Short report
Violent offenders as a target population for Public Mental Health Care

https://doi.org/10.1016/j.jflm.2016.03.003Get rights and content

Highlights

  • A study was conducted to affirm to what extent violent offenders may be eligible for public health care assistance.

  • Clinical interviews were conducted with 558 offenders, of whom 81% had complete data.

  • There was a general accumulation of addiction, mental health and social problems.

  • Up to one-third of offenders appeared eligible for public (mental) health care.

Abstract

The study sought to specify which part of a population of young adult violent offenders in Amsterdam (mean age 24.9 years, sd = 8.2) were eligible for Public Mental Health Care (PMHC). The results of a semi-structured clinical interview were used (N = 454), which included the Self-Sufficiency Matrix (SSM-D). Using the SSM-D and two distinct definitions of what constitutes a need for PMHC, the size of the PMHC target population was determined twice. Depending on which definition was used, 35.9% (mathematical algorithm which put weights to single SSM-D domains) and 34.8% (problematic levels of self-sufficiency on a selection of domains) appeared to be eligible for entering the PMHC system. The study confirms that a substantial proportion of vulnerable people are among the forensic population.

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.

References (24)

  • E. Bulten et al.

    Psychiatric disorders and personality characteristics of prisoners at regular prison wards

    Int J Law Psychiatry

    (2009)
  • M. Buster et al.

    Detainees in Amsterdam, a target population of the public mental health system?

    J Forensic Leg Med

    (2014)
  • S. Lauriks et al.

    Performance indicators for public mental healthcare: a systematic international inventory

    BMC Public Health

    (2012)
  • R.M. Andersen

    Revisiting the behavioral model and access to medical care: does it matter?

    J Health Soc Behav

    (1995)
  • L. Gelberg et al.

    The behavioral model for vulnerable populations: application to medical care use and outcomes for homeless people

    Health Serv Res

    (2000)
  • R. Kuhlmann et al.

    Elderly jail inmates: problems, prevalence and public health

    Calif J Health Promot

    (2005)
  • K.M. Abram et al.

    Comorbid psychiatric disorders in youth in juvenile detention

    Arch Gen Psychiatry

    (2003)
  • P. Skogstad et al.

    Social-cognitive determinants of help-seeking for mental health problems among prison inmates

    Crim Behav Ment Health

    (2006)
  • M. Phelan et al.

    The Camberwell Assessment of Need: the validity and reliability of an instrument to assess the needs of people with severe mental illness

    Br J Psychiatry

    (1995)
  • M. Slade et al.

    The Camberwell Assessment of Need (CAN): comparison of assessments by staff and patients of the needs of the severely mentally ill

    Soc Psychiatry Psychiatr Epidemiol

    (1996)
  • J.K. Wing et al.

    Health of the Nation Outcome Scales (HoNOS). Research and development

    Br J Psychiatry

    (1998)
  • C. Mulder et al.

    De Health of the Nation Outcome Scales (HoNOS) als instrument voor ‘routine outcome assessment’

    Tijdschr Psychiatr

    (2004)
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