Prisoners with reduced criminal responsibility stand out based on their rates of hospitalisation during their sentences

• Date: 25 July 2023
• Pages: 641-652
• DOI: https://doi.org/10.1108/IJPH-05-2022-0032
• Published date: 25 July 2023
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice
• Author: Miisa Törölä,Mika Rautanen

Prisoners with reduced criminal

responsibility stand out based on their rates

of hospitalisation during their sentences

Miisa Törölä and Mika Rautanen

Abstract

Purpose –Globally, health problems are very common among prisoners. A mental state examination

aims to help in recognisingpsychiatric problems among offenders and thepossible association of these

psychiatric issues with their committed crime. The legal-medical term ‘‘reduced criminal responsibility’’

refers to a weakenedsense of reality and the ability to control one’sbehaviour because of compromised

mental health and without an evaluated need for forensic psychiatric hospitalisation. However, little is

known about the actualneed for the health care of prisoners with reduced criminalresponsibility (PRCR).

The purposeof this study was to explore treatment-related visitsto prison by PRCR in Finland.

Design/methodology/approach –The research data comprise information on PRCR’s treatment-

related visits and that of a matched control group (n¼222). Descriptive cross-tabulation with X

2

- and

nonparametricMann–Whitney U-tests andCox regression analyses are applied.

Findings –The results show that almost every PRCR had at least one treatment-related visit during their

sentences. Visits to a psychiatric hospital for prisoners, to the prison hospital and especially to a civil hospital

are more common among PRCR. The need for treatment appears significantly earlier in their sentences.

Originality/value –These findings demonstratethe PRCR’s greater need for access to health services

and the need for further development between the Health Care Services for Prisoners, Prison and

Probation Service of Finland and public health and social services in Finland. More exploration of the

medicalreasons and locational distributionof the vast amount of civil hospitalisationis needed.

Keywords Prisoners, Health services, Prison, Hospitalisation, Reduced criminal responsibility,

Universal health care system

Paper type Research paper

Introduction

In Western societies, prisoners are more likely to experience health problems than the

general population [Butler et al.,2006;Condon et al., 2007;Fries et al.,2013;Joukamaa et

al., 2010;Morthorst et al., 2021;Sirdifield et al.,2009;Watson et al.,2004;World Health

Organization (WHO), 2005]. The discrepancies in health and in the usage of health care

services among Finnish inmates have been studied based on gender and type of

incarceration (Joukamaa et al.,2010) but not based on reduced criminal responsibility,

which usually indicates mental healthproblems.

The current study explores the quantity and timing of the realised hospitalisations of

prisoners with reduced criminal responsibility (PRCR) in Finland. Reduced criminal

responsibility is one of the three decision categories –criminal responsibility,reduced

criminal responsibility andnot criminal responsibility –in Finnish criminal law. In most cases,

a decision on reduced criminal responsibility is made based on a forensic psychiatric

examination. In these cases, the perpetrator of a crime is remanded for forensic

psychiatric examination by the court. During the evaluation process, the offender’s ability

Miisa To

¨ro

¨la

¨is based at the

UEF Law School, University

of Eastern Finland,

Joensuu, Finland.

Mika Rautanen is based at

the Health Care Services

for Prisoners, Finnish

Institute for Health and

Welfare, Helsinki, Finland.

Received 23 May 2022

Revised 22 March 2023

22 May 2023

Accepted 9 July 2023

©Miisa To

¨ro

¨la

¨and

Mika Rautanen. Publishedby

Emerald PublishingLimited.

This article is publishedund er

the Creative Commons

Attribution (CC BY 4.0) licence.

Anyone may reproduce,

distribute, translate and

create derivative works of

this article (for both commercial

and non-commercial purposes),

subject to full attribution to

the original publication and

authors. The full terms of this

licence may be seen at http://

creativecommons.org/licences/

by/4.0/legalcode

This research was funded by

the Scandinavian Research

Council for Criminology, Finnish

Cultural Foundation, and

(Finnish) Government’s

analysis, assessment, and

research activities.

DOI 10.1108/IJPH-05-2022-0032 VOL. 19 NO. 4 2023, pp. 641-652, Emerald Publishing Limited, ISSN 1744-9200 jINTERNATIONAL JOURNAL OF PRISONER HEALTH jPAGE 641