Lecture 5: Mental Disorder and Crime Flashcards
Views of people with Mental Illness
Previous view: People with MI are dangerous. High stigma
New View: stigma around MI remains high. Effort to reduce stigma through stigma reduction programmes
Star (1955) study design (view the public had on MI)
- He wanted to assess the view the public had on MI
- Used vignettes to show people as having mental illnesses (SZ, alcoholism, phobia)
Star (1955) findings
found that very few identified the problems posed as being linked to MI. MI can dehumanise an individual and takes people away from what they really are
* this gives evidence of high stigma
Nunnally (1991) - stigma
Evidence that the stigma around MI remains high.
They found that MI individuals were classified as ‘dangerous, dirty’, ‘unpredictable’ and ‘worthless.
Phelan et al., (1991) findings
Found that stereotypes of mentally ill individuals are getting worse (particularly dangerousness)
A study that aimed to improve stigma around MI
Angermeyer and Matschinger (2005):
* they argued a need for increased public health literacy around MI
* Explained MI as a biological cause.
Repercussions of Angermeyer and Matschingers (2005) study
This produced an increase in stigma around MI. Encouraged increased distancing from MI individuals. Made public view MI as having a problem with their brain.
Why is stigmatisation of MI a major societal problem?
- 9/10 people with MI have suffered stigma and discrimination
- people with MI experience social drift - pushed out of society, making it harder to find work, maintain a relationship, have decent living circumstances. Leading to substance misuse and violence.
Examples of stigma reduction campaigns/resources
- Mind charity Stigma reduction campaigns
- The Guide
- The Guide Cymru
Thornicroft et al., (2016) design and findings:
Narrative review of published reports on Stigma reduction programmes.
Found modest change in short term attitudes but little change in knowledge.
- issues around the quality of studies used in the review as they did not assess long term changes or changes in stigma in people with mental disorders.
Milin et al., (2016) study design and findings
- RCT involving 534 Canadian students in year 11-12
- they tested the effectiveness of the curriculum guide that aimed to inform students on mental health content.
Findings: students who took the guide showed an increase in MH knowledge and a decrease in stigma
Limitations to Milin et al’s (2016) study
- effect is not strong
- control groups knowledge around MH gets worse
Why do we need to change stigma around MI at a young age?
MI can be detected as young as 14 (mean age of onset of MI = 14), so education need to be provided before this age to stop stigma.
Simkiss et al., (2020) study design
- RCT in all schools in Wales providing the Guide Cymru at age 11.
- They developed a new measure (KAMHs) to assess a range of impacts the guide will have in the individual:
1. knowledge
2. stigma to others
3. anticipated stigma
4. self-stigma
5. good mental health behaviours
6. help-seeking/disclosure
Simkiss et al., (2020) Findings
- Knowledge of MI increases
- Stigma towards other people with MI decreases
- Good mental health behaviour increases
How to investigate the relationship of MI and violence 1/3
Examine amount of patients with MI in a prison and compare to a control population.
Limitations: people with psychotic illness may be over-represented in the prison population
How to investigate the relationship of MI and violence 2/3
Examine records of patients with or without MI to see levels of past violence
Limitations: violence is used to define mental illness - hard to know the direction of the relationship
How to investigate the relationship of MI and violence 3/3
Examine patients discharged from hospital to see their rates of violent crime
Limitations:
* ethics
* different population comparison (people who have been hospitalised or imprisoned)
* effects of confounds (social drift is still a problem)
Swanson et al (2015) study design and findings
Assessed violence after 6-12 months in individuals released from prisons.
Found that involuntarily committed inpatients and first episode psychosis patients had a higher percent of violence within the time frame
There is a debate whether there is a relationship between MI and Violence. What studies support this debate?
- Swanson et al., (2015)
- Arsenault et al., (2000)
There is a debate whether there is a relationship between MI and Violence. What studies go against this debate?
- Monahan & Steadman (1983)
- Bonta et al., (1998)
- Harris et al., (1993)
Monahan & Steadman (1983) study design and findings and limitations
Controlled for confounds (age, social class, institutionalisation etc) and assessed the link between MI and violence
Findings: they found no significant effect between MI and violence
Limitations: by taking away confounds, you take away the effect, so there is no suprise no effect was found.
Monahan (1993) explanation of previous study
They explained faults in previous conclusions. Explained that MI causes social drift, so correcting for this attenuates the relationship between MI and Violence
explain that mental illness causes 1) drift in social class and also causes people to 2) be in institutions, which all lead to violence
Bonta et al., (1998) Study design and findings
- meta-analysis of 64 samples of data.
- caluclated effect sizes for prediciting general recidivism or violent recidivism
Findings: the predictors for general and violent recidivism are the same for both MI and typical offenders.
- Clinical variables had no effect size.
- Criminal history large effect size
Evidence for no relationship between MI and violence
What is the VRAG?
Violence Risk Appraisal Guide (Quinsey et al., 1998; 2006)
* An actuarial measure of violence risk (risk assessment)
Harris et al., (1993) - VRAG - violence and SZ
Wanted to see the effectiveness of the VRAG. In doing so, they examined 618 patients who were charged with violent crime. Once discharged, these were followed for 7 years.
Findings: found a negative relationship between SZ and Violent reoffending. SZ was a protective factor
Consideration point when discussing Harris et al’s., (1993) findings
the finding that SZ was a protective factor could be explained by the comparison population within the institution - PSYCHOPATHS (known to be extremely more violent)
Arsenault et al., (2000) study design
- Total birth cohort of 961 Ps in New Zealand
- Examined violence and MI
- they looked at violence in the last 12 months through self reports, crime statistics, and interviews
Arsenault et al., (2000) Findings
- ‘usual’ relationship between substance and alcohol use around violence
- people with SZ were 2.5 times more likely to be violent in the past 12 months
noted that SZ individuals explained violence due to delusions
Fazel et al., (2009)
SCZ associated with violence. BUT large part of this is due to substance use co-morbidity
SCZ or Symptoms view
SCZ is a broad group, it may be better to look at specific symptoms of SCZ and its link to violence:
* Delusions
* Threat/Control override
* Command Hallucinations
What are Threat/Control override symptoms of SCZ?
- patients see others as out to get them (threat)
e.g. they are poisening my food - Or override condemnations against violence (they justify their violence as the act itself is deemed better than the consequence)
e.g. I did that act to stop the devil from rising
Applebaum et al., (2000) Study design
- This was a prospective study that used data from the MacArthur study.
- Large sample of patient’s and controls were given thorough assessment (interview, self-report, informants) to determine diagnosis and signs of delusions.
- Violence over the next year was monitored
Applebaum et al., (2000) findings
Found that individuals WITHOUT delusions were more violent. Suggesting that individuals experiencing threat/control override symptoms are not violent
When looking into the types of delusions displayed, the same results were found - those WITHOUT certain types of delusions committed more acts of violence
Link et al., (1998) study design
- large sample of Israeli Ps
- gathered violent behaviors through self-reports of previous violence (retrospective) and psychiatric interviews
Differences between Applebaum et al (2000) study and Link et al (1998) study
Applebaum et al., (2000): found that TCO was not related to violence
Link et al., (1998) found that TCO was related to violence
differences because:
* Prospective Vs retrospective designs
* In Applebaums study, there was more strict criterion for delusion acceptance. Removing this strictness displays similar results to Link’s study
Link et al., (1998) findings
found elevated rates of violence when increased Threat/control override symptoms were displayed.
* 7.3% of violent individuals often believed that people wish to do them harm
* 9.7 % of violent individuals often believed that thoughts were put into their head
Ulrich et al., (2013) study, findings, conclusion
Original study: using the MacArthur data, repeated previous findings that delusions did not prospectively predict violence.
Reanalysed their data to consider temporal proximity of the delusions (were individuals aggressive at the time the delusions were taking place). This showed associations between specific delusions (angry affect) and violence.
they concluded that delusions can cause anger that lead to violence
What are Command Hallucinations?
these are hallucinations (usually auditory) that order acts of violence
e.g. “You have to get physical with your partner”
Why are Command Hallucinations linked to violence?
Numerous case studies have explained the act of violence being down to a command hallucionation. This is for different types of violence:
- sexual offending
- violence to others
- self amputation
- swallowing objects
Evidence of Command Hallucinations linking to violence before 2000s
Dominant finding: NO relationship
- 7 controlled studies found no relationship
- 3 literature reviews found no relationship
Evidence of Command Hallucinations linking to violence after 2000s
New view:
WAS a relationsip .
- McNeil et al., (2000)
- Monahan et al., (2001)
McNeil et al., (2000) - what did they report?
they reported a positive association for violent content command hallucinations and pre-admission violence when adjusting for social desirability
Note - when severity of CH was removed, the relationship was removed (as expected - you are removing the effect)
Monhan et al., (2011) What did they report?
reported a positive association between violent content command hallucinations and prospective violence at 20 and 50 weeks discharge.
Rogers et al., (not published) study design (1)
- Using the MacArthur study data they assessed a large sample of patients and the impact the nature of command hallucinations has on their violence.
- They were followed up every 10 weeks for a year after discharge through self reports, informant report, arrest records, hospital admitting incident chart information, and rehospitalization records.
Rodgers et al., (not published) findings
- command hallucinations with non-violent content was not a concern
- violent content command hallucinations shows a vast increase in violence
Rodgers et al., (not published) study design (2 - after first findings)
- wanted to assess if there were any mediating factors in those with violent-content command hallucinations
- looked at the temporal proximity of the CH
- looked at having to “obey” to the voice
Rodgers et al., (not published) findings (2)
of the 105 Ps with violent-content command hallucinations, the most violent indiciduals were when the command hallucinations:
* have to obey but not recent
* have to obey and are recent
What is the percent of being more violent if you have a MI?
According to IMHO, 300% increase for mental health alone
* at an individual level, this is alot, however it is not when looking at the societal level
If we could cure all MI, violence would reduce by 4% (not a big risk)
