Sweden vs. Finland - forensic psychiatric care and subsequent recidivism in violent crime.

Abstract

Introduction: Legal and medical approaches to mentally ill offenders vary internationally, but those with severe mental disorders are often sentenced to forensic psychiatric care, where one of the main objectives is to prevent recidivism. This retrospective cohort study compared violent recidivism after discharge from such treatment in Sweden and Finland.

Methods: The Swedish cohort included patients discharged between 2009 and 2019, with recidivism data collected until December 2019. Finnish patients discharged between 1999 and 2018 were followed for recidivism until 2019. Violent recidivism was analyzed using cumulative incidence curves and Cox regression models for relevant variables.

Results: The violent recidivism rate was 3294 per 100,000 person-years in Sweden versus 1083 in Finland. The estimated cumulative incidence of violent crime in Sweden was 6.3% at 12 months, 9.9% at 24 months, and 13.6% at 60 months, versus 0.4% at 12 months, 2.7% at 24 months, and 7.6% at 60 months in Finland. Among Swedish patients with schizophrenia spectrum disorder, the recidivism rate was 11.5% at 60 months. A history of substance use disorder was associated with a more than two-fold risk of committing a violent crime in both Sweden and Finland. Conversely, higher age at discharge reduced the risk in both countries.

Conclusion: The rate of violent recidivism among former forensic psychiatric patients is higher in Sweden than in Finland, with the cumulative incidence at five years being 1.8-fold in Sweden (1.5-fold among patients with psychosis). History of substance use disorder and higher age at discharge significantly influenced recidivism risk in both countries.