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REHABILITATION AND MENTALLY ILL OFFENDERS P. DONCHEV M.D. (SOFIA) HE rehabilitation of the mentally ill demands that the complex actions resuming personality and its social relations should be quickly transferred into extrahospital environment. The early discharge from hospital made possible by the neuroleptic therapy enables the prevention of lessening the adaptive potentials of the patients due to the
the
long stay. The highly developed facilities for outpatients’ care and treatment in Bulgaria make possible a broad special training and rehabilitation of the patients out of the mental hospital. For example, in the course of 1969 only 19.6% of all registered mentally ill and mentally retarded have undergone hospital treatment and for the rest of them, 80.4% have been secured care and rehabilitation within a system of checks provided by dispensary facilities (Molhov J. et al.-1). On the other hand, the extrahospital treatments of early discharged patients increases their opportunities for committing violent actions. As a rule, the hospital stay results in a comparative balance of mental disturbance but the mental state is still dynamic, rather unstable and subjected to fluctuation. And when such patients come into contact with the microsocial environment, then, even inconsiderable misfortunes stir define degree of danger for other persons. For example, among 110 schizophrenic criminals examined at the forensic psychiatric department of the Research Institute for Neurology and Psychiatry in Sofia for the period 1952-1969 we found that the offences had been facilitated in one third of the cases by living or working psychotraumatic conditions, in 10% by drunkenness, and in a number of cases the motives for the criminal act reflected actual pecuniary difficulties. An epidemiologic investigation of the offences made by the mentally ill was provided in three regions of our country with 1,000,000 population. We found out that 4.7% of all registered mentally ill have committed various dangerous acts. Only with 10% the first offence had been made before a year passed from the beginning of the mental illness, with 80% this period is more than three years. At the time of the first dangerous act half of the patients have already been treated of known as mentally ill. All this proves that the problem of preventions of the dangerousness of the mentally ill is above all a problem of their treatment, rehabilitation and resocialisation in the phase of the chronic development of the disease. The protection against the repeated violent actions is of extraordinary importance and it depends on the appropriate hospital treatment of the criminal patients followed by special aftercare and rehabilitation provided by the dispensary facilities. Hence, the question follows: if the contingent of these mentally ill offenders has its own characteristic features or not? Among 7,752 mentally ill (except alcoholics, narcotists and psychopaths) registered at the end of 1970 in Sofia we did not observe any difference between the diagnostic structure of the patients with and without violent actions. But within various contingent of mentally ill offenders certain differences may be noticed. For example, there are 25.8% schizophrenics among the offenders in all the dispensary contingent. They are 42.7% among the compulsory admitted to the ordinary state mental hospital (data from our investigation in the Kourilo Mental Hospital near Sofia) and 56% among the compulsory admitted to the specialised department for exclusively dangerous mentally ill offenders in the Lovech
Downloaded from isp.sagepub.com at UCSF LIBRARY & CKM on April 13, 2015
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Hospital (Rachev 1.-3). The epileptics show comparatively permanent percentage in the three contingents already mentioned above-13.2%, 7.7% and 11.7% respectively. With the mental retarded (oligophrenia) the percentage shows a decrease of the contingents of the compulsory treated in the ordinary state mental hospital (3.9%) ’ and of the exclusively dangerous treated in the specialised departments (5.4%) while the outpatients treated make 27.6%. Apart from all this the contingent of the compulsory admitted mentally ill offenders distinguishes by a greater therapeutic resistance and the number of previous hospital treatments. Now we come to the peculiarities of the psychiatric treatment and rehabilitation of the mentally ill offenders. Among these peculiarities the problem of hospital stay terms is of special interest. The analysis of the data of the compulsory admitted -4 patients shows a tendency to a considerable prolongation of these terms in comparison with the terms of hospital stay of the patients without dangerous acts. For the period 1969-1971 from the Kourilo Mental Hospital have been released only 1.6% of the compulsory admitted after a stay for less than 3 months while the released among the voluntary admitted form 63%; after a stay from 3 to 6 months there have been . released 59% of the compulsory admitted and 20% of the voluntary admitted; after a stay from 6 to 12 months there are 33% of the compulsory admitted and only 7.3% of the voluntary admitted. In the specialised department for extremely violent patients the stay is considerably prolonged. For example, half of them stay from 9 to 12 months, and 12% stay for 5 years and even more. As we can see there is a strong tendency to shorten the hospital stay even for the category of the most violent patients, while in some other countries these terms are much longer. For instance in England and Wales in 1969 45% of the mentally ill offenders treated in special hospitals have been releases after 5 years’ stay, and only 24% are released till the end of the second year of the hospital stay (Statistical Report-4). The treatment and the hospital rehabilitation of the mentally ill offenders make use of medical means and rehabilitation complexes which do not differ from those applied to the patients without violent actions. The high efficiency of our dispensary system for psychiatric outpatient care makes possible a successful application of extrahospital treatment and taking special care of the patients with violent action. Of all violent patients registered to the end of 1970 in Sofia about 50% have been treated and rehabilitated extrahospitally. But the percentage differs in the various diagnostic groups. Only 20% of the violent schizophrenics namely those with insignificant offences have been treated extrahospitally, while the corresponding percentage of mentally retarded patients has reached 90%. The active extrahospital rehabilitation of mentally retarded offenders is very successful on the territory of Sofia aided by the sheltered facilities for working , therapy, the system of checks and aftercare (Peneva M.-2). The prevention of the offences made by the mentally ill is an important task for the psychiatrist, it forms a part of all psychiatric rehabilitation and a means for removing the real danger of compromising the extramural rehabilitation itself. Mental
..
REHABILITATION AND MENTALLY ILL OFFENDERS P. DONCHEV M.D. (SOFIA) HE rehabilitation of the mentally ill demands that the complex actions resuming personality and its social relations should be quickly transferred into extrahospital environment. The early discharge from hospital made possible by the neuroleptic therapy enables the prevention of lessening the adaptive potentials of the patients due to the
the
long stay. The highly developed facilities for outpatients’ care and treatment in Bulgaria make possible a broad special training and rehabilitation of the patients out of the mental hospital. For example, in the course of 1969 only 19.6% of all registered mentally ill and mentally retarded have undergone hospital treatment and for the rest of them, 80.4% have been secured care and rehabilitation within a system of checks provided by dispensary facilities (Molhov J. et al.-1). On the other hand, the extrahospital treatments of early discharged patients increases their opportunities for committing violent actions. As a rule, the hospital stay results in a comparative balance of mental disturbance but the mental state is still dynamic, rather unstable and subjected to fluctuation. And when such patients come into contact with the microsocial environment, then, even inconsiderable misfortunes stir define degree of danger for other persons. For example, among 110 schizophrenic criminals examined at the forensic psychiatric department of the Research Institute for Neurology and Psychiatry in Sofia for the period 1952-1969 we found that the offences had been facilitated in one third of the cases by living or working psychotraumatic conditions, in 10% by drunkenness, and in a number of cases the motives for the criminal act reflected actual pecuniary difficulties. An epidemiologic investigation of the offences made by the mentally ill was provided in three regions of our country with 1,000,000 population. We found out that 4.7% of all registered mentally ill have committed various dangerous acts. Only with 10% the first offence had been made before a year passed from the beginning of the mental illness, with 80% this period is more than three years. At the time of the first dangerous act half of the patients have already been treated of known as mentally ill. All this proves that the problem of preventions of the dangerousness of the mentally ill is above all a problem of their treatment, rehabilitation and resocialisation in the phase of the chronic development of the disease. The protection against the repeated violent actions is of extraordinary importance and it depends on the appropriate hospital treatment of the criminal patients followed by special aftercare and rehabilitation provided by the dispensary facilities. Hence, the question follows: if the contingent of these mentally ill offenders has its own characteristic features or not? Among 7,752 mentally ill (except alcoholics, narcotists and psychopaths) registered at the end of 1970 in Sofia we did not observe any difference between the diagnostic structure of the patients with and without violent actions. But within various contingent of mentally ill offenders certain differences may be noticed. For example, there are 25.8% schizophrenics among the offenders in all the dispensary contingent. They are 42.7% among the compulsory admitted to the ordinary state mental hospital (data from our investigation in the Kourilo Mental Hospital near Sofia) and 56% among the compulsory admitted to the specialised department for exclusively dangerous mentally ill offenders in the Lovech
Downloaded from isp.sagepub.com at UCSF LIBRARY & CKM on April 13, 2015
146
Hospital (Rachev 1.-3). The epileptics show comparatively permanent percentage in the three contingents already mentioned above-13.2%, 7.7% and 11.7% respectively. With the mental retarded (oligophrenia) the percentage shows a decrease of the contingents of the compulsory treated in the ordinary state mental hospital (3.9%) ’ and of the exclusively dangerous treated in the specialised departments (5.4%) while the outpatients treated make 27.6%. Apart from all this the contingent of the compulsory admitted mentally ill offenders distinguishes by a greater therapeutic resistance and the number of previous hospital treatments. Now we come to the peculiarities of the psychiatric treatment and rehabilitation of the mentally ill offenders. Among these peculiarities the problem of hospital stay terms is of special interest. The analysis of the data of the compulsory admitted -4 patients shows a tendency to a considerable prolongation of these terms in comparison with the terms of hospital stay of the patients without dangerous acts. For the period 1969-1971 from the Kourilo Mental Hospital have been released only 1.6% of the compulsory admitted after a stay for less than 3 months while the released among the voluntary admitted form 63%; after a stay from 3 to 6 months there have been . released 59% of the compulsory admitted and 20% of the voluntary admitted; after a stay from 6 to 12 months there are 33% of the compulsory admitted and only 7.3% of the voluntary admitted. In the specialised department for extremely violent patients the stay is considerably prolonged. For example, half of them stay from 9 to 12 months, and 12% stay for 5 years and even more. As we can see there is a strong tendency to shorten the hospital stay even for the category of the most violent patients, while in some other countries these terms are much longer. For instance in England and Wales in 1969 45% of the mentally ill offenders treated in special hospitals have been releases after 5 years’ stay, and only 24% are released till the end of the second year of the hospital stay (Statistical Report-4). The treatment and the hospital rehabilitation of the mentally ill offenders make use of medical means and rehabilitation complexes which do not differ from those applied to the patients without violent actions. The high efficiency of our dispensary system for psychiatric outpatient care makes possible a successful application of extrahospital treatment and taking special care of the patients with violent action. Of all violent patients registered to the end of 1970 in Sofia about 50% have been treated and rehabilitated extrahospitally. But the percentage differs in the various diagnostic groups. Only 20% of the violent schizophrenics namely those with insignificant offences have been treated extrahospitally, while the corresponding percentage of mentally retarded patients has reached 90%. The active extrahospital rehabilitation of mentally retarded offenders is very successful on the territory of Sofia aided by the sheltered facilities for working , therapy, the system of checks and aftercare (Peneva M.-2). The prevention of the offences made by the mentally ill is an important task for the psychiatrist, it forms a part of all psychiatric rehabilitation and a means for removing the real danger of compromising the extramural rehabilitation itself. Mental
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