The mortality among forensic psychiatric patients was up to threefold higher than that of the general population in Finland. The most significant difference compared to the general population was the sevenfold elevated suicide risk, according to the doctoral dissertation of Ilkka Ojansuu, Lic Med.
The purpose of the study was to analyse mortality among Finnish forensic psychiatric patients who, after having committed a crime, were diagnosed with a psychotic disorder during their forensic psychiatric examinations and who had been committed to involuntary psychiatric treatment instead of being sentenced to prison. The aim of the dissertation is to examine the overall mortality of Finnish forensic psychiatric patients, mortality by the cause of death, the effect of substance use disorder on mortality and the effect on mortality of the patient’s age at the time of commitment to psychiatric treatment. The study population consists of the patients committed to compulsory forensic psychiatric hospital treatment in Finland from 1980 to 2009.
The study found that the mortality among forensic psychiatric patients was up to threefold higher than that of the general population. The majority of the deaths were natural but the most significant difference compared to the general population was the sevenfold elevated suicide risk. Over half of the suicides occurred during forensic psychiatric hospital treatment which reveals an obvious treatment failure in these cases. Forensic psychiatric patients who were younger than middle-aged at the start of treatment were found to have a higher standardised mortality ratio than middle-aged or older patients during follow-up. Mortality due to natural and unnatural causes among Finnish forensic psychiatric patients was found to be similar to the mortality of Finnish schizophrenia patients in general.
The majority of Finnish forensic psychiatric patients had clear evidence of a substance use disorder (SUD) in addition to a psychotic disorder during their forensic psychiatric examination. However, the study also found that 30% of the patients with clear diagnostic evidence of an SUD in the examination were left without an appropriate diagnosis. This indicates problems with identifying and diagnosing substance use disorders which may have led to deficiencies in providing proper treatment for such patients. Age-adjusted mortality was found to be considerably higher in patients with an SUD and the higher mortality in men with an SUD was clearly associated with unnatural deaths.
Comparing the results of this study with earlier international studies on the mortality of forensic psychiatric patients is problematic as these other data also included other patients and not just psychotic disorder patients. The mortality of Finnish forensic psychiatric patients was found to be similar, albeit in part significantly lower than that observed in these studies in other countries. The greatest difference was with regard to the number of suicides which was found to be manifold in the other data compared to the mortality of Finnish forensic psychiatric patients. The study detected clearly longer treatment periods for Finnish forensic psychiatric patients compared to those reported in other countries, and this was identified as a factor that could protect from mortality.
Despite investments in the treatment of Finnish forensic psychiatric patients, a clear excess mortality due to both natural and unnatural causes was observed in this patient cohort and SUDs are one key factor behind this excess mortality. In order to reduce mortality, it is important to identify patients with a higher risk of suicide both during forensic psychiatric treatment and outpatient care and to draw attention to the treatment of the possible SUD in addition to the psychotic disorder. The appropriate treatment of somatic diseases must be arranged not only during forensic psychiatric hospital treatment but also after the patient has transferred to outpatient care.
The doctoral dissertation of Ilkka Ojansuu, Licentiate of Medicine, entitled Mortality among forensic psychiatric patients in Finland, will be examined at the Faculty of Health Sciences. The Opponent in the public examination will be Professor Jyrki Korkeila of the University of Turku, and the Custos will be Professor Jari Tiihonen of the University of Eastern Finland. The public examination will be held online in Finnish on 5 February 2021.
