Care times longer than previously known

Text: Annika Lund, for the magazine Medicinsk Vetenskap nr 3 2023 / Spotlight on forensic psychiatric care

The average treatment time for a person who has been discharged from forensic psychiatry is five years, or 60 months. This figure is often communicated in discussions on forensic psychiatry and it is accurate, says Lenka Sivak, forensic psychiatrist and doctoral student at the Department of Neuroscience at Karolinska Institutet. 

However, it does not provide the answer that many people are looking for. 

"That figure doesn't answer the question as to how long the average care time is for the entire group that has been sentenced to care. Some people receive treatment for 30 years. They have not been factored into figures that only include those that have been discharged", she says. 

She has based her research on over 2,000 patients who were sentenced to forensic psychiatric care between 2009 and 2019. The care times have been estimated with use of a so called survival analysis, a method that is in cancer research, to name just a few areas. A group is then monitored over time from a special point in time, such as the time when a diagnosis is made. 

In this case, the researchers have measured the time between when a judgment has gained legal force and the time when half of the patients had been discharged. With this method of assessment, it turned out that the patients had been deprived of liberty for roughly 7.5 years on average, or 90 months. 

The psychotic disorder was linked to longer care times than, for example, affective disorders, such as severe depression. Substance abuse was also linked. 

The crime's level of severity also had an impact. Lethal violence was linked to the longest care times, followed by non-lethal violence. The shortest care time occurred for crimes that were not related to violence. 

An overall legal principle is that a sanction should be proportionate in relation to the crime - a more serious should result in a sanction that entails a more serious intervention. However, from a medical perspective, a person who had completed their treatment should not be kept in care. Although researchers feel that the way the punishment of forensic psychiatric care is currently designed, it creates is a collision between these ethical principles. 

"There is an ongoing societal debate on the treatment of mentally ill offenders. We are trying to build a scientific foundation for that debate, so that it is based on facts", says Lenka Sivak.