Violent victimization and health service utilization in a forensic psychiatric context: a comparison between offenders with mental disorders and matched controls

Mats Persson,Henrik Belfrage,Marianne Kristiansson

doi:10.1186/s12888-017-1251-0

Abstract

BackgroundOffenders with mental disorders constitute a particularly exposed group in society, with high rates of morbidity, mortality, and social deprivation. Often thought of primarily as perpetrators, these individuals may also be subjected to violence. Previous research indicates that violent victimization during lifespan is a risk factor for violent perpetration among psychiatric patients, but victimization studies on the group of offenders with mental disorders are scarce. Health services are pivotal to this group, but although most individuals do utilize these services, their vulnerability seems to remain. This study aimed at exploring the rates of victimization and health service utilization, including perceptions of unmet health care needs, among offenders with mental disorders.MethodsTwo hundred detainees undergoing a forensic psychiatric evaluation in Stockholm were asked about violent victimization and health service utilization. Each detainee was compared with three controls from the general population, matched regarding age, sex, and occupation.ResultsVictimization during the past year was reported by 52.3% of the detainees and 11.1% of the controls, with a corresponding risk ratio of 8.2. Health service utilization during the past three months was reported by 47.7 and 23.7%, respectively (risk ratio 2.0); and unmet health care needs by 42.2 and 16.7%, respectively (risk ratio 3.4). There was no distinct association between victimization and health service utilization among detainees.ConclusionsOffenders with mental disorders are at great risk of being victimized, and they experience impediments to receiving requisite health care. A possible way to reduce victimization and improve health service utilization may be to establish interdisciplinary yet specialized health centers with outreach teams but without complicated referral procedures.

Highlights

Offenders with mental disorders constitute a exposed group in society, with high rates of morbidity, mortality, and social deprivation
Characteristics of the study sample Severe mental disorders were less common among participating detainees (46.5%) than non-participating detainees (61.6%), but the difference was not significant after Bonferroni corrections were conducted
Missing data Missing data regarding victimization and health service utilization are reported in Tables 3 and 4

Summary

Introduction

Offenders with mental disorders constitute a exposed group in society, with high rates of morbidity, mortality, and social deprivation. Previous research indicates that violent victimization during lifespan is a risk factor for violent perpetration among psychiatric patients, but victimization studies on the group of offenders with mental disorders are scarce. Offenders with mental disorders constitute a exposed group in society They often have multiple psychiatric diagnoses [1], somatic comorbidity [2], and addiction [3]; mortality rates are high [4,5,6] and social deprivation is widespread [7]. Well-known demographic risk factors are young age, male sex, unemployment, unmarried state, and poverty [14]; other important risk factors are homelessness [15, 16] and substance abuse [17]. The victim precipitation theory posits that victims contribute or sometimes even instigate to the violent acts being committed [21]

Methods

Results

Conclusion