June 22, 2012

expert reaction to trial of Anders Breivik

Prosecutors in the trial of Anders Breivik, who killed 77 people in Norway on the 22 July 2011, decided to ask that he to be sent to a mental institution not prison.

Seena Fazel, Clinical Senior Lecturer in Forensic Psychiatry at the University of Oxford, and Honorary Consultant Forensic Psychiatrist, said:

“It would have been better to do the assessment in an inpatient secure hospital setting.

“The interesting part of this is the prosecutor’s view that it is ‘worse to sentence a psychotic person to prison than to place a non-psychotic person in psychiatric care’.

“This is consistent with research evidence from many countries that has demonstrated that psychotic persons in prison are often undetected, untreated and under-treated. The other problem with many prison services is that they have poor, if any, links with community mental health services, which may be a factor in explaining the high suicide and overdose death rates of released prisoners.”

Fin Larkin, Consultant Forensic Psychiatrist, Broadmoor Hospital, said:

“For Anders Breivik to be admitted to a hospital, a psychiatrist would first have to agree to take him, although there would probably be no problem with that.

“In addition, the reoffending rates from hospital admissions are much lower than they are for similar cases sent to prison, although in this case it’s unlikely he will ever be released from either route.

“The prosecution are shrewd going for a verdict of insanity in that it shows they dismiss his dangerous ideology as madness, and he will end up somewhere with a very low reoffending rate.

“However, it would seem the prosecution haven’t made a particularly strong case for insanity, and there is the remote risk that Breivik might end up under a clinical team who believe that he should be discharged, which (although unlikely) could occur and would be an issue of concern.

“As an aside the view expressed in some papers that he will be out in 21 years if sent to prison there is erroneous, his release must be reviewed then (as, unlike here, they do not do whole life sentences at the time of sentencing), but his imprisonment can be extended further then (and his case most likely would be). In effect if they sentence him to prison they can, and most likely would, continue his detention beyond that point.”

Additional information on reoffending rates from Fin Larkin Reconviction one year after release from UK prisons is about 35-70%, whereas reconviction two years (ie even longer) after release from UK Secure hospitals is less than 4%, and 0% of patients released with the agreement of their clinical team committed a ‘grave offence’. (The 4% figure includes lesser offences; theft, drug use etc. It’s 0% for serious violence against a person.) In more detail: Looking at national UK figures (i.e. for all offenders grouped together) hospital treatment programs are more effective than alternatives; for example they are considerably more effective at reducing future offending than criminal justice routes. Prison reoffending rates: Ministry of Justice (MoJ) figures typically show 35-70% one year reconviction rates, e.g. MoJ figures 2009; one year reconviction rates were largely in this range, they were above 70% in 14 prisons in England and Wales; and two prisons had one year reconvictions rates above 90%; 92% and 97% Hospital Reoffending rates: MoJ figures; from 1999-2006; for those mentally disordered offenders released into the community with the agreement of their clinical team; general offending reconvictions were 4% at two years, and 0% for ‘grave’ offences. In more detail: MoJ 2008 Statistics Bulletin on Mentally Disordered Offenders for the years 1999-2006: Restricted hospital patients (judged to be the most dangerous): Two year reconviction rate on release from secure hospitals is 4-7%. For those released with team and MoJ agreement it was 4%, and for grave offences 0% (for the entire 8 year period). For those discharged by an MHRT, i.e. without the consent of the team and secretary state, offending rates were significantly higher (7% at 2 years for all offenses, and 1% at 2 years for ‘grave’ offenses). For those released with team and MoJ agreement only 2% were reconvicted for violent offences and 0% for grave offences in the eight year period. (1% of those released over the entire 8 year period were convicted of ‘grave’ offenses within two years, and all of those had been discharged by an MHRT, i.e. without the consent of the team and secretary of state). References: 1999 BJP Maden; hospitals lead to ‘much lower’ reoffending than criminal justice options BMJ Study by Maden in 2004; two year reconviction rate for violence was 6% (restricted and unrestricted cases) 2010 BMJ article;‘The reconviction rate for offenders treated at Broadmoor, one of four high security hospitals in the UK, is between four and six times lower than for mentally ill offenders held in prison’