Mental disorder and offender behaviour Flashcards
what is forensic psychiatry
- “That part of psychiatry which deals with patients and problems at the interface of the legal and psychiatric systems”
- “Forensic psychiatry is the prevention, amelioration, and treatment of victimization that is associated with mental disease”
John Gunn, Emeritus Professor of Forensic Psychiatry, Institute of Psychiatry (2004)
Clinical Forensic Psychiatry
Assessment & treatment of mental disorder
Disorder appears to be associated (not necessarily causally) with offending behaviour
what is Legal Psychiatry
All law relating to mental disorder, and to the treatment and care of those suffering from mental disorder
Bilateral relationship
- Giving psychiatric evidence in legal proceedings
- Use of law for clinical purposes and regulating clinical practice
when do psychiatrists get involved in crime
When the offender is mentally disordered
When the offence is unusual or odd e.g., necrophillia
When a person needs treatment
what are the clinical skills
Assessment & Treatment of Mental Disorder
Assessment of aggression and violence assisting others in understanding
Understanding of violence – reactive (anger, fear, danger) vs. instrumental (obtain desired outcome, profit, political, submission) vs. sadistic (paraphilia, enjoyment) violence
what are clinicolegal skills
Utilising understanding of medical and legal concepts to map one onto the other
Assisting Legaland in the psychological understanding of violent behaviour
what are the different types of crime
- Violence against the person
o Any violent offences ranging from common assault to murder - Sexual offences
o Ranging from sexual harassment to rape - Robbery
o Stealing associated with the use or threat of force upon a person - Burglary
o Stealing from property, either domestic (dwelling) or commercial (non-dwelling) - Theft and handling stolen goods
o Any other forms of stealing, including cars, shoplifting, mail, proceeds of crime - Fraud and forgery
o Obtaining money under false pretenses or by falsifying documentation - Criminal damage
o Damage inflicted to property or vehicles, including all forms of arson - Drug offences
o Either possession or trafficking (i.e. dealing or handling) of all classes of illicit drugs or drugs which require a prescription
o Most common in prisons - Other offences
o A wide range of offences which do not fit into other groups, including blackmail, kidnapping, high treason, offences relating to courts, planning offences etc.
what social factors are there that can lead to more acts of violence and antisocial behaviour
Economic and health factors- Poverty, unemployment, chronic physical and mental illness
Familial factors-Parental inadequacy, criminality, Intra-family violence, Large family size, Child abuse and neglect
Peer factors- Antisocial/delinquent peers/gang membership, School factors, Low educational ability and academic attainment, Lack of parental involvement
Societal factors- Inequality – access to education, housing, Prejudice, Poor support network and lack of social cohesion
facts on ACE (adverse childhood experiences)
Four or more ACEs increase risk of conviction for repeated and severe violence (Fox et al 2015)
Admission for childhood trauma increases risk of violent offending in both sexes ( Webb et al 2017)
Mediating factors: disorganised attachment, mood dysregulation, unresolved distress, personality dysfunction, increased risk of substance misuse, increased risk of susceptibility to psychosis?
the importance of relational factors- victimology (what Qs may be asked)
Is a relationship with the victim a key factor in this violence?
How is the victim perceived? (Narrative)
What has been achieved by the violence?
Is this a repetition of an unresolved distress?
consider the history of the offender
Previous violence
Lack of supportive relationships
Poor concordance with treatment, discontinuation or disengagement
Impulsivity
Alcohol or substance use, and the effects of these
Early exposure to violence or being part of a violent subculture
Are the family/carers at risk? History of domestic violence
Lack of empathy
Relationship of violence to personality factors.
consider the environment of the offender
Access to potential victims, particularly individuals identified in mental state abnormalities
Access to weapons, violent means or opportunities
Involvement in radicalisation
consider the mental state of the offender
MENTAL STATE
TCO
Emotions related to violence
Specific threats or ideas of retaliation, Grievance thinking
Thoughts linking violence and suicide (homicide–suicide)
Thoughts of sexual violence
Restricted insight and capacity
some Stronger factors for violence regardless of mental state:
Male
15-30
Socioeconomically deprived
Past Hx of violence
stats with some mental disorders
CONTROVERSIAL DATA
Psychosis higher in those prisoners with violent offence than in those with non-violent offences
~10% of schizophrenic patients report a violent act in 12 month period in comparison to 2% of those w/o mental disorder
However; 12 times higher in ETOH dependence and 16x higher in drug dependence
Homicide perpetrators: 5% prevalence of schizophrenia in comparison to general population (1%)
BUT – those with MI are at much higher risk of being victimised, suicide and self-harm
what is the difference between murder and manslaughter
Murder – the taking of life with specific intent to do so e.g., homicide
Manslaughter – the taking of life be it accidental or other forms of mitigation
facts about Homocide
Homicide – most victims are family members/known to the perpetrator or the result of aggression between young men with alcohol (pub brawl)
- 75% of cases, victim known to perpetrator
- Infanticide – 66% of all infant related homicide
- Don’t forget Domestic Violence!!!
Charges for homicide in the UK:
- Murder, manslaughter or infanticide
- Infanticide – Legal Defence if child has been killed within the first year of birth and accused had a disturbance of mind as a result of the effects of childbirth or lactation
National Clinical Survey of people convicted of homicide (1594) in England and Wales from 1996 to 1999 (Shaw et al, 2006):
34% (545) of homicide perpetrators have lifetime diagnosis of mental disorder
5% (85) had diagnosis of schizophrenia
9% (143) PD, 7% (117) ETOH dep, 6% (95) drug dependence
10% (164) of perpetrators had abnormal mental state
5% (76) were actively psychotic at the time of the killing
9% (145) had contact with MH services 12 months prior to offence
9% (149) convicted of manslaughter by reason of diminished responsibility
7% (111) received a hospital disposal
The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness between 1997 and 2006 recorded 5884 general population homicide convictions in England and Wales (Swinson et al, 2011).
10% (605) had a mental illness at the time of the offence
10% (598) had recent contact with MH services
6% (348) had schizophrenia
6% (355) received a hospital disposal [offence directly related to mental state requiring treatment/offering mitigation]
ETOH and homocide
Number of homicide perpetrators with schizophrenia increased at a rate of 4% per year, those with psychotic symptoms at the time of the offence increased by 6% per year. Rate of ETOH and drug misuse increased by the same magnitude as well.
