Advanced

Otillräkneliga eller allvarligt psykiskt störda lagöverträdare - Vilka psykiskt störda lagöverträdare som bör särbehandlas, och framför allt hur

Wanhainen, Kristina LU (2011) JURM01 20102
Department of Law
Abstract (Swedish)
Psykiskt störda lagöverträdare har ofta inte samma förutsättningar som andra att följa lagen då de kan ha en annan föreställning av, eller en annan förmåga att resonera kring, verkligheten. Det är vår föreställning av verkligheten som ger oss skäl att göra eller att inte göra vissa saker, och vår uppfattning om vilka följder vårt handlande kommer att få, får betydelse för om vi företar handlingen eller inte. Har man en felaktig föreställning av verkligheten har man även felaktiga uppgifter på vilka man grundar sitt beslut om vad för slags handling man ska företa. Av denna anledning särbehandlas psykiskt störda lagöverträdare inom straffrätten.

I nästan alla med Sverige jämförbara rättsordningar sker denna särbehandling genom att man... (More)
Psykiskt störda lagöverträdare har ofta inte samma förutsättningar som andra att följa lagen då de kan ha en annan föreställning av, eller en annan förmåga att resonera kring, verkligheten. Det är vår föreställning av verkligheten som ger oss skäl att göra eller att inte göra vissa saker, och vår uppfattning om vilka följder vårt handlande kommer att få, får betydelse för om vi företar handlingen eller inte. Har man en felaktig föreställning av verkligheten har man även felaktiga uppgifter på vilka man grundar sitt beslut om vad för slags handling man ska företa. Av denna anledning särbehandlas psykiskt störda lagöverträdare inom straffrätten.

I nästan alla med Sverige jämförbara rättsordningar sker denna särbehandling genom att man har satt upp ett krav på tillräknelighet för att den tilltalade ska kunna ha ett straffrättsligt ansvar. Tillräknelighet är då ett mått på psykisk utveckling och mognad, och för att vara tillräknelig ska man veta vad man gör, och kunna kontrollera sitt handlande. Om en person t.ex. på grund av vanföreställningar inte förstår vad han gör, eller på grund av uppmanande rösthallucinationer inte kan anpassa sitt handlande trots att han förstår gärningens innebörd, är han enligt tillräknelighetsläran inte straffrättsligt ansvarig för sina gärningar, och kan därför inte (på samma sätt som om han hade saknat uppsåt) dömas för brott. Grunden för tillräknelighetsläran är att det är orättfärdigt att straffa någon som begått en gärning under påverkan av en psykisk störning, om gärningen då inte kan sägas vara ett utslag av gärningsmannens fria val och han därför inte rår för den.

I Sverige sker istället denna särbehandling i påföljdsledet och har fram till en lagändring 2008, haft en större krets av psykiskt störda som särbehandlas. Särbehandlingen sker genom att en otillräknelig (även om man inte använder det uttrycket) lagöverträdare inte får dömas till fängelse. Han blir dock inte frikänd utan döms till någon av de andra påföljderna. Den lagöverträdare som led av en allvarlig psykisk störning, men ändå var tillräknelig, får emellertid dömas till fängelse om det föreligger synnerliga skäl. Innan lagändringen fick domstolen inte döma någon som vid gärningstillfället led av en allvarlig psykisk störning till fängelse (förutsatt att det förelåg ett kausalsamband mellan störningen och gärningen). Allvarlig psykisk störning är ett juridiskt begrepp som innefattar flera olika psykiatriska diagnoser beroende på art och grad, och innebär en vidare krets av psykiska störningar än vad tillräknelighetsbegreppet gör. Anledningen till detta är förmodligen att begreppet även avgränsar vilka som ska kunna dömas till rättspsykiatrisk vård samt vilka som kan tvångsvårdas i enlighet med LPT (Lagen (1991:1128) om psykiatrisk tvångsvård).

Anledningen till att vi har denna unika reglering med ett fängelseförbud istället för en tillräknelighetsreglering är att vi i Sverige avskaffade tillräknelighet som brottsförutsättning i och med införandet av Brottsbalken. Skälet till detta var att man ansåg att frågor om ansvar och skuld var föråldrade och metafysiska och att de därför inte skulle förhindra att en lämplig påföljd skulle dömas ut. Dock verkar fängelseförbudet i sig vara en rest av tillräknelighetsläran, då det krävs ett kausalsamband mellan gärningsmannens psykiska störning och gärningen för att domstolen ska förhindras att döma till fängelse. Hade fängelseförbudet handlat om att fängelse inte är en lämplig påföljd för den som är psykiskt störd, så hade det rimligtvis varit gärningsmannens psykiska tillstånd vid tiden för domen som hade varit relevant.

Syftet med detta arbete var att utreda hur psykiskt störda lagöverträdare bör särbehandlas i straffrätten; om en tillräknelighetsreglering, eller en reglering så som den svenska med ett fängelseförbud, vore att föredra. För att exemplifiera de båda möjligheterna använde jag mig av svensk rätt, både före och efter lagändringen 2008, och Psykansvarskommitténs förslag om en tillräknelighetsreglering.

Den svenska regleringen med fängelseförbudet i BrB 30 kap. 6 §, har lett till ett flertal problem. En del av dessa problem, som berodde just på fängelseförbudet, löstes dock genom reformen 2008. Andra problem med den svenska regleringen rör samhällsskyddet. Om någon som bedöms som farlig t.ex. har begått ett grovt brott mot någons liv eller hälsa, men inte kan dömas på grund av att hans psykiska störning har uteslutit uppsåt, har vi i svensk rätt ingen möjlighet att ta hand om honom med hänsyn till samhällsskyddet. Detta tros vara en av anledningarna till varför vi har problem med domstolar som lite väl lätt anser att uppsåtsrekvisitet är uppfyllt gällande psykiskt störda lagöverträdare. En annan orsak till detta tros vara att domstolen vill försäkra sig om att den tilltalade får psykiatrisk vård, genom att döma honom till rättspsykiatrisk vård. Samhällsskyddet beaktas genom att domstolen dömer den tilltalade till rättspsykiatrisk vård med särskild utskrivningsprövning. Detta innebär nämligen att det är en förvaltningsdomstol, och inte en läkare, som bestämmer när den intagne ska bli utskriven. På så sätt slipper man problemet med dömda som blir utskrivna för tidigt, men det medför dock etiska konflikter i vården, då läkare kan tvingas vårda intagna som inte är sjuka på grund av att domstolen finner att det fortfarande föreligger en återfallsrisk.

De som blir dömda till rättspsykiatrisk vård får i alla fall den vård de behöver, vilket man tyvärr inte kan säga om dem som döms till fängelse. En stor andel av de fängelsedömda lider av någon form av psykisk störning, och även om deras störning inte räknas som allvarlig psykisk störning (vilket är ett krav för påföljden rättspsykiatrisk vård), så kan de ha ett lika stort vårdbehov ändå. Meningen är att de ska få vård även i fängelse, men i praktiken fallerar det. Detta gäller även de psykiskt utvecklingsstörda lagöverträdarna som döms till fängelse, vilket, som borde vara uppenbart för alla, är mycket olämpligt.

Fördelen med en fängelsedom är att man då i alla fall vet hur länge man ska straffas, och får ett straff som är proportionellt i förhållande till brottet. Rättspsykiatrisk vård är en tidsobestämd påföljd, den dömde vårdas helt enkelt tills han är frisk (eller till dess att domstolen inte tycker att han är farlig längre), vilket kan betyda att han får sitta frihetsberövad förhållandevis länge även vid mindre allvarlig brottslighet.

Ett annat problem med den svenska regleringen utgör det faktum att Sverige mer eller mindre är ensamt i världen om en straffrättslig reglering utan ett tillräknelighetskrav. Detta skulle nämligen kunna försvåra ett internationellt samarbete på straffrättens område.

Slutligen kan man även se det faktum att alla, även de som är psykotiska och så att säga befinner sig i en annan värld, är straffrättsligt ansvariga, som ett problem. Men det är bara om man anser att begrepp som skuld och ansvar fortfarande betyder något.

Alla dessa problem hade lösts med Psykansvarskommitténs förslag om utformandet av tillräknelighetsreglering. De hade tänkt sig ett system där straffrättslig ansvarsfrihet skulle föreligga om gärningsmannen till följd av en allvarlig psykisk störning, en tillfällig sinnesförvirring, en svår utvecklingsstörning eller ett allvarligt demenstillstånd har saknat förmåga att inse gärningens innebörd eller att anpassa sitt handlande efter en sådan insikt. På detta sätt hade de som inte kunnat klandras för sitt brott, inte heller dömts för det.

De allmänna reglerna om straffmätning och påföljdsval skulle i högre grad styra och sätta upp ramarna för straffrättsligt ingripande vid tillräkneliga gärningsmän. Den psykiska störningen skulle inte påverka valet av påföljd, men hur påföljden verkställs. En psykisk störning skulle alltså inte vara ett hinder för att döma till fängelse, och ett fängelsestraff skulle inte vara ett hinder för att få erforderlig psykiatrisk vård. Alltså ville man avskaffa både rättspsykiatrisk vård såsom självständig påföljd och fängelseförbudet.

Samhällsskyddet skulle beaktas genom tidsobestämda samhällsskyddsåtgärder till vilken man kunde döma både tillräkneliga och otillräkneliga, farliga lagöverträdare. Dessa samhällskyddsåtgärder skulle vara en reaktion som domstolen kunde använda sig av i de fall då ett väsentligt samhällsskydd inte kan tillgodoses genom straff och andra åtgärder, och verkställigheten skulle anpassas efter den dömdes egna förutsättningar och behov.

Genom avskaffandet av fängelseförbudet och den rättspsykiatriska vården samt införandet av samhällsskyddsåtgärder hade man renodlat systemet så att intressekonflikter mellan vård- samhällsskydds- och straffrättsliga frågor kunde undvikas eller i alla fall tydligaregöras. På detta sätt hade man förmodligen löst problemen med domstolarnas extensiva uppsåtsbedömningar, och då samhällsskyddet kunde tillgodoses utan rättspsykiatrisk vård, torde läkarnas etiska dilemman försvinna.
Straffen skulle bli proportionella till brotten oavsett om den dömde led av en psykisk störning eller inte, eftersom vården skulle vara en verkställighetsform av fängelsestraffet, inte en tidsobestämd påföljd.

En ny verkställighetsform, slutet boende, skulle även införas för psykiskt funktionshindrade lagöverträdare. Det skulle utformas som ett särskilt gruppboende för dömda, med få intagna och personal med särskilda kunskaper om psykiskt funktionshindrade.

Psykansvarskommittén konstaterade att fängelsedömda redan idag hade rätt till vård, men då de inte får det, ville de förtydliga i KvaL (Lagen (1974:203) om kriminalvård i anstalt) att deras rätt till psykiatrisk vård skulle uppmärksammas, samt genomföra vissa ekonomiska och organisatoriska förändringar i ett försök att lösa problemen med den rättspsykiatriska vården.

Det var ett bra förslag överlag och det är en reglering som tilltalar mig, men jag har några betänkligheter angående förslaget. Jag skulle bland annat förespråka dels en inskränkning och dels en utvidgning av tillräknelighetsrekvisitet. Inskränkningen skulle ske genom att man inför ett krav på att den bristande insikten ska gälla huruvida gärningen var moraliskt rätt eller fel. Utvidgningen skulle ske genom införandet av ett tredje effektrekvisit som skulle innebära att även den som saknade förmåga att inse att en gärning är moraliskt fel (trots att han förstår gärningens deskriptiva innebörd) är otillräknelig. Detta skulle nämligen utgöra en rimligare gräns för ansvarsfrihet, då detta, i alla fall enligt mig, utgör gränsen för vilka man moraliskt kan klandra för sina gärningar.

Den svåraste frågan rör samhällsskyddsåtgärderna. Ett införande av samhällsskyddsåtgärder ter sig mer eller mindre ofrånkomligt, särskilt om man skulle utvidga tillräknelighetsrekvisitet så som jag anser, då flera farliga återfallsförbrytare skulle anses otillräkneliga och därmed inte kunnat dömas till fängelse. Men i vilken utsträckning och på vilket beslutsunderlag har staten rätt att frihetsberöva någon i (i alla fall delvis) förebyggande syfte? Psykansvarskommitténs samhällsskyddsåtgärder är tidsobestämda, och de metoder man använder för riskbedömningar idag är osäkra på individnivå. Samhällsskyddsåtgärderna ska dock användas restriktivt, och beslutet ska omprövas kontinuerligt. Dessutom har vi redan en tidsobestämd samhällskyddsåtgärd i svensk rätt, som kallas rättspsykiatrisk vård med särskild utskrivningsprövning, så Psykansvarskommitténs förslag är i alla fall inte sämre i den frågan.

Jag tycker att begrepp som ansvar och skuld är viktiga, och då en tillräknelighetsreglering uppenbarligen också kan innebära lämpliga påföljder, vilket innebär att man med en tillräknelighetsreglering både kan äta kakan och ha den kvar, anser jag att en tillräknelighetsreglering vore att föredra. Detta är jag inte ensam om, även regeringen förespråkar ett system där tillräknelighet är en brottsförutsättning. De har därför tillsatt en (till) utredning, Psykiatrilagsutredningen, som när de utreder hur framtidens lagstiftning rörande psykiskt störda lagöverträdare ska se ut, ska utgå från att en större reform med utgångspunkt i Psykansvarskommitténs förslag kommer att genomföras. Nu hoppas jag bara att man efter femton års utredande, som varje gång utmynnat i att ett återinförande av tillräknelighetsläran vore att föredra, slutligen, när Psykiatrilagsutredningen redovisar sitt förslag i december 2011, beslutar sig för att sluta utreda och börja införa ett system där tillräknelighet är en förutsättning för straffrättsligt ansvar. (Less)
Abstract
Mentally disordered offenders often do not have the same preconditions as others to follow the law as they may have a different perception of, or a different ability to reason about, reality. It is our perception of reality that gives us reason to do or not do certain things, and our perception of the consequences our actions will have has an impact on whether we undertake them or not. If you have a false perception of reality you also have inaccurate data on which you base your decisions regarding what kind of action you should undertake. For this reason, mentally disordered offenders are given special treatment in penal law.

In almost all of the legal systems comparable with Sweden’s this special treatment of mentally disordered... (More)
Mentally disordered offenders often do not have the same preconditions as others to follow the law as they may have a different perception of, or a different ability to reason about, reality. It is our perception of reality that gives us reason to do or not do certain things, and our perception of the consequences our actions will have has an impact on whether we undertake them or not. If you have a false perception of reality you also have inaccurate data on which you base your decisions regarding what kind of action you should undertake. For this reason, mentally disordered offenders are given special treatment in penal law.

In almost all of the legal systems comparable with Sweden’s this special treatment of mentally disordered offenders is made by accountability or capacity for liability as a prerequisite for criminal liability. Accountability (or capacity for liability) is a measure of mental development and maturity, and to be accountable you should understand what you are doing, and be able to control your actions. For example, if a person does not understand the meaning of his act because of delusions, or if he because of admonishing voice hallucinations can not adjust his actions even though he understands the character of the offense, he is according to the accountability doctrine not criminally liable for his actions, and therefore can not (in the same manner as if he lacked intent) be convicted of a crime. The basis of the accountability doctrine is that it is unjust to punish anyone who committed an offense under the influence of a mental disorder, if the act can not be said to be a manifestation of the offender's freedom of choice and he therefore can not be blamed for it.

In Sweden, this special treatment is made during the selection of sanctions instead and had, until the legislative amendment in 2008, a larger group of mentally disordered that were given special treatment. The special treatment consists of a prohibition against sentencing offenders who aren’t accountable to imprisonment. He is not acquitted, but convicted to one of the other sanctions. The offenders who committed the crime under the influence of a serious mental disorder (“allvarlig psykisk störning”), but still was accountable, may be imprisoned if there are extraordinary reasons (“synnerliga skäl”). Before the legislative amendment the court was prohibited to sentence anyone who at the time of the criminal act suffered from a serious mental disorder to imprisonment (if there were a causal connection between the mental disorder and the criminal act). Serious mental disorder (“Allvarlig psykisk störning”) is a legal term that includes several different psychiatric diagnoses depending on the kind and degree of the disorder, and involves a broader range of mental disorders than the accountability concept does. The reason for this is probably that the term also defines who can be sentenced to forensic psychiatric care and who could be submitted to compulsory mental care under the Compulsory Mental Care Act (Lagen (1991:1128) om psykiatrisk tvångsvård).

The reason we have this unique regulation with an “imprisonment prohibition” instead of an accountability legislation is that Sweden abolished the accountability legislation through the introduction of the Swedish Penal Code (Brottsbalken). The reason for this was that the legislator considered issues of responsibility and guilt outdated and metaphysical and that they therefore should not prevent an appropriate sanction to be imposed. However, it seems like the imprisonment prohibition in itself is a remnant of the accountability doctrine, since it requires a causal connection between the offender's mental disorder and the criminal act for the Court to be prohibited to sentence the offender to imprisonment. Had the prohibition been about imprisonment not being an appropriate sanction for those who are mentally disordered, it would reasonably have been the perpetrator's mental state at the time of the judgement which would have been relevant.

The purpose of this thesis was to investigate in which way we should give mentally disordered offenders a special treatment in penal law; if an accountability legislation or a system like the one we have in Sweden, with the imprisonment prohibition, would be preferable.

To exemplify the two possibilities I used Swedish law, both before and after the legislative amendment in 2008, and the report of Psykansvarskommittén (a commission of inquiry, translated “Mental Liability Commission”) which proposes an accountability legislation.

The Swedish legal system, with the imprisonment prohibition in Chapter 30, section 6 of the Penal Code (BrB 30:6), has led to numerous problems. Some of these problems, which were due to the imprisonment prohibition, were solved by the reform 2008. Other problems with the Swedish legislation concerns public protection. If someone has committed a serious crime of violence, and is assessed as dangerous, but can not be convicted because of a lack of criminal intent due to his mental disorder, we have no possibilities in Swedish law to detain him with regard to public protection. This is believed to be one of the reasons why we have problems with courts that too readily considers that mentally disordered persons has committed the act with intent. Another reason for this is believed to be that the court wants to ensure that the defendant receive psychiatric care, through sentencing him to forensic psychiatric care. Public protection is considered through the sanction of “transfer to forensic psychiatric care combined with special review of remission” (“överlämnande till rättspsykiatrisk vård med särskild utskrivningsprövning”). This implies that there is an administrative court, and not a doctor, who decides when the inmate should be discharged. That way you avoid the problem of offenders who are discharged too early, but it poses ethical conflicts in health care, since doctors could be forced to treat inmates who aren’t sick because the court finds that there still is a risk of recidivism.

Those who are sentenced to forensic care at least get the care they need, which unfortunately cannot be said about those who are sentenced to imprisonment. A large proportion of those who have been sentenced to imprisonment have some form of mental disorder, and even if their disorder is not considered to be a serious mental disorder (“allvarlig psykisk störning”, which is a requirement for the sentencing to forensic psychiatric care), they may have as great a need for care anyway. It is intended that they should receive care in prison, but in practice it fails. This also applies to the mentally retarded offenders who are sentenced to imprisonment, which, as should be obvious to all, is very inappropriate.
The benefit of an imprisonment sentencing would be to at least know how long one should be punished, and receive a punishment that is proportional to the crime. Forensic psychiatric care is an indefinite-term sanction, the offender is simply treated until he is sane (or until the court does not think he's dangerous any more), which means that he may be in confinement relatively long even if having committed a less serious crime.
Another problem, as it may hamper international cooperation in criminal matters, is the fact that Sweden is more or less alone in having a criminal legislation without a requirement on accountability for criminal liability.
One could also see the fact that everyone, even those who are psychotic and so to speak reside in another world, is criminally liable as a problem. But that is only if one believes that concepts such as guilt and responsibility still mean something.
All these problems would have been resolved with the proposal of the Mental Liability Commission on the form of an accountability legislation. They had envisioned a system in which grounds for exclusion of liability would exist if the offender as a consequence of a serious mental disorder, a temporary mental derangement, a serious developmental impairment or a serious condition of dementia is incapable of understanding the meaning of his act or of adapting his act in accordance with such an understanding. In this way, those who could not been blamed for their crime, would not be convicted of it.
The general principles for determination of punishment and selection of sanctions would, to a greater extent than today, govern and determine the frameworks for the criminal law intervention concerning the accountable perpetrators. The mental disorder would not affect the choice of the sanction, but how they are enforced. In other words: A mental disorder would not be a barrier for sentencing to imprisonment, and an imprisonment sentencing would not be an obstacle for getting the necessary psychiatric treatment. For this reason they wanted to abolish both transfer to forensic psychiatric care as a special sanction and the imprisonment prohibition.
Public protection was to be taken into account through the indefinite-term public protection measures to which one could sentence mentally disordered, dangerous offenders, whether they are accountable or not . These public protection measures would be a sanction that the court could use in cases where a fundamental interest for public protection can not be satisfied by a penalty or other measures, and the enforcement of the public protection measures would be adapted to the offender's own abilities and needs.
With the abolition of the imprisonment prohibition and the forensic psychiatric care, and the introduction of public protection measures, the system would have been refined so that conflicts of interest between care issues, public protection issues and criminal law issues could be avoided or at least be made clearer. In this way, they probably would have solved the problems with the courts broad intent assessments, and since public protection could be met without forensic psychiatric care, physicians’ ethical dilemmas would go away.
Penalties would be proportionate to the crimes whether the offender was suffering from a mental disorder or not, because the care would be an enforcement form of imprisonment, not an indefinite-term sanction.
A new form of enforcement of imprisonment, closed housing (“slutet boende”), would also be introduced for the mentally retarded offenders. It would be designed as a closed group-housing for offenders, with few inmates and staff with specialized knowledge and skills regarding people with mental disabilities.
The Mental Liability Commission noted that prison inmates already have the right to psychiatric care, but since they do not get the care they need, the Mental Liability Commission wanted to emphasize further, in the Act on Correctional Treatment in Institution (Lagen (1974:203) om kriminalvård i anstalt), that the inmates right to psychiatric care would be put to attention. They also recommended certain financial and organizational changes in an attempt to solve the problems of the forensic psychiatric care.
The proposal of the Mental Liability Commission was good overall and it is a legislation that appeals to me, but I have some misgivings regarding the proposal. One thing I would advocate is partly a limitation and partly an extension of the accountability prerequisite. The limitation of the prerequisite would be done by requiring that the incapability of understanding the meaning of the act should apply to whether the act was morally right or wrong. The extension would be made through the introduction of a third effect prerequisite which would imply that someone who lacked the ability to recognize that an act is morally wrong (even though he understands the descriptive meaning of the act) is unaccountable. That would constitute a more reasonable limit on criminal liability, since this, at least in my opinion, represents the limit of who we morally can blame for their actions.
The most difficult issue is the public protection measures. The imposition of public protection measures seem more or less inevitable, especially if one were to extend the accountability prerequisite as I believe we should, since more dangerous repeat offenders would be considered unaccountable and therefore could not be sentenced to imprisonment (or any other sanction). But to what extent and on which grounds of decision, does the state have the right to detain any person in a (at least in part) preventive measure? The public protection measures in the report are an indefinite-term, and the techniques employed today for risk assessment are uncertain at an individual level. However, the public protection measures are meant to be used sparingly, and the decision is to be reviewed continuously. Moreover, as we already have an indefinite-term public protection measure in Swedish law, known as the sanction of “transfer to forensic psychiatric care combined with special review of remission”, the Mental Liability Commission’s proposal is at least not worse in this matter.
I do believe that concepts of responsibility and guilt are important, and since an accountability regulation apparently also can include appropriate sanctions, which means that with an accountability regulation you can both eat your cake and have it too, I believe that a system which requires accountability for criminal liability would be preferable. In this, I am not alone; also the government advocates a system where accountability is a prerequisite for criminal liability. They have therefore set up a commission of inquiry, Psykiatrilagsutredningen (“The Psychiatry Law Commission”) which, when they examine how future legislation concerning mentally disordered offenders should be, should assume that a major reform based on the report of the Mental Liability Commission will be implemented. Now I just hope that after fifteen years of investigation, which each time resulted in the notion that a reinstatement of the accountability doctrine would be preferable, that the government when the Psychiatry Law Commission presents its report in December 2011, decides to stop examining and begin introducing a system where accountability is a prerequisite for criminal liability. (Less)
Please use this url to cite or link to this publication:
author
Wanhainen, Kristina LU
supervisor
organization
alternative title
An Accountability Prerequisite or an Imprisonment Prohibition? - How mentally disordered offenders should be treated differently in penal law
course
JURM01 20102
year
type
H3 - Professional qualifications (4 Years - )
subject
keywords
Straffrätt, Tillräknelighet, Fängelseförbud, Psykisk störning
language
Swedish
id
1787189
date added to LUP
2011-03-04 15:34:27
date last changed
2011-03-04 15:34:27
@misc{1787189,
  abstract     = {Mentally disordered offenders often do not have the same preconditions as others to follow the law as they may have a different perception of, or a different ability to reason about, reality. It is our perception of reality that gives us reason to do or not do certain things, and our perception of the consequences our actions will have has an impact on whether we undertake them or not. If you have a false perception of reality you also have inaccurate data on which you base your decisions regarding what kind of action you should undertake. For this reason, mentally disordered offenders are given special treatment in penal law.

In almost all of the legal systems comparable with Sweden’s this special treatment of mentally disordered offenders is made by accountability or capacity for liability as a prerequisite for criminal liability. Accountability (or capacity for liability) is a measure of mental development and maturity, and to be accountable you should understand what you are doing, and be able to control your actions. For example, if a person does not understand the meaning of his act because of delusions, or if he because of admonishing voice hallucinations can not adjust his actions even though he understands the character of the offense, he is according to the accountability doctrine not criminally liable for his actions, and therefore can not (in the same manner as if he lacked intent) be convicted of a crime. The basis of the accountability doctrine is that it is unjust to punish anyone who committed an offense under the influence of a mental disorder, if the act can not be said to be a manifestation of the offender's freedom of choice and he therefore can not be blamed for it.

In Sweden, this special treatment is made during the selection of sanctions instead and had, until the legislative amendment in 2008, a larger group of mentally disordered that were given special treatment. The special treatment consists of a prohibition against sentencing offenders who aren’t accountable to imprisonment. He is not acquitted, but convicted to one of the other sanctions. The offenders who committed the crime under the influence of a serious mental disorder (“allvarlig psykisk störning”), but still was accountable, may be imprisoned if there are extraordinary reasons (“synnerliga skäl”). Before the legislative amendment the court was prohibited to sentence anyone who at the time of the criminal act suffered from a serious mental disorder to imprisonment (if there were a causal connection between the mental disorder and the criminal act). Serious mental disorder (“Allvarlig psykisk störning”) is a legal term that includes several different psychiatric diagnoses depending on the kind and degree of the disorder, and involves a broader range of mental disorders than the accountability concept does. The reason for this is probably that the term also defines who can be sentenced to forensic psychiatric care and who could be submitted to compulsory mental care under the Compulsory Mental Care Act (Lagen (1991:1128) om psykiatrisk tvångsvård).

The reason we have this unique regulation with an “imprisonment prohibition” instead of an accountability legislation is that Sweden abolished the accountability legislation through the introduction of the Swedish Penal Code (Brottsbalken). The reason for this was that the legislator considered issues of responsibility and guilt outdated and metaphysical and that they therefore should not prevent an appropriate sanction to be imposed. However, it seems like the imprisonment prohibition in itself is a remnant of the accountability doctrine, since it requires a causal connection between the offender's mental disorder and the criminal act for the Court to be prohibited to sentence the offender to imprisonment. Had the prohibition been about imprisonment not being an appropriate sanction for those who are mentally disordered, it would reasonably have been the perpetrator's mental state at the time of the judgement which would have been relevant.

The purpose of this thesis was to investigate in which way we should give mentally disordered offenders a special treatment in penal law; if an accountability legislation or a system like the one we have in Sweden, with the imprisonment prohibition, would be preferable.    

To exemplify the two possibilities I used Swedish law, both before and after the legislative amendment in 2008, and the report of Psykansvarskommittén (a commission of inquiry, translated “Mental Liability Commission”) which proposes an accountability legislation.

The Swedish legal system, with the imprisonment prohibition in Chapter 30, section 6 of the Penal Code (BrB 30:6), has led to numerous problems. Some of these problems, which were due to the imprisonment prohibition, were solved by the reform 2008. Other problems with the Swedish legislation concerns public protection. If someone has committed a serious crime of violence, and is assessed as dangerous, but can not be convicted because of a lack of criminal intent due to his mental disorder, we have no possibilities in Swedish law to detain him with regard to public protection. This is believed to be one of the reasons why we have problems with courts that too readily considers that mentally disordered persons has committed the act with intent. Another reason for this is believed to be that the court wants to ensure that the defendant receive psychiatric care, through sentencing him to forensic psychiatric care. Public protection is considered through the sanction of “transfer to forensic psychiatric care combined with special review of remission” (“överlämnande till rättspsykiatrisk vård med särskild utskrivningsprövning”). This implies that there is an administrative court, and not a doctor, who decides when the inmate should be discharged. That way you avoid the problem of offenders who are discharged too early, but it poses ethical conflicts in health care, since doctors could be forced to treat inmates who aren’t sick because the court finds that there still is a risk of recidivism. 

Those who are sentenced to forensic care at least get the care they need, which unfortunately cannot be said about those who are sentenced to imprisonment. A large proportion of those who have been sentenced to imprisonment have some form of mental disorder, and even if their disorder is not considered to be a serious mental disorder (“allvarlig psykisk störning”, which is a requirement for the sentencing to forensic psychiatric care), they may have as great a need for care anyway. It is intended that they should receive care in prison, but in practice it fails. This also applies to the mentally retarded offenders who are sentenced to imprisonment, which, as should be obvious to all, is very inappropriate. 
The benefit of an imprisonment sentencing would be to at least know how long one should be punished, and receive a punishment that is proportional to the crime. Forensic psychiatric care is an indefinite-term sanction, the offender is simply treated until he is sane (or until the court does not think he's dangerous any more), which means that he may be in confinement relatively long even if having committed a less serious crime. 
Another problem, as it may hamper international cooperation in criminal matters, is the fact that Sweden is more or less alone in having a criminal legislation without a requirement on accountability for criminal liability. 
One could also see the fact that everyone, even those who are psychotic and so to speak reside in another world, is criminally liable as a problem. But that is only if one believes that concepts such as guilt and responsibility still mean something. 
All these problems would have been resolved with the proposal of the Mental Liability Commission on the form of an accountability legislation. They had envisioned a system in which grounds for exclusion of liability would exist if the offender as a consequence of a serious mental disorder, a temporary mental derangement, a serious developmental impairment or a serious condition of dementia is incapable of understanding the meaning of his act or of adapting his act in accordance with such an understanding. In this way, those who could not been blamed for their crime, would not be convicted of it. 
The general principles for determination of punishment and selection of sanctions would, to a greater extent than today, govern and determine the frameworks for the criminal law intervention concerning the accountable perpetrators. The mental disorder would not affect the choice of the sanction, but how they are enforced. In other words: A mental disorder would not be a barrier for sentencing to imprisonment, and an imprisonment sentencing would not be an obstacle for getting the necessary psychiatric treatment. For this reason they wanted to abolish both transfer to forensic psychiatric care as a special sanction and the imprisonment prohibition. 
Public protection was to be taken into account through the indefinite-term public protection measures to which one could sentence mentally disordered, dangerous offenders, whether they are accountable or not . These public protection measures would be a sanction that the court could use in cases where a fundamental interest for public protection can not be satisfied by a penalty or other measures, and the enforcement of the public protection measures would be adapted to the offender's own abilities and needs. 
With the abolition of the imprisonment prohibition and the forensic psychiatric care, and the introduction of public protection measures, the system would have been refined so that conflicts of interest between care issues, public protection issues and criminal law issues could be avoided or at least be made clearer. In this way, they probably would have solved the problems with the courts broad intent assessments, and since public protection could be met without forensic psychiatric care, physicians’ ethical dilemmas would go away. 
Penalties would be proportionate to the crimes whether the offender was suffering from a mental disorder or not, because the care would be an enforcement form of imprisonment, not an indefinite-term sanction. 
A new form of enforcement of imprisonment, closed housing (“slutet boende”), would also be introduced for the mentally retarded offenders. It would be designed as a closed group-housing for offenders, with few inmates and staff with specialized knowledge and skills regarding people with mental disabilities. 
The Mental Liability Commission noted that prison inmates already have the right to psychiatric care, but since they do not get the care they need, the Mental Liability Commission wanted to emphasize further, in the Act on Correctional Treatment in Institution (Lagen (1974:203) om kriminalvård i anstalt), that the inmates right to psychiatric care would be put to attention. They also recommended certain financial and organizational changes in an attempt to solve the problems of the forensic psychiatric care. 
The proposal of the Mental Liability Commission was good overall and it is a legislation that appeals to me, but I have some misgivings regarding the proposal. One thing I would advocate is partly a limitation and partly an extension of the accountability prerequisite. The limitation of the prerequisite would be done by requiring that the incapability of understanding the meaning of the act should apply to whether the act was morally right or wrong. The extension would be made through the introduction of a third effect prerequisite which would imply that someone who lacked the ability to recognize that an act is morally wrong (even though he understands the descriptive meaning of the act) is unaccountable. That would constitute a more reasonable limit on criminal liability, since this, at least in my opinion, represents the limit of who we morally can blame for their actions. 
The most difficult issue is the public protection measures. The imposition of public protection measures seem more or less inevitable, especially if one were to extend the accountability prerequisite as I believe we should, since more dangerous repeat offenders would be considered unaccountable and therefore could not be sentenced to imprisonment (or any other sanction). But to what extent and on which grounds of decision, does the state have the right to detain any person in a (at least in part) preventive measure? The public protection measures in the report are an indefinite-term, and the techniques employed today for risk assessment are uncertain at an individual level. However, the public protection measures are meant to be used sparingly, and the decision is to be reviewed continuously. Moreover, as we already have an indefinite-term public protection measure in Swedish law, known as the sanction of “transfer to forensic psychiatric care combined with special review of remission”, the Mental Liability Commission’s proposal is at least not worse in this matter.   
I do believe that concepts of responsibility and guilt are important, and since an accountability regulation apparently also can include appropriate sanctions, which means that with an accountability regulation you can both eat your cake and have it too, I believe that a system which requires accountability for criminal liability would be preferable. In this, I am not alone; also the government advocates a system where accountability is a prerequisite for criminal liability. They have therefore set up a commission of inquiry, Psykiatrilagsutredningen (“The Psychiatry Law Commission”) which, when they examine how future legislation concerning mentally disordered offenders should be, should assume that a major reform based on the report of the Mental Liability Commission will be implemented. Now I just hope that after fifteen years of investigation, which each time resulted in the notion that a reinstatement of the accountability doctrine would be preferable, that the government when the Psychiatry Law Commission presents its report in December 2011, decides to stop examining and begin introducing a system where accountability is a prerequisite for criminal liability.},
  author       = {Wanhainen, Kristina},
  keyword      = {Straffrätt,Tillräknelighet,Fängelseförbud,Psykisk störning},
  language     = {swe},
  note         = {Student Paper},
  title        = {Otillräkneliga eller allvarligt psykiskt störda lagöverträdare - Vilka psykiskt störda lagöverträdare som bör särbehandlas, och framför allt hur},
  year         = {2011},
}