In a democratic society, it is assumed that the criminal law is applied ultima ratio and that certain requirements regarding legal certainty are met. These include the principle of conformity. This means that only those who had the ability and opportunity to comply with the law may be criminal liable. Consequently, those who are young or suffer from a severe mental disorder at the time of the crime must be free from criminal liability. Yet such persons can be held accountable in Sweden as the Swedish Criminal Code (1962:700) lacks a requirement of accountability. If a defendant at trial still suffers from a severe mental disorder, they will be sentenced to treatment. To achieve the requirements of a fair trial in these cases the court may only, as in other criminal cases, impose criminal liability if it is established beyond reasonable doubt that the act alleged by the prosecutor was committed by the defendant with intent or negligence. This must be evident in the judicial decision even if a simplified form for the judgment is applied. The latter is possible to use when a defendant was suffering from a severe mental disorder when committing the act, has confessed, and has been sentenced to treatment. The purpose of the present work is to investigate in a number of judgments whether and how the court reasons in relation to intent or negligence. Furthermore, it investigates whether a simplified form is used and how it relates to the requirements of a fair trail. The survey shows that in almost half of the judgments the issue of guilt is not mentioned at all. Instead, the emphasis is on external circumstances and the level of the defendents consciousness. The reasons given for the jugdgment are very brief and often issued in a simplified form. The survey reveals that the evaluation of evidence regarding guilt in these cases is problematic and probably a consequence of the absence of a requirement of accountability in the Criminal Code. The study concludes that the absence of this accountablity requirement results in the exclusion of a very vulnerable group from the principle of conformity. In other words, this group of defendants is deprived of a fair trial regarding the issue of guilt in the event of conviction. This is a right aimed at maintaining confidence in the judiciary and the criminal justice system.