Schizophrenia : Poor Treatment = Increased Criminality

Prelapse Magazine, No. 2, September 1995
A [new] Danish investigation shows that criminality among people suffering from schizophrenia has been increasing by 6.8 per cent a year during the past decade. There can be only one explanation.
The statistics are known as the “obvious catastrophes” in Danish psychiatric circles: Suicide among people suffering from schizophrenia is 16 times more frequent than among the general population. 1 per cent of every generation of young men suffering from schizophrenia is murdered. 50 per cent of young men suffering from schizophrenia abuse drugs. And now there are yet more statistics to fill out the picture: From 1980 to 1994, the number of people sentenced in the courts to special psychiatric measures increased by 6.8 percent annually. The figure in 1980 was just over 300. By the end of 1994, the total had risen to 834, of whom approximate half were people suffering from schizophrenia. In Denmark, special psychiatric measures include both committal to a psychiatric hospital and, for less serious cases, psychiatric day-care. The possible reasons Peter Kramp, senior consultant at the Ministry of Justice’s forensic psychiatry clinic and the man behind the survey, has naturally also looked into the possible reasons for this dramatic trend. The cause has nothing to do with a general increase in criminality in Denmark. On the contrary. During the past five years, the number of punishable offences recorded has remained constant at around 520,000 annually, while the number of cases in which the offender has been sentenced to psychiatric measures has increased by 50 per cent. Nor is the reason a rise in the number of people suffering from schizophrenia – the level remains at around 16,000 – or a change in the diagnostic criteria defined by the forensic medicine council. Only one explanation “There can be only one explanation,” says Peter Kramp. “Psychiatric patients, of whom around half suffer from schizophrenia, are committing more and more crimes. And it’s not difficult to identify the cause of the increase. “It lies in the serious gaps in the psychiatric treatment system. During the period we investigated, the number of psychiatric beds in Danish hospitals was halved. The immediate consequence was a sharp reduction in the opportunities available for providing the necessary longterm treatment for patients with severe schizophrenia. And it has to be said that the facilities for psychiatric treatment in district clinics have been able to do little to stop the increase. Similar experience “In Denmark, we have now documented the trend statistically, but experience is precisely similar in other countries where there have been sharp reductions in the number of psychiatric hospital beds,” continues Peter Kramp. “The reductions have usually been motivated by two things: the wish to treat patients in their usual surroundings and a political wish to achieve savings. And even though we have not undertaken any economic investigations, I believe that it is quite clear that the costs – in the shape of an increased rate of suicide, drug abuse and criminality – are far in excess of any savings. “In the USA, investigations have shown that the average cost of dealing with psychiatric patients sentenced by the courts is equivalent to a six-month stay in hospital. “So it is quite clear that we can only reverse the trend revealed by the new statistics by ensuring that there is adequate long-term treatment capacity in the psychiatric area,” says Peter Kramp. Not a simple equation However, he is very careful to emphasise that his investigation does not reveal a simple equation between high criminality and schizophrenia. “We know,” says Peter Kramp, “that, when given proper treatment, people suffering from schizophrenia do not commit more crimes than other members of the population. We therefore naturally have a duty to ensure that the correct, effective treatment facilities are in place. “If that does not happen, it is highly probable that the community at large will demand effective action. In recent years, there has been a sharp focus in the media on the links between schizophrenia and increased criminality. I would prefer society’s help for and treatment of people suffering from schizophrenia to be based on their need for help and not on a perception of them as a criminal minority.”