Mental health in the twilight zone

Take note – story published 6 years ago

A new journalistic collaboration looks at problems with mental health care in Latvia. A lack of databases recording the whereabouts and histories of people with serious mental health issues poses a potential threat to the public, as several cases already show. 

Sergey (not his real name) has schizophrenia. In the late 1990s he brutally murdered his wife. He was deemed incapacitated by court of law and sent for treatment in a secure psychiatric hospital.

Fifteen years later, doctors concluded that his mental health had improved sufficiently that their patient could be returned to society, provided he used prescription drugs.

A couple of months later, Sergey beat his mother to death with a hammer.

This example demonstrates issues with the monitoring of mentally ill criminals in Latvia.

According to the official registry, at the end of the year 2014, 84,301 people in Latvia had psychiatric and mental behavior disorders, or 4.2% of the population of Latvia.

Around 100 people from this category are compulsorily detained every year, some of them after committing felonies. Such patients are judged incapable of answering for their actions in a court of law  and are sent for treatment, though the court does not determine the longevity of treatment, according to Ieva Kulagina, a judge of Riga's Latgale county court, whose duties include supervising Forced Treatment Appointment Cases (FTAC).

When deciding about forced treatment, the court does not take into account the punishments prescribed by the Criminal Code of Latvia, but the level of threat posed to society by offenders and their medical condition, says Rihards Bredermanis, head of the secure forced treatment ward of the Psychiatry and Narcology Centre.

Currently 44 people are relieved from criminal responsibility due to their medical condition are being treated there, 12 of them after having committed murder.

Health Ministry statistics o not say how many people are receiving compulsory treatment after committing violent crimes.

Lack of information

Recognition of a mental disorder is complicated. In one case a woman with a higher education, good job and knowledge of multiple languages was tried for murdering her mother. She kept the body in the bathroom. The only 'motive' of the homicide was an irresistible will to commit murder. Experts diagnosed that the murderer had schizophrenia.

State prosecutor Jekaterina Kushakova has worked on numerous such difficult criminal cases: "If there is an impression that the suspect is incapacitated, the court will decide upon an investigation."

If in the pre-trial investigation a person is deemed incapacitated and dangerous to society, the investigating judge decides whether to put them in psychiatric hospital for a term of up to six months. After the pre-court investigation, based on the conclusion of experts, a verdict is made to pass the criminal case to court for application of compulsory medical treatment.

Criminal cases about implementation of FTAC are reviewed in a closed court, which may take into account expert reports, clear the defendant of criminal responsibility and appoint one of three restrictive measures.

If a defendant is not recognized dangerous to society, relatives can take care of them. Mentally ill patients can be put into ambulatory care with visits to a psychiatrist at specific intervals.

Third way to treat these patients is in a closed or open type of psychiatric hospital. On the face of it these methods seem transparent, but when explored deeper, several problems were detected.

Even in the most serious cases, psychiatric hospital does not mean confinement for life. The law allows the perpetrator to leave the institution and recover at home, provided his mental health state improves.

Herein lies one of the chief routes into the dangerous Twilight Zone.

Regular convicts are put under the authority of the probation service after their release. However, control regarding patients who have undergone forced psychiatric treatment is stretched between several institutions with no one agency responsible for monitoring the health condition of the patients.

"Plenty of patients don't have an environment to return to, there is no one to look after them,“ says Dr. R. Bredermanis, an expert in psychiatric care in criminal cases. Hence patients who had improved while in care will frequently decline once they are released.

As they have been relieved of criminal responsibility, their names are not recorded in registers used by police to cross-check criminal records, which creates an obvious loophole and means even people responsible for serious acts of violence may have exemplary official records.

Lack of access to the registry of mentally ill criminals is an issue, admits Janis Anspoks, chief of Daugavpils precinct in the Latgale regional administration of the State Police.

"We have been trying to address this matter, in order that dispatchers can see if a person living at an exact address has been receiving treatment when receiving a distress call," he says.

However, there has been no response from officials. Neither do paramedics have access to any such database, even though the number of times paramedics need the help of police in handling mentally ill patients is increasing.

In the year 2014 there were 6,991 such cases. Last year there were 7,106.

In addition, if for example a person who is declared a resident in Liepaja moves to Daugavpils, law enforcement officers have no way of finding out if that person has been sentenced to forced medical treatment by a court.

There is also no information about how often released patients commit new criminal acts.

The Health Ministry will not reveal the data, justifying it with protection of personal information.

Only the Psychiatric Hospital of Daugavpils agreed to provide data about recurring crimes among mental patients. During the last 10 years 182 people have been compulsorily treated in Daugavpils, 15 of them repeatedly.

Repeat offenders

A recent crime displays the problem all too clearly recurrence.

Last February two bodies were discovered at the ruins of a burned-out house in Saulkrasti. Police found that the victims were killed before the fire started and it was just an effort to conceal the homicides.

The chief suspect, Karlis (not his real name), born in 1994, admitted his guilt, but could not explain the reasoning behind his acts – he had killed his grandmother and uncle. This was not the first crime under his belt.

In 2013 Karlis was being prosecuted for an attempted murder. He was deemed incapacitated and sentenced to treatment in a psychiatric hospital. Around a year later, depending on the verdict of a doctors’ commission, Vidzeme county court decided to lighten the punishment and Karlis was appointed to ambulatory treatment.

Such cases are assessed on an annual basis.

Since patients do not exist in databases of regular convicts, their right of free movement remains completely unrestricted, both within Latvia and within the rest of the European Union.

(Journalists contributing to the project were: Ilya Kozins of Latvijas Radio; Ilze Kuzmina, of newspaper Latvijas Avīze; Viktorija Puskele of news portal; Ivars Soikans of news agency LETA; Antra Ergle of newspaper Bauskas Dzīve and Anda Rozukalne, associate professor of Riga Stradins University, leader of the project team and editor.)

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