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
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