Practically all prisoners with mental and behavioural disorders are treated in the psychoneurological unit of the Prison Hospital when they need in-patient care. It is therefore useful to analyse the statistical information available on those patients. Analysis reveals that 122 prisoners with mental and behavioural disorders were placed in in-patient care in 2009. This means that only 1.8 % of all prisoners with mental and behavioural disorders received in-patient psychiatric treatment. It is possible that cases with neurotic, stress-related and somatoform disorders or disorders of adult personality did not require in-patient care. However, it is unlikely that this applies to all prisoners with disorders like this. Table 15.2 shows the distribution of in-patients admitted to the Prison Hospital in 2009 by diagnosis.

As can be seen from Table 15.2, patients suffering from organic, including symptomatic mental disorders and neurotic, stress-related and somatoform disorders, comprised the largest group. However, the longest term treatment based on average bed days per patient was found in the group suffering from schizophrenia, schizotypal and delusional disorders. The average length of treatment in hospital for patients with disorders of this kind was 62.4 days while the average length of treatment in hospital for patients of all mental and behavioural disorders (F00–F99) was 34.2 days. The comparatively small number of patients diagnosed as psychotic in the Prison Hospital compared to the number of patients diagnosed as neurotic could be explained by the fact that psychotic patients are more often defined as insane and undergo treatment in secure psychiatric units or psychiatric hospitals. If a person becomes mentally ill while he/she is in prison, then the length of custody is reviewed by the Criminal Court system so that the person can receive treatment outside prison as soon as possible.

Taking into account the high prevalence of mental and behavioural disorders in prisons, it is important to understand the resources of medical staff available for the treatment of patients. 15 social workers were employed in prisons in 2008, providing individual or group treatment; they carried out 2,455 individual consultations. There were 18 psychologists working in prisons in 2008. They provided consultations as requested by the prisoners, interventions in crises related to suicidal behaviour and psychological diagnostics. There were 1,762 individual consultations and 2,124 series of consultations provided. An individual consultation consists of one session with a psychologist. If the issue is not resolved in one session, then a series of consultations takes place. 800 psychological profiles of prisoners were written, as well as 2,257 psychodiagnostics and 187 interventions in cases of crisis were carried out in 2008 (Puķīte 2009). It is possible that these activities helped to reduce the prevalence of mental and behavioural disorders. It is also important to mention that a great deal of support is given to training and employment activities for prisoners. For example, 2,278 prisoners were involved in educational activities in 2008 and 1,379 prisoners took part in different types of employment activities. Spiritual support also plays an important role. This can take the form of services of different religions, individual support from chaplains, Christian educational activities, etc.

When evaluating the ethical aspects of forensic psychiatry, it is important to be aware of the system of forensic psychiatry in Latvia, its scope and specific features. The evidence of forensic psychiatric experts can often determine the future of an individual – e.g. he/she will receive psychiatric treatment in a hospital or will serve a sentence in prison.

Forensic psychiatry is a sub-discipline of psychiatry in Latvia. A forensic psychiatrist is a specialist psychiatrist. Consequently, they need to acquire additional knowledge and practical skills to obtain this status. The task of forensic psychiatrists is to study the clinical expressions of psychological disturbances, provide diagnoses, predict the potential development of the disorders and associated risk and to provide treatment along with rehabilitation. All these tasks have to be implemented within a particular legal framework (Taube et al. 2007).

If, during legal proceedings, suspicion arises that a person could have mental health problems which have influenced his/her behaviour during the process of committing a crime, a forensic psychiatrist becomes involved. Forensic psychiatry is regulated by a number of specific laws. The most significant of them are the Criminal Law (Saeima 1998b), the Law of Criminal Procedure (Saeima 2005), the Civil Law (Saeima 1937), the Law of Civil Procedures (Saeima 1998a) and the Law of Forensic Experts (Saeima 2006). The most important question that the court needs to answer is if the person, during the process of committing a crime, was of sound mind or not – which means that the person because of his/her mental disorder or mental illness could not understand or manage his/her behaviour (Saeima 2005). In Latvian legislation, apart from the concept of insanity, there is also a concept of diminished responsibility, which means that a person, during the process of committing a crime, was not fully able to understand his/her actions or to manage these actions as a result of his/her psychiatric disorder. In order to determine responsibility, the court appoints appropriate individuals to carry out psychiatric or psychological or complex examinations. Complex is taken to mean – a combination of psychiatric and psychological investigations. From an ethical point of view very sensitive issues are sometimes arbitrated in a civil court when assessing the ability of a person to manage a property or financial resources. The number of examinations undertaken in Latvia between 2006 and 2008 are shown below in Table 15.3.

Examinations of people who could have mental health problems which have influenced their behaviour during the process of committing a crime can be carried out in out-patient units at psychiatric hospitals or in psychiatric hospitals as an in-patient. The court experts can be invited to attend court sessions to give evidence during the trial; experts testified in 450 cases in 2008. If a person has committed a very serious crime and has been arrested and remanded in a high security prison, the examination is carried out in a specialised unit with similar security systems to those in prison. There is only one department authorised to carry out these specialised psychiatric examinations in Latvia. This is a psychiatric unit in Rīga that can guarantee an appropriate level of security. The unit is well-equipped and conforms to the requirements of a psychiatric hospital. It is quite common that prisoners who do not have any mental disorders simulate them to spend some time in a hospital which provides a higher level of comfort compared to a prison.