Intended effects and actual outcome of the Forensic Mental Care Act of 1992: A study of 367 cases of forensic psychiatric investigation in Sweden

Abstract

The legislation regulating sanctions for offenders with mental disorders has been under parliamentary review in Sweden, and major changes have been discussed. In the present study, we have explored the expectations and effects of the previous change in legislation, introduced in 1992 and aimed at reducing coercive psychiatric treatment. Two cohorts of male subjects, admitted for forensic psychiatric investigation before (1988–90, n=187) and after (1993–95, n=180) 1992, were compared regarding sanctions, diagnoses and background data with a possible impact on the study populations. Contrary to expectations, the 1993–95 cohort was characterized by increased proportions of psychotic disorders and sentences to forensic psychiatric treatment. In both cohorts, few cases had an adequate outpatient treatment. A tendency to shorter compulsory inpatient treatment periods during the last year before the index crimes was found for those with psychotic disorders in the 1993–95 cohort. The frequency of immigrants with psychotic disorders was markedly increased in the later cohort. The intention of the new legislation to minimize forensic psychiatric treatment was thus counteracted by an unexpected increase in number of offenders with psychotic disorders. To what extent these findings are ascribable to factors other than the new legislation, such as reduced inpatient treatment facilities and generally decreased economic growth rate that coincided with the observation period, cannot be estimated in a limited study population such as ours.