By Matthew Davis
BBC News Online
A dramatic reassessment of the killer of Swedish Foreign Minister Anna Lindh has concluded that he is mentally ill, a reversal of psychiatrists' initial claims Mijailo Mijailovic was fit for a life behind bars.
Mijailovic has "significant psychiatric problems"
Critics have seized on the case as more evidence of Sweden's failing psychiatric care system.
But one of the key questions is how doctors could be so divided on their diagnosis.
Experts have raised concerns over untrained prison staff carrying out initial clinical observations, whether the media distorted doctors' findings, and even whether pressure to punish someone for the killing influenced psychiatrists.
In March, with Sweden still reeling from the fatal stabbing of one of its brightest political stars, it was announced that weeks of testing on her killer had found him sane.
Trial judge Goeran Nilsson said there were "no good reasons" for a review, sentencing Mijailovic - who had a history of psychiatric problems - to life in jail.
When the 25-year-old appealed, however, the court heard from two more psychiatrists who gave wildly different opinions of his mental state.
'A threshold case'
A psychiatrist who led the testing during the lower court trial argued that while the killer was disturbed, he knew what he was doing when he stabbed Lindh - and had to go to prison.
Testing mental health
Psychiatrists, social workers and psychologists do three-week observation
Series of psychological tests, like ink blot test
Brain examined for lesions
MRI, EEG or CAT scans
Team has complete medical history
Aims to produce score on GAF mental health scale
This ranges from 1 (seriously ill) to 100 (no problems at all)
Mijailovic may have been near the "threshold" of 40
But a leading expert with the National Board of Health, claimed Mijailovic was seriously mentally ill - a view the appeals court shared, describing the killer as a "traumatised person with significant psychiatric problems".
The problem with categorising Mijailovic is that he was "a threshold case", Sten Levander, a forensic psychiatry professor from Malmo University Hospital, told BBC News Online.
"The diagnosis was not obvious. The first team found he had a personality disorder, a low psychosis threshold - but decided he was not mentally ill. But there were problems with their procedures."
For a start, Mijailovic was subject to weeks of observation while he was in prison, on remand, because it was deemed too risky to move him to a secure hospital, the professor said.
Medical experts could not watch him 24 hours a day - instead, much observation work was left to untrained prison staff.
In addition, Prof Levander says, the team assessing the killer was not run by the most senior psychiatrists available, because "many had been involved with the media" in the wake of the murder, and were not seen as impartial.
The high profile of the case could have influenced the findings, he said: "Politically it was wanted that he could be punished, because then we knew he [would be] locked up for 15 years."
The Anna Lindh case has stirred up a lot of anxiety in Sweden
But what is most worrying, Prof Levander says, is that psychiatrists are having to do the work of the courts.
"In deciding if someone is mentally ill, we are really being asked to decide whether they have criminal responsibility... This is very wrong, and it has been going along like that for 10 years."
The review of the Mijailovic case was run by the Legal Aid Council (part of Sweden's National Board of Health and Welfare), used to advise courts in difficult cases.
A spokeswoman said the council of lawyers, doctors and lay people was split over the report by psychiatrist Anders Forsman that said Lindh's killer was mentally ill.
But, after argument, it sided with Forsman's assessment, perhaps swayed, as Prof Levander suggests, by his fuller examination of the troubled Mijailovic.
"He [Forsman] had Mijailovic at a clinic under 24-hour watch where he could compile better information about him over a longer period of time. That I think, did the trick."
'Receipt for failure'
But commentators say the court's verdict could undermine faith in Sweden's judicial system.
Lawyer Leif Silbersky said it had taken "the easy way out" by siding with the assessment that Mijailovic was insane.
"What is it that convinces them that [Anders] Forsman is right and the others are wrong?" Mr Silbersky said.
"I think this will lead to a very intensive debate regarding how experts can reach such different conclusions regarding someone's mental health."
Lindh's tragic death rekindled an already heated debate in Sweden about the country's deteriorating psychiatric care system - and spawned an inquiry into how to turn it round.
Even before the minister was murdered while out shopping, a series of attacks by deranged offenders had raised fears that Sweden was not protecting its citizens from psychotics.
"The Anna Lindh case has stirred up a lot of anxiety," said Prof Levander. "That is very good. They [the politicians] have a receipt that we have failed."