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When psychiatrists and psychologists conducted forensic assessments to determine criminal responsibility in Norway from 2009 to 2018, they relied more on the person’s diagnosis than symptoms during the offence.
Relying on the diagnosis made during an examination after the person committed the offence is a common problem in forensic evaluations in many countries.
Using scales, scores, and structured interviews designed for clinical settings has limitations in forensic examinations. They may not capture the person’s mental state during the offence.
However, using information from many sources and the person’s behaviour during the offence should be used in evaluations.
Those were the key points Dr. Pia Jorde Løvgren made in her presentation for the International Forensic Psychiatry Lecture Series. She shared the findings of a co-authored study of 500 forensic assessments written between 2009 and 2018.
Symptoms During the Offence
The person’s symptoms during the offence are important. Dr. Løvgren gave the example of a person with a mental illness who could be free of symptoms or could have serious symptoms affecting their functioning and understanding of reality when they committed the offence.
Other studies have found that giving the diagnosis more importance than the symptoms of the person’s mental disorder is a common mistake in forensic reports. Another common problem is when evaluators give the person’s mental state during the evaluation more importance than their mental state during the offence.
Dr. Løvgren’s co-authored study found both problems.
However, the reports had some positive features. Many used standard scales and scores as part of the assessment. But forensic mental health professionals should use these tools with caution. They are designed to capture the person’s mental state during the examination, not the person’s mental state during the offence.
All the reports used information from multiple sources, such as friends, family, employers, and general practitioners, as well as records from police, hospitals, and prisons. Using many sources of information helps create a full description of the person’s mental disorder and state of mind.
Before Regulation Changes
Before the regulation changes in 2020, people charged with a crime in Norway could be found not criminally responsible due to a a serious mental disorder or psychosis. They could also be found not criminally responsible due to intellectual disability or impaired consciousness.
About a quarter of the 500 people examined were found not criminally responsible for the offence. Among those who were, most were found to have a serious mental disorder that affected their ability to understand reality during the offence.
Reports recorded many symptoms during the evaluation, but much fewer from the time during the offence. Symptoms included delusions, thought disorder, hallucinations, psychotic symptoms, and impaired level of function.
Delusions were the symptom considered most important in deciding whether the person was criminally responsible. The forensic reports showed that people with schizophrenia were twice as likely to be found to have an actively psychotic episode during the evaluation if they had delusions. But people with other psychotic disorders were 18 times more likely to have an actively psychotic episode if they had delusions.
Dr. Løvgren said she thinks this may be because the schizophrenia diagnosis was considered more important than specific symptoms. However, evaluators considered symptoms much more often in evaluating people with other types of psychosis.
Changes to Forensic Evaluations in Norway
The study also looked at whether the 2012 mass murder trial of Anders Behring Breivik changed psychiatrists’ and psychologists’ approach in assessing people who had been charged. At the time, two assessments of Breivik reached different conclusions. Observers called this a “crisis in forensic psychiatry” in Norway. It was one of the factors leading to a change in regulations for forensic evaluations.
The study found that the murder trial had little effect on forensic evaluations, except that the phrase “psychotic symptoms” was described more often and thought disorders were described less often in reports after 2012.
Dr. Løvgren’s team completed the study before regulations for forensic evaluations changed in 2020.
Both before and after 2020, courts ask forensic experts to evaluate whether the person had a serious mental disorder during the offence and to suggest a diagnosis.
Before 2020, forensic experts also stated their opinion on whether the person was criminally responsible.
However, after 2020, courts ask experts whether the person had diminished function and ability to understand reality at the time of the offence. Then the court, rather than the expert, decides whether the person’s mental state makes them not criminally responsible for their actions.
For more details, watch the recording of the September 25, 2025, lecture, “Symptoms or Diagnoses — Which Do Forensic Experts Rely on When Evaluating Legal Insanity?” on our website.
Written by Carolyn Brown and approved by Dr. Pia Jorde Løvgren
