Lecture 7: Forensic mental health and terrorism

Question 1

The DSM-V and ICD-10 classification manuals

Answer 1

-Classification based manuals which define symptoms of mental disorders

Question 2

Psychotic disorders

Answer 2

• Psychosis = loss of contact with reality

- Experiences include hallucinations, delusions and unusual sensory phenomena

Question 3

Personality disorder

Answer 3

• Common diagnoses include: ASPD, BPD, paranoid personality disorder or narcissistic personality disorder
• Roots in attachment and other developmental dangers, disorders developed as a result of self-protective strategies

Question 4

Mental health act (1983, 2007)

Answer 4

-Allows practitioners to detain individuals with mental health issues
Most often seen:
-Section 3 = six month detention for treatment
-Section 37 = hospital order from court, those who have 37 usually have 41
-Section 41 = restriction order, justice system continues to monitor them until discharges
-Section 45a = referral to hospital for treatment then recalling to serve sentence but issues with personality disorders as no way of treating it
-Section 47/49 = psychotic person in prison moved to hospital

Question 5

Forensic mental health and custody suites

Answer 5

• Place of safety
• Psychologists go into room to see if they are distressed
• Idea that they have moved away from putting criminals into cells when they have significant mental health needs

Question 6

Forensic mental health in prison - study

Answer 6

Hassan et al (2011)

• Reported 10% of UK prisoners were psychotic, 32% clinically depressed, 67% drug addicts, 52% alcoholics
• Reported stability over time

Question 7

Forensic mental health in probation

Answer 7

• Offender personality disorder pathway set up to work with those who met a high risk threshold
• Money comes from danger and severe personality disorder units

Question 8

Secure care

Answer 8

• Transferred from court from prison or local psychiatric units
• Caring environment
• Holistically care for individuals
• Tension between therapy and risk reduction where psychology want to address issues whereas government want risk reduction
• Patients can have leave but risk assessments are completed

Question 9

Forensic mental health community outpatients

Answer 9

• Once people leave secure care, this is their aim to be an outpatient
• Addresses many difficulties they face such as housing and people are integrated back into society
• Under certain mental health sections, some patients remain under care of forensic services

Question 10

Role of psychologist in secure care

Answer 10

• Case management
• Risk assessment
• Formulation (how everyone contributes)
• Intervention = offence focused interventions and individual therapy
• Research

Question 11

Criticisms of DSM-V and ICD-10

Answer 11

• No scientific underpinning
• Much co-morbidity
• Reliability of diagnosis is poor
• Focus on behaviour rather than function
• Labels can be stigmatising

Question 12

Terrorism

Answer 12

• The act or threat designed to influence the government or intimidation the public
• Usually to advance political, religious or ideological cause

Question 13

Terrorism Act (2000,2006)

Answer 13

• Explosive substances: causing explosion that endangers life or property or attempts to cause explosion
• Encouragement of terrorism
• Proscribed organisations: having a membership or supporting it
• Funding terrorism: included fundraising and money laundering
• Failure to disclose info about acts of terrorism
• Possession for terrorists purposes

Question 14

What is extremism?

Answer 14

-Vocal or active opposition to fundamental values e.g. democracy

Question 15

Themes for extremism

Answer 15

• On the fringe of the society
• Conspiracy beliefs
• Distrust of authorities
• Rigid world view
• Dehumanisation of others
• Powerful influential leaders

Question 16

How has terrorism evolved

Answer 16

• Historically terrorism conducted by organisation with motive and agenda
• Attacks were planned and strategic and often involved weaponry
• Membership was restricted
• Picture changed after ISIS
• DIY terrorism started to increase and function is to bring terror
• Social media now used and recruitment to specialist roles e.g. doctors

Question 17

Mental disorder and terrorism: Paradigm 1 and 2

Answer 17

Paradigm 1 = psychopathy and yes/no dichotomy as to whether a terrorist
Paradigm 2 = specific personality types, source is childhood maltreatment, narcissistic personality traits developed, when adulthood reached individuals seeks to turn aggression towards external world

Question 18

Mental disorder and terrorism: Paradigm 3 and 4

Answer 18

Paradigm 3 = mental disorders not related to terrorism, argues terrorists are like general pop., within general pop there are people with mental health problems, those who commit the most violent acts have the most serious psychopathology, people with pscyhological disorders don’t make good terrorists as they lack discipline, rationality and self control, true for IRA not for ISIS
Paradigm 4 = there is complex picture and mental disorders part of it

Question 19

How can psychologists contribute

Answer 19

• Use evidence to guide
• Diagnosis gives indication of difficulties
• Need to abandon focus on symptoms and make sense of function
• People complex and cannot be reduced to Likert scales or checklists
• Need to get to know person to understand the risk