Nonimputability: a study on inmates at Instituto Psiquiátrico Forense Maurício Cardoso

Abstracts

INTRODUÇÃO: A pesquisa traçou um perfil dos internos inimputáveis do Instituto Psiquiátrico Forense Maurício Cardoso. MÉTODOS: Durante o período de abril a agosto de 2005, foram selecionados 617 sujeitos para inclusão no estudo. RESULTADOS: A análise dos dados revelou que os internos apresentam as seguintes características: idade média de 43,22 anos, sexo masculino (91,3%), profissão definida (73,2%), primeiro grau completo (74,6%), sem companheiro(a) (83,2%), crime contra a pessoa como delito gerador da inimputabilidade (62,1%), com antecedentes criminais (58,3%), prazo mínimo fixado na sentença de 1,76 anos, cumprindo medida de segurança detentiva (91,4%), média do tempo de internação de 9,33 anos, sob o regime de alta progressiva (81,5%), com internação prévia em outras instituições psiquiátricas (55,2%), sem cumprimento anterior de medida de segurança (83,3%), com o diagnóstico de esquizofrenia e outros transtornos psicóticos (61,4%). Os cruzamentos de variáveis que tiveram relevância estatística foram: dos internos com internação prévia, 61,9% possuíam antecedentes criminais, e quanto maior o nível de escolaridade do interno, menor o índice de reincidência. Evidenciou-se uma preponderância de internos com antecedentes criminais em pacientes com transtornos relacionados a substâncias (56,5%) e transtorno de personalidade (59,7%). Verificou-se que 60,8% daqueles que cometeram crimes contra a pessoa possuíam diagnóstico de transtornos relacionados ao álcool, estabelecendo uma relação entre criminalidade violenta e os transtornos de uso de substâncias. CONCLUSÕES: A partir da análise dos prontuários dos 617 internos do Instituto Psiquiátrico Forense Maurício Cardoso, o presente estudo procurou apresentar um mapa dos indivíduos considerados inimputáveis no Rio Grande do Sul.

Inimputabilidade; medida de segurança; violência

ORIGINAL ARTICLE

Nonimputability: a study on inmates at Instituto Psiquiátrico Forense Maurício Cardoso

Gabriel Jose Chittó Gauer^I; Fernanda Correa Osório^II; Alfredo Cataldo Neto^III; Letícia Teixeira^IV; Mariane Caum^IV; Taís Amaral da Costa Souza^IV; Verônica Valle^IV; Vivian Cristófoli^IV

^IPsychiatrist. Professor,Graduate Program: Psychology, and Master's Degree in Crinimal Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil

^IILawyer, Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil. MSc. in Criminal Sciences, PUCRS. Professor, Faculdades Planalto, Centro Universitário La Salle, Canoas, RS, Brazil

^IIIPsychiatrist. Associate professor, Department of Psychiatry and Forensic Medicine, Faculdade de Medicina, (FAMED), PUCRS. Master's Degree in Criminal Sciences, PUCRS

^IVMedical students, FAMED, PUCRS

Correspondence

ABSTRACT

INTRODUCTION: This study analyzed the profile of nonimputable inmates at Instituto Psiquiátrico Forense Maurício Cardoso.

METHODS: Between April and August 2005, a total of 617 patients were selected for inclusion in the study.

RESULTS: Data analysis revealed that the inmates presented the following characteristics: mean age of 43.22 years, male (91.3%), defined profession (73.2%), completed elementary school (74.6%); without a partner (83.2%), crime against a person was the felony that generated nonimputability (62.1%), criminal records (58.3%), minimal sentence time was 1.76 years, serving it in criminal commitment (91.4%), mean time in prison of 9.33 years, under regime of progressive release (81.5%), previous hospitalization in other psychiatric institutions (55.2%), no previous probation measure (83.3%), diagnosis of schizophrenia and other psychotic disorders (61.4%). The following variables were statistically significant: among inmates with previous hospitalization, 61.9% had criminal history; and the higher the inmates' schooling level, the lower the level of criminal relapse. Results showed a predominance of inmates with criminal records in patients with disorders related to substances (56.5%) and personality disorder (59.7%). It was also verified that 60.8% of those who committed crimes against a person were alcohol addicts, establishing a relation between violent criminality and disorders caused by substance misuse.

CONCLUSIONS: Based on the analysis of the medical records of 617 inmates at Instituto Psiquiátrico Forense Maurício Cardoso, this study aimed at presenting a map of individuals considered nonimputable in Rio Grande do Sul.

Keywords: Nonimputability, criminal commitment, violence.

Introduction

This study aims at establishing the profile of individuals considered nonimputable, agents without ability of censurability, at Instituto Psiquiátrico Forense Maurício Cardoso (IPFMC), located in Porto Alegre, Brazil, this being the only institution for that purpose in the State of Rio Grande do Sul.

Ability of legal imputation is the name given to the psychological status that is based on the understanding a given individual has on the criminal character of the fact and on the ability of judgment according to that understanding. Such ability can be total, partial or null. When imputation ability is null, it means that the agent was, at the time the crime was committed, totally incapable of understanding the criminal character of the fact or totally incapable of judgment according to that understanding. Therefore, the crime committed by such individual is inimputable, and the agent can be legally judged irresponsible for what he did. Thus, ability of legal imputation depends on the individual's faculty of understanding and judgment. Faculty of understanding is based on the possibility that the agent has of knowing the nature, conditions and consequences of a given act. It implies knowledge of penalty, legal organization, social consequences and supposes a certain degree of experience, maturity, education, intelligence, lucidity, orientation and memory. Faculty of judgment is based on the ability to choose between practicing or not a given act, which requires serenity, reflection and distance from any pathological condition that can imprison the individual's will, pushing him toward a given act.^1,2

The Brazilian legal penalty, to make the author of a crime accountable, demands nothing more than the consciousness of the criminal nature of the fact and freedom of choice between practicing it or not. According to article 26 of the Penal Code, the agent that, due to mental disease or incomplete or retarded mental development, was at the time of a given action or omission entirely unable to understand the illicit nature of a given fact or to judge according to such understanding cannot be penalized.³

IPFMC is a penal medical establishment belonging to the penitentiary network of the Government of the State of Rio Grande do Sul, linked to the Department of Penitentiary Services. It is destined to hospitalization and rehabilitation of mentally diseased offenders submitted to probation measure and of convicts affected by mental disease. Also, the institute performs examinations and expert examinations to verify accountability and penal hazardousness for law suits.

This research aims at identifying the main characteristics of inmates submitted to probation measure at IPFMC.

Thus, the present study, in an attempt to establish the map of nonimputability in Rio Grande do Sul, contributes to the debate on the issue involving probation measure, mental disease and criminality.

Method

Sample

This study was carried out at IPFMC. The population being studied was formed by all nonimputable inmates between April and August 2005. A total of 617 nonimputable inmates were undergoing treatment during that period. Inmates waiting for trial, those declared semi-imputable and those submitted to probation measure due to occurrence of mental disease were excluded from the study.

Data were collected from legal medical charts filed at IPFMC using a specific instrument. Analyses of sentences, evaluation reports of penal responsibility, verification reports of hazard cessation and other documents were also analyzed. Sociodemographic data, such as age, schooling level and marital status, were collected based on the current status of inmates, and not when the criminal act was committed or when nonimputability was declared.

Data treatment

Results were inputted in a database using the statistical package SPSS 10.0 (SPSS Inc., Chicago, 2000), and a univariate descriptive analysis was initially performed to calculate frequencies, means and standard deviations. At a second moment, a bivariate analysis was performed. To relate independent variables, such as gender, age group and socioeconomic level, to dependent variables, such as type of criminal offense, criminal records, hospitalization time and others, an association test between variables was applied (independence chi-square). Existence or not of statistically significant associations between means, concerning quantitative variables, was verified using Student's t test for independent samples. Significance level was set in p ≤ 0.05.

Ethical/legal aspects

The research project was submitted to and approved by the IPFMC director, by the judge of Execution and Probation Measure Court and by the Research Ethics Committee at PUCRS.

Results

General characteristics of the sample

According to the medical charts, nonimputable inmates who were at IPFMC between April and August 2005 had the following characteristics: mean age of 43.22 years, with prevalence of men (91.3%), most of them having a defined profession (73.2%). As to schooling level, we found the following percentages: 74.6% went to elementary school; 16.4% were illiterate; 7.3% went to high school; and 1.6% had higher education. The great majority had no partner when data were collected (83.2%). The most prevalent offense generating nonimputability among inmates was offense against the person (62.1%), followed by offense against property (20.6%) and offense against morality and decency (16.2%). At a lower percentage, there are offenses against public peace (3.4%), offenses belonging to the Toxic Act (2.6%), offenses against public administration (2.3%), offenses against religious feelings and respect for the deceased (0.6%), misdemeanors (0,5%), offenses against public faith (0.3%) and offenses belonging to the Torture Act (0.3%). Results indicate a 58.3% prevalence of inmates with criminal records. Mean minimal period determined for probation measure was 1.76 years. There was significant prevalence of confinement as probation measure (91.4%). Mean time at the institution in this sample is 9.33 years, and half of the inmates had been at the institution for more than 7 years, and the longest period was 41 years. As to inmate status, most were under progressive release (81.5%). With regard to previous hospitalization at a psychiatric institution, there was a slightly higher prevalence of inmates with previous hospitalization (55.2%). Most inmates had not been submitted to previous probation measure (83.3%). The most frequently found diagnoses were schizophrenia and other psychotic disorders (61.4%), followed by disorders related to substance use (27.5%), mental retardation and communication disorder (20.5%), personality disorder (12.4%), mood disorders (10%), mental disorders caused by a general medical status (3.4%), sexual disorders (3.1%), delirium and dementia (1.1%), anxiety disorders (0.3%), dissociative disorders (0.2%), sleep disorders (0.2%) and impulse control disorder (0.2%).

Associations

Nonsignificant associations

There were no statistically significant associations between the following variables: gender and age group (p = 0.638), gender and schooling level (p = 0.241), gender and existence of defined profession (p = 0.192), gender and marital status (p = 0.928), gender and minimal sentence period (p = 0.191), gender and time at the institution (p = 0.741), gender and type of probation measure (p = 0.198) and gender and hospitalization in other psychiatric institutions (p = 0.504).

Gender and offense generating nonimputability

As to gender and offense generating nonimputability, there was prevalence of offenses against the person, both in male and female gender. However, among women, percentage reaches 84.6%, whereas among men they account for 59.9% of cases. Table 1 shows distribution of inmates according to gender and offense generating nonimputability.

Gender and existence of criminal records

Comparison of variables gender and criminal records shows statistically significant association (p < 0.001). Among women, 86.5% did not have and 13.5% had criminal records. Among men, 44.5% had and 55.5% did not have criminal records.

Gender and diagnosis

When these two variables were associated, there was higher prevalence of diagnosis of schizophrenia and other psychotic disorders, both in men (61.4%) and women (59.6%). There was also higher prevalence of diagnosis of disorders related to substance use in men (29.2%) compared to women (9.6%). There was also a higher number of cases of diagnosis of mood disorders in women (19.2%) compared to men (9.2%).

Hospitalization in other psychiatric institutions and criminal records

Comparing these variables, considering inmates who had criminal records, 61.9% had and 38.1% had not been previously hospitalized in other psychiatric institutions. Among inmates who had no criminal records, 50.6% had been previously hospitalized in other institutions, and 49.4% had not. There was existence of a statistically significant association between existence of criminal records and hospitalization in other institutions (p = 0.05). Figure 1 shows associations between criminal records and hospitalization in other institutions.

Figure 1
- Click to enlarge

Disorders related to alcohol, cannabis and cocaine and offense generating nonimputability

When these variables were associated, 60.8% of inmates who had committed any offense against the person had a disorder related to alcohol; 30.4% had a disorder related to cocaine; and 26.5% had disorders related to cannabis. In offenses against property, 52.2% of inmates had a disorder related to cocaine; 47.1% had a disorder related to cannabis; and 20.8% had a disorder related to alcohol.

In offenses against morality and decency, 13.3% of inmates had a disorder related to alcohol, and 11.8% had a disorder related to cannabis.

In offenses belonging to the Toxic Act, 23.5% of inmates had a disorder related to cannabis; 21.7% had a disorder related to cocaine; and 4.2% had a disorder related to alcohol.

Schooling level and existence of criminal records

When the variables schooling level and existence of criminal records were associated, 49% of illiterate inmates had criminal records, and 51% did not; among those who had elementary school, 41.9% had criminal records, and 58.1% did not; among those who had high school, 33.3% had criminal records, and 66.7% did not; and among the 10 inmates with higher education, none (100%) had criminal records. Thus, there is a statistically relevant association between the variables schooling level and existence of criminal records (p = 0.014).

Diagnosis and existence of criminal records

In a comparison of the variables previous hospitalization in other psychiatric institutions and criminal records, there was a statistically significant association (p = 0.005). Among inmates who had previous hospitalization, 61.9% had and 50.6% did not have criminal records. Among inmates who had no previous hospitalization in other institutions, 38.1% had and 49.4% had no criminal records. It can be inferred that inmates who had criminal records, i.e., a history of violent behavior, had already undergone psychiatric treatment.

Comparing diagnosis and existence of criminal records, 61.1% of inmates diagnosed with schizophrenia and other psychotic disorders did not have criminal records, and in those with disorders related to substance use, 56.5% had criminal records. Among inmates diagnosed with mental retardation and communication disorder, 51.1% had criminal records, and 59.7% of inmates diagnosed with personality disorder had criminal records. Out of 62 cases diagnosed with mood disorder, 56.5% did not have criminal records, whereas 43.5% did. Among patients diagnosed with mental disorders caused by a general medical status, 61.9% did not have criminal records, and 38.1% did. Out of 19 cases diagnosed with sexual disorders and paraphilia, 63.2% did not have criminal records, and 36.8% did. Table 2 shows association between diagnosis and existence of criminal records.

DISCUSSION

According to results, nonimputable inmates at IPFMC had the following prevalent characteristics: male gender, mean age of 43.22 years, defined profession, completed elementary school, without a partner, offense against the person was the felony that generated nonimputability, criminal records, minimal sentence time was 1.76 years, serving it in criminal commitment, mean time in prison of 9.33 years, under regime of progressive release, previous hospitalization in other psychiatric institutions, no previous probation measure, and diagnosis of schizophrenia and other psychotic disorders.

With regard to inmate gender, men were prevalent (91.6%), explained in the literature as a result of biological, social and cultural factors that lead men to adopt higher risk behaviors, and sometimes more aggressive than women.^4,5

As to inmate mean age and gender, the prevalent age group in male and female inmates was 40-49 years (28% of men and 36.5% of women). Worsening of disorder throughout the years and multiple productive episodes, associated with worsening of clinical status are probably one of the factors related to the offense at a later age than the population of convicts, which starts committing offenses earlier.^4,5

In the association between the variables gender and schooling level, elementary school is the most prevalent, both for men (74.1%) and women (78.8%). Low schooling level of IPFMC inmates can be explained by their poverty conditions, worsened by hard access to specialized treatments and by limited possibility of learning due to mental disorder.

There was a statistically relevant association between the variables schooling level and existence of criminal records (p = 0.014). This means that the higher the schooling level, the lower the rates of criminal recurrence: 49% of illiterate inmates; 41.9% in those who had elementary school; 33.3% in those who had high school; and none of the 10 inmates with higher education had criminal records.

Despite the small sample of individuals with higher education, it can be supposed that the higher the schooling level, the better the inmate's socioeconomic condition and, consequently, the better the access conditions to specialized psychiatric treatment, which reduced chances of getting involved in criminal conflicts and practices.

In the association between gender and marital status, male (83.3%) and female (82.7%) inmates had no partner. There was higher incidence of inmates with no partner (83.2%) than inmates with partner (16.8%). It can be assumed that, concerning offenders with mental disease, diseased added to violence makes even more difficult to establish permanent bonds.

Comparison of variables gender and criminal antecedents shows statistically significant association (p < 0.001). Proportion of men with criminal records (44.5%) is higher than that of women in the same condition (13.5%), confirming the higher incidence of a violent past among men, as can be seen in prevalence of the male gender among the inmates. Biopsychosocial factors contributing to a higher prevalence of violent behavior in men in relation to women have been widely studied.^6-8

Considering the variables gender and previous hospitalization in other psychiatric institutions, 59.6% of women and 54.8% of men at IPFMC had already been hospitalized in other psychiatric institutions. There were no statistically significant associations between gender and occurrence of hospitalization in other institutions (p = 0.504); most inmates, both men and women, had a previous history of psychiatric hospitalization, which is in agreement with the idea that criminal behavior is associated with clinical status chronicity and with presence of previous psychotic episodes.

When relating the variables diagnosis and previous hospitalization in psychiatric institutions, among inmates diagnosed with schizophrenia, most (60.9%) had previous hospitalization; the same was observed among inmates diagnosed with disorders related to substance use (54.8%), mental retardation and communication disorders (51.6%), mood disorders (62.9%) and mental disorders caused by a general medical status (52.4%). Once again, one of the explanations for existence of previous hospitalization is the severity of such mental disorders, which are mostly characterized by a deep disorder in psychic processes, with severe morbid symptoms requiring therapeutic approach.

However, existence of previous psychiatric hospitalization was not observed in diagnoses of personality disorders and sexual disorders. In personality disorders, 64.5% of inmates, i.e., most of them did not have previous hospitalization. In sexual disorders, 89.5% of inmates did not have previous hospitalization either. Nevertheless, it is known that patients with personality disorders, especially those with antisocial personality disorder, frequently have early problems with the justice, and their difficulties are approached by the judiciary or penal system, and not by health professionals.

Among inmates who had previous hospitalization, 61.9% had and 50.6% did not have criminal records. Among inmates who had no previous hospitalization in other institutions, 38.1% had and 49.4% had no criminal records. It can be inferred that inmates who had criminal records, i.e., a history of violent behavior, had already undergone psychiatric treatment.

As to gender and offense that generated nonimputability, there was prevalence of offenses against the person, both in male and female gender. However, among women, percentage reaches 84.6%, whereas among men crimes against the person account for 59.9% of cases.

When the variables gender and diagnosis are associated, there is higher prevalence of diagnosis of schizophrenia and other psychotic disorders, both in men (61.4%) and women (59.6%). In 61.1% of inmates diagnosed with schizophrenia, that is, most of them, there were no criminal records, whereas in disorders related to substance use, 56.5% had criminal records, and 59.7% of inmates diagnosed with personality disorders also had history of violent behavior.

In the analysis of previous probation measure by IPFMC inmates, 62.5% diagnosed with schizophrenia had no previous probation measure. The inmates diagnosed with disorders related to substance use and personality disorders had higher levels of previous probation measure; among those with personality disorders, 25.2% had already had probation measure, whereas 9.9% had not; among those with disorders related to substance use, 34% had already had probation measure, whereas 26.3% had not. Thus, in longitudinal terms, personality disorders and disorders related to substance use have higher association with criminality and violence when compared to schizophrenia. There was also higher prevalence of diagnosis of disorders related to substance use in men (29.2%) compared to women (9.6%).

Regarding disorders related to alcohol, cannabis and cocaine and offense that generated nonimputability, there was existence of a relationship between violent criminality and alcohol-related disorders. When these variables were associated, 60.8% of inmates who had committed any offense against the person had a disorder related to alcohol; 30.4% had a disorder related to cocaine; and 26.5% had disorders related to cannabis.

With regard to inmate status, 81.5% (501 inmates) were under progressive release; the other patients were in closed unit (9.1% or 56 inmates) and in open unit (9.4% or 58 inmates).

As to mean minimal period determined for probation measure, out of 56 inmates, 2% of cases are below 2 years, and in 40.7% it ranges between 2 and 4 years.

Gender of offenders with mental disease did not influence minimal period for probation measure. It should be stressed that during survey in inmates' medical charts, there were periods above the minimal period established by law, since they are previous to the Penal Code Reform in 1984, which limited minimal hospitalization period.

As to type of probation measure, 91.4% or 562 inmates serve in criminal commitment, and 8.6% or 53 inmates, out of 615 cases, serve in restrictive safety measure.

Conclusion

Based on the analysis of 617 medical charts at IPFMC, an institution destined to hospitalization and rehabilitation of offenders with mental diseases, the present study aimed at presenting a map of individuals considered nonimputable in Rio Grande do Sul.

One of the facts verified in this study is the relationship between offense and existence of a severe, chronic mental disorder in individuals with previous episodes and low socioeconomic level. This shows that the lack of public and support policies by the community in general is one of the main factors contributing to occurrence of violent behavior in patients with mental disorders. The aim of the following study is not to deepen the comparative study of our reality with that in other countries, but to provide data obtained in our country. However, these facts are certainly not a privilege of Brazilian psychiatric patients, and reports of situations with similar characteristics can be found in the international literature.⁹ Therefore, the data presented herein reveal the importance of supporting, in terms of care level in the health and social area, people with mental disorders.

We believe that our data can contribute to the development of proper policies to equip mental services as the profile of hospitalized patients is analyzed. This study was carried out using that perspective of the need of investigations in the area of an interface between mental health and its disorders and violence.

References

• 1. Cataldo Neto A, Gauer GJC, Osório FC, Teixeira L, Caum M, Valle V. Inimputabilidade e doença mental. In: Gauer RMC, ed. Sistema penal e violência. Rio de Janeiro: Lúmen Júris; 2007. p. 157-63.
• 2. Breier A, Paz RA, Gauer GC. Imputabilidade: uma análise crítica. In: Gauer GC, ed. Agressividade uma leitura biopsicossocial. Curitiba: Juruá; 2001. p. 149-62.
• 3. Hungria N, Flagoso HC. Comentários ao código penal. Rio de Janeiro: Forense; 1983.
• 4. Black DW. Bad boys, bad men: confronting antisocial personality disorder. New York: Oxford University; 1999.
• 5. Niehoff D. The biology of violence. New York: Free; 1999.
• 6. Gauer GJC, Guilhermano TF. Fatores biológicos associados à conduta agressiva. In: Gauer GC, ed. Agressividade uma leitura biopsicossocial. Curitiba: Juruá; 2001. p. 11-37.
• 7. Stout M. The sociopath next door. New York: Bradway; 2005.
• 8. Gauer GJC, Cataldo Neto A. Transtorno de personalidade anti-social. In: Cataldo Neto A, Gauer GJC, Furtado NR, eds. Psiquiatria para o estudante de medicina. Porto Alegre: EDIPUCRS; 2003. p. 595-608.
• 9. O'Malley S. Are you there alone? New York: Simon & Schuster; 2004.

Publication Dates

• Publication in this collection
  31 Mar 2008
• Date of issue
  Dec 2007

History

• Accepted
  05 Aug 2007
• Received
  15 May 2007