The Time Before the Crime - Risk Patterns in Offenders Undergoing a Forensic Psychiatric Evaluation

Case-control study

Design and methodology:

The study is designed as a case-control study. The study population consists of individuals aged ≥ 18 years who have had or currently have contact with a psychiatric care provider within Region Stockholm (public clinic or private provider with a regional agreement) whose medical records were requested by the NBFM in 2023 for forensic psychiatric evaluation (§ 7-evaluation or FPE), estimated to be n=250.

The control group consists of individuals aged ≥ 18 years who have had or currently have contact with a psychiatric care provider within Region Stockholm (public clinic or private provider with a regional agreement) whose medical records were not requested by the NBFM in 2023. The control group is matched to the study population based on gender, age and psychiatric care unit (psychiatric intensive care units, psychosis ward, general psychiatric ward, psychiatric outpatient clinic, psychiatric emergency unit). Thereby we hope that the control group will consist of individuals with similar psychiatric conditions and care burden as the study population.

An exclusion criterion for the study population is if the offense underlying the NBFM request for the medical records (the index offense) occurred before 2018. This is because the study aims to investigate psychiatric care as it is currently structured and provided. An exclusion criterion for the control group is if the individual previously underwent an FPE at some point. Additional exclusion criteria for both groups are if there is no registered psychiatric care contact in Region Stockholm's shared electronic medical record system, TakeCare, three months prior to the date of the index offense.

The individuals whose medical records were requested by the NBFM in 2023 for forensic psychiatric evaluations (§ 7 evaluation or FPE) are identified by retrieving data from TakeCare. The NBFM's requests for medical records are documented routinely with a specific search term in TakeCare, minimizing the risk of missing data. Once the individuals in the study population are identified, their personal identification numbers (PINs) are sent to the NBFM. Based on the PINs, the NBFM retrieves the relevant dates of criminal offenses for each individua in the study population. Additional variables are also identified in the NBFM case management system, including criminal charges, prior convictions, information about substance use at the time of the offense, and court rulings. If an individual has committed multiple offenses, the most serious offense is selected, i.e., the one with the highest penal value. In cases of repeated offenses with similar penal value or multiple offenses within the same criminal charge category, the date of the first offense is chosen as the index crime.

The retrospective record review is conducted systematically based on a predefined review template containing 26 markers. Each marker has a specific definition. During the planning phase of the project, the project team received input from a reference group consisting of professionals from various areas within healthcare. The reference group participated in meetings during the project's planning phase. The development of the 26 markers in the review template was carried out in collaboration with the reference group to ensure that the markers are as relevant and specific as possible. The review period is set to three months prior to the date of the alleged offense, as this is considered the period in which there would be the greatest opportunity to design specific interventions. In the control group, the medical record review is based on the same month as the dates of the matched offenses.