Insane Sex Offenders: Psychiatric and Legal Characteristics of Sexual Offenders Found Not Guilty by Reason of Insanity

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

Introduction

In 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.

Methods

We 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.

Results

The 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.

Discussion

Younger 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.

Serious Mental Illness and Sexual Offending in Forensic Psychiatric Patients

The role of serious mental illness among those who sexually offend is not well understood. We investigated clinical and risk-related areas of difference between male forensic psychiatric patients with (n = 86) and without (n = 245) a sexual offense history, including the age at which indications of mental disorder and criminal offending first emerged, from a registry of Ontario patients adjudicated Not Criminally Responsible on account of Mental Disorder (NCRMD) from 1999-2012. We further explored motivations for offending among a subset of patients deemed NCRMD for a sexual offense specifically (n = 41). While no differences were found in the age onset of illness or offending across those with and without a sexual offending history, the former group was rated as having higher levels of historical/static risk for violence. Forensic patients with a sexual offense history were also more likely to offend against a stranger, and less likely to offend against a family member. Sexual index offenses were psychotically-motivated in the majority of cases, but with a meaningful proportion appearing to reflect criminogenic motivations, especially substance use and paraphilic interests. Results suggest greater similarity than difference among forensic patients with and without a sexual offense history, but also highlight an important divergence from the literature showing that victims of sexual offenses are frequently known to the individual committing them.

Psychiatric and Forensic Characteristics of Sex Offenders With Child and With Adult Victims

This study presents psychiatric and forensic characteristics of people accused of a sexual crime and sent for evaluation. Data were drawn from the only institutional psychiatric forensic assessment center in Croatia, during a 9-year period, from January 1, 2010 to December 31, 2018. There were 72 cases of sex offenses: 37 with child victims and 35 with adult victims. People accused of sex offenses with child victims were more often sexually abused during childhood and treated psychiatrically as inpatients. They used alcohol less often. Sex offenders with child victims were diagnosed with narcissistic and antisocial personality disorder, dementia, and pedophilic disorder. Those with adult victims were diagnosed with antisocial personality disorder, alcohol related disorders and dementia. Due to these differences, the management of these two groups of offenders in both mental health and penal systems should be different.

Forensic psychiatric evaluations of people charged with rape in Croatia

Introduction: Sexual violence is a substantial public health problem that is associated with a major impact on victims, and in Croatia, more than half of reported cases of sexual violence involve rape. To help understand their general profiles and consider any implications arising, the aim of this research was to describe the forensic psychiatric characteristics of people charged with rape. Methods: All evaluations of people charged with rape and sent for evaluation at the largest assessment centre in Croatia during the period 2010-2018 were analysed (n  =  56). Results: Alleged offences most often took place in a perpetrator or victim's home (71%), while the next most frequent location was the street (15%). Over 80% of alleged victims were known to the accused. Alcohol use and abuse were present in 73% of the accused, and 29% were drinking at the time of the alleged offence. Alcohol-related disorders were presented in 38% of the accused, while 38% had a personal history of drug use, and antisocial and narcissistic personality disorders were present in 48% and 29%, respectively. Psychotic disorders were rare (1.8%). Most of the accused were found to be criminally responsible; however, forensic psychiatric assessment procedures were inadequate when considering psychosexual assessments. Conclusions: Interventions based around public health and education should be considered in this field, and forensic psychiatric assessments should be prioritized for improvement.

The prevalence of mental disorders in incarcerated contact sexual offenders

OBJECTIVE

Mental disorders in sexual offenders are relevant in terms of risk assessment and psychotherapeutic and pharmacological treatment.

METHODS

The present cross-sectional study was conducted between 2001 and 2017 and included 1511 sexual offenders who were assessed at the Federal Evaluation Center for Sexual and Violent Offenders in the Austrian Prison System. All sexual offenders were assessed with the Structured Clinical Interview for Axis I (SCID I) and Axis II disorders (SCID II).

RESULTS

N = 1250 (92.9%) sexual offenders were diagnosed with a mental disorder, whereby the great majority received multiple diagnoses. The most frequently found disorders were alcohol misuse (40.0%), paraphilic (43.3%), and personality disorders (53.6%) with a special emphasis on Cluster B personality disorders (47.8%). While sexual offenders against children were more likely to be diagnosed with paraphilic disorders, sexual offenders against adults were more likely to be diagnosed with a personality disorder.

CONCLUSION

Prevalence rates of mental disorders in sexual offenders are considerable. Besides specific risk reducing treatment, the psychological and social sequelae of the mental disorder have to be addressed in interventions in order to reach an effective and sustainable risk reduction.