Mental Illness and Offending

Question 1

What’s an issue with the CJS?

Answer 1

Violence at the time of arrest leads to the individual being processed through the CJS
Some prison cases should be entered into psychiatric care

Question 2

Why is social class a good example of a confounding variable?

Answer 2

Downward social drift among the mentally ill
They may not be able to keep their job and cope with the stresses
Once their socioeconomic status has dropped they get into contact with violent subcultures e.g. living on the streets, homeless
The mentally ill tend to be of lower socioeconomic status
Removing the socioeconomic status in studies could distort the findings

Question 3

Do offenders experience psychosis?

Answer 3

e.g. schizophrenia, schizo-affective disorder, delusional disorder
These disorders are associated with violent behaviour
More likely that a person with psychosis will commit a crime over a person without
However, researchers are still wary of suggesting that psychosis causes violence

Question 4

Why is medication a confounding variable?

Answer 4

Psychiatric drugs are given to the mentally ill to help control their symptoms
The side effects could lead to violent behaviour
Maybe the violent behaviour is caused by the drug and not the illness

Question 5

How do traumatic injuries cause violence?

Answer 5

Mental disorders can occur due to physical disease or traumatic injuries. Particularly, to the brain and its temporal or frontal lobes. This can encourage aggressive behaviour

Question 6

What are command hallucinations?

Answer 6

Type of auditory hallucination
The hearing of voices instructing the patient to commit violence
This heightens the risk of violence

Question 7

How do the police treat those that are mentally ill?

Answer 7

Mentally ill people don’t have the same degree of confidence in the police
They feel they aren’t treated fairly by the police
Police misidentify mentally ill people often
Police likely to threaten or use weaponless contact against mentally ill people
When contact is made, mentally ill people are mildly injured

Question 8

What is mental illness?

Answer 8

Variety of psychological conditions in which there is a characteristic disabling and distressing impairment in some aspect of the psychological functioning of the individual

Question 9

What is the mental health act (2007)?

Answer 9

Mental disorder: any disorder of the mind
Includes personality disorders where their beliefs and behaviours cause longstanding life problems
Categories: suspicious (schizophrenia), emotional & impulsive (borderline), anxious (avoidant, dependent)
Antisocial is both suspicious and emotional/impulsive

Includes EDs, learning disabilities, autism spectrum disorders

Question 10

What is the discrepancy between mental illness in the public and those in prison?

Answer 10

More people in prison suffer from mental illness than the general population

Question 11

What are the prison characteristics of those who are mentally ill and in prison?

Answer 11

Homeless
Unemployed before imprisonment
No qualifications

Question 12

What are the rates of mental disorders in people convicted of homicide?

Answer 12

500 homicide cases
England/Wales
44% had a record of mental illness at some point in their life
14% had symptoms of mental illness at the time of the offence
8% had contact with mental health services in the year before the offence

Question 13

What is the DSMV used for?

Answer 13

Diagnosed using the DSMV
Key published source for definitions of mental illness
Categorised into axis

Question 14

What are the different categories of axis in the DSMV?

Answer 14

Axis 1: clinical disorders (major depression, Schizophrenia
Axis 2: Personality disorders, mental retardation
Axis 3: General medical conditions
Axis 4: Psychosocial and environmental problems
Axis 5: Global functioning

Question 15

What types of diagnoses is common in prison?

Answer 15

Axis 2 in the DSMV
Personality disorders and depression/anxiety is higher in prison than the general population

Question 16

What is the definition of Schizophrenia?

Answer 16

Problems differentiating real experiences from unreal experiences
Unable to think logically about issues
Struggle to behave as others do in social situations

Question 17

What requirements does the DSMV suggest patients need to be diagnosed with Schizophrenia?

Answer 17

2 or more symptoms present often during a one month period
At least one of these should be: delusions, hallucinations and disorganised speech

Also includes negative symptoms and catatonic behaviour

Question 18

What is the General Personality Disorder?

Answer 18

Behaviour that deviates markedly from the norms and expectations of an individual’s culture
Manifested in: cognitions, affectivity, interpersonal functioning, impulse control

Question 19

What is an Antisocial Personality Disorder?

Answer 19

Mental disorder
Characterized by persistent disregard for the rights of others and violations of these rights
These people are manipulative and deceitful
This term is not applied to those under the age of 18 years, as typically young people can grow out of this behaviour

Question 20

What are the characteristics of ASPD according to the DSM?

Answer 20

Failure to conform to social norms
Deceitfulness
Impulsivity
Irritability
Lack of remorse
Consistent irresponsibility

Question 21

What is the criteria for ASPD according to the DSM?

Answer 21

Over 18 years old
Evidence of conduct disorder from before age of 15
Not exclusively present during Sz or Bipolar disorder

Question 22

Is there a diagnostic bias?

Answer 22

Violence as a diagnostic criterion
In the DSM1 only 2% of diagnoses included violence
in the DSM3 47% of psychiatric diagnoses included violence

Circularity in the diagnosis: a person is classified as mentally ill because of their violent behaviour, this diagnosis is then used to explain their violent behaviour

Question 23

How does the media influence the perceptions of offenders?

Answer 23

Media shapes the public’s beliefs about how dangerous the mentally ill is
Public attitudes of the mentally ill become more negative after highly publicised violent incidents involving the mentally ill

Question 24

What did Link et al find?

Answer 24

Compared mental health patients to never treated community residents
Controlled for socioeconomic status
Mental health patients had higher rates of violent and illegal behaviour
This difference is because of psychotic symptoms

Question 25

What did Swanson et al find?

Answer 25

Community sample
Those who said they engaged in violent behaviour:
4x more likely to have Sz or major affective disorders
14x more likely to engage in substance abuse
17x more likely to have a mental disorder and engage in substance abuse
Turn to substances to cope with their issues, but it can exacerbate their issues

Question 26

What did Hodgins find?

Answer 26

Longitudinal study
15000 people
in 1953
Stockholm
Men: 32% engaged with crime with no mental disorder but 50% engaged in crimes but had a major mental disorder
Women: 6% non mentally ill but 19% of mentally ill women became criminals

Question 27

What is co-morbidity?

Answer 27

Presence of a disease or condition to the one of primary interest, resulting in a combined effect
Mental illness has comorbidity with drug abuse and alcoholism

Question 28

Is there a link between violent crime and mental illness?

Answer 28

The mentally ill are more likely to be victims of crime than other people

Question 29

What are the clinical aspects of crime?

Answer 29

Mental illnesses aren’t always associated with violent behaviour
Mental illness is not an invariant feature of a person’s life- changes in intensity and form over time
Other factors affect the likelihood of violence, not just mental illness

Question 30

What did Smith and Taylor find?

Answer 30

Male Sz sex offenders
94% had some sort of delusions and hallucinations at the time of the offence
51% of these offenders said the hallucinations were coincedental and no bearing on the attack
25% had delusions that were of sexual nature but didn’t reflect the characteristics of the sexual assault
18% had delusions that appeared to be directly related to the sexual attack

Question 31

What did McNeil find?

Answer 31

Gender is a poor predictor of violence
Previous history of violence is the best single predictor of future violence
Being victimised increases the risk of acting violently
Care givers and nurses are at the greatest risk of violence
Poor social networks are associated with violence
Some environments are threatening
Homelessness is associated with violent behaviour
The availability of the weapons increases risk

Question 32

What is the CJS process like in America?

Answer 32

The Miranda rights protect individuals but mentally ill people can waive these rights

Plea: individual will be assessed, may be unfit to plead, sent to a unit to restore competence

Trial: individual returns to court for their trial if their competency is restored within a reasonable period of time

Sentence: most common outcome is that they will be sent to prison and receive psychiatric care there

Question 33

What is the CJS process like in England and Scotland?

Answer 33

An appropriate adult is appointed e.g. police, and the patient is diverted into psychiatric care

Opportunity to plea: unfit to plead if the individuals don’t understand the difference between a guilty and not guilty plea

A trial: judge may deem it undesireable for an individual to give evidence, instead they may be remanded to hospital for treatment

Sentence: plead guilty and psychiatric evidence, most common outcome is a hospital order, but prison treatment is possible

Question 34

What’s the interplay between the CJS and the Medical Systems?

Answer 34

Problematic individuals will be diverted into one or the other system according to the capacity within the medical system
British mental hospital admission correlate negatively with rates of imprisonment

Question 35

What’s a limitation of psychiatrists treating offenders?

Answer 35

Psychiatrists often link the reduction in risk to reduction in psychiatric symptoms and compliance in medication
This is why multiple professionals will work on an offender so psychiatrists can’t fall into this trap