Why psychotic killers get care, not prison time in Norway

Tromso, Norway — Unlike in America, people diagnosed with chronic psychosis in Norway are deemed "unaccountable" if they commit a crime and quickly placed in a psychiatric hospital or intensive outpatient treatment program.

It's believed their minds are so altered by illness that they are incapable of rational thought, said Dr. Erland Bugge of Asgard Hospital in Tromso, Norway. He is the head of forensic psychiatry for the Northern Region of Norway and leader of a national network of research on the use of compulsion and coercion in psychiatry. 

Residents of Norway can also be found unaccountable in the absence of a chronic psychotic disorder, such as schizophrenia, if it's clear that they were in a psychotic state when they committed their crime. 

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That is what happened in the case of Stein, one of Bugge's patients, who suffered a single catastrophic psychotic episode in 2017 and killed his mother. The 40-year-old specialist in geographic information systems asked that his last name be withheld due to the stigma associated with severe mental illness.

Stein, who suffers from bipolar disorder, was in the midst of a severe depression when an inability to sleep combined with effects from the months-long period of darkness in arctic Norway, known as Polar Night, plunged him into an abyss so deep that he broke with reality. 

A hallucinatory being told him that his mother was possessed by a demon that would destroy the world, Stein said. In an effort to rid her of the purported demon, he beat his mother to death at the family's home on a remote island two hours by boat from Tromso, the largest city in Norway's arctic region. 

Afterward, he walked next door and told his uncle what he had done and why. 

Stein spent three hours in jail before being transferred to Asgard, a sprawling psychiatric complex located in the snow-covered mountains at the edge of Tromso. In the aftermath, he felt betrayed because the hallucinatory being had promised his mother would survive, Stein told The Detroit News.

On the recommendation of Bugge and one other court-appointed forensic psychiatrist, a judge found Stein unaccountable for his crime. Many members of Stein's community traveled to Tromso to support him during his hearing, Bugge said. 

Stein spent one year as an inpatient at Asgard, where he said he gained insight into how and why his mental condition had devolved in the months leading up to his crime. 

Stein now lives independently in his own apartment on the hospital grounds. He said he has learned how to take care of himself to prevent another psychotic break. The socialized country pays for his housing, and he receives a small stipend. Relieved of financial burdens, he concentrates on his recovery.

Stein participates in outpatient therapy and socializes with other mental health outpatients who live on the property. He enjoys daily soccer matches with his friends, loves to ski, and is free to come and go as he likes. 

In Michigan, Stein likely would have been jailed while awaiting evaluation at the state Center for Forensic Psychiatry, one of Michigan's five public mental hospitals. The prosecutor then would decide whether to ask the judge for a ruling of mental incompetence  or proceed to trial.

The average wait for treatment for offenders found incompetent to stand trial is 127 days, according to the state Department of Health and Human Services. In Michigan, a person found incompetent to stand trial for a crime still can face charges if competence is restored. 

Michigan juries rarely find defendants not guilty by reason of insanity, said attorney Daniel Hilf of Troy.  It is more common for somebody to be found “guilty but mentally ill," meaning that the judge’s sentence may include incarceration, albeit with some mental health provisions, he said.

Jurors often are reluctant to find a defendant insane because they mistakenly believe the person will be immediately set free, Hilf said.

By law, those found not guilty by reason of insanity are immediately confined in a state mental hospital, Hilf said. But neither the judge nor the defense attorney can explain this to a jury because of Michigan's evidentiary rules that are meant to prevent jurors from knowing the potential punishment when considering the case.

“It’s difficult for the jury to listen to sometimes gruesome and straightforward facts and then decide there’s no accountability based on a finding of insanity,” Hilf said. “When deliberating, the jury usually has the option to find the defendant guilty but mentally ill.

"It gives them an out, but the jury doesn’t understand the difference of these verdicts. It looks like a compromise or a reduction, but it really isn’t and can lead to incarceration (instead of) mental health treatment."

“Healing justice” is a Detroit News project made possible through a fellowship with the Association of Health Care Journalists funded by the Commonwealth Fund, a nonprofit foundation focused on health.

kbouffard@detroitnews.com

Twitter: @kbouffardDN

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