精神疾病犯罪者監護處分後再犯的決定因子

The Determinants of Recidivism after Release from Custodial Protection among Offenders with Mental Disorders

10.30074/FJMH.202409_37(3).0002

郭宇恆(Yu-Heng Kuo)；李俊宏(Chun-Hung Lee)；歐陽文貞(Wen-Chen Ouyang)；吳文正(Wen-Cheng Wu)

精神疾病 ； 瘋狂抗辯 ； 監護處分 ； 再犯 ； 刑事責任 ； mental disorder ； insanity defense ； custodial protection ； recidivism ； criminal responsibility

中華心理衛生學刊

37卷3期（2024 / 09 / 01）

229 - 251

繁體中文;英文

研究目的：臺灣在刑事法規上仿效德、日的規定，但在精神疾病犯罪者監護處分上卻有所不同，由執法單位督導，讓獲判監護處分的精神疾病犯罪者，與一般非犯罪的精神疾病者接受相同治療。此模式是否能有效降低再犯率，值得探究。故本研究探討臺灣精神疾病犯罪者結束監護處分後一年及三年的再犯率與再犯的相關因子。研究方法：本研究運用2010至2020年某精神專科教學醫院司法精神醫學資料庫，除病歷回顧外，並以司法判決書檢索系統確認是否再犯，長期追蹤研究74位有監護處分的精神疾病犯罪者1到11年，運用存活分析Cox迴歸模型了解再犯的相關因子。研究結果：精神疾病犯罪者結束監護處分後一年及三年的再犯率分別為8.1%及21.6%；監護處分三至五年者的再犯率極低。再犯的決定因子包括：犯罪行為時小於30歲｛風險比（hazard ratio, HR）=21.8,p=0.005｝監護處分期間短於1年（HR = 15.0, p = 0.015）、犯罪時責任能力喪失者（HR = 11.8, p = 0.024）及有物質使用相關診斷（HR = 4.7, p = 0.028）。研究結論：本研究提出精神疾病犯罪者監護處分結束後再犯的相關因素，可作為監護處分裁判及執行的參考。本研究建議「精神疾病犯罪者監護處分三年可能已經足夠」。當監護處分期間超過三年，要再延長時，建議要謹慎的評估必要性。

Purpose: The regulations on criminal responsibility in Taiwan are derived from those in Germany and Japan. However, Taiwan, Germany, and Japan have different judicial treatment and supervision systems for offenders with mental illness. Unlike in Germany and Japan, in Taiwan, offenders with mental illness under custodial protection are treated in the same way as ordinary mental illness patients without legal problems, and they are cared for in the same healthcare system. Judicial agencies in Taiwan do not directly intervene in medical matters; they only supervise medical institutions. In order to investigate whether the different judicial treatment systems for custodial protection of offenders with mental illness can effectively reduce recidivism, we examined the recidivism factors and rates within the first year and the first 3 years after release. Methods: We analyzed a forensic psychiatric database from a psychiatric teaching hospital in Southern Taiwan with data collected from 2010 through 2020 that included medical records for 91 custodial protection offenders with mental illness (81% male, 19% female) who had been followed for 1 to 11 years after release from custodial protection. We confirmed whether there was recidivism by searching the judicial judgment retrieval system. The results of the survival analysis (Cox regression) were used to identify the factors related to recidivism after release from custodial protection. Results: The first-year and the first-three-year recidivism rates were 8.1% and 23.8%, respectively. The factors related to recidivism include being under 30 years old at the time of the offence, the length of custodial protection being less than 1 year, a ruling of no criminal responsibility at the time of the offence, and a history of drug or alcohol dependence. We identified no instances of recidivism when the duration of custodial protection exceeded 3 years (with a maximum of 5 years). Conclusion: This study identified factors related to recidivism among offenders with mental illnesses after the end of custodial protection in order to provide a reference for judicial decisions and the execution of custodial protection. We conclude that a 3-year custodial protection sentence may be sufficient to prevent recidivism in offenders with mental disorders. If it is necessary to extend the duration of custodial protection beyond 3 years, we recommend carefully evaluating the necessity of such an extension.

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