Dr Marcel WesterlundConsultant Forensic & General Adult PsychiatristMRCPsych, FRSM, MD, RN

Forensic psychiatric work in Bermuda

Bermuda Hospitals Board

No conflict of interest

Objectives

• Overview of crime, traffic accidents and drugs in Bermuda

• Overview of 14 individuals with forensic psychiatric reports

• To establish who dies of what and where

• To establish what BPS is doing

• To conclude what needs priority

• Recommendations

Brachial plexus syndrome (Thoracic outlet syndrome)

Ref: Bermuda Police

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Total0

2

4

6

8

10

12

14

Livery cycleAuxiliary cycleCar or TaxiBicycleOther Pedestrian

Number of traffic casualties in Bermuda 2002 – 2013 excl. MC

Number of all traffic casualties in Bermuda 2002 - 2013

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Total0

10

20

30

40

50

60

70

80

90

100

2 3 2

8

129 10 10 9

75

9

1

87

Livery cycleAuxiliary cycleMotorcycleCar or TaxiBicycleOther Pedestrian

Ref: Bermuda Police

Number of traffic fatalities in Bermuda 2002 - 2013

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

2

4

6

8

10

12

14

16

18

Fatalitites

Fatalitites

Number of traffic fatalities and murder in Bermuda 2002 - 2013

Ref: Bermuda Police

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

2

4

6

8

10

12

14

16

18

FatalititesMurder

Number of traffic fatalities and murder Bermuda 2000 - 2013

Ref: Source: Eurostat Statistics Database. Data are age-standardised to the WHO European standard population. Bermuda numbers based on fatalities/100 000 calculated on official statistics provided by Bermuda Police.

Age standardised traffic mortality rates/100 000

Romania Bermuda Germany Sweden0

5

10

15

20

25

30

201020112011, 2012, 2013

Cannabis Opioids Opiates Cocaine ATS "Ecstazy" Any illicit drug0

50

100

150

200

250

300

350

LowHigh

World Drug Report 2012, WHO

Low – high numbers of illicit drug users world wide in millions

Alcohol Marijuana Crack cocaine

Heroin Methadone Cocaine powder

Ecstazy BZ Other0

10

20

30

40

50

60

70

80

90

76.8

64.2

15.511.3

4.12 1.7 0.3 0.3

% of n=293

% of n=293

BDIN (Bermuda Drug Information Network) 2011

Current prevalence of drug use in Bermuda

BDIN (Bermuda Drug Information Network) 2011

Alcohol Marijuana Crack cocaine

Heroin Methadone Cocaine powder

Ecstazy BZ Other0

10

20

30

40

50

60

70

80

90

% of n=2931000 users in Bermuda

Estimated numbers of drug users in % and 1 000 in Bermuda 2011

Cocaine Cocaine crack Heroin Cannabis Cannabis resin Cannabis plants

Ecstazy0

10000000

20000000

30000000

40000000

50000000

60000000

2012201120102009

BDIN (Bermuda Drug Information Network) 2012

Drug seizures by total street value 2009 - 2012

BDIN (Bermuda Drug Information Network) 2011

Numbers of persons stopped

Numbers failed Passed Number of accidents Impaired driving0

50

100

150

200

250

300

350

400

450

390

205

57

177

169

280

145

37

172

178

259

141

28

175

193

200620072008

Enforcement of drink and driving by BPS

Substa

nce use

disord

er

Any men

tal diso

rder

Personali

ty diso

rder

Depres

sion

Anxiety

disord

er

Schizo

phrenia

0

1

2

3

4

5

6

7

8

9

10

9

4.9

3.2

2.62.2

1.8

Substance use disorderAny mental disorderPersonality disorderDepressionAnxiety disorderSchizophrenia

Mental Disorders and Vulnerability to Homocidal Death: Swedish Nationwide Cohort Study, BMJ 2013;346:f557

Risk of homicidal death – Swedish Nationwide Cohort Study

1

1

11

1

1

Attempted murder

Assault

Wounding with intent, bladed article, intimidat-ing a witness

Stealing

Willful damage

Intruding upon the privacy of a female

2

1

1

1

AssaultStealingUnlawful wounding, bladed articleOffensive words, bladed article

1

1

1

MurderStealingSexual assault

Schizophrenia/schizo-affective disorder Drug induced psychosis/drug dependence

PD & Klüver–Bucy's syndrome © Dr Westerlund MWI/BHB

Offence in relation to offenders diagnosis

6

5

2 1

Diagnosis

Schizophrenia/schizoaffective

Drug dependence

PD

Klüver–Bucy's syndrome 11

12

Sentencing

Sentence agreedKlüver–Bucy's syndromeSchizophrenia

© Dr Westerlund MWI/BHB

Age 17 – 54 Median 31 years All males

14 offenders diagnosis and sentencing following reports

Ref: Homicides, Firearm Offences and Intimate Violence 2010/11: Supplementary Volume 2 to Crime in England and Wales 2010/11 Kevin Smith (Ed.), Sarah Osborne, Ivy Lau and Andrew Britton

Finlan

d

Scotla

nd

Irelan

d

Belgium

Luxe

mbourg

Northern

Irelan

d

Portuga

l

France

Engla

nd/Wale

s²

Denmark Ita

ly

Swed

en

Greece

Netherl

ands

Spain

German

y

Austria

0

0.5

1

1.5

2

2.5

Homicde rate/100 000 in European countries ranked high to low

Homicide rate/100 000 in European countries

Finlan

d

Scotla

nd

Irelan

d

Belgium

Luxe

mbourg

Northern

Irelan

d

Portuga

l

France

Engla

nd/Wale

s²

Denmark Ita

ly

Swed

en

Greece

Netherl

ands

Spain

German

y

Austria

Bermuda

0

1

2

3

4

5

6

7

8

9

Homicde rate/100 000 in European countries ranked high to low

Ref: Homicides, Firearm Offences and Intimate Violence 2010/11: Supplementary Volume 2 to Crime in England and Wales 2010/11 Kevin Smith (Ed.), Sarah Osborne, Ivy Lau and Andrew Britton

Homicide rate/100 000 in European countries

2009 2010 2011 20120

2

4

6

8

10

12

14

BermudaEngland/WalesSwedenUSA

Ref: USA - FBI Bermuda Police UK, Citizens Report Sweden, BRÅ

Number of murders/100 000 in Bermuda, England/Wales, Sweden and USA

2008 2009 2010 2011 20120

2

4

6

8

10

12

0

6.15

10.79

7.69 7.69

3.04 2.93 2.83 2.743.2

0.190.04

BermudaUSASwedenUK

Ref: FBI and Bermuda Police“Guns in Sweden: Facts, Figures and Firearm Law”. Gunpolicy org. University of Sydney School of Public Health.“Guns in UK: Facts, Figures and Firearm Law”. Gunpolicy org. University of Sydney School of Public Health

Fire arm fatalities/100 000 in U.S, UK, Sweden and Bermuda 2008 - 2012

Bermuda USA Sweden UK Jamaica Honduras0

10

20

30

40

50

60

70

6.152.93

10.79

2.830.19 0.04

39.4

64.8

7.69

2.747.69

3.23.04

20082009201020112012

Ref: FBI and Bermuda Police“Guns in Sweden: Facts, Figures and Firearm Law”. Gunpolicy org. University of Sydney School of Public Health.“Guns in UK: Facts, Figures and Firearm Law”. Gunpolicy org. University of Sydney School of Public Health“Guns in Jamaica: Facts, Figures and Firearm Law”. Gunpolicy org. University of Sydney School of Public Health“Guns in Honduras: Facts, Figures and Firearm Law”. Gunpolicy org. University of Sydney School of Public Health

Fire arm fatalities/100 000 in Bermuda, USA, Sweden, UK, Jamaica & Honduras 2008 - 2012

Conclusions

• Too many young black males die on our roads under influence

• MANY people are constantly under influence on Bermuda roads

• MC’s are 9x more dangerous than any other vehicles

• A combination of MC’s, drugs, speeding & poor driving skills is fatal

• Substance use, PD’s, & mental disorder increases risk of being subject of homicide

• More people die on Bermudas roads than due to violence

• BPS needs to start enforcing drivers under influence to save lives NOW

• Gov. of Bermuda needs to prioritise the huge costs of traffic deaths and injuries