Sweden looking at new curbs on mentally ill

STOCKHOLM, Sweden — With the arrest of a mentally troubled man in the killing of their foreign minister, Swedes’ grief has turned to outrage over shortfalls in their psychiatric care system.

Even before Sept. 10, when Anna Lindh was fatally stabbed while shopping at a department store, a spate of deadly attacks by mentally deranged offenders raised fears that the Scandinavian welfare state could not protect its citizens from psychotics.

Then, the day after Lindh was attacked, a 23-year-old mental patient from an open-doors psychiatric clinic wandered into a kindergarten in Arvika, 240 miles west of Stockholm, and stabbed a 5-year-old girl to death.

Three decades of reforms have softened Sweden’s once coercive approach to psychiatric care, in which lobotomies and sterilizations were common practice.

But the more liberal approach instituted in the 1990s has gone too far, critics say, and now innocent people are paying with their lives.

"Death is on the loose. … It’s a lottery which one of us runs into him," Jan Guillou, a best-selling author, wrote in a recent newspaper column. "In this massacre, Anna Lindh became victim No. 4."

Guillou was referring to two attacks in May in the Stockholm area — an assailant wielding an iron bar who killed an elderly man and injured six people outside a subway station, and a driver who intentionally plowed into a crowd, killing two and injuring 30.

As debate raged about the mentally deranged roaming the capital, news broke that Lindh’s suspected attacker had prior convictions and documented psychiatric problems.

The suspect, Mijail Mijailovic, a Swede of Yugoslav origin, hasn’t been charged and says he’s innocent.

Further stoking the outcry was a letter in the tabloid Aftonbladet from Anders Moquist, whose daughter Sabina was killed at the kindergarten, bitterly denouncing the psychiatric reforms of the 1990s that were designed to help mental patients integrate into society.

"Without this worthless new approach, maybe our recently murdered daughter would have been allowed to live," he wrote.

Sweden takes great pride in its socialized health care. But now many are calling for special prisons and coercive powers to keep dangerous patients away from the public.

"The way the law is now, we must release them even though we know there is an imminent risk that they will take drugs again, that they will become psychotic again and start fighting again," said Anna Aaberg Wistedt, head of one of two psychiatric emergency care units in Stockholm.

Not everyone, however, believes straitjackets and forced medication are the solution.

"It makes me a bit nervous if you’re going to solve the problems with a new law on coercive treatment," said Johan Cullberg, a psychiatry professor working for the Stockholm county health care authority. "We must not turn back the clock."

Cullberg experienced Swedish psychiatry’s dark era, before laws were changed in 1976, when 30,000 people were sterilized under coercion or pressure — a rate surpassed only by Nazi Germany.

The number of hospital beds for the mentally ill dropped to 6,000 from more than 30,000 in the 1960s. The number of mental patients forcibly hospitalized fell from nearly 10,000 in 1979 to 2,250 in 2001, according to the National Board of Health and Welfare.