Forensics Flashcards
How much more common is violence in mentally ill compared with gen pop
4-6x
How many crimes can be attributed to mental illness
<10%
Risks of conviction for serious violence by men with SCZ compared to gen pop
5x risk of being convicted of serious violence
Annual risk of patient with SCZ committing homicide
Men - 1:3000
Women - 1:33,000
Prevalence of psychosis in male prisoners
3.7%
Prevalence of depression in male prisoners
10%
Prevalence of PD in male prisoners
65%
How much more common is psychosis in prison compared to gen pop?
10x more
Rate of homicide in the UK
1.2 in 100,000
% of individuals convicted of homicide who have mental illness
9% have SCZ
12% have other psychotic disorder
54% have secondary PD diagnosis
10% had contact with MH services in last year
Annual risk of person with SCZ committing homicide
1 in 10,000
What is filicide
Mother killing ones own child
Common mental illnesses in filicide
Depression - 25%
Psychosis - 40%
PD - EUPD and dependent
Dissociative response
Types of filicide
Battering mothers - impulsive (loss of temper)
Mentally ill mother
Neonaticides - within first 24 hours of life
Retaliating women - aggression towards spouse displaced on to child
Unwanted children - passive neglect or active aggression associated with unplanned pregnancies and socioeconomic hardship
Mercy killing
Definition of infanticide under Infanticide Act 1938
when a mother ‘causes death of her child under the age of 12
months by wilful act or omission, but at the time of the act or omission the balance of her mind was
disturbed by reason of her not having fully recovered from the effect of her having given birth to the child or
by reasons of the effect of lactation consequent on the birth of the child’.
Incidence of infant homicide in UK
30-45 per year
Incidence of murder-suicide
0.2-0.3 per 100,00 per year
Most common mental illness in murder-suicide
Depression - 20-60%
What is parricide
Killing ones parents
How many homicides are parricides
2%
What is common assault?
intentionally/recklessly causes another person to apprehend the
application of immediate unlawful force
What is aggravated assault?
when the individual attempts to cause serious bodily injury to another
or causes such injury purposely, knowingly, or recklessly under circumstances
manifesting extreme indifference to the value of human life; or attempts to cause or
purposely or knowingly causes bodily injury to another with a deadly weapon.
When is battery?
if he/she intentionally/recklessly applies unlawful force to the body of another
person. (A battery is committed when the threatened force actually results in contact with
the other and that contact was caused either intentionally or recklessly.)
How many individuals convicted of non-fatal violence have SCZ
9%
What mental illnesses are linked with shoplifting
Affective disorders
Alcoholism and drug addiction
Depression in middle-aged women
What is kleptomania
Impulse control disorder
How many shoplifters have kleptomania
1-2%
How many fire setters intentionally start the fire i.e. arson
1 in 4
What mental illnesses occur in patients with fire setting behaviour
8% SCZ
11% Bipolar
Alcohol misuse is common
LD
M:F ratio of arson
2.5:1
What is pyromania
Arson occurs on 2+ occasions and results in relief of tension
Pyromaniacs are fire-
raisers who derive a pathological excitement from setting the fire, attending the scene,
busying themselves with it, or having called out the fire brigade in the first instance.
DSM IV criteria of pyromania
Deliberate and purposeful fire setting on more than one occasion;
Affective arousal and tension prior to the act; Fascination with, and attraction to, fire and its
situational context; Pleasure, gratification or relief when setting fires or witnessing or
involvement in their aftermath; The exclusion of other causes (see above); The fire-setting is
not ‘better accounted for’ by conduct disorder, or antisocial personality disorder.
What are juvenile fire setters
Younger than 10
Make up >50% of arrests
Motive is often curiosity
More common in females
Risk factors of recidivism in arson
childhood firesetting problems,
younger age at first firesetting and arson, total number of firesetting offences, no concurrent
charges other than arson, verbalized threats to commit arson, setting fires alone, unmarried
and low IQ.
Treatment for arson
largely behavioural or focused on intervening in the family or
intrapersonal stresses that may precipitate episodes of fire setting. Behavioural treatments like
aversive therapy have helped fire setters. Other treatment methods
rely on positive reinforcement with threats of punishment and stimulus satiation.
M:F ratio of stalking
8-9:1
Types of stalkers
• The rejected who pursues ex-intimates, either in the hope of reconciliation or for
vengeance.
• Intimacy seekers who stalk someone they believe they love and they think they will
reciprocate
• Incompetent suitors, who inappropriately intrude someone, usually seeking a date or brief
sexual encounter
• The resentful who pursue victims to exact revenge for actual or perceived injury.
• The predatory whose stalking forms a part of sexual offending.
Primary diagnoses in stalkers
PD - Cluster B in ex-intimate stalkers
Substance abuse
Delusional disorders - erotomania followed by jealousy and persecution
SCZ
Affective and organic psychosis in stranger and star stalkers
Risk factors of assault in stalking
- Substance misuse
- History of offending behaviour
- Male gender
- Making threats of violence or suicide or fantasising about assaults
- Presence of PD (Narcissistic or antisocial)
- Unemployed and socially isolated
- Access to victims
- Sense of desperation (crisis periods)
- History of non-compliance to treatment
Treatment of stalking
• The nature of the contributory mental disorder and an understanding of what is sustaining
the behaviour
• Confronting self-deception, which minimise or justify the behaviour
• Instilling empathy for the victims plight
• Addressing inadequate or inappropriate social and interpersonal skills
• Combating substance misuse.
How many sex offenders have Mental illness?
<10%
Common mental illnesses in sex offenders
LD PD SCZ Alcohol use Hypomania
How many offences are sex offences?
1%
How many victims of paedophiles are a relative?
13%
How many victims of paedophiles are known to them
68%
M:F ratio of paedophiles
9:1
How many sex offenders are adolescents
33%
Characteristics of high deviancy group of sex offenders
individuals committing
offences outside and inside the family; individuals offending against both boys and girls;
high deviants were twice as likely to have committed previous sexual offences; more likely
to have been abused as a child.
How many paedophiles have another paraphilia?
70%
How much more likely are paedophiles to engage in physical contact with a child than voyeurestic or exhibitionistic activities
2.5x more likely
How much incest is against children
30%
Causes of indecent exposure
Exhibitionism
Alcohol and drug use
Rarely dementia or hypomania
Impulsive during time of stress
Re-offending rate of indecent exposure
20-30%
Common causes of in
If reoffending results in conviction
Angry, aggressive exhibitionist (erect when offending)
What is internet based sex-offending associated with
Emotional dysregulation
Intimacy deficits
Depression
Hypersexuality
Psychological characteristics to consider when assessing sex offender
- Sexual interests (including sexual preoccupation, as well as sexual preference for children)
- Distorted attitudes and beliefs (cognitive distortions, and beliefs supportive of rape)
- Socio-affective management (for instance, emotional regulation and intimacy difficulties)
- Self-management (for instance, poor problem-solving abilities, lifestyle impulsiveness).
Treatment of CBT
Understanding the offence cycle, Challenging distorted
thinking, Understanding the harm done to victims, Fantasy modification, Social skills and
anger control and Relapse prevention work
When is pharmacotherapy considered for sex offenders
If contributing mental illness, then to treat the illness
Medications used in sex offenders
Cyproterone acetate - blocks testosterone receptors
Medroxyprogesterone acetate - induces hepatic enzyme testosterone alpha-reductase, thus enhancing clearance of testosterone
Impact of cyproterone acetate
Reduces sexual drive
SEs of cyproterone acetate
Deranged LFTs
Osteoporosis
Gynaecomastia
Deterioration of depressive tendency
Recidivism rate of sex offenders
less than 1 in 5
How many sex offenders have no previous conviction for a sexual offence
75-80%
How many convicted sex offenders are reconvicted after 6 years?
<10%
Prognostic factors for reduced risk of recidivism in sex offenders
Index offence against child in own family
Risk factors for further sex offences in convicted sex offendres
Index offence against child outside ones family, particularly boys
Multiple paraphilias
Index offence against stranger
Homosexual and extra-familiar sex offenders
Predictors of a sexual offence
• Sexual deviancy: Higher number of sex offences, especially more than one type of
sexual offence, and previous criminal history.
• Diversity in offending, including violent and general crimes;
• Offences against male children carries more reoffending risk than offences against girls;
there is a lower risk of recidivism if the primary offence is an incest
• Phallometric evidence of response to paedophile stimuli and/or nonsexual violence
• Elevated score on Hare Psychopathy Scale (Rice et al., 1990)
• At time of index offence, reduced self-esteem, impaired victim empathy (high risk) or
increased anger
• Being a victim of childhood sexual abuse,
• Presence of violent sexual fantasies
• Longstanding social isolation (present in some sexual murderers)
• Choice of occupational location to facilitate access to potential victims
• Use of sadomasochistic or paedophilic pornography
• Non-compliance or failure to complete treatment. This is often associated with dissocial
traits.
• Often more deviant sexual practices are seen as relatively younger victims.
• Psychological maladjustment, including substance use or abuse, antisocial attitudes and
personality disorders
How many women will be victims of DV at some point in their life
1 in 4
Women most at risk of DV?
<40 years
How many violent attacks are the result of DV?
44%
How many prison inmates misuse substances
> 50% (2% gen pop)
How many prison inmates misuse alcohol
> 40% (4% gen pop)
How many non-fatal assaults and murders are associated with acute intoxication
50% non-fatal
66% murders
Risk of violent offending in patients with SCZ who misuse substances
25x increase compared to gen pop
3.6 risk ratio in those with SCZ without substance use
Prevalence of antisocial PD in prisons
63% remanded men
49% sentenced men
31% female prisoners
Risk of violence in those with antisocial PD
10x more than gen pop
EUPD PD in prisoners
23% of remanded men
14% sentenced men
20% female prisoners
Narcissistic PD in prisoners
8% remanded men
7% sentenced men
6% female prisoners
Paranoid PD in prisoners
29% remanded men
20% sentenced men
16% female prisoners
Common offending in those with LD
Sex or fire-raising offences
Property offences most common
Risk of sex offending in LD
2x more than non-LD
Management of sex offending in LD
Group SOTP
Pharmacotherapy - SSRI, antilibidinal
Potential causes of sex offending in LD
high incidence of family psychopathology, psychiatric illness, social naivety, poor ability to
form normal sexual and personal relationships, poor impulse control and low self-esteem.
Re-offending rate of offenders with LD not treated vs treated
Not treated - 40-70% (similar to non-LD populations)
Treated - 20-55%
When is depression a risk factor for violence
In context of other risk factors like substance use or psychosis
Domestic killings
Mercy killings
How many prisoners have anxiety disorders
10-15%
Prevalence of epilepsy in prison
1-2%
1% in gen pop
Sx of gansers syndrome
approximate answers, clouding of consciousness with disorientation,
psychogenic physical symptoms – analgesia & hyperaesthesia and pseudohallucinations
amnesia for abnormal behaviour
Which group is gansers commonly seen in
prisoners - esp military prisoners
individuals absenting themselves from army or navy
How many offenders are women
1 in 5
Peak age of offending
14 in girls
17-18 in boys
M:F ratio of convictions
5:1
Risk of SMI in women in custody compared to gen pop
5x more likely
How many women in prison have a diagnosable MI
80%
How many female offenders have alcohol misuse problems
31% (vs 42% in men)
What is a juvenile offender
Aged 10-17
What is a young offender
18-21
How many prisoners have {TDS
20%
s35 of MHA?
Remanded for report on mental state for 28 days, renewable up to 12 weeks total
s36 of MHA?
Remanded for treatment for 28 days, renewable up to 12 weeks total - crown court only
s38 of MHA
Following conviction, interim hospital order
Aim of guardianship order under s37 MHA
Ensure offender receives care and protection; guardian also has power to require offender to live at specific place or attend specific place for treatment at specific time
How long does guardianship order last
6 months; can renew for another 6 months twice then yearly
How many prisoners have mental illness
> 90%
in 37% of sentenced male
prisoners, 63% of men on remand, 57% of sentenced women prisoners and 76% of women
remand prisoners.
Suicide rate in prison compared to gen pop
8x higher
Which prisoners are at most risk of suicide
First 6 months of imprisonment
Life prisoner
Remand and young offenders
History of substance use and violent offences
Pritchard criteria for fitness to plead
- Understanding the charge/charges
- Deciding whether to plead guilty / not
- Exercising the right to challenge jurors
- Instructing solicitors and counsel
- Following the course of proceedings or
- Giving evidence in his/her own defence
TO what level does unfitness to plead need to be proven if raised by prosecution?
Beyond reasonable doubt
McNaughten 1843 rules for insanity defence
- A defect of reason (impaired, not mere failure to exercise)
- Due to a disease of mind (not externally caused)
- Leading to loss of appreciation of nature and quality of an act (the offence; physical nature
not moral). - So the accused did not realise what he was doing was wrong (either legally or morally).
Burden of proof for McNaughten insanity defence
Defence
What is needed for diminished responsibility defence
Defending counsel must demonstrate absence of mens rea
What is automatism
Automatism is a plea by a defendant that his actions were not under the control of his
conscious mind, i.e. that his bodily movements were unwilled and involuntary. Although
generally pleaded as a ‘defence’ a successful plea of automatism will negate the conduct
element of the actus reus of any offence with which the defendant is charged.
What is automatism simpliciter/sane automatism
is a complete ‘defence’ as the defendant is deemed not to be in any way to blame for what
happened. Hypoglycemia (isolated), night terror and dissociative states can be classed as
‘sane’ automatisms. Here the cause is often ‘external’.
What is insane automatism
likely to recur (‘internal’) and the counsel can plead not guilty by
reason of insanity (insanity defence). Night walking, epilepsy, hypoglycemia due to a
recurring condition are classed as ‘insane’ automatisms.
What is culpable homicide
Outcome of diminished responsibility argument
Lack of specific intent to kill
Can be involuntary - death unintended but occurs as a result of assault or negligence
Voluntary - death from intentional reckless act but because of provocation or diminished
What is involuntary intoxication as a defence
intoxication refers to someone
unwittingly taking a ‘spiked’ drink or automatism occurring as a side-effect to medical treatment.
This constitutes a valid defence. But voluntary self-induced intoxication is not a defence. Apart
from being ‘spiked’, involuntary intoxication may also include taking a drug prescribed by a
medical practitioner, using a substance that is not dangerous but in a reckless manner, using a
substance as a result of an irresistible impulse to take it (due to a dependent state). All of these
can be used as mitigating factors to reduce sentencing or acquittal.
What mitigating factors can reduce culpability of defendant
- Being provoked
- Age or vulnerability
- Mental disorder or LD
- Involuntary intoxication
- Showing remorse
- Having a limited role in the offence
Criteria for fitness to give evidence
- Understanding the question
- Applying their mind to answering them
- Conveying the answers intelligibly to the jury
Types of false confession
Voluntary
Coerced-compliant
Coerced-internalised
Factors influencing false confessions
(1) Situational factors – effects of custody/isolation – e.g.
process of police interrogation (2) Individual factors – include mental disorder, incapacity etc.
What is a professional witness in court
Comment on clinical state, where they had some involvement
What is an expert witness in court
Write reports to court regarding mental disorder or specific issue
Types of expert witnesses
Advisory
Actuarial
Clinical
Experimental (evidence)
