Jüriloo Alo, Pesonen Lauri, Lauerma Hannu
a Psychiatric Hospital for Prisoners , Finland.
Nord J Psychiatry. 2017 Oct;71(7):543-548. doi: 10.1080/08039488.2017.1351579. Epub 2017 Jul 24.
As in many European countries, Finnish psychiatric services experienced a rapid process of deinstitutionalization in the 1990s. In recent decades, the decrease in numbers of psychiatric hospital beds has in several countries been found to be linked with increasing criminality among severely mentally ill individuals. It has been concluded that deinstitutionalization could be the main reason for this development.
To investigate whether the prevalence of severely mentally ill persons to prison is a growing trend also in Finland.
We searched for the annual data in electronic case files of all prisoners about the ICD-10 diagnostic group of the most severe psychotic disorders. We also searched for the comorbid substance use disorders. Psychotic disorders due to substance abuse only were excluded from this study.
During the years 2005-2016, a rapid 10-fold increase in psychotic disorders has occurred in Finnish prisons. In 2016, 185 prisoners (5.9% of all Finnish prisoners) were diagnosed as having a psychotic disorder that was not induced by substance abuse. The causes of this dramatic change are unclear. Comorbid substance abuse disorders were detected in only 39.5% of these prisoners and therefore substance abuse can only partly explain the increasing criminality of the severely mentally ill persons. 80.5% of psychotic disorders were diagnosed in Psychiatric Hospital for prisoners and 19.5% in prison policlinic services.
Trans-institutionalization has become a serious challenge for the Finnish criminal justice and mental health systems. Further studies are needed to detect the causes of this change. More specialized services for severely mentally ill persons are needed both in the community psychiatry and also inside the prison services.
与许多欧洲国家一样，芬兰的精神科服务在20世纪90年代经历了快速的去机构化过程。近几十年来，在一些国家发现精神病医院病床数量的减少与重度精神疾病患者犯罪率的上升有关。得出的结论是，去机构化可能是这一发展的主要原因。
调查在芬兰，重度精神疾病患者入狱率是否也呈上升趋势。
我们在所有囚犯的电子病历中搜索关于最严重精神障碍的国际疾病分类第十版（ICD - 10）诊断组的年度数据。我们还搜索了共病的物质使用障碍。仅由物质滥用引起的精神障碍被排除在本研究之外。
在2005年至2016年期间，芬兰监狱中精神障碍患者数量迅速增加了10倍。2016年，185名囚犯（占所有芬兰囚犯的5.9%）被诊断患有非物质滥用所致的精神障碍。这一巨大变化的原因尚不清楚。在这些囚犯中，仅39.5%检测出共病物质滥用障碍，因此物质滥用只能部分解释重度精神疾病患者犯罪率上升的数据。80.5%的精神障碍在囚犯精神病医院被诊断出来，19.5%在监狱门诊服务中被诊断出来。
跨机构化已成为芬兰刑事司法和心理健康系统面临的严峻挑战。需要进一步研究以查明这一变化的原因。社区精神病学和监狱服务中都需要为重度精神疾病患者提供更专业的服务。
