Lecture 7: Mentally Disordered Offenders Flashcards
What are the unique static and dynamic predictors of re-offending in justice involved persons with mental illness?
- Static: Diagnosis of Schizophrenia or Psychosis
- Dynamic: Mood disturbance/Lability, co morbid substance use disorder, aggressive attributional style- suspiciousness, paranoia, delusions, perceived threats
Why is mental disorder important to assess at intake to a correctional system?
- Early identification improves treatment response (more likely to be medicated)
- Reduces victimization
- Consistent with the law- community standards of care
- Admission to jail is a high risk time (suicide risk)
Why is it important to assess suicide risk in offender samples? How does the prevalence of suicidal and para-suicidal behaviour in offender samples compare to the general population? What are the more prevalent methods for suicidal and para-suicidal behaviour in offenders?
-The prevalence of suicide is higher in prison populations (despite increased monitoring and limited methods to kill themselves). In Canada from 1997-98 prison suicide rates were 13 per 100,000 which is 4x the rate of community suicides. The most prevalent for actual suicides (completers) is hanging/suffocation (92%), for parasuicide (suicide attempts) it is also hanging/suffocation (38%) with slashing being a close second (31%).
What is the JSAT and why is it important?
-The JSAT (jail screening assessment tool) screens for prior mental health treatment, suicide/self-harm issues and mental health status (based on brief psychiatric scale). Currently being used in ON (based out of BC designed for use with forensic populations). Serves two purposes: system does an assessment to limit their liability and the second is to ensure that the people who need services get services.
What is known about prevalence of mental disorder in offender samples compared to the general population?
Across virtually every study, the rates of mental disorder are higher in offender samples compared to the general population/community and the rates appear to be increasing.
What is the risk of re-offending of mentally disordered offenders relative to other offenders or a community sample?
People with mental disorders are higher risk than the general population/community, but lower risk compared to non-mentally disordered offenders
What is the HCR-20, START and SAPROF? Why are they important?
- All of these risk assessment tools were developed for and used in populations where there are fairly high numbers of people with mental disorders.
- HCR-20 (historical, clinical risk) (AUC > .70) is a SPJ tool with 20 items and then the hare psychopathy checklist (scored as 0 doesn’t apply at all, 2 it completely applies and 1 it somewhat applies). The higher the score, the more likely a person is to reoffend. It is intended for use with civil psychiatric, forensic and criminal justice populations and must be used by a psychologist. HCR-20 somewhat unique because it includes 10 historical items (more predictive), clinical symptomatology and risk management
- START is a dynamic risk assessment with 20 items (AUC .78). It assesses 7 dynamic risk domains: violence to others, suicide, self-harm, self-neglect, unauthorized absence, substance use and victimization). Very uniquely developed- it has the same item organized as either a strength or a risk factor depending on the circumstance. Also covers mental health threats. It started the interest in protective factors.
- The SAPROF (AUC .70) is a risk assessment for protective factors of violence. Made specifically to augment the HCR-20, intended to be used in concert with the HCR-20 since the field is moving towards considering both risk and protective factors. Has a number of internal factors, motivational components and external factors, the most popular strength based measured used in the forensic population.
Do most people with mental illness commit crimes?
Most people with mental illness do not commit criminal acts; however, contact with the police is common among this population.
What are some police issues when it comes to dealing with persons with mental illness?
- The understanding and identification of mental illnesses.
- How to communicate with mentally ill persons.
- How to use defusing and de-escalization techniques.
- How to assess suicidality, risk & dangerousness.
- Issues related to stigma.
- The role of the family with mentally ill persons.
- How to access mental health services.
- The provincial Mental Health Act (MHA).
- Issues related to the use of force with mentally ill persons.
are interactions between the police and mentally ill persons positive or negative?
- 30% indicated positive perceptions of police
- 47% were somewhat or fully satisfied regarding their interactions with police.
- Moreover, following contact with police, the overwhelming majority felt better (65%), calmer (66%), respected (85%) and clearer about the situation (76%).
What is penrose’s law?
The number of persons in the mental health and corrections systems is a constant. (Their placement reflects vagaries of sociopolitical interests)
Who are justice involved persons with mental illness?
JIPWMI are those individuals who have come into contact with the criminal justice system and who also have a mental disorder
Includes:
- Those found unfit to stand trial
-Offenders found not criminally responsible on account of mental disorder (NCRMD)
- Offenders who are mentally disordered or seriously mentally ill
What are the problems with diagnoses?
- Developed primarily by psychiatry so may not reflect psychological research
- Is unrelated to causation
- There are different classification systems (DSM-IV, ICD-10)
- Prevalence varies by the model used
- Canada & UK are using severe personality disorder as a criterion for indeterminate sentencing
What are the axes of the DSM-V
- Axis I: Clinical disorders (e.g. clinical depression, alcohol abuse, schizophrenia). These disorders have concrete effects on individuals’ emotional life and perception of reality.
- Axis II: Personality Disorders and Mental Retardation
- Axis III: General medical condition
- Axis IV: Psychosocial and environmental factors
- Axis V: Global assessment of functioning
What are the assessment methods for JIPWM?
Interview Based (in order of complexity)
- Structured Clinical Interview for DSM
- Jail Screening Assessment Tool
- Diagnostic Interview Schedule (ICD)
- Brief Psychiatric Rating Scale (24 - DSM)
- Referral Decision Scale (14 - DSM)
Questionnaires
- Beck scales (Depression, Hopelessness)
- Computerized Lifestyle Assessment Inventory (Substance Abuse)
