Mental disorder, substance misuse and violent behaviour: the Swedish experience of caring for the triply troubled

Abstract

Professional standards in psychiatry, especially concerning the care of people with the combined clinical presentation of psychiatric symptoms, substance misuse and violent behaviour - the 'triply troubled', have been subject to much criticism in Sweden. To present the current Swedish situation concerning treatment and care of 'the triply troubled' and to discuss future development. Analysis of official government documents and contemporary literature as a basis for a personal assessment of the current state of the art. Due to the work of a government task force, the National Psychiatric Services Commission, considerable improvements have been seen for treating substance-abusing mentally disordered people who are not aggressively or criminally inclined. This is less true for 'the triply troubled'. The 'triply troubled' should be given higher priority in mental health services and there is a salient need for more extensive professional training, service improvement, method development and overarching coordination and planning for these people.