Placement and Treatment of Mentally Ill Offenders - Legislation and Practice in EU-Member States

Transcription

1 Page 1 of 45 EUROPEAN COMMISSION Central The SANCO Institute Directorate of General Mental Health Research Project (Agreement No. SPC ) Placement and Treatment of Mentally Ill Offenders - Questionnaire Country: Date filled out: Person filling out: Organisation Address Telephone No. Fax No. Please note: Please fill out and send back this questionnaire before October 15, 2003 to: (mailing address:) Dr. Hans Joachim Salize Mental Health Services Research Group Central Institute of Mental Health J5 D Mannheim Germany In case of questions, please contact Mrs. Heidrun Ferrari or Mrs. Anja Schmidt (Project Coordinators) Phone Fax

2 Page 2 of 45 Introduction This questionnaire is part of the research project Placement and Treatment of Mentally Ill Offenders -, funded by the European Commission (Agreement No. SPC ). This project aims to describe and summarise the current legislation in the fifteen Member States of the European Union with regard to mentally ill offenders as well as the current practice with regard to their placement and treatment. The purpose of this questionnaire is to gather relevant information so as to be able to do this in a standardized format. All questions concern legislation or placement practice with regard to adult mentally ill offenders. If the rules, regulations or placement practice for adolescent mentally ill offenders differ, please outline this in the accompanying chapter you are asked to contribute along with this questionnaire. If your national legislation or practice does not distinguish clearly between mentally ill offenders and involuntarily placed or treated civilly admitted persons who have not committed a crime, so that some of your answers may pertain to both issues, please describe this more closely in the respective item of this questionnaire or the chapter. Legislation regarding the treatment or placement of persons suspected of having committed a crime under the influence of disorders other than mental disorders, for example, communicable diseases, is not an issue pertinent to this project. This questionnaire is an endeavour to gather information from fifteen different countries, which most probably differ in their approaches towards or their history of forensic psychiatry or legal systems or traditions. Due to these differences, some items in this questionnaire might deal with certain aspects only on a global level in order to cover all countries involved. Thus, some items might fail to satisfactorily describe special aspects in your own country. Again, these aspects which might not satisfyingly be described merely by answering the questionnaire should be detailed in the chapter you are asked to contribute along with this questionnaire. How to fill out the questionnaire Most of the questions in this questionnaire can be answered with either yes or no. You are kindly asked to tick the respective box (see below). If possible, please avoid ticking the unknown box too often. If you find please describe: as an additional item, you are kindly asked to answer the respective question at your discretion. The aim will often be to describe certain exact terms, definitions or criteria. If this is the case, please fill in the exact definitions, terms or wordings as used in the laws of your country. If there is not enough space, please use additional sheets and append them to the questionnaire (indicating the respective item no. on the separate sheet). If it is not possible to answer a certain question because an items is not applicable to the special conditions or circumstances in your country, please indicate this by writing down not applicable. Translation /Language problems Some items in this questionnaire may ask for expressions, definition or terms as used in the laws of your country. These expressions, definitions or terms should be given in English. Since national laws usually have not been translated into English at least not officially - translation might be difficult in some cases. If there are no official English translations of terms available, please provide the best translation from your own expertise and add in brackets the original wording or term in your language, if this would facilitate a better understanding. Should any English translation of your national laws or acts be available, you are kindly asked to enclose it with this questionnaire. Please do likewise with any reference or relevant scientific paper on your national situation that you might consider as backing up the information given in this questionnaire. Thank you in advance for all your support. Do not hesitate to contact us in case of any query.

3 Page 3 of Legislation The following questions identify the legal instruments that are currently in force in your country to regulate the judicial procedures for or the placement and treatment of offenders with any form of mental disorder. Additionally, this section describes both the scope of these legal instruments and the individuals to whom they apply. 1. Are there specific laws, acts or legal instruments in your country regulating the judicial procedures for or the placement and treatment of mentally ill offenders? If no, how are the judicial procedures for the placement and treatment of mentally ill offenders regulated? Please explain: 2. Please specify the relevant laws, codes or statutes of laws applicable for the different stages of the judicial process, and the placement and treatment of mentally ill offenders. Stage Name of law or no. of code or statute Type of law (e.g. penal law, mental health act, procedural law) Law took effect (year) Law last changed (year) Pre-trial* Trial Psychiatric Assessment Placement Treatment Discharge / Aftercare * Pre-trial refers to any procedures and decisions prior to a trial, including pre-trial placement

4 Page 4 of 45 If the laws of your country cannot be broken down into these stages, please describe, if possible, any similar structure of your laws: 3. Are there major changes in legislation planned or in preparation regarding the placement or treatment of mentally ill offenders? If yes, please describe briefly the cause or nature of any planned changes: 4. Are the above-mentioned laws, acts or legal instruments (item 2) applicable nationwide or do different laws or regulations apply to certain regions in your country (e.g. Federal States, Provinces, Departments etc.)? Above-mentioned acts (item 2) have a Nationwide scope Regional scope If there are regulations with a limited regional scope additional to or different from national legislation, please describe (e.g. in how far and why they differ from nationwide laws): If there are different regulations (regional or national), please indicate clearly below to which law you are referring when answering the following questions (nationwide laws preferred):

5 Page 5 of Do legal procedures for mentally ill offenders overlap with legal procedures for mentally ill persons who have been civilly detained (non-offenders), or are procedures for involuntarily placed or treated mentally ill persons (non-offenders) regulated separately by law? Overlap Separate Unknown If there is a full or partial overlap, please explain: 6. At which age are adolescents held fully accountable with regard to the penal law of your country? (Years of age) No age defined Unknown 7. Are there specific laws and regulations for adolescent mentally ill offenders separate from the laws specified in item 2? If yes, please state the respective age range to which these laws or regulations apply: From (Years of age) to (Years of age) What are the main differences between the laws applying to adolescents and those applying to adults?

6 Page 6 of Key Concepts 2.1 Mental Disorder 8. Please list the English wordings that come closest to the judicial terms as used in the legal instruments, laws and statutes (item 2) indicating various forms of mental disorder. 9. Which of the medical definitions of mental disorders (ICD-10 definitions) listed below are covered by the terms as used in your laws (item 8)? Please mark whether the ICD-10 diagnoses are fully covered by the laws, or whether they are not specified or covered by the laws but are common in the routine practice of forensic placement or treatment, or whether they are explicitly excluded from procedures for mentally ill offenders. Covered Covered in Explicitly Un- Diagnosis (ICD10) by law routine practice excluded known Organic mental disorders (F0) Mental disorders due to substance abuse (F1) Schizophrenia (F2) Affective and mood disorders (F3) Neurotic, stress-related, somatoform disorders (F4) Disorders of adult personality and behaviour (F6) Dissocial personality disorder (F60.2) Disorder of sexual preference (F65) Mental retardation (F7)

7 Page 7 of Do the laws, acts or legal instruments (item 2) also apply if suspects do not suffer from any form of mental disorder but have committed a crime of passion (e.g. under the influence of extreme affective conditions)? If no, please describe how offenders who have committed a crime of passion are dealt with in terms of legal procedures, placement and/or treatment: 11. Do the laws, acts or legal instruments (item 2) also apply if suspects do not suffer from any form of mental disorder but have committed an offence while being intoxicated with alcohol or drugs? If no, please describe how offenders who have committed an offence while being intoxicated are dealt with: 2.2 Criminal Responsibility 12. Is the concept of criminal responsibility incorporated into the above-mentioned laws (item 2)? If yes, are different categories of criminal responsibility defined? If yes, which categories of criminal responsibility are defined? (Multiple choices are possible) Full criminal responsibility Diminished criminal responsibility Yes No Unknown Lack of criminal responsibility Yes No Unknown Other: Yes No Unknown

8 Page 8 of 45 If applicable, please list the legal pre-requisites for lack of criminal responsibility or diminished criminal responsibility (e.g. ability of insight, ability to control one s actions etc.): Lack of criminal responsibility: Diminished criminal responsibility: If the concept of criminal responsibility is unknown or not used, please name or describe the concepts or the overall philosophy according to which the laws of your country distinguish the criminal responsibility of mentally ill offenders from that of mentally non-disturbed offenders: 3. Pre-trial Procedures 13. Do the laws, acts or legal instruments (item 2) regulate the pre-trial placement of persons suspected of having committed a crime under the influence of a mental disorder? If yes, what is the purpose of the pre-trial placement of mentally ill suspects? (Multiple choices are possible) Suspects assumed to be mentally ill are allowed to be placed for treatment. Suspects assumed to be mentally ill are allowed to be placed for reason of security. Suspects assumed to be mentally ill are allowed to be placed for expert assessment. Suspects assumed to be mentally ill are allowed to be placed for other reasons. If yes, please specify other reason:

9 Page 9 of According to the laws (item 2), where can suspects assumed to be mentally ill be placed prior to a trial? (Multiple choices are possible.) General psychiatric facilities Specialised forensic facilities Prison Other: 15. According to the above-mentioned laws, acts or legal instruments (item 2), who is entitled to order a preliminary placement as described above? (Multiple choices are possible.) Court Police Prosecutor Other: 16. Do the above-mentioned laws, acts or legal instruments (item 2) require any preliminary expert assessment or statement to decide on a pre-trial placement of suspects assumed to suffer from a mental disorder? If yes, please specify: 17. Do the above-mentioned laws, acts or legal instruments (item 2) specify a maximum time frame for pre-trial placement? If yes, please specify: total no. of weeks

10 Page 10 of Regular Psychiatric Assessment 18. Do the laws, acts or legal instruments (item 2) stipulate a regular assessment of the mental state of suspects assumed to be mentally ill (other than a provisional assessment for pre-trial placement as indicated in item 16) as a mandatory prerequisite for a trial? If no, what will serve as the basis of the verdict? (Multiple choices are possible.) The preliminary assessment of the pre-trial phase No psychiatric assessment at all, but a court expertise can suffice. 19. If there is a regular assessment of the mental state of suspects assumed to be mentally ill, is it legally defined whether additional conditions or circumstances have to be assessed? (Multiple choices are possible.) If yes, please mark: Ability to control one s actions Ability of insight Danger to the public Recidivism Other: If you ticked Other, please specify: 20. Do the laws, acts or legal instruments (item 2) require an obligatory assessment of the mental state of suspects having committed specific types of offences (e.g. murder, manslaughter, rape) disregarding any signs of a mental disorder at the time of the offence? If yes, please list offences:

11 Page 11 of 45 If no, is it routine practice to assess the mental state of suspects having committed severe crimes disregarding any signs of a mental disorder at the time of offence? If yes, please specify in which cases this is routine practice: 21. Who is legally entitled to order an assessment of the mental state of suspects assumed to be mentally ill? Court Prosecutor Defence Police Other: 22. Who is legally entitled to appoint the expert for the assessment of the mental state? Court Prosecutor Defence Other: 23. Do the above-mentioned laws, acts or legal instruments (item 2) require a written and/or an oral report on the assessment of the mental state at trial? Oral report at trial, but no written Written report at trial, but no oral Written and oral report at trial Other: 24. Do the above-mentioned laws, acts or legal instruments (item 2) define certain quality standards for the report on the assessment of the mental state? If no, are quality standards defined elsewhere?

12 Page 12 of 45 If yes, please describe the defined quality standards and source / quality managers: 25. Must the assessment of the mental state explicitly explore whether the offence was a direct consequence of a mental disorder? 26. Do the above-mentioned laws, acts or legal instruments (item 2) specify how many experts have to contribute to the assessment of the mental state? If yes, please specify: One expert Two experts More than two experts 27. Do the above-mentioned laws, acts or legal instruments (item 2) provide for the possibility of ordering two or more independent expert opinions to assess a mental disorder of suspects? If yes, are two or more independent expert opinions: obligatory in each case/trial? optional? If optional, please specify the criteria for more than one independent expert opinion, if any: 28. Do the above-mentioned laws, acts or legal instruments (item 2) require a particular professional background on the part of the expert(s) assessing the mental state?

13 Page 13 of 45 If yes, please specify (Multiple choices are possible.): Psychiatrist Any physician Yes No unknown Psychologist Yes No unknown Criminologist Yes No unknown Social worker Other: 29. Is a psychiatrist mandatory for assessing the mental state of suspects assumed to be mentally ill? 30. Do the above-mentioned laws, acts or legal instruments (item 2) require that the experts assessing the mental state of suspects hold a specific certification? If yes, please name the type of certificate and indicate which institution / board is authorised / licenced to certify: If no, please specify whether there are any other (e.g. non-official) quality standards applicable to experts eligible to assess the mental state of suspects: 31. Is there a pre-qualified (short-listed) board of experts appointed to assess the mental state of suspects assumed to be mentally ill?

14 Page 14 of Who pays for the assessment of the mental state of suspects assumed to be mentally ill (Multiple choices are possible.)? Department of health Department of justice Health insurance Social security Suspected person him-/herself Other: Yes No unknown 33. Are expert-report(s) delivered directly to the court or are there institutions or persons that receive the report(s) prior to the court? Directly to court Other institutions Unknown If other institutions or persons, please name and describe their tasks as well as the rationale for the delivery of reports to them prior to delivery to the courts: 34. According to the above-mentioned laws, acts or legal instruments (item 2), do suspects have the right to refuse an assessment of their mental state? If yes, what is the consequence?: No psychiatric assessment Observation of the suspect Others:

15 Page 15 of Trial 35. a. Is there a certain hierarchical or regional structure of the courts responsible for trials against suspected mentally ill defendants? If yes, please describe briefly the structure of the courts and any resulting consequences in terms of responsibilities (e.g. for certain types of crimes): b. Does the number of judges in trials against suspected mentally ill defendants differ from the number of judges in trials against defendants not suspected of being mentally ill? If yes, how many judges are regularly involved in trials against suspected mentally ill defendants?: suspected mentally non-disturbed offenders?: 36. Is a jury involved in trials against suspected mentally ill defendants? If yes, please describe the tasks or responsibilities of the jury in trials against suspected mentally ill defendants:

16 Page 16 of Does the prosecutor in trials against suspected mentally ill defendants have specific tasks or responsibilities that differ from its tasks in trials against defendants who are not mentally ill? If yes, please describe how the tasks or responsibilities of the prosecutor in trials against suspected mentally ill defendants differ from its tasks in trials against defendants who are not mentally ill: 38. Does the defence in trials against suspected mentally ill defendants have specific tasks or responsibilities that differ from its tasks in trials against defendants not suspected of being mentally ill? If yes, please describe how the tasks or responsibilities of the defence in trials against suspected mentally ill defendants differ from its tasks in trials against defendants who are not mentally ill: 39. Does the prosecutor or the defence or do both have the right to order an additional independent expert report in trials against suspected mentally ill defendants? Prosecutor Defence Both If yes, please list any conditions under which the prosecutor and/or the defence are permitted to order an additional independent expert report:

17 Page 17 of Is it legally defined that suspected mentally ill defendants have the right to claim for an assigned counsel? If yes, who pays for an assigned counsel? Department of health Department of justice Health insurance Social security Suspected person him-/herself Other: 41. Is it legally defined that suspected mentally ill defendants can be assigned a counsel against their will? If yes, please describe the conditions under which suspected mentally ill defendants can be assigned a counsel against their will: 42. Are there legally defined conditions or circumstances in which trials against suspected mentally ill defendants can be conducted without defence counsel? If yes, please describe the conditions under which trials against suspected mentally ill defendants can be conducted without defence counsel:

18 Page 18 of Is it legally defined whether trials against suspected mentally ill defendants have to start within a certain time frame after prosecution? a. If yes, please specify time frame(s): b. If yes, please describe the consequences if the deadline is not met: 44. Do suspected mentally ill defendants have to attend each session of a trial? If no, please specify the conditions for sessions without the defendant(s) in attendance (e.g. in case of the defendant being unfit to plead): 45. Please describe the consequences (e.g. for the trial or the verdict) when offenders become unfit to plead due to their mental state before or during a trial although the offence was not committed under the influence of a mental illness:

19 Page 19 of Verdict The items below deal with final decisions for the placement and/or treatment of a mentally ill defendant as made by the court, judge or jury. For detailing this decision we have separated several modalities, although the terms or wordings used might overlap or describe different concepts in your country. Please try to answer all questions according to the definitions below: Verdict: Sentence: means the overall decision by the judge, court or jury, regulating a sentence, a placement in a prison or any other penal institution, a psychiatric or forensic facility, or any treatment of the disorder of a mentally ill offender including discharge procedures. Thus, the verdict might detail one, several or all modalities as defined below (sentence, placement, treatment). Additionally, verdicts might include regulations of discharge from placement or treatment of mentally ill offenders. This term is used to describe court decisions or parts of court decisions according to penal law. This decision might be separated from or does not include regulations for specialised placements or treatments due to a mental disorder. Nevertheless specialised placements or treatments could be decided by the court along to or in addition to a sentence according to penal law. Placement: defines all institutions where a mentally ill offender is placed according to the decision of the court, judge or jury. This covers all modalities of the verdict (sentence according to penal law and/or facilities for specialised treatment etc.) and might include placement in prisons or other penal institutions, high-security units, medical wards of prisons, forensic institutions, psychiatric hospitals, outpatient departments or even the home of the person concerned (in the case of home treatment). Treatment: describes only those parts of the decision regulating specialised psychiatric treatments of the offender, no matter where these treatments might be conducted (e.g. in prison, in specialised facilities, in outpatient settings, at home). Please note: For most of the questions below it is assumed that the court has confirmed the mental illness of the respective suspect at the time of the offence! Some items compare verdicts for mentally ill offenders with verdicts for non-disturbed offenders. In this case, it is assumed that mentally ill offenders and mentally non-disturbed offenders have committed similar offences. 46. To confirm a mental disorder of a defendant by verdict, does the judge or court always have to follow the result of the regular expert assessment of the mental state? If no, what will most likely serve as a basis for confirming a mental disorder in the verdict? Preliminary pre-trial assessments Expertise of court or judge Other:.

20 Page 20 of Is it mandatory that the judge or court have to consider anything else to rule against mentally ill offenders (e.g. pieces of evidence, additional documents, testimony)? If yes, please describe: 48. According to the specific laws, acts or legal instruments in your country (item 2), is a confirmed mental illness of an offender sufficient to justify a verdict differing from a verdict against a mentally non-disturbed offender (assuming both defendants have committed similar offences)? If yes, please specify possible differences in the verdict (in terms of sentence, placement, treatment): 49. According to the specific laws, acts or legal instruments in your country (item 2), is a confirmed mental illness of an offender combined with additional criteria (e.g. reduced ability of insight and/or reduced ability to control one s behaviour, criminal responsibility, severity of offence, danger to the public, recidivism of offence) sufficient to justify a verdict differing from a verdict against a mentally non-disturbed offender (assuming both having committed similar offences)? If yes, please specify the additional criteria: If yes, please also specify possible differences in the verdict (in terms of sentence, placement, treatment):

21 Page 21 of According to the specific laws, acts or legal instruments (item 2), does the verdict against an offender who committed a crime of passion (item 10, but was not mentally ill at the time of offence) differ from a verdict against a mentally non-disturbed offender (assuming both defendants have committed similar offences)? If yes, please specify possible differences in the verdict (in terms of sentence, placement, treatment): 51. According to the specific laws, acts or legal instruments (item 2), does the verdict against an offender who committed an offence while being intoxicated with alcohol or drugs (item 11, but was not mentally ill at the time of offence) differ from a verdict against a mentally nondisturbed offender (assuming both defendants have committed similar offences)? If yes, please specify possible differences in the verdict (in terms of sentence, placement, treatment): 52. Are there legally defined types of offences that require automatically an order of a psychiatric / psycho-social treatment (e.g. sex offences)? If yes, please list the types of offences and the rationale for treatment: 53. If both psychiatric treatment and a prison sentence are imposed on mentally ill offenders, is the sequence of execution regulated by law?

22 Page 22 of 45 If no, how is the sequence of execution regulated? (Multiple choices are possible.) Based individually on the verdict According to capacities of the forensic facilities Other: 54. Which sequence is most frequently executed? Prison sentence before treatment Treatment before prison sentence Both at the same time 55. If both psychiatric treatment AND a prison sentence are imposed on mentally ill offenders, is the duration of the treatment counted towards the duration of the prison sentence? If yes, please specify which criteria are relevant if the duration of psychiatric treatment is to be counted towards the duration of a prison sentence: Please specify also the maximum amount of time that can be counted towards the prison sentence:

23 Page 23 of Placement / Treatment 56. Where are convicted mentally ill offenders placed in your country? a. General psychiatric facilities If yes, please specify the types of facilities which are included in this category (e.g. psychiatric hospitals, psychiatric departments in general hospitals etc.): Please describe the decisive criteria for placing mentally ill offenders in a general psychiatric facility: b. Specialised forensic facilities yes no unknown If yes, please specify the types of facilities which are included in this category (e.g. forensic hospitals, special or secure units of a psychiatric hospital etc.): Please describe the decisive criteria for placing mentally ill offenders in a specialised forensic facility:

24 Page 24 of 45 c. Prison If yes, please specify any modality which is included in this category (e.g. prison unit with integrated treatment modules, specialised prison departments etc.): Please describe the decisive criteria for placing mentally ill offenders in prison: d. Specialised outpatient facilities If yes, please specify any modality or service which is included in this category (e.g. outpatient department of forensic facilities, specialised home treatment services etc.): Please describe the decisive criteria for placing mentally ill offenders in a specialised outpatient facility: e. Other institutions for placement:

25 Page 25 of Which facilities are explicitly named by the respective laws (item 2)? 58. Are there specialised facilities exclusively for offenders with specific mental disorders and offences (e.g. substance abusers, sex offenders)? If yes, please list these facilities and the respective target groups: 59. Is the concept of unlimited placement for treatment purposes incorporated into the laws, acts or legal instruments (item 2)? If yes, please list the decisive criteria for an unlimited placement (e.g. major offences, danger to the public, type of treatment) 60. Is the concept of limited placement for treatment purposes incorporated into the laws, acts or legal instruments (item 2)?

26 Page 26 of 45 If yes, please list the decisive criteria for a limited placement (e.g. offences of minor severity, certain psychiatric diagnoses, type of treatment): 61. Are there different forms of leave permitted during placement / treatment of mentally ill offenders? If yes, which types of leave are permitted? (Multiple choices are possible.) a. Attended leave on the premises of the psychiatric/forensic facility b. Unattended leave on the premises of the psychiatric/forensic facility c. Attended leave outside the premises of the psychiatric/forensic facility d. Unattended leave off the premises of the psychiatric/forensic facility e. Attended over-night stay off the premises of the psychiatric/forensic facility f. Unattended over-night stay off the premises of the psychiatric/forensic facility 62. Which concepts of leave are explicitly named by the respective laws (item 2)?

27 Page 27 of Who decides whether or not a request for leave will be granted? (Multiple choices are possible.) a. Attended leave on the premises of the psychiatric/forensic facility Judge Therapist Other: Unknown b. Unattended leave on the premises of the psychiatric/forensic facility Judge Therapist Other: Unknown c. Attended leave off the premises of the psychiatric/forensic facility Judge Therapist Other: Unknown d. Unattended leave off the premises of the psychiatric/forensic facility Judge Therapist Other: Unknown e. Attended over-night leave off the premises of the psychiatric/forensic facility Judge Therapist Other: Unknown f. Unattended over-night leave off the premises of the psychiatric/forensic facility Judge Therapist Other: Unknown 64. Are any patients categorically excluded from leaves (e.g. offenders with a record of more than three cases of recidivism)? If yes, please list these patients: 7.1 Re-Assessment 65. Do the laws, acts or legal instruments (item 2) stipulate periodical re-assessments of the placement criteria? If yes, who makes the re-assessment? Psychiatrist of treatment facility Independent psychiatrist Other: If there are periodical re-assessments, are specific time frames legally defined?

28 Page 28 of 45 If yes, which time intervals have been legally defined for the re-assessment? 66. Do the laws, acts or legal instruments (item 2) stipulate an assessment prior to discharge with regard to the prerequisites of the placement criteria? If yes, who assesses the discharge? Psychiatrist of treatment facility Independent psychiatrist Other: 67. Which aspects have to be obligatorily re-assessed? Mental state Risk of re-offending Danger to the public Other: 68. Is the commensurability between the severity of the offence and the duration of placement a decisive criterion for the discharge of mentally ill offenders? 69. If a re-assessment is obligatory, does a standardised risk assessment have to be applied? If yes, which standardized instrument is used for the risk assessment? Historical Clinical Risk (HCR-20) Psychopathy Checklist-Revised (PCL-R) Other:

29 Page 29 of Specific Therapeutic Procedures 70. Does the treatment for mentally ill offenders differ - in any other respect than for security reasons - from the treatment of mentally ill non-offenders suffering from the same mental disorder? If yes, please describe: 71. Are standardised treatment programs, e.g. reasoning and rehabilitation (Ross, Fabiano & Ewles, 1988) for mentally ill offenders provided in your country? If yes, please briefly describe the treatment programs: 72. Can specific treatments be applied to mentally ill offenders against their will? If yes, which treatments? Anti-hormonal therapy Psychopharmacological treatment Depot neuroleptic treatment Electro-convulsive treatment (ECT) Other:

30 Page 30 of Can specific treatments be applied to mentally ill offenders only after provision of informed consent (e.g. psychosurgery)? If yes, please list treatments: 74. Is it legally defined (item 2) that specific types of treatment have to be confirmed by the court? If yes, please list: 75. Are there specific legally defined (item 2) consequences in your country for mentally ill offenders refusing any type of treatment? If yes, please list the consequences if mentally ill offenders refuse treatment: 76. Is there a legally defined procedure for reporting on the effectiveness of forensic treatments? Yes, periodically Yes, before scheduled discharge Not legally defined If yes, please describe the possible frequency of the report(s) and the recipient(s):

31 Page 31 of Are there legally defined criteria for the effectiveness of forensic treatment? If yes, please describe the criteria: 78. Who confirms legally whether forensic treatment is effective? Treating psychiatrist or therapist Independent expert(s) Judge or court Other: 79. Which consequences may arise when forensic treatment is not effective and the originally scheduled time frames (according to verdict or treatment plan) have elapsed? (Multiple choices are possible.) Prolonged stay in forensic facility Referral to prison Referral to psychiatric long-stay facility Referral to security custody Discharge Other: Please describe further (e.g. criteria for various consequences, defined maximum time frames for prolonged placements, authorities involved, re-assessment details, decision procedures etc.):

32 Page 32 of Who decides on the further placement of mentally ill offenders in the event of non-effective forensic treatment? Treating psychiatrist or therapist Judge or court Other: 81. If forensic treatment is effective prior to the end of an additional prison sentence, does the prison sentence have to be completed? In all cases Not applicable In no cases Not applicable Depending on individual decision Not applicable Other: Not applicable In case of completion of prison sentences, is it legally defined that further therapeutic support will be provided in prison? 82. Who certifies the treatment facilities for mentally ill offenders? Ministry of Justice Ministry of Health Other: 83. Are any treatment facilities for mentally ill offenders privatised in your country? If yes, please describe briefly (e.g. degree of privatisation etc., number of privatised facilities):

33 Page 33 of Patients Rights 84. Do mentally ill offenders have the right to appeal against a pre-trial assessment? a pre-trial placement? the result of an expert assessment? the verdict regarding the sentence? the verdict regarding the placement? the verdict regarding the treatment? denied leave request? denied discharge request? other?: 85. Are there legal regulations regarding specific civil rights (e.g. free communication, right to vote, right to receive visits) exclusively defined for mentally ill offenders? If yes, please list the specific restrictions: If yes, are there differences compared to regulations for mentally non-disturbed offenders? Please describe: If yes, are there differences compared to regulations for mentally ill non-offenders? Please describe:

34 Page 34 of According to the laws, acts or legal instruments (item 2) are there long-lasting restrictions on the civil rights for mentally ill offenders effective after discharge (e.g. right to vote)? If yes, please list the specific restrictions and the conditions under which these restrictions are imposed: 87. With regard to scientific research on mentally ill offenders, do different legal regulations apply than for mentally non-disturbed offenders or non-offending mentally ill patients (e.g. research only upon provision of informed consent)? If yes, please list the specific regulations for scientific research on a mentally ill offender: 88. Is a case register implemented for mentally ill offenders in your country? National case register Regional case register Other: If yes, which data is stored? (Multiple choices are possible.) a. Diagnosis b. Type of offence c. Biological data (e.g. genetic fingerprint) d. Cases of recidivism d. Prognosis of danger e. Other:

35 Page 35 of Is there a legally defined storage period for data on mentally ill offenders in a case register? If yes, state minimum and maximum time periods: Minimum time period: Maximum time period: 90. Who has access to the database? a. Offender Unlimited access Limited access by individual permission Unknown b. Prosecutor Unlimited access Limited access by individual permission Unknown c. Court Unlimited access Limited access by individual permission Unknown d. Police Unlimited access Limited access by individual permission Unknown e. Researcher Unlimited access Limited access by individual permission Unknown f. Other: Unlimited access Limited access by individual permission Unknown 7.4 Discharge 91. Do mentally ill offenders have to be discharged on probation according to the laws, acts or legal instruments (item 2)? Always Never Under certain conditions If discharge on probation is applicable only under certain conditions, please describe them:

36 Page 36 of If there is discharge on probation, are minimum and maximum time frames for probation legally defined? If yes, please state the minimum and maximum time frame: Minimum time frame: Maximum time frame:

37 Page 37 of Epidemiology The last section asks for epidemiological data on mentally ill offenders as well as for information from overall crime statistics as collected by official institutions, such as National Bureaus of Statistics, Departments of Health, Departments of Justice, National Health Registers et cetera. Please do NOT provide any data collected in surveys and studies. Usually we are asking for time series from 1990 onwards. Please provide any available data even when incomplete (e.g. data available only for certain parts of this period). If some of the items below do no fit the definitions or inclusion criteria as used in your country, please provide the figures most similar to those required. In this case, please also add the respective definition used in your country. In case only proportions or percentages rather than total numbers are available, please provide these figures instead. 93. Time series for total number of convicted mentally ill offenders (placed in forensic treatment facilities as described in item 56). Time series for total number of assessments of mental state of suspected offenders (only regular assessments ordered by court, excluding re-assessments or independent assessments as required by defence or prosecutor): Year Total number of mentally ill offenders (including new admissions) Total number of newly admitted mentally ill offenders Total number of psychiatric assessment ordered by court Data origin: Data not recorded

38 Page 38 of Time series for total number of mentally non-disturbed offenders in prison in your country. If not available, please provide any other information or data on the overall rise or decline of crime in your country: Year Total number of mentally non-disturbed offenders in prison Total number of newly admitted mentally non-disturbed offenders in prison Data origin: Data not recorded

39 Page 39 of Time series of diagnostic data for mentally ill offenders. If ICD 10-criteria are not applicable, please provide any other diagnostic data grouped or defined otherwise (by adding the respective definition or inclusion criteria). When only newly admitted cases are available rather than the total number of mentally ill offenders in forensic treatment for the respective year, please provide these figures instead. Do likewise in case of availability of proportions instead of total numbers. Year Organic mental disorder (F0) Mental disorders due to substance abuse (F1) Schizophrenia (F2) Affective and mood disorders (F3) Neurotic, stressrelated somatoform disorders (F4) Personality disorders (F6) Dissocial personality disorder (F60.2) Disorder of sexual preference (F65) Mental retardation (F7) Data origin: Data not recorded

40 Page 40 of Total number of offences (decided court trial cases) according to type of offence in Total number of offences committed by mentally ill offenders (decided court trial cases) according to type of offence in (If figures are not available for 2002, please give the most recent ones). Year: Type of offence Total number of offences Total number of offences by mentally ill offenders Murder Robbery Assault Sex offences Data origin: Data not recorded 97. Distribution of gender for mentally ill offenders (decided court trial cases) for the most recent year available: Year Total number male Total number female Data origin: Data not recorded 98. Total number of foreign residents among mentally ill offenders (decided court trial cases) for the most recent year available: Year Total number of foreign residents Among mentally ill offenders Data origin: Data not recorded

41 Page 41 of How many beds assigned specifically for the treatment of mentally ill offenders are available in your country? Year Total number of beds in general psychiatric facilities Total number of beds in forensic inpatient facilities Total number of beds in forensic outpatient facilities Total number of beds in prison suitable for forensic treatment Total number of beds in other facilities for forensic treatment Data origin: Data not recorded

42 Page 42 of Please give the mean length of stay for convicted mentally ill offenders in your country. Year Number of mentally ill offenders placed for forensic treatment Mean length of stay Data origin: Data not recorded

43 Page 43 of Please indicate time series for the total number of convicted mentally ill offenders according to their respective individual length of stay in forensic facilities. (If data cannot be grouped as below, please use any other breakdown most suitable to available data) Year < 1 year 1-3 years 4-5 years 6-10 years >10 years Data origin: Data not recorded

44 Page 44 of Total number of recidivism of index crime (type of offence the offender was originally convicted for): - among mentally ill offenders discharged from forensic treatment - among mentally non-disturbed offenders released from prison sentence. Year Total number of cases of recidivism among mentally non-disturbed offenders Total number of cases of recidivism among mentally ill offenders Data origin: Data not recorded 103. Please provide contact details (address / web-sites) of all institutions stated as data origin

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46 This report was produced by a contractor for Health & Consumer Protection Directorate General and represents the views of the contractor or author. These views have not been adopted or in any way approved by the Commission and do not necessarily represent the view of the Commission or the Directorate General for Health and Consumer Protection. The European Commission does not guarantee the accuracy of the data included in this study, nor does it accept responsibility for any use made thereof.