Psychiatric admissions at different levels of the national health care services and male criminality: the Northern Finland 1966 Birth Cohort study.

BACKGROUND: It has earlier been suggested that one-third of violent offenders are recorded in psychiatric case registers. Our aim was to study whether violent and non-violent offenders differ with respect to admissions to any health care inpatient service due to psychiatric disorders.
METHODS: We used a genetically homogeneous, general population database from the Northern Finland 1966 Birth Cohort, together with the Finnish Hospital Discharge Register and national crime registers.
RESULTS: We found that one-third of violent and one-fourth of non-violent male offenders had at least one hospital admission due to a psychiatric disorder before the age of 32. Sixty-five violent criminals - 1.2% of all cohort males (n = 5636) - accounted for 14.4% of all psychiatric treatment days. The admission rates among both violent and non-violent male offenders were significantly higher when compared with males with no criminal history. Among violent males, only half (55.5%) of the inpatient hospital days due to psychiatric disorders occurred in psychiatric hospitals. The corresponding percentages for non-violent criminals and non-criminals were 64.9% and 74.1%, respectively. Among the violent offenders, one-third of hospital inpatient days occurred in university hospitals or central hospitals, and only 1.9% of them occurred in a comprehensive community care system.
CONCLUSIONS: Violent offenders' admission rates due to a psychiatric diagnosis are high, and they are frequently treated at an inappropriate health care level.