T HE F REQUEN CY OF L AW B REAKIN G AN D C OMPULSORY H OSPITALIZATION A MON G THE M EN TALLY I LL P EOPLE IN K ATOWICE , P OLAND

It is a common belief that mental disorders are widely associated with dangerous, threat-posing behavior and law-breaking. The paper analyzes the problem of law -breaking by the mentally disordered. We performed an analysis of cases concerning compulsory psychiatric treatment or confinement in a medical institution on the grounds of mental incompetence to commit an offence or mental unfitness to stand the trial obtained from the court and the public prosecutor's office in Silesia from 2007 to 2009. 14 cases were analyzed. All the offenders were male, mean age was 44,6. All the offenders were diagnosed by psychiatrists, most of them with schizophrenia (n=10 cases). Other diagnoses included paranoic syndrome (n=1), bipolar affective disorder with manic episode (n=1), schizoaffective disorder (n=1), delusion syndrome (n=1). 9 out of 14 offenders were diagnosed prior to the offence, some of whom were also hospitalized (n=5). 8 of analyzed cases concerned use of violence, 3 concerned la rceny, 2 concerned posing a threat to others’ life or health and 1 concerned fraud. 2 of the offenders were previously sentenced for other offences. 12 of the offenders were compulsory treated by psychiatrists, 10 out of whom are still hospitalized at the time of writing this report. The small number of the cases analyzed (14 cases in the whole of a few thousands) suggests that mentally disordered persons do not break law often. There seems to be a higher risk associated with male gender, though. Also, the frequency of violent acts and offences committed despite previous treatment is disturbing.


IN TROD UCTION
It is a com mon belief that the mentally ill persons are violent, u npred ictable and th at they often pose a threat to others health and safety. These w id ely held op inions contribute to creating and reinforcing stigm a attached to mental illness (Filipovits & Farkas, 2008;Furczyk et al., 2011). The fact rem ains how ever that althou gh mental illnesses are associated w ith increased risk of violent behavior, the association is not ind epend ent of mod ifying factors such as psychoactive substance abuse, history of family violence or other environmental stressors. Violent behavior may resu lt in law -breaking attitud es (Fazel et al, 2009a;Elbogen Johnson, 2009;Fazel et al, 2009b). Accord ing to the Polish law a person w ho, as a result of psychiatric illness, mental retar d ation or other d isturbance in psychic functions, has no ability to control his or her ow n behavior or to fu lly recognize its p ossible ou tcom e, althou gh breaking the law , d oes not com mit a crime (Polski Kod eks Karny, 2009). In such cases, if the behavior is d estructive and socially harm ful, and it is probable that this kind of cond uct repeats, a person may be d etained by the court's d ecision in an approp riate med ical facility (Polski Kod eks Karny, 2009). Therefore a nu mber of Polish court cases resulting i n compu lsory psychiatric treatment or confinement in a med ical institution on the grou nd s of mental incompetence to commit a crime reflects the frequency of law breaking am ong the mentally ill.
The aim of this p aper is to present and characterize the case s of law breaking by the mentally d isord ered in the city of Katow ice. The legal qualification of committed offences and the resu lts of legal p roceed ings w ith sp ecial em p hasis on the asp ect of violent behavior is d escribed .

METHOD
For the purp oses of this research, the record s of all the cases from the years 2007 to 2009 w ere obtained from tw o Public Prosecutor's Offices and one District Court of Katow ice. All the cases resulting in w ithd raw ing the case on the ground s of the d efend ant's mental unfitnes s to stand the trial or in stating their mental incompetence to com mit an offence w ere selected and analyzed .

RESULTS
Only 14 out of a few thou sand s of all cases w ere found to fit the research criteria. All the d efend ants w ere m ale. Their mean age w as 44.6 years. At the moment of breaking the law , the you ngest of the d efend ants w as 21, w hile the old est w as 72 years old . In the course of the legal p roceed ings all of the d efend ants w ere exam ined , observed and d iagnosed by forensic psychiatrists. In m ost cases the final d iagnosis w as that of schizop hrenia (10 cases, 9 out of w hich w ere d iagnosed as paranoid schizophrenia, w hile the remaining 1 w as schizop hrenia combined with mental retard ation). Other d efend ants were d iagnosed w ith paranoid synd rome (n=1), psychotic manic episod e in the course of the bipolar affective d isord er and concom itant alcohol d ep end ence (n=1), schizoaffective d isord er (n=1) and p ersistent d elu sion synd rome (n=1). 9 out of 14 d efend ants had been treated and d iagnosed by p sychiatris ts before breaking the law , how ever in three cases after the examination by the sw orn experts the d iagnoses w ere changed . Five out of these 9 d efend ants had also been hosp italized for psychiatric reasons before they broke the law , w hile the rest of them ha d only been treated as ou tp atients. Eight ou t of 14 analyzed cases w ere associated w ith violence and in m ost of them (n=5) the violence w as d irected against the d efend ant's fam ily members. As for the legal qu alification of offences the d efend ants w ere accu sed of committing, the analysis revealed 8 cases of assault, 3 cases of larceny, 2 cases of posing a threat to others' life or health and 1 fraud . All cases of larceny involved objects of very small value, to give a vivid examp le, in one case a gold fish.
Tw o d efend ants had been accused of com mitting other crimes in the p ast, w hile for the rest of them the analyzed cases w ere their first contact w ith the law . As a result of the legal proceed ings, tw elve of the d efend ants w ere hospitalized and comp ulsory t reated . Ten of them are still hospitalized at the time of w riting this report.

D ISCUSSION
Accord ing to the information fou nd on the Katow ice court's w ebsite, an average number of cases taking place each year in the offices w hich provid ed the d ata for this analysis reaches a few thousand . With this taken into consid eration, the d escribed 14 cases are found to constitute only a very small p ortion of the w hole nu mber of cases. This strongly contrasts with a popular im age of violent, d angerous 'm ad men' kn ow n from the med ia, influencing the w ay the m entally ill are seen by the society (Cu tcliffe & H anningan, 2001).
Analyses cond ucted in other parts of Poland as w ell as abroad confirm this conclusion. Betw een 1997 and 2002 in the Polish city of Szczecin and the surround ing area there w ere 128 cases in w hich compu lsory psychiatric treatment of the d efend ant w as consid ered by the court. As a resu lt of the legal proceed ings, the court d ecid ed institutionalization in a med ical facility w as necessary in 85 of these cases (Kolasinski & Korecka, 2004). In 1998 in Baltim ore 14 out of 11497 d efend ants tried for d ifferent crimes plead ed insanity (Janofsky, Vand ew alle, & Rappep ort, 1989). All of them w ere m ale, w hich seem s to confirm d ifferences betw een men and w om en in regard s to criminal and violent behavior (Vaske et al., 2011) The hereby presented analysis show ed schizop hrenia to be the most comm on d isease d iagnosed in the researched group of d efend ants, a fact w hich confirm s that this d isease is associated w ith aggressive and criminal behavior (Fazel et al., 2009a;Ran et al, 2010;H aller, Dittrich, & Kocsis, 2004). In some of the d escribed cases a m atter of occasional alcohol abuse by the d efend ants w as also raised . Alcohol abuse is know n to increase the risk of aggressive behavior, mostly d irected against the subject's ow n fam ily members (Fazel et al., 2009b;Thom pson & Kingree, 2006). This kind of aggression w as particularly com mon in the presented cases, w hich might be attributed both to the fact the d efend ants w er e mentally d isturbed and to the coexisting problem of alcohol abu se.
Large nu mber of mentally ill d efend ants presented in this p aper had been d iagnosed and treated by p sychiatrists even before they broke the law . In these cases treatment d id not prevent the d isord ered from com mitting the crime, althou gh, as the related p apers show , an early d iagnosis, system atic and often visits to p sychiatrist, as w ell as treating concomitant ad d ictions all result in significant red uction of the risk of criminal behavior (Thompson & Kingree, 2006;Van Dorn et al., 2011).
The presented analysis confirms the results of other similar research. Am ongst the mentally d isord ered it is male patients d iagnosed w ith schizop hrenia w ho are especially inclined to present w ith criminal behavior. Violence in this group of patients is most often d irected against their ow n family members, w hich also is related to alcohol abuse. The fact that a lot of crimes w ere committed in spite the fact that the d efend ants w ere being treated by psychiatrists suggests that the d octor-p atient relationship need s continu ous improvement and the scale of criminal risk has to be carefully and ind ivid u ally assessed in each and every case. Still, although there clearly is an association betw een mental d isord er s and aggressive or crim inal behavior, the nu mber of cases against the mentally ill seems minute w hen comp ared to the w hole nu mber of cases. There is an urgent need to start a public d iscu ssion concerning this matter to influence the w hole society, an by t his prevent stigm atization of the mentally d isord ered .