffering from schizophrenic disorders are at increased risk of committing violent crimes. In the present study, we investigated the conditions of preventing offences by general inpatient psychiatric services. Method. The sample enclosed 75 patients treated at forensic hospitals in BadenWurttemberg, Germany. Data on frequency and date of previous delinquency and general psychiatric treatments were collected from the clinical records and from the psychiatric expertise provided for the sentencing. Results. Prior to the severe offence leading to forensic detainment, eighty-three per cent of the cases had been treated at least once at a general psychiatric hospital while indications of a risk of delinquency were already present. Even if more specific risk indicators were used and patients with only one general psychiatric treatment episode were excluded, nearly two thirds of cases remain as target group for prospective general psychiatric prevention programs. On average, six inpatient treatments during the course of six years would have provided opportunities to prevent delinquency. However, in twenty-five per cent of the cases, the crime leading to admission to a forensic unit took place within an institutional environment (wards, penal institution). Of the offences that were committed outside of an institution, fifty per cent occurred during the first year after a general psychiatric treatment. Two thirds of the sample had committed an offence before first admission to general psychiatric treatment. On average, the first offence preceded the first admission by 4,6 years. Conclusions. General psychiatric services provide promising opportunities to prevent delinquency among schizophrenics at risk for criminal offending. Specific programs that are effective beyond discharge from a general psychiatric ward should be developed and evaluated.