Mad or Bad? : Explaining the different outcomes of reforming treatment organisation for mentally disordered offenders in Britain & Sweden

Sammanfattning: Britain and Sweden have had similar backgrounds when it comes to organising treatment of Mentally Disordered Offenders who are sentenced to forensic psychiatric care instead of prison. Traditionally care has been centrally controlled and isolated from mainstream healthcare structures. However since the 1980s, both countries have had similar stated policy objectives of wanting to integrate services for forensic psychiatric treatment into general healthcare structures. Both countries have regionally organised healthcare with decisions on treatment provision made by the regional organisation. The term integration suggests that forensic services would be decentralised to Health Authorities in the same way as other healthcare services. Yet these seemingly similar policy objectives have resulted in very different outcomes. This leads to a puzzle, what is the explanation for the differing outcomes? This study aims to explain the reason(s) for the different outcomes by tracing the causative process using a comparative case-study method. The study demonstrates that both political institutions and service culture explain why Sweden was able to decentralise forensic psychiatric treatment but not Britain.