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Mental Disorder, Substance Misuse and Violent Behaviour: The Swedish Experience of Caring for the Triply Troubled

NCJ Number
Criminal Behaviour and Mental Health Volume: 17 Issue: 4 Dated: 2007 Pages: 242-249
Per Lindqvist
Date Published
8 pages
Based on an analysis of official government documents and contemporary literature, this paper assesses Sweden's treatment for persons who are "triply troubled" with psychiatric symptoms, substance abuse, and violent behavior.
Currently in Sweden, mentally ill people with substance abuse problems but who are not chronically aggressive are increasingly receiving effective treatment. The same has not been true for mentally ill, substance-abusing, violent individuals. Advancements for the treatment of the triply troubled have emerged mainly from prison psychiatry and forensic mental health. There are two prison psychiatry projects in Stockholm relevant to the triply troubled. One is for inmates about to be released and who are screened and examined for attention deficit/hyperactivity disorder. If the diagnosis is confirmed, the inmate is prescribed methylphenidate, a central nervous system stimulant. The program then requires that the inmate be supervised and treated by a named psychiatrist within the mental health services after release. A social supervisor is also assigned, accompanied by support for housing and other social needs. The other prison psychiatry project is similar, differing only in the targeting of the triply troubled at an earlier stage. In the area of forensic mental health, the Forensic Psychiatric Services, the Center for Dependency Disorder, and the Probation Service have started a special security clinic for the outpatient treatment of mentally ill, antisocial patients with extensive treatment needs. The staff consists of senior psychiatrists, nurses, and case managers. Formal education and training, supervision, and continuing professional development must focus on the development of appropriate attitudes and services for the treatment of the triply troubled if their treatment and care are to be improved and expanded. 10 references