Acquitted after forensic psychiatric evaluation
Every year, ca. 500 criminal suspects undergo a forensic psychiatric evaluation (FPE). About half of them are sentenced to inpatient psychiatric care while the remaining persons receive other sanctions. However, FPE is carried out before courts make final decisions on cases and it happens that persons are acquitted after undergoing FPE. For instance, if someone was unable to understand the consequences of their actions as a result of mental illness. It is currently unknown how often persons who underwent FPE are acquitted.
This research project (1) maps the occurrence of acquittals after FPE in criminal cases, (2) ascertains the basis for acquittals and (3) determines which importance courts attach to psychiatric information. Acquittals after FPE are an urgent legal, forensic and policy issue. Failing to allow for acquittals undermines legal certainty and can be discriminatory. However, the fact that FPEs can be followed by acquittals also raises questions among the practitioners performing FPE regarding the risk that courts interpret psychiatric information in a way that is not intended and/or in a way that prejudicially affects the outcome of the cases.
In this project, legal researchers collaborate with practitioners in forensic psychiatry with the aim of filling a knowledge gap that is both theoretical and practical and that has significance for the legal security of people with mental illness/disability.
This research project (1) maps the occurrence of acquittals after FPE in criminal cases, (2) ascertains the basis for acquittals and (3) determines which importance courts attach to psychiatric information. Acquittals after FPE are an urgent legal, forensic and policy issue. Failing to allow for acquittals undermines legal certainty and can be discriminatory. However, the fact that FPEs can be followed by acquittals also raises questions among the practitioners performing FPE regarding the risk that courts interpret psychiatric information in a way that is not intended and/or in a way that prejudicially affects the outcome of the cases.
In this project, legal researchers collaborate with practitioners in forensic psychiatry with the aim of filling a knowledge gap that is both theoretical and practical and that has significance for the legal security of people with mental illness/disability.
Final report
Purpose and Background
The purpose of the project was to examine the occurrence of acquittals following forensic psychiatric examinations in criminal proceedings, to determine how common it is, on what grounds acquittals are based, and what significance forensic psychiatric information is given in the judicial assessment.
Forensic psychiatric examinations provide the court with a basis for deciding what sanction an offender should be sentenced to. However, they take place before the court has determined whether the person is to be convicted of a criminal offence, and it does occur that individuals who have undergone examination are acquitted. Mental illness may entail that the requirement of culpability (intent or negligence) necessary for a conviction is not fulfilled. A person with severe mental illness may, for example, have lacked sufficient insight into the consequences of their actions. In such cases, a forensic psychiatric report may contribute information of relevance to the court’s assessment.
The fact that such an examination may be followed by an acquittal raises questions and discussions at the Swedish National Board of Forensic Medicine, which performs the examinations. Their task concerns issues of treatment needs and risk of reoffending, which are relevant to the choice of sanction. Forensic psychiatric assessors are not to express opinions on culpability or in relation to legal rules on criminal responsibility. However, due to principles of free evaluation of evidence, courts are free to use the information contained in a forensic psychiatric report in all parts of the trial.
Despite the recurring attention given to this issue, it has remained unknown how common acquittals are. The project therefore carried out a broad mapping of the occurrence of acquittals following forensic psychiatric examinations, with the aim of filling a legal and forensic psychiatric knowledge gap of both theoretical and practical significance.
Implementation
In the project, a legal scholar with particular expertise in the intersection between criminal law and forensic psychiatry worked together with investigators at the Swedish National Board of Forensic Medicine. With the support of a qualified research assistant, the project team mapped all district court judgments following forensic psychiatric examinations during the years 2000–2022, in total 12,913 judgments. Among these, 64 acquittals were identified (approximately 0.5%). Around one third of the acquittals were overturned on appeal and replaced with convictions. The acquittals were analysed from a legal perspective using quantitative and qualitative methods in order to describe their legal and forensic psychiatric characteristics. To deepen the analysis, the project material was expanded to also include the forensic psychiatric reports, and a supplementary ethical review was conducted.
With regard to the qualitative analysis, the project drew on previous research and development work focusing particularly on the relationship between forensic psychiatric assessments and the criminal law evaluation of culpability. Since 2008, forensic psychiatric examinations may include the question of whether the offender has “lacked the capacity to understand the meaning of the act or to adapt their conduct in accordance with such understanding” (capacity for insight and control). In practice, this assessment is relevant only if there are exceptional reasons to impose imprisonment rather than forensic psychiatric care (Chapter 30, Section 6 of the Swedish Penal Code). These conditions arise only in cases of very serious crime combined with limited treatment needs. Nevertheless, courts often request an opinion on capacity, and the National Board of Forensic Medicine must therefore make such assessments in cases where it evidently cannot affect the choice of sanction. Previous research has noted that courts instead use the assessment in the culpability evaluation.
This creates a conflict of interest. From a forensic psychiatric perspective, it is generally the offenders who are most severely mentally ill—and thus have the greatest treatment needs—who lack capacity. However, courts have on occasion acquitted individuals with reference to such lack of capacity, in which case the person cannot be sentenced to forensic psychiatric care. A concern discussed within the organisation is that formulations regarding capacity, intended to provide a basis for sentencing, are instead used in the culpability assessment and given significance in a way that is neither intended nor foreseeable from the assessor’s perspective.
Results
First and foremost, the project has demonstrated how common—or rather uncommon—acquittals following forensic psychiatric examinations are. Acquittals of individuals who undergo such examinations occur rarely, on average in only 2–3 cases per year. Too limited a scope for acquittals in cases where persons with mental illness or disability are prosecuted raises concerns from a legal certainty perspective and prompts questions about discrimination within the justice system. At the same time, convincing evidence is required for a forensic psychiatric examination to be conducted. The low number of acquittals is therefore not necessarily indicative of a systemic failure.
It is also of interest that the number of acquittals remained stable at 1–2 judgments per year up until 2008. Thereafter, the variation is considerably greater, ranging from 0 to 6 acquittals per year. As the project has been expanded, an in-depth qualitative analysis is still ongoing, but a preliminary conclusion is that the introduction of the forensic psychiatric capacity assessment in 2008 has contributed to increased variation in how courts assess culpability in these cases.
The study also shows that the grounds for acquittal vary and that it is not only lack of culpability that leads to acquittal. In one third of the judgments, deficiencies instead concern the criminal act itself (objective grounds), including insufficient evidence that the act constitutes a crime or that it was indeed the accused person who committed it. This is surprising, since a forensic psychiatric examination may only be carried out if there is convincing evidence or a confession. The purpose of this limitation is to ensure that the examination—an expensive and intrusive process—is not conducted unnecessarily. That the person examined has in fact done what the prosecutor claims is also an important prerequisite for the assessment. If it turns out that a large proportion of those acquitted underwent the examination solely on the basis of a confession, these results may provide grounds for amending the law to remove that possibility.
Regarding the use of forensic psychiatric information, the analysis shows that the capacity assessment may be relevant to culpability evaluations, but that forensic psychiatric conclusions about capacity alone are rarely sufficient as the basis for an acquittal. In culpability assessments, the court conducts an independent evaluation of factors such as behaviour in connection with the offence and the degree of confusion. Nevertheless, the forensic psychiatric material plays a central role, and the National Board of Forensic Medicine is therefore recommended to continue its work of clarifying what the capacity assessment entails from a forensic psychiatric perspective. Courts have limited opportunities to challenge the assessments, making it crucial that communication is adapted in a way that reduces the risk that questions of culpability—properly to be decided in court—are indirectly determined through forensic psychiatric reports.
Dissemination of Results
The work of the project group will continue during 2026, and two peer-reviewed scientific articles will be finalised during 2026. In autumn 2025, part of the material was analysed by psychology student Alexandra Carlström in the master’s thesis “Unconscious and (not)guilty? – A qualitative study of forensic psychiatric reports and acquittals in cases where the requirement of awareness was not fulfilled.” A draft final report was presented and discussed at the National Board of Forensic Medicine in January 2026.
In addition to scientific publications, project results have been continuously presented and discussed both at the National Board of Forensic Medicine and at Lund University. The principal investigator has also presented the project at Swedish and international conferences and seminars for researchers and practitioners within the justice system, and has participated on multiple occasions in the media and in popular science contexts in order to disseminate knowledge on issues concerning the intersection of criminal law and forensic psychiatry. One example is episode 9 (“Vansinnesdåd”) of the podcast Kriminalsamtal (www.kriminalsamtal.se).
Collaboration and New Research Questions
With support from the National Board of Forensic Medicine and Lund University, the project group will continue working to complete the expanded and deepened analysis during 2026. Within this framework, collaboration will continue, and the principal investigator will remain engaged in organisational development based on the project results.
The project has enabled an in-depth analysis of an important legal issue of central relevance to forensic psychiatry. The work of the project group has integrated research and organisational development, thereby benefiting both activities in a way that is otherwise rarely possible. Beyond the ongoing project, the collaboration has established a solid foundation for further development work concerning cooperation between the agency and the university in other areas as well. Particularly urgent is the ongoing work to develop new risk assessments in preparation for the introduction of the new risk-based sanction of preventive detention (säkerhetsförvaring) in spring 2026, where criminal law expertise is of great value to the organisation.
The purpose of the project was to examine the occurrence of acquittals following forensic psychiatric examinations in criminal proceedings, to determine how common it is, on what grounds acquittals are based, and what significance forensic psychiatric information is given in the judicial assessment.
Forensic psychiatric examinations provide the court with a basis for deciding what sanction an offender should be sentenced to. However, they take place before the court has determined whether the person is to be convicted of a criminal offence, and it does occur that individuals who have undergone examination are acquitted. Mental illness may entail that the requirement of culpability (intent or negligence) necessary for a conviction is not fulfilled. A person with severe mental illness may, for example, have lacked sufficient insight into the consequences of their actions. In such cases, a forensic psychiatric report may contribute information of relevance to the court’s assessment.
The fact that such an examination may be followed by an acquittal raises questions and discussions at the Swedish National Board of Forensic Medicine, which performs the examinations. Their task concerns issues of treatment needs and risk of reoffending, which are relevant to the choice of sanction. Forensic psychiatric assessors are not to express opinions on culpability or in relation to legal rules on criminal responsibility. However, due to principles of free evaluation of evidence, courts are free to use the information contained in a forensic psychiatric report in all parts of the trial.
Despite the recurring attention given to this issue, it has remained unknown how common acquittals are. The project therefore carried out a broad mapping of the occurrence of acquittals following forensic psychiatric examinations, with the aim of filling a legal and forensic psychiatric knowledge gap of both theoretical and practical significance.
Implementation
In the project, a legal scholar with particular expertise in the intersection between criminal law and forensic psychiatry worked together with investigators at the Swedish National Board of Forensic Medicine. With the support of a qualified research assistant, the project team mapped all district court judgments following forensic psychiatric examinations during the years 2000–2022, in total 12,913 judgments. Among these, 64 acquittals were identified (approximately 0.5%). Around one third of the acquittals were overturned on appeal and replaced with convictions. The acquittals were analysed from a legal perspective using quantitative and qualitative methods in order to describe their legal and forensic psychiatric characteristics. To deepen the analysis, the project material was expanded to also include the forensic psychiatric reports, and a supplementary ethical review was conducted.
With regard to the qualitative analysis, the project drew on previous research and development work focusing particularly on the relationship between forensic psychiatric assessments and the criminal law evaluation of culpability. Since 2008, forensic psychiatric examinations may include the question of whether the offender has “lacked the capacity to understand the meaning of the act or to adapt their conduct in accordance with such understanding” (capacity for insight and control). In practice, this assessment is relevant only if there are exceptional reasons to impose imprisonment rather than forensic psychiatric care (Chapter 30, Section 6 of the Swedish Penal Code). These conditions arise only in cases of very serious crime combined with limited treatment needs. Nevertheless, courts often request an opinion on capacity, and the National Board of Forensic Medicine must therefore make such assessments in cases where it evidently cannot affect the choice of sanction. Previous research has noted that courts instead use the assessment in the culpability evaluation.
This creates a conflict of interest. From a forensic psychiatric perspective, it is generally the offenders who are most severely mentally ill—and thus have the greatest treatment needs—who lack capacity. However, courts have on occasion acquitted individuals with reference to such lack of capacity, in which case the person cannot be sentenced to forensic psychiatric care. A concern discussed within the organisation is that formulations regarding capacity, intended to provide a basis for sentencing, are instead used in the culpability assessment and given significance in a way that is neither intended nor foreseeable from the assessor’s perspective.
Results
First and foremost, the project has demonstrated how common—or rather uncommon—acquittals following forensic psychiatric examinations are. Acquittals of individuals who undergo such examinations occur rarely, on average in only 2–3 cases per year. Too limited a scope for acquittals in cases where persons with mental illness or disability are prosecuted raises concerns from a legal certainty perspective and prompts questions about discrimination within the justice system. At the same time, convincing evidence is required for a forensic psychiatric examination to be conducted. The low number of acquittals is therefore not necessarily indicative of a systemic failure.
It is also of interest that the number of acquittals remained stable at 1–2 judgments per year up until 2008. Thereafter, the variation is considerably greater, ranging from 0 to 6 acquittals per year. As the project has been expanded, an in-depth qualitative analysis is still ongoing, but a preliminary conclusion is that the introduction of the forensic psychiatric capacity assessment in 2008 has contributed to increased variation in how courts assess culpability in these cases.
The study also shows that the grounds for acquittal vary and that it is not only lack of culpability that leads to acquittal. In one third of the judgments, deficiencies instead concern the criminal act itself (objective grounds), including insufficient evidence that the act constitutes a crime or that it was indeed the accused person who committed it. This is surprising, since a forensic psychiatric examination may only be carried out if there is convincing evidence or a confession. The purpose of this limitation is to ensure that the examination—an expensive and intrusive process—is not conducted unnecessarily. That the person examined has in fact done what the prosecutor claims is also an important prerequisite for the assessment. If it turns out that a large proportion of those acquitted underwent the examination solely on the basis of a confession, these results may provide grounds for amending the law to remove that possibility.
Regarding the use of forensic psychiatric information, the analysis shows that the capacity assessment may be relevant to culpability evaluations, but that forensic psychiatric conclusions about capacity alone are rarely sufficient as the basis for an acquittal. In culpability assessments, the court conducts an independent evaluation of factors such as behaviour in connection with the offence and the degree of confusion. Nevertheless, the forensic psychiatric material plays a central role, and the National Board of Forensic Medicine is therefore recommended to continue its work of clarifying what the capacity assessment entails from a forensic psychiatric perspective. Courts have limited opportunities to challenge the assessments, making it crucial that communication is adapted in a way that reduces the risk that questions of culpability—properly to be decided in court—are indirectly determined through forensic psychiatric reports.
Dissemination of Results
The work of the project group will continue during 2026, and two peer-reviewed scientific articles will be finalised during 2026. In autumn 2025, part of the material was analysed by psychology student Alexandra Carlström in the master’s thesis “Unconscious and (not)guilty? – A qualitative study of forensic psychiatric reports and acquittals in cases where the requirement of awareness was not fulfilled.” A draft final report was presented and discussed at the National Board of Forensic Medicine in January 2026.
In addition to scientific publications, project results have been continuously presented and discussed both at the National Board of Forensic Medicine and at Lund University. The principal investigator has also presented the project at Swedish and international conferences and seminars for researchers and practitioners within the justice system, and has participated on multiple occasions in the media and in popular science contexts in order to disseminate knowledge on issues concerning the intersection of criminal law and forensic psychiatry. One example is episode 9 (“Vansinnesdåd”) of the podcast Kriminalsamtal (www.kriminalsamtal.se).
Collaboration and New Research Questions
With support from the National Board of Forensic Medicine and Lund University, the project group will continue working to complete the expanded and deepened analysis during 2026. Within this framework, collaboration will continue, and the principal investigator will remain engaged in organisational development based on the project results.
The project has enabled an in-depth analysis of an important legal issue of central relevance to forensic psychiatry. The work of the project group has integrated research and organisational development, thereby benefiting both activities in a way that is otherwise rarely possible. Beyond the ongoing project, the collaboration has established a solid foundation for further development work concerning cooperation between the agency and the university in other areas as well. Particularly urgent is the ongoing work to develop new risk assessments in preparation for the introduction of the new risk-based sanction of preventive detention (säkerhetsförvaring) in spring 2026, where criminal law expertise is of great value to the organisation.