Basic Principles for Accountability:
From 1929 the absolute biological (medical) principle has been ruling in the General civil penal code. Section 44 says that an offender who at the time of the crime was either psychotic, unconscious or severe mentally retarded is forensically irresponsible. He/she will either have to be released or, on particular condition, given a sort of compulsory mental health. However, between 1902 -1929 the psychological principle was practiced, meaning that there should be causality between the crime and the psychotic ideation before the offender is to be set free. In medieval time the “district penal legislation” guaranteed that an insane person could not be given an ordinary sentence for his or her crime. The biological principle has recently been criticized, mainly by representatives from the court of justice and by influential prosecutors, increasingly also by psychiatrists.
The Provision of Forensic Psychiatric Services in Norway
The forensic psychiatric work is in all individual cases almost exclusively done by two private psychiatrists (sometimes one psychiatrist together with one private psychologists), appointed by the court on an ad hoc-basis. Annually Norwegian forensic psychiatrists produce some 250 - 400 forensic reports (2008: 350). There are no public institutions (hospital or clinic) which are established for the purpose, or obliged to provide forensic psychiatric services upon a decision made by a court of justice. In special occasions, a hospital can decide whether or not to receive a criminal offender in order to carry out forensic examinations and evaluations, after a court decision. At the moment, there are no concrete plans for financing and establishing public forensic institutions for these purposes, but the need for it is under evaluation, and a project for its planning is probably in its very beginning.
Forensic Psychiatrists/Psychologists – Education and Training:
So far there has been no formal demand on training or education for psychiatrist or psychologists doing forensic psychiatric work. The recruiting of specialists within this field seems to be accidental. For some years specialists that take an interest in forensic psychiatry have been offered some training courses, on a voluntary basis. Recently a group within the three Centres for forensic psychiatry (Oslo, Bergen and Trondheim) has started to prepare for the development of an education that in the longer term will form the basic for the creation of a professional expertise group of forensic psychiatrists and psychologists, who have all passed these required courses.
The Norwegian Medical Forensic Board (MFB):
This public service reports to the Ministry of Justice and was founded in 1900. Very soon it was extended to include forensic psychiatry. It controls all the forensic reports, sees to that the two specialists have done the examination and evaluation thoroughly, and that there are reasonable connections between description of symptoms and conclusions regarding accountability and other main topics. No Norwegian court of law will accept any forensic report as a foundation of its verdict, unless it is accepted by the MFB. The position of the MFB within the forensic field is rather strong, and it is reasonable to state that in the lack of formal forensic institutions, the MFB has played an essential role in developing a good culture for what is the “gold standard” within forensic psychiatry.
The Concept of Forensic Psychiatry in Norway
Being mainly a service of giving expert opinion to the court, the concept of forensic psychiatry in Norway has traditionally been a narrow one, compared to what is seen in most western European countries. Norwegian forensic psychiatry is traditionally an activity restricted to present to the court an opinion of expert before and under the trial, and has so far not included the management of ordinary security wards or the psychiatric services given to the prisoners. The old “criminal asylum” Reitgjerdet was closed down in the early 1980’s and replaced by three regional security departments (RSA) in Oslo, Bergen and Trondheim, and smaller local units in almost all counties. The two levels are supposed to share the public task of giving adequate treatment for those who combine severe mental illnesses with a potential of violent or dangerous behaviour. The patients are referred to the hospital partly from the ordinary psychiatric services, partly as a consequence of a court decision or a verdict of cumpulsory mental health care. The health authorities have stated some distinct goals for increased capacity as well as improved professional competence in the security wards, but the number of bed are strikingly reduced. All security wards are managed as part of the health system, controlled by the Ministry of Health. The general health services for prisoners are given within the prison by the local community, whilst the psychiatric services come from the local psychiatric hospital. During severe mental brake downs the prisoners will be transferred to the local psychiatric hospital and thereafter returned to the prison.
“Particular Reactions” Linked to Reduced/Lost Accountability or Severe Personality Disorders:
In 2002 a new legislation divided the mentally disturbed that commit severe crimes (violence, murder, rapes, arson etc.) in to three categories: Those who at the time of the crime were psychotic or “unconscious”, those who are severe mentally retarded, and those who have severe conduct disorders or personality disorders. If deemed necessary for the protection of society, these groups are likely to receive the following verdicts: The first group will regularly be transferred to a psychiatric hospital for compulsory mental health care. The second group will be transferred for examination and evaluation to a central expert unit, established for the purpose, and further on transferred to his or her local community, taken care of by means of special measures. For the third group a sentence of preventive detention in an institution under the correctional services will be imposed. For all groups the sentence can be continued by a court decision, in case there have been no real progress and there is a danger that a crime of the same kind can be repeated.
Lately, there has been some pressure from the political and public opinion that compulsory mental health care should be imposed as a “particular reaction”, even on those psychotic (unaccountable) offenders that are doing economic crimes or are behaving just annoyingly. The Ministry of Justice considers at the moment a new legislation for this purpose, but many instances and professionals have warned against it. There are reasons to believe that the annoying behaviour at stake results from the fact that a lot of mentally ill people are not sufficiently taken care of within the psychiatric services, mainly due to incomplete capacity in the wards designed especially for this group of patients. From this point of view, the prevailing legislation is robust enough to solve the problems without an extension of the “particular reactions” as described.
Standard of Academy and Research:
Compared to ordinary psychiatric services, the academy of Norwegian forensic psychiatry doesn’t have a strong position. Traditionally the academic “needs” have been taken care of by scientific staff within the general psychiatry. “Clinical” research within forensic psychiatry has been sparse, but is now increasing. There are expectations that the three regional Centres for security, prison and forensic psychiatry (Oslo, Bergen and Trondheim) will boost research within forensic psychiatry and pave the way for a new academic development. For this purpose the three centres should be even more closely linked to the Faculty of Medicine at the three universities than they are today.
Current Norwegian Ideological and Political Debate on compulsory mental health care:
There are allegations that Norwegian psychiatric services employ too much of compulsory mental health care, by admitting patients to the hospital by force “when not necessary”, as well as putting too much restraints on them during their stay in the hospital. The country has a fairly well developed data basis for analysis of what is going on within the services. Yet the legislation and the health care systems differ a lot between the countries, even between the Nordic ones. Direct comparison between them is for that reason rather difficult or risky, and it is hard to say whether or not the allegations are correct. In the media there has been for some five - ten years a rather importunate debate on this topic, with a strong ideological conviction that the opportunity to employ force or compulsory measures should to be substantially reduced. To some extent the professionals within the psychiatric services regard the health authorities as being absent from the debate scene, thus giving legitimacy to the forming idea that a lot of psychiatric patients are badly treated victims.
Yngve Ystad, senior consultant, specialist in psychiatri
Leader of the Working Committee on Forensic Psychiatry,
under the Board of The Norwegian Psychiatric Association