A German court has ordered a 23-year-old Lebanese nursing trainee placed in a psychiatric hospital indefinitely after ruling that he strangled a 91-year-old patient to death in a Chemnitz nursing home.

Mouemen A. killed Klara Liane M. at noon on Jan. 18 in the woman’s room by strangling her with part of her pajamas, the court found at the end of security proceedings. The court determined there was no doubt that the Lebanese man had killed the woman but he could not be held criminally responsible because of his mental illness.

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The court found that voices in his head forced the man to murder the woman because he suffers from schizophrenia. The mental disorder developed while the nursing trainee was still living in Lebanon. Schizophrenia then developed further in Germany as well, according to German outlet Tag24.

“They had felt persecuted and developed delusions,” said Judge Janko Ehrlich, 53, while explaining his verdict.

Due to the illness, Ehrlich told the Lebanese man: “You can’t help it.”

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Remix News reported on the story earlier this month, where Senior Public Prosecutor Ingrid Burghart confirmed that the suspect has made no statement about the alleged crime. Some German media outlets are reporting that the victim was strangled with her own pajamas, while others say that her swimsuit was used as a ligature.

Now, it has been determined that Mouemen A. will be permanently placed in a psychiatric hospital and it is possible that the killer could also be deported during this time.

It remains unclear what kind of screening and hiring policies allowed for a man with a history of mental illness to obtain employment working with vulnerable elderly patients.