RESEARCH. Rågården in Gunnilse outside of Gothenburg is not just a forensic psychiatry clinic for individuals who have been ordered to undergo forensic care. It is also a center for cross-disciplinary research in forensic psychiatry where Peter Andiné and Thomas Nilsson contribute important initiatives.
The first snow of winter forms a thin blanket over Rågården, reflecting a soft light through the large windows. I meet up with Peter Andiné after trading in my driver’s license for a visitor’s pass and walking through a security turnstile. An elegant stone staircase leads to the upper floors; the researchers’ offices are on the third floor.
“We’re proud of our beautiful facilities. The setting is an important part of rehabilitating our patients,” says Peter Andiné.
Peter is an associate professor in forensic psychiatry, chief physician at Rågården, Sahlgrenska University Hospital, and associate professor at the Institute of Neuroscience and Physiology. He is also an analyst with the National Board of Forensic Medicine (RMV). Psychologist Thomas Nilsson is also an associate professor and analyst at the same institutions. We walk onto a large terrace with a view of a building that has a sign reading ‘activity building’ in colorful letters. The adjacent buildings have 72 rehab beds and 24 emergency care beds for new admissions. The patients who receive care here have committed crimes while suffering severe mental disorders and have therefore been sentenced to care rather than prison time. About 15–20 percent are women.
Sowing and harvesting
The buildings surround a large snow-covered courtyard. A man jogs across the yard, but otherwise it is empty. The basketball court and other spaces for exercise, socializing and relaxing are deserted.
“See the greenhouse?” says Thomas, pointing. “Seeds are planted there in spring, and vegetables are harvested in autumn.”
The greenhouse could symbolize the work at Rågården, where research and clinical treatment are the seeds, and the results of these efforts are the harvest. It makes sense for Rågården to house research in forensic psychiatry; it has patients and care methods on which the research projects are based. The Centre for Ethics, Law and Mental Health (CELAM), an interdisciplinary research network formed in 2012, is located here and Peter Andiné and Thomas Nilsson are participants. CELAM recently received SEK 15 million from Forte to develop evidence-based practices in forensic psychiatry. The funding will last for three years, with the possibility for a three-year extension. A number of research projects are already underway, and several new ones will launch in the spring. Thomas and doctoral student Sven Pedersen will be running one of them.
“We’re going to examine patient needs for support and help, how they experience the forensic care they receive, and their participation in this care,” says Thomas.
To some extent, it is possible today to understand why people commit violent crimes. But it is harder to understand how to cure people with aggressive antisocial behavior. That is why developing evidence-based practices in forensic psychology is important, according to Thomas Nilsson.
“Our goal is for the methods we use for diagnosis, treatment and rehabilitation to have proven effects,” says Thomas.
“We haven’t had a great deal of evidence, which is due in part to the fact that the care group is complex, with challenging mental disorders that have no specific diagnosis. Many of these people have addictions which trigger or aggravate their aggressive antisocial behavior,” says Peter Andiné.
“The research has transitioned from a clinical focus on patients to reviewing and evaluating the actions taken. These actions should now be based on evidence,” adds Thomas Nilsson.
Experience from legal proceedings
NEUROFOR is an ongoing project led by Peter.
“We’re exploring forensic psychiatric patients’ capacity for impulse control, among other ways, by having them undergo inhibition tests while measuring their brain activity with an EEG. We’re also studying their physical performance and how they experience the legal proceedings they have to undergo every six months to determine whether or not their care should continue,” says Peter.
There is a courthouse on the first floor, Peter pointing to it. A table in the corridor outside has a handful of staff alarms, which beep occasionally. The alarms belong to some of the participants in the adjacent courtroom in a seminar series called Kulturresan (Culture Journey).
“Other people answer those alarms,” Peter explains.
All academic levels
One of Thomas’ former doctoral students, Anna-Kari Sjödin, comes out for a moment and explains that an adjustment of attitude is required for their values-based assessments.
“We’re a public authority that works with restrictions of liberty; what is the best way for us to handle that?”
Anna-Kari Sjödin holds a doctoral degree in violence in relationships and works in forensic psychiatric outpatient care at Järntorget, which along with the Rågården forensic psychiatric hospital, comprises Sahlgrenska University Hospital’s forensic psychiatric care.
Supervising and improving expertise at all academic levels is an essential part of Andiné and Nilsson’s work tasks. Both have backgrounds as analysts at the National Board of Forensic Medicine, the authority which provides courts with a basis for who should receive care at Rågården or be sentenced to imprisonment. They have insights into RMV’s assessments when those individuals come to Rågården, how the assessments are made and how certain they are.
“We serve as a link between the National Board of Forensic Medicine, Sahlgrenska University Hospital and the University of Gothenburg, which are our responsible authorities. We have an annual meeting in January where everyone meets and learns about what we’ve achieved over the year. We find out what information they need and how to move forward,” says Peter.
Physical and mental health
Forensic psychiatry is an incredibly small discipline, which makes collaboration even more important. With help of the grant from Forte, the goal is to create a national platform for increased collaboration within forensic psychiatry. This will provide stronger evidence through more research data, thus making the findings more certain.
“Our long-term goal is to develop national guidelines for clinical treatment, and for the guidelines to be implemented so that all 25 forensic psychiatric care units in Sweden can offer equivalent treatment,” says Peter.
Seven doctoral students have been active with various projects, and nearly as many more will be hired for the upcoming Forte projects. One of the doctoral students approaches us quickly. Henrik Bergman has studied patient physical health and physical ability. It is known that the target group often dies prematurely and has increased risks of diabetes and cardiovascular disease.
“It’s been shown that most of them are in frighteningly poor condition, 30–35-year-olds with the values of a 75-year-old. So it’s important to work with both physical and mental health,” says Henrik Bergman.
Training with dogs
He is on his way to the dog daycare for a walk with his dog Zita. But this is no ordinary dog daycare for the staff’s dogs.
“These aren’t trained therapy dogs, but they have been specifically selected to be able to work with these patients. It can be good social training if you suffer from mental illness and have a hard time relating to others,” explains Henrik, who together with Thomas Nilsson and occupational therapist Wioletta Romland, is planning to map the active components of this unique forensic psychiatric rehabilitation practice and evaluate its effects on participants.
Zita doesn’t say much but is thrilled to come out and play for a moment with her owner in the snow.
TEXT AND PHOTO: ANNA REHNBERG
- Project manager for the Forte grant is Märta Wallinius, PhD in psychology at the University of Gothenburg and Lund University, affiliated with Sahlgrenska Academy.
- Rågården Sahlgrenska University Hospital, the forensic psychiatric outpatient care unit at Järntorget and the National Board of Forensic Medicine’s forensic psychiatric research unit in Hisings Backa, together with the Institute of Neuroscience and Physiology at Sahlgrenska Academy, support the forensic psychiatric research and finance parts of CELAM’s operations.
- The research projects often span time periods ranging from five to twenty years.
- Rågården has 96 beds, 24 of which are emergency care beds for new admissions.
- Rågården opened in February 2013.
- Many forensic psychiatric patients have a total care time of over five years, the last portion of which is usually forensic psychiatric outpatient care.
- In total there are about 1,700 forensic psychiatric patients in Sweden, about half of which are in outpatient care.
- Sweden has 25 forensic psychiatric care units.
PhD projects connected to Sahlgrenska Academy:
- Carl Delfin – Disinhibition: neurobiology, neural cognition and behavior
- Christian Baudin – Adult sexual criminals: Perpetrator characteristics, victim relationships, crime and relapse
- Karin Trägårdh – Women who have experienced severe/fatal violence: Connections between mental health, risk factors for criminality and behavior.
- Henrik Bergman – Physical exercise in forensic care
- Sven Pedersen – Forensic care and its legal trials – care needs, experiences and reactions in patients.
- Caroline Mårland – Adult validation of the Autism, Tics, ADHD and other Comorbidities Inventory.
- Emma Bolund Lauenstein: Personality and connection to reality in perpetrators of violence who have undergone forensic evaluation.
For more information about the research projects at CELAM: www.celam.gu.se