Young female patients with self-harm have been
treated at forensic psychiatric clinics in Sweden, even if they have never been
charged with crimes or convicted. Some have been as young as 16 years of age,
placed in the same wards as notorious violent or sexual offenders, prevented
from locking their door during the night, and at least one rape in a
“high-security ward” has been reported.
Several reports, including an autographical book
(End-station Forensic Psychiatry by Sofia Åkerman and Thérèse Eriksson) and an
investigative TV program aired yesterday, highlight how illegal forms of
restraint have been used routinely at certain clinics, including locked hockey
helmets, leather gloves and forearm plasters. A study by Herman Holm and
co-workers (Journal of the Swedish Medical Society, 2011) found that the largest group of patients treated under the
Involuntary Care Act was indeed young women with personality disorders, and
that they had been subjected to physical restraints more often than other
groups of patients.
Interstingly, this has been known to the
authorities in charge of over-seeing the health care system for many years, and
numerous complaints have been filed to the police. Official
criticism has been raised, but no doctor or hospital director has been
prosecuted, and the public clinics responsible have been more or less let alone
by the authorities. Instead, the treatment programmes are slowly being stopped
based on “media pressure”.
This shows that psychiatric practice may run a
course that is not consistent with the intentions of the legislator, even in flagrant conflict with the law.
Unfortunately, the last decade has seen the
development of a much more repressive psychiatry in Sweden. New clinics are
built outside cities surrounded by walls, electronic supervision and
involuntary out-patient treatment have become common, and a governmental report
has proposed changes that would reduce patient autonomy even further: involuntary
care would be initiated among out-patients who have never needed in-patient
treatment, a mere professional opinion that the patient needs involuntary care
to avoid a relapse would suffice for involuntary treatment and mentally ill persons would be subjected to
special measures for “societal protection” after having served penal sanctions.
Fortunately, the only proposal that has come from
the government to this day rejected the idea of a “committee for exemptions”
that would be able to grant authorization for otherwise illegal measures of
restraint retrospectively. According to the proposal, users
would not be granted even a single seat in the committee.
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