Crime and Mental Illness
The increase of crime over the years, has led to various assumptions on the causes of these rapid escalations in crime. Hence, experts including psychiatrists have been engaged in this debate. Experts have been involved in the contention as to whether mental disorders and their symptoms have a direct influence on the tendency to commit crime among the related people. The purpose of this paper is to consider the generic question about whether mental disorder is significantly correlated to crime with particular reference to the issues associated with psychiatry and forensic psychiatry.
This paper will firstly explore the relationship between mental disorder symptoms and crimes as well as establish whether there is a direct relationship between symptoms of mental illness and criminality. Mental disorders, especially anxiety disorders, bipolar disorders and psychotic disorders will be discussed and considered in relation to their link to criminality.
In the UK, research has shown that mental health needs of young offenders are not being met, due to the lack of expertise and resources in the custody system (The Mental Health Foundation, 2002).
As such, this essay aims to analyse and critique how the detained youth are diagnosed in psychiatry; predominantly focusing on the potential role of psychiatry in alleviating the mental health illnesses amongst the young offenders in the juvenile system.
Crime and mental illness symptoms
In the UK, studies conducted have shown that In the UK, research has shown that the prevalence rate of mental health problems among the youth in the general population ranges at 13% for the girls and 10 percent for the boys.
On the other hand, the prevalence rate of juveniles with mental disorders in the criminal justice system ranges from 25 to 81 percent (The Mental Health Foundation, 2002). While many researches have been directed towards investigating mental disorder as the cause of crime, the policy makers have also assumed that the metal illness symptoms have a direct connection to the crimes committed (Torrey, 2011). Hence, programs that have been initiated to remedy this situation have always operated under the assumption that medication and mental health treatment will reduce the criminal behavior (Skeem, Manchak & Peterson, 2011).
On the other hand, some researchers have suggested a novel approach where studies are conducted on two groups of offenders: one group entails a small group of criminal offenders whose mental illness symptoms relate directly to their crime and a larger group of offenders where their crimes do not relate to their criminal behavior (Swanson et al., 2008; Skeem et al., 2011). The results of this studies indicated that for the smaller group of offenders, access to mental illness medical treatment led to reduced relapse into criminal behavior. On the other hand, studies conducted the larger group whose criminal actions were not directly connected to mental illness showed that interventions needed to go beyond the treatment of mental illness symptoms if the criminal justice outcomes was to be improved. Hence, the approach of treating mental health symptoms as a way of reducing criminal behavior relapse should not be applied indiscriminately. There should be a distinctions between these two groups: one group with offender whose criminal behavior was motivated by mental health symptoms and the other group whose criminal behavior is not directly linked to mental health symptoms.
Definitions of direct relationships between mental illness symptoms and criminal behavior
According to the UK law, section 1(2) of the Mental Act 2007, the mental disorders recognized include eating disorders, personality disorders, autistic spectrum disorders and mental illnesses (such as bi-polar disorder, schizophrenia, depression and learning disorders). Before one can consider the how offenders are motivated by mental illness symptoms to commit crimes, one should first consider the definition of links between the mental illness symptoms and the criminal behavior. Hence, if there is enough evidence that the suspect or defendant is suffering from significant mental illness, the prosecution may not be appropriate lest the crime committed is serious and there is a high possibility of the offender repeating the crime (The Crown Prosecution Service, 2014). According to the section two, part three of the Mental Health Act which adds a new subsection 1(2A) to the 1983 Mental Health Act, learning disability is interpreted as the incomplete development of the mind including social impairment and social functioning. Under this Act, alcohol or drug dependence is not categorized under the mental disorder. However, the mental illness that are as a result of the use or the stopping of drug use are included in the interpretation of mental disorder. Under this section of the UK constitution, immoral conduct and sexual deviancy are not included in mental disorders because they are not clinically recognized to be mental disorders.
Despite the legal definition of insanity, most individuals found to be guilty due to mental insanity have been found to be primarily diagnosed with schizophrenia and were suffering from the symptoms of psychosis during the time that the crime was committed (Callahan et al., 1991). This is because the symptoms of psychosis (such as anger and impulsivity) are a direct indicator of serious mental illness and the symptoms of schizophrenia, including hallucinations and delusions, alter an individual’s sense of reality, hence motivating criminal behavior (McNiel, Eisner & Binder, 2009; Douglas, Guy & Hart, 2009).
Research on the correlation between mental health symptoms and criminal behaviour
Many researches, including forensic research, have been concentrating on the connection between mental disorder and criminal behaviour. Monahan et al. (2001), conducts a study which involves more than one thousand psychiatric patients, focusing on the role psychosis plays during the precedent of the violent incident. Predominantly, patients were asked whether they experienced episodes of hallucinations or even delusions while the violent incidents transpired. The results indicated that only 12% of the patients were experiencing mental illness symptoms at the time the violent incident occurred.
Peterson et al. (2010) also conducted a similar study involving one hundred and twelve parolees with mental illness compared to one hundred and nine other parolees who were not suffering from mental illnesses. Based on the information collected through interviews and records, the offending patterns were drawn. The research findings showed that the emotionally reactive pattern of offending was common for most of the offenders, whether suffering from mental illness or not. On further investigation of the offenders with mental illness, the results indicated that only 5% of the parolees committed crimes as an outcome of their psychotic symptoms.
Junginger et al. (2006) incorporated the use of a broader definition of the symptoms of metal disorder. They conducted their study on one hundred and thirteen individuals arrested while suffering from symptoms of mental illness and other disorders of substance eligible for the jail diversion schedule. Their findings indicated that only 4% of the offenders had been arrested for committing crimes directly relating to psychosis while another 4% of the offenders were arrested for crimes that were not directly related to psychosis symptoms such as depression, confusion, irritability and thought disorder. It is, however, not clear how symptoms such as irritability are distinguished from normative personality characters and the emotional features found among offenders without mental disorders.
The Difficulty in distinguishing between Symptoms and Traits
The symptom of mental disorder and normative risk factors for crime becomes hard to distinguish once the mental illness symptoms are broadened beyond psychosis. Anger, for example is strongly related to psychosis symptoms (hallucinations and delusions), symptoms of personality disorders (which includes emotional stability), symptoms of mood disorders (anger attacks and irritability) and symptoms of post-traumatic stress disorder (Novaco, 2011). On the other hand, anger is also a fundamental human emotion that is also a dynamic risk factor for criminal violence among both the general offenders and psychiatric patients (Gardner et al., 1996).
In another study involving one hundred and thirty-two subjects, Skeem et al. (2006) findings indicated that anger is a strong indicator of predicted violence, as opposed to other symptoms that were related to mental disease (such as delusions). Hence, approaching anger as a mental illness symptom risks making a human emotion appear as a symptom of a serious mental illness.
Another example of a difficult distinction involves impulsivity which is related to particular symptoms of bipolar disease including being easily distracted and excessive indulgent in pleasurable activities which has a possibility of a painful outcome (American Psychiatric Association, 2000). Hence, impulsivity is a common for people suffering from bipolar disease as compared to the general population (Jimenez et al., 2012). On the other hand, impulsivity is a label common in the criteria for diagnosing antisocial personality disorder (American Psychiatric Association, 2000) and has been proved to be one of the strongest predictors of criminal acts among both juveniles and adults (Kruger et al. 2007). Hence, it is difficult to distinguish whether impulsivity is a normative personality trait or a serious mental illness symptom.
Mental illnesses and their symptoms
Anxiety disorder involves a tendency of individuals to be withdrawn and avoid confrontation with other people. People with anxiety disorders exhibit heightened anxiety, worry and fear that this constant and overwhelming in a way that is crippling. Types of anxiety disorders includes panic disorders, social anxiety disorders, certain phobias towards a specific situation or object and generalized anxiety disorder where a person has excessive worry even when there is nothing that has provoked anxiety. A person with panic disorder is overwhelmed with a feeling of terror without warning has other symptoms such as chest pain, strong and irregular heartbeats and a feeling of being choked. General symptoms of anxiety disorders include problems with sleeping, panic, fear, shortness of breath, the inability to stay calm, dry mouth, muscle tension, nausea, dizziness and shortness of breath. While research has indicated that the youth with anxiety are less likely to be involved in aggressive tendencies (Connor, 2002), those with posttraumatic stress disorder (PTSD) have a significant susceptibility to reacting aggressively to threats and in an unexpected manner (Charney et al. 1993). On the other hand, those with posttraumatic disorder combined with conduct disorder (involving antisocial tendencies) were also found to be more aggressive and impulsive as compared with individuals with conduct disorder only (Cauffman, 1998).
Bipolar disorder involves mood swings ranging from feelings of depression to mania. Bipolar disorder is divided into several categories depending on the patterns of symptoms exhibited by the patient. Bipolar I disorder entails mood swings which lead to increased difficulty in a person’s workplace, school or relationships and manic episodes can be serious. Bipolar II disorder is less serious compared to bipolar I. It involves symptoms such as elevated moods, with some minimal adjustments to the functioning of a person but the he or she can conduct the normal routine. In this case, one experiences hypomania instead of a full mania. Hypomania is a less severe form of mania compared to full mania. The third type of bipolar disorder is known as cyclothymic disorder with is the mild form of bipolar disorders. In this case, a person experiences hypomania & depression that can be disruptive, but the highs and lows are not as serious as the bipolar I and II disorders. Some symptoms involving the manic or hypo-manic stage of bipolar disorder include: Euphoria, poor judgment, aggressive tendencies, risky behavior, racing thoughts, increasing drive to achieve goals, irritability and psychosis. The depressive stage of bipolar disorder includes excessive sadness, hopelessness, suicidal behavior, fatigue, difficulty in concentrating, irritability, guilty and poor performance at school or the workplace (Mayo Clinic Staff, 2015). The highs and lows experience by patients can lead them to perform criminal activities especially when they are excessively depressed and easily irritated and can respond to the actions of other members of the society in a way that is harmful.
Psychotic disorders include thought disturbances involving unusual interpretations of happenings. Psychotic disorders alter the ability of a person to make rational judgments, think clearly, understand reality, communicate well and behave in the appropriate manner. Patients with severe symptoms of psychotic disorders find it difficult to stay in touch with reality and as such, they can engage in criminal activities even without realizing that what they are doing is wrong. Schizophrenia is one type of psychotic disorder where patients experience changes in behavior and encounter hallucinations and delusions with can last for even more than half a year which greatly diminishes their function and increases their susceptibility to commit crime even without realizing it.
Psychiatry is a speciality that deals with the treatment, diagnosis and prevention of mental disorders. On the other hand, a mental disorder is a mental anomaly that causes one to not function properly in society. Forensic psychiatry deals with the treatment of criminal offenders with mental disorders. There is evidence of individuals with mental health illnesses either being segregated for care or containment for hundreds of years now. Hoswells (1975) recounts that a psychiatric care of the mentally ill was being practices in the health facilities in Islamic countries as early as the 8th century and India this practice implemented as early as the 10th century. Hospitals dedicated for people with mental health problems in England were present even as early as the Middle Ages, as evidenced by the Bethlem Hospital which was built in 1247. Earlier treatments of individuals with mental illnesses involved the use of milieu therapy, counseling among other archaic methods. The story of modern psychiatry began with the introduction of legislation to protect the rights of individuals with mental illness. The Mental Health Act introduced in 1983 was introduced to protect the rights of detained patients with mental illnesses.
Psychiatry and the detained juveniles with mental illnesses
Psychiatry presents the best methods in treating mental disorders especially among the youth who have a higher chance of being reformed as compared to adults with mental illnesses. However, following the findings showing a high prevalence rate of mental illnesses among the youth within the correctional institutions, improvements must be implemented if the detained youth are to undergo complete behavioral rehabilitation (Odgers et al., 2005).
The juvenile offenders in the justice system require supplementary attention given their vulnerability to mental health problems. Research has shown that most of the juvenile offenders have more disorders that can be easily diagnosed if close attention is given to them. While many researchers differ on the number of juveniles with diagnosable disorders, the fraction lies between 50- 70% of the total young population (Colins et al., 2010). Research shows that due to the lack of attention given by the justice authorities, juveniles suffer from more than one mental disorder, with the female juveniles being more inclined to mental health illnesses compare to the male juveniles (Schubert & Mulvey, 2014).
Howard et al. 2013) conducted a study to explore some factors that would lead to increased criminal recidivism among forensic patients. The findings of their study indicated that those who had endured a severe childhood disorders and drug dependence during adolescence were more likely to engage in rescind to their criminal behavioral patterns as compared to those who did not engage in neither childhood conduct disorders nor drug dependence. As such, forensic psychiatrist should consider the past experiences of their patients if they are to successfully rehabilitate their patients. High risk patients who have a past experience of childhood conduct disorders and drug dependence should be monitored carefully monitored and given enough support in order to control their urge to engage into criminal activities after being released from a controlled environment to the community.
While the youth with mental illnesses only commit a small fraction of the delinquencies in the community, they are at high risk of offending or re-offending as compared to the youth in the general population. Hence, more research need to be conducted to inform more effective policies to respond appropriately. Particularly, the processing of juveniles in the justice system should be improved so as to identify the youth with critical mental health needs. As such, evidence-based psychiatry services should be incorporated to identify the juveniles who may be in need of long term mental health support. The screening results should then be recorded to provide information that is required for planning and resource development (Grisso, 2008).
This essay highlighted the relationship between criminality and mental illnesses at length and it was found that there was a significant relationship but the breath of the definition of mental disorder was a key factor when evaluating this relationship. It was found that some symptoms of mental illness such as depression, confusion, irritability or even thought disorder are not directly related to crime committed given that they can also be categorized as normal personality traits. Hence the breath of the definition of mental illness is key in determining its correlation with crime. This relationship was also evaluated from a legal point of view when determining whether to prosecute offenders with mental illnesses and it was established that such offender should only be prosecuted if there is a high possibility of committing the crime again. Under the UK law, mental disorder is any disability of the mind and does not include alcohol dependence, immoral conduct nor sexual deviancy. This research essay also discussed psychiatry and it role in treating the detained youth with mental illnesses. While psychiatry presents one of the most effective methods of treating mental illnesses among detained youths, the high prevalence rates of mental illnesses in the juvenile justice systems indicate the need for research based methods in psychiatry services so as to isolate the juvenile who may be in need of long term mental health support. This is because, this group of juveniles pose the highest risk of repeating the crimes they committed with released into the community.
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