Problem 1 Flashcards
There are high levels of psychiatric morbidity in prisoners. Researchers tried to find out where this stems from.
What were their main findings?
- Rates of psychosis were significantly higher in low- and middle income countries than in high-income ones
- No gender differences in rates of psychosis + depression
- No increase in rates of psychosis + depression over time
What is the difference between a prison and a jail ?
Prison
- an institution under state jurisdiction for confinement of people convicted of serious crimes
Jail
- a place under the jurisdiction of a local government, (e.g. county) for the confinement of people awaiting trial or those convicted of minor crimes
Why is it so important to reinforce appropriate screening and referral for treatment at intake to jail or prison ?
Because in not doing so a lot of prisoners often have undetected mental illnesses when going to jail
–> this way these inmates are at increased risk of
- clinical deterioration
- disciplinary concerns
- suicide attempts
Are there gender differences in undetected mental health disorders of prison inmates ?
Yes,
Women are more likely to have an undetected mental health illness
–> as a result they also have a higher morbidity rate
Are there racial differences in undetected mental health disorders of prison inmates ?
Yes,
White inmates are more likely than black/hispanic ones to have an
- affective disorder
- Anxiety disorder
Do severe mental illnesses necessarily lead to violent behavior ?
No,
Because severe mental illnesses do not independently predict future violent behavior mental illnesses can not be seen as the leading cause of violence in the general population
THUS: understanding the link between violent acts + mental disorder requires taking into account their association with other variables
e.g.: Substance abuse, environmental stressors, history of violence etc.
Why did people previously assume that the cause of violence by mentally disordered people is linked fundamentally to the mental disorder itself ?
Because, these disorders usually involve paranoid psychotic symptoms
e.g. schizophenia, depression
Social stress model
Suggests that stressful life events increase psychological disorder, whereas social support decreases it
Theory of general strain
(Agnew)
- Suggests that individuals who are stressed are more likely to experience negative affective states
- these states in turn create an internal pressure called corrective action
- this pressure is most likely to lead to violent behavior when violence is viewed as
a) an alternative means to goal achievement
b) as form of retribution aimed at punishing those believed responsible for the strained situation
Social bond theory
(Cullen)
The more social support in a persons social network - the less crime will occur
–> because, social support is an important precondition to effectively exert social controls
THUS: individuals in supportive relationships are likely to experience a greater degree of social control over their behavior than those who are not
Do stressful life events + impaired social support contribute to the association between mental disorder and violence?
Yes,
When stressful life events occure but you have strong social support, the association between mental disorder + violence is substantially reduced
Psychopathological theory of criminal behavior
Suggests that untreated mental illnesses such as schizophrenia and other psychotic disorders are considered a direct cause of criminal behavior
Is psychopathology a predictor for recidivism ?
No,
But age of onset of criminal activity is a significant moderating factor on the relationship between mental illness and recidivism
–> early age of onset is before 18
How is the forensic psychiatric system different in England and Wales vs Germany and Netherlands ?
- In EW psychiatric hospitals are divided into separate security levels whereas in GN all levels of security are put into one institution
- In EW almost all responsibility is put unto the responsible clinician whereas in GN patients retain autonomy where possible
- In EW hospitalization time is added unto the prison time if you don’t have diminished responsibility whereas in GN hospitalization time is deducted from prison sentence
Why is it suggested in EW to reform the current diminished responsibility plea ?
To bring it more in line with the varying levels of responsibility available in GN
–> this can be applied to any offense, this way many more people w/ mental health issues can be recognized and treated more appropriately
What exactly is the diminished responsibility plea seen in EW ?
In EW an MDO is either fully responsible or fully irresponsible, there is no in-between
–> only MDOs charged with murder can get diminished responsibility
There are much higher incarceration rates in GN than EW.
Where do these possibly come from?
1. Differences in admission criteria
- e.g. criminal responsibility
2. Different interpretations of the legal framework
3. Bed availability
- there are much more beds in the Netherlands than in England
THUS: these factors will have a significant impact on what services are available for MDOs + the rates of psychiatric detention
In the netherlands and Germany the recidivism rates have been steadily falling after being discharged. In England however there are relatively poor outcomes.
Where might these come from ?
1. Ineffective treatment
2. Poor reintegration into society
- UK policies are highly restrictive
ex. : criminal record checks greatly reduce employment opportunities, sex offender register prolongs stigma
A serious offense (traditional view) consists of 2 elements.
Name them.
- Physical/ external element
- Fault element
ex. : Murder consists of a voluntary act that causes death + an intention to kill
BUT: if prosecution fails to prove that the conduct was voluntary, the result is that the accused is acquitted
A serious offense in a newer view consists of 3 elements.
Name them.
- Physical/external element
- Fault element
- Minus a defense
ex. : Murder may be defined as a voluntary act causing death + an intention to kill minus acting in self-defense or as a result of provocation
How does evidence of a mental disorder fit within the newer model of the “serious offense framework” ?
An individual with a mental disorder will not act rationally and his act was thus involuntary or unintentional
–> this way the first + second element are “excused” and it counts as a insanity defense
Insanity defense/M’Naghten Rules
The accused is exculpated from criminal responsibility because of he is unable to know the nature + quality of the conduct or that the conduct was wrong
Why is the insanity defense said to be limited in its scope ?
Because it emphasizes on cognitive rather than emotional + volitional factors
--> this is why some broaden the scope of the defense by including a volitional component
Automatism
Refers to a rarely used criminal defense where the defendant was not aware of his or her actions when making the particular movements that constituted the illegal act
ex.: woman that threw her child out the window believing the house was on fire, whereas she was sleepwalking
Explain the difference between sane vs insane automatism.
- If acquitted on the basis of “sane” automatism one is entitled to complete acquittal as the act is considered involuntary
- If acquitted on the bases of “insane” automatism one one will become subject to detention in a psychiatric facility
Mental disorder has often been used to negate the voluntariness + intention requirements for serious offenses. How is this problematic ?
fehlt
Intentional conduct
Refers to behavior that is adapted to the current environment but is determined by an act of conscious choice
–> caused by the act of forethought/planning + goal setting
Is crime, committed during a dissociative episode, always seen as an involuntary act?
No,
Goal-directed behavior can occur in states of impaired consciousness where some partial awareness exists
THUS: behavior can still be purposeful or goal directed even when performed in states of altered consciousness
Terbeschikkingstelling (TBS)
Refers to a provision in the dutch criminal code that allows for a period of treatment following a prison sentence for MDOs
–> 1. Prison, 2. TBS
What is the primary aim of TBS ?
Shielding society from a dangerous MDO for as long as necessary, meaning as long as he is considered dangerous
How are the gradations of diminished responsibility determined?
A prison sentence is imposed for the part for which the perpetrator is deemed culpable
–> the greater the culpability (Schuld) the longer the sentence
Does the MDO always have to serve the full prison sentence ? If, not why ?
No,
only 1/3 of the prison sentence have to be served and this period may even be shortened due to
- unsuitability for detention
- serious medical need for treatment
A TBS can be renewed by a period of 1 or 2 years. Explain how this works.
- The director of the TBS hospital must submit recommendations to the court on the behavior + progress of the patient
- Then a public prosecutor must request it, after revising the recommendations
- Court hearing
- Each year the court must be advised on the desirability of a renewal
What are the treatment methods offered at TBS hospitals ?
- Socio-therapy
- Transmuralization
- Group vs individual therapy
Transmuralization
Refers to a socialization program whereby patients are placed in accommodation near the hospital as soon as they show that they are following their treatment program + cease to display mental disorder
Mensrea
Refers to the mental element of a person’s intention to commit a crime or knowledge that one’s action or lack of action would cause a crime to be committed
–> necessary element of many crimes
