Chapter 10 - Mental Disorders in CJS Flashcards
deinstitutionalization (1950s - 1970s)
- corresponding increase in numbers of prisoners
- ‘fitness and criminal responsibility test’ for potential diversion to forensic mental health system
DSM mental disorder definition
a syndrome characterized by clinically significant disturbance in cognition, emotion regulation, or behavior
- reflects psych, bio, and/or dev. dysfunction
- DSM often ignores envir. or sociocultural factors
- usually associated w/ sig distress in social and/or occupational functioning
What was Axis I in DSM’s prior multi-axial system
axis I: clinical disorders, including schizophrenia, dissociative, SUDs
- more likely to lead to diversion into forensic mental health system
- disconnection from reality
- most likely to be detected by police, courts, and corrections
what was Axis II in DSM’s prior multi-axial system
personality disorders (ASPD and psychopathy) and intellectual disability
- person w/ PD ‘knows right from wrong’
- ASPD is extremely common among incarcerated offenders
what 3 times are symptoms assessed in court process
symptoms do not directly cause crime but should be considered. Assessed:
1) at time of alleged crime (criminal resp. assessment)
- ex: by police and then a mental health professional for treatment, involuntary admitted to psych hospital
2) during jail or court proceedings to assess fitness to stand trial (if UFST, try to stabilize, or not criminally resp. on account of mental disorder (NCRMD))
3) when in prison (transferred to correctional psych hospital if problems continue)
unfit to stand trial definition (UFST)
accused is unable to participate in their defense due to mental disorder; unable to:
- understand the nature or objective of the proceedings
- understand the possible consequences of the proceedings, or
- communicate with counsel
what happens to individuals UFST
accused is diverted to mental health system until sentencing
- ex: 2018 shooting in Fredericton by Matthew Raymond
- in 2019, he was found unfit; schizophrenia
- reassessed after 60 days of treatment in facility
- 2020, still UFST, not criminally resp., sent to psych hospital
- 2021: denied request for escorted trips outside hospital
- 2023: granted supervised outings for treatment purposes
not criminally responsible on account of mental disorder (NCRMD)
criminal responsibility requires mens rea, actus reus, causation, and absence of viable defense
- this defense is applied to fewer than 1/1000 cases 2005-2012
- ex: Vince Li (2008 murder of Tim McLean was found NCRMD in 2009 and granted absolute discharge in 2017
what happens to person NCRMD
person is committed to psychiatric hospital until risk to public can be managed in community
- a criminal code review board of mental health and legal professionals and citizens decide on:
1) continued detention
2) conditional discharge
3) absolute discharge
Crocker et al. (2015) NCRMD findings for main offences and diagnoses
Main offences: uttering threats (27.4%); assaults (26.5%); property crimes (16.9%); homicides (6.9%); sexual offences (2.3%)
Main diagnoses: psychotic disorders like schizophrenia (70.9%); SUD (30.8%); mood disorder (23.2%); PD (10.6%)
- unlikely to get NCRMD status w/ PD or SUD alone
- 57.6% were experiencing psychotic symptoms; 23.1% were under influence
mental illness stigma
- stigma is major barrier to treatment (assumption of violence and/or unpredictability)
- public stigma; due to bias in media portrayals
- self-stigma: people w/ MI often accept and agree w/ negative stereotypes, may feel ashamed, try to conceal MI
statistics about public stigma towards MI
public stigma; due to bias in media portrayals (2013)
- 40% of news articles negatively associate MI w/ crime, violence, danger
- 17% included the voice of someone w/ MI
- 25% included the voice of an expert
- 19% discussed treatment
- 18% discussed recovery or rehabilitation
clinical risk factors for crime
contact w/ police is common
- 2/5 people w/ MI get arrested at some point
- 3/10 have had police involved in care pathway
- police are becoming less reactive and more proactive in Canada
clinical risk factors: why is contact w/ police common?
- co-occurring substance use
- treatment non-compliance
- social and systemic factors:
1) improper deinstitutionalization/lack of treatment
2) community disorganization
3) homelessness
4) poverty
5) poor mental health and social services
mental illnesses in CJS
schizophrenia
alcohol or other SUD
ASPD
BP
BPD
paranoid personality disorder
schizophrenia
a broad spectrum of cognitive and emotional dysfunctions leading to sig emotional and beh difficulties
- including delusions, hallucinations, disorganized speech
- can include grossly disorganized or catatonic beh and/or neg. symptoms like diminished emotional expression or avolition
alcohol or other SUDs
a problematic pattern of alcohol or other substance use leading to clinically sig impairment or distress
ASPD
pervasive pattern of disregard for and violation of the rights of others, occurring since 15 years old
bipolar disorders
major depressive episodes alternating w/ hypomanic or full manic episodes
BPD
pervasive pattern of instability in interpersonal relationships, self-image, and affects..
- …and marked impulsivity, all beginning by early adulthood across a wide range of contexts
paranoid personality disorder
pervasive distrust and suspiciousness of others beginning by early adulthood
- ex: hostile attribution bias
prevalence of MIs among offenders in Canada (Beaudette and Stewart, 2016)
- more serious disorders are more prevalent (esp. SUD and ASPD)
- over 80% lifetime prevalence
- almost 75% currently met criteria for a disorder
- almost 5% lifetime prevalence for psychotic and bipolar disorders (vs. 1% in community samples)
- 1/3 lifetime or current prevalence of anxiety/stress disorder, esp. PTSD or panic disorder
- almost half had diagnosis of ASPD
- 15.9% had borderline PD
- 2/3 lifetime prevalence alcohol and SUD
what is most common diagnosis among offenders in Canada
alcohol and SUD
prevalence of MIs among offenders in Canada (Wilton & Stewart, 2017)
robbery most likely to be associated w/ sub. use and co-occurring disorder
prevalence of MIs among offenders in Canada (England et al., 2008)
looked at 1396 incarcerated male violent offenders
- 73% met criteria for any PD
- 65% for ASPD
- 22% paranoid personality disorder
- 18% BPD
prevalence of MIs among offenders in Canada (Warren, 2002)
sample of US incarcerated women
- 67% had PD
- ASPD (43%, paranoid (27%), BPD (24%)
which mental health symptoms have criminogenic potential
psychosis associated w/ 49-68% increase in odds of violence (Douglas et al., 2009)
- schizophrenia w/ active hallucinations and/or delusions
- psychotic disorder: 350% increase in odds of violence in community vs. 27% in correctional settings
- TCO (threat/control override) symptoms: cause someone to feel threatened or involve intrusion of thoughts that can override self controls. Most command hallucinations are non-violent
what does psychosis provide for criminogenic potential
1) motivation for violent behaviour
- ex: paranoid delusions
2) destabilization of decisions and behaviour; disorganized and impulsive acts
- ex: command hallucinations (voices that instruct person to act a certain way)
3) disinhibition of factors that normally inhibit violence
- ex: negative affect
delusions definition
fixed beliefs not amenable to change in light of conflicting evidence
- bizzare (aliens controlling thoughts) or non-bizarre (police are constantly watching you)
