Conflicting Priorities Between Risk Management and Treatment of Schizophrenia in Swiss Forensic Services—A Case Report

Abstract

The Swiss Criminal Code provides measures for mentally-ill offenders focusing on their need for treatment. This may lead to the deprivation of the patient's liberty up to several years. Under certain circumstances the mentally-ill offender can be sentenced to an indefinite incarceration. This case presentation we will describe a forensic psychiatric patient diagnosed with schizophrenia who was ordered an indefinite incarceration in Switzerland after he had been sentenced to 8 years of imprisonment for a deliberate killing. Initial presentation of symptomatology included formal thought disorders and negative symptoms such as affective flattening and alogia. Due to a scarcity of adequate treatment sites in the 90s and lack of scope for risk assessment and management, the patient could only be treated within highly regiment prison environments in the past. There, the patient's treatment concept primarily focused on short-term psychiatric care instead of providing an adequate treatment plan that would have been essential for the patient's improvement of chronic symptoms. This case description aims to present some of the fundamental issues observed in the forensic mental health system, where strong efforts are made to balance risk management and the treatment of severe mental health disorders. We will put the patient's own course of treatment and his progress within the penal system into context with ethical challenges in the forensic and correctional services and will provide potential recommendations for future research in the field of forensic psychiatry.

Different needs in patients with schizophrenia spectrum disorders who behave aggressively towards others depend on gender: a latent class analysis approach

“…Similar to one study on offender patients with SMI in the Netherlands [ 31 ], but in contrast to a study set in China [ 16 ] and research on non-mentally ill offenders in the US and UK [ 7 , 14 ], present results indicated a higher probability for the female-dominated class to engage in homicide or attempted homicide. Besides cultural aspects, present findings may have been skewed by not including offender patients with SSD waiting in prisons to be transferred into forensic psychiatric treatment [ 55 , 56 ] and who may be more likely to have committed less serious crimes.…”

Forensic-Psychiatric Risk Evaluations: Perspectives of Forensic Psychiatric Experts and Older Incarcerated Persons From Switzerland

“…The judicial system has a difficult role to play in forensic-psychiatric evaluations. It is tasked to ensure the safety of the public, while assuring that the rights of the incarcerated persons are not violated and that they do not suffer undue harm ( 7 ) - described in some legislations as cruel and unusual punishment ( 36 ) or cruel, inhumane and degrading treatment ( 37 ). To ensure a fair process, objectivity is sought in these forensic-psychiatric evaluations.…”

“…Forensic assessment informs judicial decisions made to incarcerate the person (i.e., sentence vs. measures, prolongation of measures), (further) treatment, privileges, and release from prisons ( 5 , 6 ). The forensic mental health system is tasked with the role of balancing risk management to avoid future potential harm to others as well as providing treatment to incarcerated persons who suffer from severe mental health illness ( 3 , 7 ).…”

Evaluating the reliability of hair analysis in monitoring the compliance of ADHD patients under treatment with Lisdexamphetamine

“…To exemplify, these implications will be discussed in the areas of criminal law, social law and traffic law in the Swiss juridical system. In criminal law, in particular, release from therapeutic measures according to the Swiss Criminal Code (SCC) is linked to a reduced risk of reoffending [ 62 , 63 ]. Therapy adherence is considered an important variable during risk assessment [ 64 , 65 ].…”