Few offenders are mentally healthy
In Finland, people with psychotic disorders end up in prison and fall to recidivism instead of receiving hospital treatment because the number of forensic psychiatric examinations has been declining, says Markku Lähteenvuo, Professor of Forensic Psychiatry.
Lähteenvuo was appointed Professor of Forensic Psychiatry at the University of Eastern Finland, based at Niuvanniemi Hospital in Kuopio, this spring.
Niuvanniemi Hospital is a state psychiatric hospital tasked with conducting forensic psychiatric examinations and offering specialised forensic psychiatric care. Its patients include offenders who have been found not criminally responsible. In addition, wellbeing services counties refer patients who are particularly difficult to treat and dangerous to the hospital. The hospital is also responsible for the university’s research and education in forensic psychiatry.
“Our patients have psychotic disorders in which their grasp of reality is impaired, such as schizophrenia. Many also have personality disorders and substance abuse problems. When all of these coincide in the same person, unfortunate things usually start to happen.”
Lähteenvuo emphasises that a psychotic disorder as such does not make a person dangerous.
“It does require lifelong treatment, but treatment is effective. The risk of recidivism among those discharged from our hospital is around ten per cent, which is considerably lower than among those released from prison.”
“If a patient reoffends, it is usually because they have stopped taking their medication and started using substances. In many countries, legislation allows for compulsory outpatient treatment, where the patient is required to remain substance-free and to attend regular appointments for long-acting antipsychotic injections. Finland, however, has not made such an amendment to its legislation, leading to prolonged hospital stays because it is not possible to ensure that patients will cope after being discharged.”
Psychopathy is not a matter of choice, either
Cuts to psychiatric care are affecting Niuvanniemi Hospital in that up to half of its patients are now referred from wellbeing services counties. “As a result, less time can be devoted to our core work in forensic psychiatry.”
“Moreover, an increasing number of people with psychotic disorders end up in prison instead of receiving the treatment they need. Expensive forensic psychiatric examinations are ordered increasingly rarely, jeopardising timely diagnosis.”
Personality disorders are even more common among prisoners; up to one in four exhibit psychopathic traits, and 80 per cent have substance abuse problems. “People with psychopathy usually fall to recidivism soon after being released. Physicians providing forensic psychiatric care could decide not to discharge a dangerous patient, but in Finland, a person cannot be ordered into treatment on the basis of psychopathy alone. This is not considered ethical, since no effective treatment is available.”
“On the other hand, if a person simply does not follow the rules of society and poses a danger to others, one might ask whether recidivism should lead to dramatically longer sentences.”
Lähteenvuo puts it starkly: a person with a psychotic disorder does not cause intentional harm, but a person with psychopathy does. “Psychopathic traits are also strongly hereditary and more likely to develop in those who have experienced abuse when young. These people have not chosen their psychopathy.”
Mental health disorders are visible in brain cells
Lähteenvuo has studied the neurobiological mechanisms of schizophrenia and psychopathy using stem cell technology. For example, abnormalities in the opioid system have been found in people with psychopathy, and this could perhaps be treated with medication. In schizophrenia, various abnormalities in brain function have been observed, depending on the disease subtype and sex.
“In the future, data collected from nearly 10,000 patients in the national SUPER project may shed significant light on the genetics and mechanisms of psychotic disorders.”
According to Lähteenvuo, psychotic disorders are comparable to memory disorders, because in both, the first changes in the brain occur long before the onset of the disease, treatment alleviates symptoms but offers no cure, and the course of the disease is individual. As the disease progresses, it becomes necessary to assess whether the patient is capable of making decisions about their own affairs. “We are working together with scholars of neurology and elder law to establish biological indicators for assessing legal capacity.”
The effectiveness of pharmacological treatments for mental health disorders is being studied in Kuopio using register data. “In future, we will combine these data with genetic data and biological markers in an effort to better predict the course of the disorder and find the most suitable medication for each individual.”
Register-based research reveals even surprising associations: it was recently observed that GLP-1 medications used to treat obesity and diabetes may also help with depression, anxiety and alcoholism.
“One new avenue is the rehabilitation of people with psychotic disorders in virtual reality, for example in social situations. It may even be possible to reduce the dominance of auditory hallucinations by giving them a virtual character, an avatar, which the patient could interact with, supported by a therapist.”
Lähteenvuo began his academic career in cardiac gene therapy and even completed a PhD on the topic before pausing to reflect on the direction of his career. “In the end, solving the mysteries of the human mind interested me the most, and in this work, I get to deal with its diversity and even with its darkest sides.”
“As a society, I believe we should invest more consistently in the prevention of mental health disorders. By supporting families with children and by offering youth services and substance abuse services, we can address risk factors for illness and criminality before more permanent personality changes occur.”
Markku Lähteenvuo
- Professor of Forensic Psychiatry at the University of Eastern Finland, 1 April 2026–
- Licentiate of Medicine, University of Eastern Finland, 2013
- Doctor of Medicine, University of Eastern Finland, 2013
- Special Competence in Addiction Medicine, 2018
- Specialist Training in General Medicine, 2018
- Forensic Psychiatry Specialist, 2019
- Title of Docent in Forensic Psychiatry, University of Eastern Finland, 2022
Key roles
- Research Director (acting), University of Eastern Finland, 2025–3/2026
- Part-time Researcher, Niuvanniemi Hospital, 2024–
- Psychiatrist, Terveystalo, 2024–
- Specialist in Psychiatry, Wellbeing Services County of North Savo, 2023
- Part-time Chief Physician of Forensic Psychiatry, Niuvanniemi Hospital, 2023–2024
- Chief Physician of Forensic Psychiatry, Niuvanniemi Hospital, 2021–2023
- Specialist in Forensic Psychiatry, Niuvanniemi Hospital, 2018–2020
- Director responsible for health care services, Päihdepalvelusäätiö, 2017–2018
- Visiting Researcher, Harvard University, 2009–2011
- Partner and Board Member, Genomi Solutions, 2008–
