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Överlämnande till rättspsykiatrisk vård samt den särskilda utskrivningsprövningen - Krav på rättssäkerhet, förutsebarhet och humanitet

Levin, Åsa LU (2011) JURM01 20111
Department of Law
Abstract (Swedish)
Uppsatsens övergripande syfte är att utreda under vilka förutsättningar en domstol kan överlämna en psykiskt störd lagöverträdare till påföljden rättspsykiatrisk vård. Det är mycket omdiskuterat och ifrågasatt huruvida den rättspsykiatriska vården, i synnerhet den särskilda utskrivningsprövningen, är rättssäker och human för den enskilde.

Domstolen kan överlämna en gärningsman till rättspsykiatrisk vård om denne vid domstillfället lider av en allvarlig psykisk störning. Vidare måste tvångsvård bedömas som nödvändig med hänsyn till lagöverträdarens psykiska tillstånd och personliga förhållanden i övrigt. En helhetsbedömning ska därmed göras med beaktande av sysselsättning, bostadssituation, eventuellt missbruk och risk för återfall i... (More)
Uppsatsens övergripande syfte är att utreda under vilka förutsättningar en domstol kan överlämna en psykiskt störd lagöverträdare till påföljden rättspsykiatrisk vård. Det är mycket omdiskuterat och ifrågasatt huruvida den rättspsykiatriska vården, i synnerhet den särskilda utskrivningsprövningen, är rättssäker och human för den enskilde.

Domstolen kan överlämna en gärningsman till rättspsykiatrisk vård om denne vid domstillfället lider av en allvarlig psykisk störning. Vidare måste tvångsvård bedömas som nödvändig med hänsyn till lagöverträdarens psykiska tillstånd och personliga förhållanden i övrigt. En helhetsbedömning ska därmed göras med beaktande av sysselsättning, bostadssituation, eventuellt missbruk och risk för återfall i brottslighet. En rättspsykiatrisk undersökning genomförs för att utreda dessa frågor och utlåtandet som följer fungerar som beslutsunderlag för domstolen. Anser domstolen att det finns en betydande återfallsrisk i allvarlig brottslighet kan vården kombineras med särskild utskrivningsprövning. Frågan om vårdens upphörande, det vill säga om en person kan skrivas ut eller inte, prövas då av förvaltningsrätten. Förvaltningsrättens beslut grundas delvis på en riskbedömning gällande framtida brottslighet som genomförs på vårdenheten. Målet med riskbedömningen är att kartlägga eventuella riskfaktorer, exempelvis dålig behandlingsbarhet och brist på motivation. De riskbedömningar som genomförs är tämligen osäkra. Våldshandlingar kan enbart korrekt förutses i ca 75 % av fallen. Detta innebär att ungefär vart fjärde fall felbedöms. Därmed ställs två intressen mot varandra; samhällets rätt att skydda sig mot farliga medborgare och kravet på rättssäkerhet för den enskilde.

Den har ifrågasatts huruvida den särskilda utskrivningsprövningen är etisk och human för den enskilde. En patient kan sakna medicinskt behov av tvångsvård men ändå nekas utskrivning, på grund av att det finns en återfallsrisk i allvarlig brottslighet. Psykiatrin har i uppgift att såväl vårda som tillgodose samhällsskyddsaspekten vilket framförs som bekymmersamt. Vidare kan det strida mot läkaretik att vårda någon utan vårdbehov, vilket även Madriddeklarationen förbjuder.

Den rättspsykiatriska vården och den särskilda utskrivningsprövningen framstår inte som särskilt förutsägbar och rättssäker för den enskilde och en reform är behövlig. Psykansvarskommittén lade år 2002 fram ett förslag på en reform. Band annat föreslogs att den självständiga påföljden överlämnande till rättspsykiatrisk vård skulle avskaffas. Om rättspsykiatrisk vård upphävs, avskaffas även den särskilda utskrivningsprövningen och därmed möjligheten att tillgodose samhällsskyddsaspekten. För att även i framtiden kunna skydda samhället mot potentiellt farliga gärningsmän, föreslog Psykansvarskommittén ett införande av en tidsobestämd påföljd, en så kallad samhällsskyddsåtgärd. Åtgärden ska kunna tillämpas vid synnerlig grov brottslighet, då det finns en hög återfallsrisk och i de fall där övriga påföljder bedöms otillräckliga. Verkställigheten föreslogs exempelvis kunna ske inom sjukvården.

Psykansvarskommittén föreslog att en samhällsskyddsåtgärd skulle kunna tillämpas på två olika sätt, genom en primär eller en sekundär modell. Enligt den primära modellen, vilken Psykansvarskommittén förespråkade, fattas beslut om samhällsskyddsåtgärd redan vid domstillfället. Det framstår dock som tveksamt hur domstolen ska kunna avgöra om en person bör omfattas av åtgärden eller inte i detta tidiga skede. Om gärningsmannen vårdas och visar goda behandlingsresultat kan en återfallsrisk minimeras och därmed är en samhällsskyddsåtgärd inte nödvändig. Därför vore det bättre om den sekundära modellen tillämpades. Beslutet om samhällsskyddsåtgärd fattas då i ett senare skede, efter att personen vårdats eller verkställt en påföljd. Åtgärden skulle kunna verkställas inom ett särskilt institut där målet enbart är att minimera återfallsrisken, genom att exempelvis ordna sysselsättning för den enskilde. Genom denna lösning skiljs vårdbehovet och samhällsskyddet åt på ett tydligt sätt, till skillnad från nuvarande ordning. Ett antal reaktioner och kritik följde av förslaget om samhällsskyddsåtgärd, bland annat att förslaget innebär en renässans av interneringstanken.

Det är önskvärt, dock inte helt enkelt, att skapa en ordning som skyddar samhället mot farliga gärningsmän och samtidigt tillgodoser grundläggande rättssäkerhetskrav för den enskilde. (Less)
Abstract
The overall purpose of the thesis is to describe under which requisites a court can institute legal proceedings against a mentally disordered offender by handing him or her over to forensic psychiatric care. It is widely disputed and questioned how and if the forensic psychiatric care, especially the special review of remission, is safe from a legal point of view and humane for the individual.

The court can hand over an offender to forensic psychiatric care if the offender, at the time of the verdict, is suffering from a severe mental illness. In addition, compulsory mental care needs to be seen as necessary, considering the perpetrator’s psychological condition and personal relationships in general. The court needs to consider the... (More)
The overall purpose of the thesis is to describe under which requisites a court can institute legal proceedings against a mentally disordered offender by handing him or her over to forensic psychiatric care. It is widely disputed and questioned how and if the forensic psychiatric care, especially the special review of remission, is safe from a legal point of view and humane for the individual.

The court can hand over an offender to forensic psychiatric care if the offender, at the time of the verdict, is suffering from a severe mental illness. In addition, compulsory mental care needs to be seen as necessary, considering the perpetrator’s psychological condition and personal relationships in general. The court needs to consider the whole picture, including occupation, living, and possible substance abuse. The risk of future violence also needs to be taken into consideration. A forensic psychiatric examination is carried out in order to analyse these questions. The report from the psychiatric examination forms the verdict which the courts use when working and analysing cases.

If the court finds a high possibility of relapse into serious crime, the forensic psychiatric care might be combined with a special review of remission. In these circumstances, the question regarding discontinuance of the forensic psychiatric care, whether a person might be released from the care, is then decided by the Administrative court. The court’s decision is partially based upon a violence risk management regarding future crime. The risk management takes place where the offender is being treated. When instituting an inquiry regarding the risks, the goal is to outline possible risk factors such as poor treatability and lack of motivation. The inquiries carried out are rather unsure. Future violence and criminal acts can only be correctly expected in approximately 75% of the cases, 25% is not expected correctly. Here, two interests stand against each other; the society’s right of protection against dangerous citizens and the demand of safe legal action towards the individual.

The special review of remission has been questioned regarding ethical and humane aspects for the individual. A patient might not, from a medical point of view, need compulsory institutional care. However, the patient might still be denied discharge due to the risk of relapse into serious crime. The psychiatric care needs to pay attention to the patient and also meet the demands of safety for the society. This is being suggested as troublesome. Moreover, it might be in opposition to medical ethics; to care for someone who is in no need of care. The conduct might therefore be in conflict with The Declaration of Madrid, and therefore with international law.

The forensic psychiatric care and the special review of remission do not seem particularly human, predictable nor legally secure for the individual and a reform is needed. In 2002, a committee, Psykansvarskommittén, presented a reform proposal for forensic psychiatric care. One of their suggestions was to eliminate the penalty of handing over an offender to forensic psychiatric care.

If forensic psychiatric care is removed, the possibility to protect the society through the special review of remission is lost. Instead, the committee suggested introducing an indefinite time sanction, as a mean for future protection of the society against potentially dangerous criminals. This was supposed to be put into practice in three different cases; particularly serious crimes, when there is high risk of relapse and in cases where other sanctions is considered insufficient. The execution was proposed to take place within the health care system.

The committee suggested that this action could be applied in two different ways, through a primary or a secondary model. According to the primary model, which the committee advocated, a decision about the action is made as early as at the time of sentencing.

However, it seems doubtful that the court is able to determine whether the prosecuted should be covered by this action or not at this early stage. Also, if the offender is cared for and shows good results of treatment, a relapse risk is minimized and therefore the action is not needed. For that reason, it would be better if the secondary model is applied. According to that model, the decision of action takes place at a later stage, after the offender has received treatment or penalty has been enforced. The measure could be implemented within a specific institution where the goal is merely to minimize the risk of relapse, for example by arranging employment for the individual. This solution separates the need for care and the social protection in a distinct way, unlike the current practice.

Various reactions and criticism followed the committee’s proposal, as it among other things is considered a renaissance of the idea of internment. It is desirable, though not trivial, to create a system that protects society from dangerous offenders and simultaneously satisfies the fundamental security of life and property for the individual. (Less)
Please use this url to cite or link to this publication:
author
Levin, Åsa LU
supervisor
organization
alternative title
The forensic psychiatric care and the special review of remission - Demands regarding rules of law, predictability and humanity
course
JURM01 20111
year
type
H3 - Professional qualifications (4 Years - )
subject
keywords
straffrätt, överlämnande till rättspsykiatrisk vård, särskild utskrivningsprövning
language
Swedish
id
1973822
date added to LUP
2011-06-03 10:46:06
date last changed
2011-06-03 10:46:06
@misc{1973822,
  abstract     = {The overall purpose of the thesis is to describe under which requisites a court can institute legal proceedings against a mentally disordered offender by handing him or her over to forensic psychiatric care. It is widely disputed and questioned how and if the forensic psychiatric care, especially the special review of remission, is safe from a legal point of view and humane for the individual. 

The court can hand over an offender to forensic psychiatric care if the offender, at the time of the verdict, is suffering from a severe mental illness. In addition, compulsory mental care needs to be seen as necessary, considering the perpetrator’s psychological condition and personal relationships in general. The court needs to consider the whole picture, including occupation, living, and possible substance abuse. The risk of future violence also needs to be taken into consideration. A forensic psychiatric examination is carried out in order to analyse these questions. The report from the psychiatric examination forms the verdict which the courts use when working and analysing cases.  

If the court finds a high possibility of relapse into serious crime, the forensic psychiatric care might be combined with a special review of remission. In these circumstances, the question regarding discontinuance of the forensic psychiatric care, whether a person might be released from the care, is then decided by the Administrative court. The court’s decision is partially based upon a violence risk management regarding future crime. The risk management takes place where the offender is being treated. When instituting an inquiry regarding the risks, the goal is to outline possible risk factors such as poor treatability and lack of motivation. The inquiries carried out are rather unsure. Future violence and criminal acts can only be correctly expected in approximately 75% of the cases, 25% is not expected correctly. Here, two interests stand against each other; the society’s right of protection against dangerous citizens and the demand of safe legal action towards the individual. 

The special review of remission has been questioned regarding ethical and humane aspects for the individual. A patient might not, from a medical point of view, need compulsory institutional care. However, the patient might still be denied discharge due to the risk of relapse into serious crime. The psychiatric care needs to pay attention to the patient and also meet the demands of safety for the society. This is being suggested as troublesome. Moreover, it might be in opposition to medical ethics; to care for someone who is in no need of care. The conduct might therefore be in conflict with The Declaration of Madrid, and therefore with international law. 

The forensic psychiatric care and the special review of remission do not seem particularly human, predictable nor legally secure for the individual and a reform is needed. In 2002, a committee, Psykansvarskommittén, presented a reform proposal for forensic psychiatric care. One of their suggestions was to eliminate the penalty of handing over an offender to forensic psychiatric care.

If forensic psychiatric care is removed, the possibility to protect the society through the special review of remission is lost. Instead, the committee suggested introducing an indefinite time sanction, as a mean for future protection of the society against potentially dangerous criminals. This was supposed to be put into practice in three different cases; particularly serious crimes, when there is high risk of relapse and in cases where other sanctions is considered insufficient. The execution was proposed to take place within the health care system.

The committee suggested that this action could be applied in two different ways, through a primary or a secondary model. According to the primary model, which the committee advocated, a decision about the action is made as early as at the time of sentencing.

However, it seems doubtful that the court is able to determine whether the prosecuted should be covered by this action or not at this early stage. Also, if the offender is cared for and shows good results of treatment, a relapse risk is minimized and therefore the action is not needed. For that reason, it would be better if the secondary model is applied. According to that model, the decision of action takes place at a later stage, after the offender has received treatment or penalty has been enforced. The measure could be implemented within a specific institution where the goal is merely to minimize the risk of relapse, for example by arranging employment for the individual. This solution separates the need for care and the social protection in a distinct way, unlike the current practice.

Various reactions and criticism followed the committee’s proposal, as it among other things is considered a renaissance of the idea of internment. It is desirable, though not trivial, to create a system that protects society from dangerous offenders and simultaneously satisfies the fundamental security of life and property for the individual.},
  author       = {Levin, Åsa},
  keyword      = {straffrätt,överlämnande till rättspsykiatrisk vård,särskild utskrivningsprövning},
  language     = {swe},
  note         = {Student Paper},
  title        = {Överlämnande till rättspsykiatrisk vård samt den särskilda utskrivningsprövningen - Krav på rättssäkerhet, förutsebarhet och humanitet},
  year         = {2011},
}