F Schmidt-Quernheim1, D Seifert. 1. Fachklinik für Psychiatrie und Psychotherapie, Forensische Psychiatrie, Soziale Rehabilitation, LVR-Klinik Düren, Meckerstr. 15, 52353, Düren, Deutschland, friedhelm.schmidt-quernheim@lvr.de.
Abstract
BACKGROUND: The quality and success of the aftercare treatment of forensic patients (§ 63 StGB, Penal Code) are not only of concern to therapists and law courts dealing with the question of potentially dangerous behavior; apart from politicians and the general public it is also a matter of interest for workers in general and community psychiatry. METHODS: In an evaluation of forensic patients who were discharged from confinement (§§ 67d 2, 6 and 67b StGB) into aftercare treatment between 2002 and 2006 in North Rhine-Westphalia, it was possible to collect data on recidivism from a total of 225 patients after an average follow-up period of 4.4 years. Apart from gathering statistics concerning case history, diagnosis, offence committed and resulting confinement, a dynamic analysis of how they coped in differing day to day situations was carried out with 115 of the discharged patients. RESULTS: The frequency of offence recidivism by patients who were professionally accompanied throughout the aftercare period was significantly lower in comparison to earlier studies (without specialist supervision), particularly the number of sexual offences and violent crimes (7 from 225 - 3.1 %) were noticeably reduced. By comparing patients who reoffended with those showing socially acceptable behavior it was possible to determine specific features of protection and risk characteristics. CONCLUSIONS: Low offence recidivism indicated a high degree of aftercare effectiveness but there is room for improvement and further development in the existing system. The postdischarge prognosis factors and the typical pitfalls found in the study should be adequately taken into account in order to improve risk management in the aftercare setting and therefore subsequently ameliorate the chances of discharge for long neglected problematic patient groups, in particular patients with personality disorders involved in sexual offences.
BACKGROUND: The quality and success of the aftercare treatment of forensic patients (§ 63 StGB, Penal Code) are not only of concern to therapists and law courts dealing with the question of potentially dangerous behavior; apart from politicians and the general public it is also a matter of interest for workers in general and community psychiatry. METHODS: In an evaluation of forensic patients who were discharged from confinement (§§ 67d 2, 6 and 67b StGB) into aftercare treatment between 2002 and 2006 in North Rhine-Westphalia, it was possible to collect data on recidivism from a total of 225 patients after an average follow-up period of 4.4 years. Apart from gathering statistics concerning case history, diagnosis, offence committed and resulting confinement, a dynamic analysis of how they coped in differing day to day situations was carried out with 115 of the discharged patients. RESULTS: The frequency of offence recidivism by patients who were professionally accompanied throughout the aftercare period was significantly lower in comparison to earlier studies (without specialist supervision), particularly the number of sexual offences and violent crimes (7 from 225 - 3.1 %) were noticeably reduced. By comparing patients who reoffended with those showing socially acceptable behavior it was possible to determine specific features of protection and risk characteristics. CONCLUSIONS: Low offence recidivism indicated a high degree of aftercare effectiveness but there is room for improvement and further development in the existing system. The postdischarge prognosis factors and the typical pitfalls found in the study should be adequately taken into account in order to improve risk management in the aftercare setting and therefore subsequently ameliorate the chances of discharge for long neglected problematic patient groups, in particular patients with personality disorders involved in sexual offences.