Mental examinations in Finland

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Forensic psychiatric mental examinations have been carried out in Finland since the 19th century. In the Western concept of justice it is considered just that persons with severe psychiatric illnesses should not be sentenced to prison, but that their illness should be treated by the medical authorities. By virtue of the Code of Judicial Procedure (Chapter 17, Section 45) a court may order that the mental state of a person charged with an offence be examined. The National Supervisory Authority for Welfare and Health (VALVIRA) orders where the mental examination is to be carried out. The examination is usually carried out at a hospital; the physician responsible for the examination issues a statement on the examination and delivers it to the National Supervisory Authority for Welfare and Health (Valvira), which then issues its own statement on the mental state of the accused to the court. In international comparison the Finnish practice of mental examinations stands out as being very thorough. Preliminary information concerning persons undergoing mental examination is obtained from the persons themselves and, with their consent, from their family members, friends, employers, health care units in charge of previous treatment, etc. During the mental examination the person undergoes an extensive psychiatric evaluation and standardised psychological tests, is monitored in a mental hospital or other examination facility by trained staff for a period of one to two months, and is also subjected to a physical health examination. Possible structural abnormalities of the brain may also be examined using imaging methods. Although the extensive examination practice is time-consuming and expensive, the data obtained through the use of this method are reliable by international standards, and therefore support the legal protection of the person being examined.

With regard to the reliability of forensic psychiatric mental examinations, it is important that mental examinations in Finland are carried out at the request of a court. Finnish forensic psychiatrists are obligated to present an objective opinion on the mental health of the person being examined at the time of the accused offence and the mental examination, regardless of whether the observations made during the mental examination provide evidence to support the view of the prosecution or the defence. Considering the impartiality of the physician carrying out mental examinations, it is of paramount importance that the person carrying out the mental examination is not an expert for the prosecution or defence. For example, in the United States the standard practice is that both the defence and prosecution can present the views of their respective forensic psychiatrists regarding the mental state of the person being examined. The risk inherent in such a practice is that both parties only present facts providing support for their own view. Finnish judges have expressed their satisfaction with the information obtained from mental examinations. Courts have deemed the information obtained from mental examinations to be reliable in over 90 percent of cases.

Located at Niuvanniemi Hospital, the Forensic Psychiatry Clinic of the University of Eastern Finland has carried out a wealth of epidemiological research on, for example, the risk of violent crime offenders reoffending. Information gained from research in forensic psychiatry also serves the mental examination operations. Mental examinations at Niuvanniemi Hospital are usually carried out on closed wards, which means that the wards have the preparedness and facilities required for isolating patients in accordance with the Mental Health Act. As a rule, mental examination patients reside on the ward with treatment patients, sharing rooms and recreational facilities with them; no-one is isolated without the appropriate grounds as provided by the Mental Health Act. Examinations are carried out on medical grounds, based on a case-specific consideration of necessity. As concerns mental examination patients, the provisions of the Mental Health Act are applicable. Mental examination patients may have the opportunity to meet their family, based on case-by-case assessment. During the examination period patients are not allowed hospital leave. After the examination has been completed The National Supervisory Authority for Welfare and Health grants leave to discharge the patient. The patient referred for treatment will wait for the decision of The National Supervisory Authority for Welfare and Health at the hospital. The same applies to difficult-to-assess borderline cases.