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      Legal, medical and epidemiological characteristics of persons exempt from criminal liability in the National Prison Institute of Peru, 2014-2019 Translated title: Características epidemiológicas y médico-legales de los inimputables por trastornos mentales en el Instituto Nacional Penitenciario del Perú, 2014-2019

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          Abstract

          Objectives

          To describe and correlate the epidemiological, clinical and legal characteristics of persons exempt from criminal liability registered in the National Prison Institute of Peru in the period 2014-2019.

          Material and method

          Retrospective, cross-sectional descriptive study with correlational components and secondary sources. The sample consisted of all the persons exempt from criminal liability who formed part of the prison population of Peru during the study period. A validated data collection sheet was used. Data were analyzed through descriptive statistics using SPSS v24 software. For inferential analysis, a simple binary logistic regression was carried out.

          Results

          A total of 179 persons exempt from criminal liability were identified in 36 Peruvian prisons; 94.4% were males, with an average age of 35 years; 6.1% were undocumented. 67.0% had a diagnosis of the schizophrenia spectrum. The main crimes were against freedom (39.1%) and against life, body and health (36.8%). In 74.6% of cases, the duration of involuntary commitment was more than five years; 11.5% remained in prison after the date of release. In 18.4%, involuntary commitment was established by the Peruvian National Prison Institute. Associations between variables such as diagnosis, type and severity of the crime were found.

          Discussion

          Aspects that violate national and international regulations (excessive length of involuntary commitment, in unsuitable locations, unjustified imprisonment, etc.) were identified, affecting the fundamental human rights of persons exempt from criminal liability in prison.

          Resumen

          Objetivos

          Describir y correlacionar las características epidemiológicas, clínicas y legales de los inimputables por trastornos mentales recluidos en el Instituto Nacional Penitenciario del Perú (INPE) durante el periodo 2014-2019.

          Material y método

          Estudio descriptivo con el componente correlacional, retrospectivo, de corte trasversal, de fuente secundaria. La muestra se conformó con la totalidad de las personas inimputables por salud mental que formaron parte de la población penal del Perú en el periodo del estudio. Se utilizó la ficha de recolección de datos validada. Los datos fueron analizados mediante la estadística descriptiva utilizando el software Statistical Package for Social Science (SPSS) v24. El análisis inferencial se desarrolló mediante regresión logística binaria simple.

          Resultados

          En total, se identificaron 179 inimputables por trastornos mentales en 36 establecimientos penitenciarios peruanos; 94,4% eran varones, la mediana de edad fue 35 años; el 6,1% eran indocumentados. El 67,0% tenía el diagnóstico de espectro de la esquizofrenia. Los principales delitos fueron contra la libertad (39,1%) y contra la vida, el cuerpo y la salud (36,8%). En el 74,6% de los casos, la duración de la medida de seguridad fue superior a cinco años; el 11,5% permanecían presos después de su vencimiento. En el 18,4%, la medida de seguridad se determinó para el INPE. Se encontraron las asociaciones entre variables como el diagnóstico, el tipo y la gravedad del delito.

          Discusión

          Se identificaron aspectos (excesiva duración de medidas de seguridad, en lugares no apropiados y privación de libertad injustificada, entre otros) que colisionan con la normatividad nacional e internacional, afectando a los derechos humanos fundamentales de las personas inimputables por trastornos mentales en prisiones.

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              Mortality, Rehospitalisation and Violent Crime in Forensic Psychiatric Patients Discharged from Hospital: Rates and Risk Factors

              Objectives To determine rates and risk factors for adverse outcomes in patients discharged from forensic psychiatric services. Method We conducted a historical cohort study of all 6,520 psychiatric patients discharged from forensic psychiatric hospitals between 1973 and 2009 in Sweden. We calculated hazard ratios for mortality, rehospitalisation, and violent crime using Cox regression to investigate the effect of different psychiatric diagnoses and two comorbidities (personality or substance use disorder) on outcomes. Results Over mean follow-up of 15.6 years, 30% of patients died (n = 1,949) after discharge with an average age at death of 52 years. Over two-thirds were rehospitalised (n = 4,472, 69%), and 40% violently offended after discharge (n = 2,613) with a mean time to violent crime of 4.2 years. The association between psychiatric diagnosis and outcome varied—substance use disorder as a primary diagnosis was associated with highest risk of mortality and rehospitalisation, and personality disorder was linked with the highest risk of violent offending. Furthermore comorbid substance use disorder typically increased risk of adverse outcomes. Conclusion Violent offending, premature mortality and rehospitalisation are prevalent in patients discharged from forensic psychiatric hospitals. Individualised treatment plans for such patients should take into account primary and comorbid psychiatric diagnoses.
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                Author and article information

                Journal
                Rev Esp Sanid Penit
                Rev Esp Sanid Penit
                sanipe
                Revista Española de Sanidad Penitenciaria
                Sociedad Española de Sanidad Penitenciaria
                1575-0620
                2013-6463
                May-Aug 2021
                03 July 2021
                : 23
                : 2
                : 49-59
                Affiliations
                [1 ] originalNorbert Wiener Private University. National Prison Institute of Peru. Lima. Peru. normalizedUniversidad Privada Norbert Wiener orgnameNorbert Wiener Private University Lima, Peru
                Author notes
                [Correspondence: ] Andrey Sindeev Postgraduate School, Norbert Wiener Private University, Jr. Larrabure y Unanue 110, Santa Beatriz, Lima, Perú. E-mail: asindeev@ 123456samgmu.org

                Conflict of interest: None declared by the author.

                Article
                10.18176/resp.00031
                8592266
                34279532
                518d769b-e6db-423b-a564-1cbe399ae566

                This is an open-access article distributed under the terms of the Creative Commons Attribution License

                History
                : 09 August 2020
                : 29 October 2020
                Page count
                Figures: 1, Tables: 4, Equations: 0, References: 40, Pages: 11
                Funding
                Funded by: Norbert Wiener Private University
                Award ID: 077-2019-R-UPNW
                The study was financed by the Grant Fund for 2019 of the Norbert Wiener Private University (Lima, Peru). Ruling No. 077-2019-R-UPNW.
                Categories
                Original

                forensic psychiatry,insanity defense,liability,security measures (mesh),psiquiatría forense,imputabilidad,responsabilidad legal,medidas de seguridad (decs)

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