Short reportViolent offenders as a target population for Public Mental Health Care
Introduction
The Public Mental Health Care (PMHC) system provides care and support for individuals and families with severe and complex problems, amongst other target populations. Clients of the PMHC system are typically those who do not actively or independently seek help for their problems or who do not have their needs met by regular health services.1 Possible explanations for this specific type of vulnerability include the presence of multiple competing needs, the conditional nature of the health care system (e.g. one has to have health insurance) and the lack of a perceived need for care.2, 3
Studies have shown that many forensic populations (e.g. delinquents, arrestees, prisoners, detainees) constitute (future) target populations for the PMHC system.4, 5, 6 This is indicated by an accumulation of addictive behaviour, psychiatric disorders and social problems, in combination with a general lack of personal coping skills, including the tendency to inadequately use health services.6, 7, 8 Moreover, the majority of PMHC clients are signalled by the police or (via hotlines) by citizens who worry about or experience nuisance from fellow local residents.6, 1
Despite consensus about the vulnerability of forensic populations, actually determining whom the PMHC should treat is difficult. In deciding whom to allocate to PMHC and whom to refer to different (private) social or health care providers, professionals typically weigh all available information about the clients' situations against an implicit reference framework of the PMHC target group, current municipal policy and personal experience. Therefore, the present study sought to further investigate and specify the vulnerability of an emerging forensic population of violent offenders.
Section snippets
Setting and study population
A diversion program was initiated in Amsterdam in 2011 to reduce the number of violent high impact (i.e. on the victim) crimes. Examples of such crimes are theft and burglary, public/aggravated assault and armed invasion/robbery. The diversion program is primarily based on civil law, rather than criminal law, and was implemented by the municipality on a city level. Organisations that contribute to the program represent a wide array of stakeholders, including law enforcement (police, public
Results
By the end of October 2014, 922 violent offenders had been identified by the diversion program, of whom 558 (61%) had been screened by the PHS. Only persons with complete data on the SSM-D (454 people or 81%) were included in the present study. Their average age was 24.9 years (sd = 8.2). Overall, 18.5% did not finish any kind of education, 34.8% only finished elementary school, 30.6% had lower vocational or high school education, while 11.2% had some form of higher education (4.8% with
Discussion
This short study sought to investigate and specify which part of an emerging forensic population of violent offenders in Amsterdam appears to be eligible for admittance to the capital's PMHC system. Based on two different definitions, it was indicated that this counted for at least one third of the study population, which is considerable. For example, Buster et al. found an accumulation of addiction, mental health and social problems in 35% of their study population consisting of arrestees.6
Conflict of interest
None.
Funding
None declared.
Ethical approval
None declared.
Acknowledgements
The authors would like to thank Steve Lauriks from the Amsterdam Public Health Service for providing the algorithm for the Decision Support Tool. Tina Dorn and Anita Wilkinson provided valuable comments on previous drafts of the manuscript. Finally, the authors thank the reviewers, whose comments significantly improved the original manuscript.
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