New research from a team of Finnish psychiatrists has shown that at the same time criminal offenders in Finland are receiving fewer mental health assessments, the number of prisoners in Finland's correctional institutes diagnosed with psychotic or schizophrenic disorders has increased ten-fold.
Thirty years ago in Finland, between 200 and 300 mental health assessments were carried out on suspected lawbreakers each year. In 2017, this number fell to the lowest it has been in years: 73. Most of the criminals that were evaluated last year were suspected of either committing homicides or a violent crime.
Alo Jüriloo, chief physician at the Vantaa psychiatric prison hospital is worried about the development.
"It easily leads to people just looking through their fingers at offenders who need psychiatric care and not a prison sentence," he says.
Mental health assessments examine the suspected offender's health with numerous studies of their physical, psychological and social situations and a detailed analysis of their life story. It normally takes two months to carry out the testing, at a cost of about 20,000 euros.
Jüriloo says Finland's system for assessing the state of people's mental health is among the most comprehensive and expensive evaluations in the world.
In recent years, assessments have determined that about 30 individuals were of unsound mind and therefore unable to understand the ramifications of their criminal actions. The number of psychiatric evaluations that reach this finding among criminals has steadily increased in Finland.
Severe mental illnesses on the rise
Research from Jüriloo and his team has determined that the number of prisoners in Finland with either psychotic or schizophrenic illnesses has risen ten times over in the last decade. The results were recently published in the Nordic Journal of Psychiatry.
In 2017, there were 160 prisoners in Finland with a psychotic disorder and 84 that were diagnosed with schizophrenia. This number is ten times what it was just over ten years ago, in 2006.
Hannu Lauerma, chief physician of Turku's psychiatric prison, says he has calculated that the number of prison sentences that have been suspended for psychiatric reasons has also doubled in Finland. In the last few years, there have been four or five of such cases annually.
The number of criminals serving time in Finland's prisons has fallen slightly in recent years. In 2017, there were about 3,000 inmates in 26 prison establishments or institutions.
Average prison sentences for inmates that are later diagnosed with psychotic disorders are notably long.
"This begs the question of if they are in the right place to begin with. Maybe a mental health assessment before the sentence would have been a better idea," says Jüriloo.
Further studies are being conducted into the rise in psychotic prisoners in Finland, and results are expected before the year is out. The National Institute for Health and Welfare (THL) is starting up an investigation into the new findings in the autumn.
Faults in the system
Jüriloo says one reason for the growth in psychotic disorders is increasing substance abuse. His research found that this was the case with only 39.5 percent of prisoners, however. He blames failures in the nation's psychiatric services for another share of the problem.
"Patients in prison's psychiatric care are not just criminals, they are also victims of an insufficient care system," he states.
Finland has systematically taken steps to cut psychiatric care to thousands of needy people in the last few decades. The number of beds in care facilities has dramatically decreased, as the country has tried to move towards a more outpatient-oriented care paradigm.
Jüriloo says the mechanisms for determining who receives outpatient care in Finland are wanting.
"We can't have a situation in which people are only getting the care they need in prison. I hear our patients saying it every once in a while."
Just a few years ago, suspected criminals in Finland often requested a mental health assessment in the hopes that it would lower their sentence. Since then, things have been inverted: people diagnosed with mental health disorders end up being confined for a longer period, which leads many to hide their mental health history.
"That way they avoid psychiatric hospitalization, which can be much longer than a possible prison sentence. According to THL data, typical treatment periods for voluntary or involuntary psychiatric care handed down by the courts can continue for 7 to 9 years."