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Chapter 10

Chapter 10 Summary

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PSYC 3402
Ralph Serin

Psyc 3402 – Chapter 10 – Mentally Disordered Offenders Mental Disorders and the DSM - DSM first published in 1952 in order to facilitate the diagnosis of mental disorders and collect statistical information about the prevalence of different types of disorders - DSM organizes diagnoses into 5 axes relating to different aspects of disorders: o 1. Axis 1: clinical disorders, including mood disorders, anxiety disorders, phobias, schizophrenia, bipolar disorder, dissociative disorder, gender identity disorders, eating disorders, substance-related disorders, and developmental and learning disorders o 2. Axis 2: mental retardation and personality disorders, including avoidant, dependent, obsessive-compulsive, histrionic, antisocial, borderline, narcissistic, paranoid, schizoid, and schizotypal disorders o 3. Axis 3: general medical conditions that may be related to the mental disorder or that might influence the choice of medications for treating the disorder o Axis 4: psychosocial or environmental factors that contribute to disorders, including family problems, educational problems, economic problems or problems with the legal system o Axis 5: assessment of the patient’s general level of functioning - Number of criticisms of the DSM including construct validity and reliability of the diagnostic categories and symptoms - Not clear why certain disorders are included and how the symptoms for each disorder were elected - DSM lacks a strong empirical basis - 280% increase in number of disorders listed between DSM–I and DSM-IV - DSM’s symptomatological bias also promotes an atheorietical stance that de-emphasizes etiological or causative information about a disorder - Criticized for having a reductionist bias with claims that its system of making categorical distinctions between disorders and between normal and abnormal is unjustified Mentally Disordered Offenders - Significant proportion of the millions of individuals incarcerated worldwide experience serious mental disorders - Movement to deinstitutionalize psychiatric patients began in the 1960s - Odds ratio comparing the odds of prisoners having a psychiatric disorder with the community sample, indicated that prisoners were more than 10 times as likely to have a psychotic disorder, post-traumatic stress disorder, opioid use disorder, sedative use disorder, or stimulant use disorder compared to the community sample Prevalence of Personality Disorders - Rates of personality disorders in prison populations are substantially higher compared to community populations - Personality Disorders: are maladaptive patterns of relating perceiving, and thinking that are relatively inflexible and serious enough to cause distress or impaired functioning - 10 specific personality disorders listen in DSM-IV grouped into 3 clusters: o Cluster A: personality disorders involve odd or bizarre behaviour (paranoid, schizoid, and schizotypal) o Cluster B: disorders involve dramatic or erratic behaviour (antisocial, histrionic, narcissistic, and borderline) o Cluster C: disorders involve anxious or inhibited behaviour (depending avoidant, and obsessive-compulsive) - Most common type of personality disorders found in male prison populations are antisocial and paranoid personality disorders o Female prison populations, most common are antisocial and borderline personality disorders - In a study of 1396 male violent offenders in England, found prevalence rate of 73% for any personality disorder - Prisoners with personality disorder were more likely to report childhood conduct problems, adverse childhood experiences and victimizations than those with no personality disorder Role of Mental Illness in the Courts Unfit to Stand Trial (UST) - in Canada if an accused is not able to participate in their own defence on account of a mental disorder it is deemed unfair to try this person - Section 2 of the Canadian Criminal Code, an accused is UST if he or she is: o Unable on account of a mental disorder to conduce a defence at any stage of the proceedings before a verdict is rendered or to instruct counsel to do so and in particular on account of mental disorder to: o A) understand the nature or object of the proceedings o B) understand the possible consequences of the proceedings; or o C) communicate with counsel - When courts finds an accused UST, the review board must give the accused a conditional release or detention order within 45 days (cannot order an absolute discharge). Review boards must have at least 3 members (judge/lawyer, psychiatrist, and third person) - Deciding on the type of disposition, the board must consider: o Protection of the public, accused’s mental state, reintegration of the accused into society, accused’s other need - Until a person is found UST, they remain under the authority of the board until they are deemed fit to stand trial or the charges are stayed or withdrawn. Board review the case yearly, courts must review it every two years to determine if there is sufficient evidence for the accused to stand trial if fitness is restored - Bill C-10 in 2006, which gave the courts the authority to order a stay of proceedings for an accused found UST if the accused is unlikely to become fit to stand trial and does not post a significant threat to public safety Mental State at the Time of an Offence - In order to find a person guilty of a crime, mens reas or criminal intent must be established o If there is no criminal intent there is no crime o Assumption is that if you know what you are doing and choose to do it, you are culpable. However, if you are mentally disordered and do not understand the consequences of your actions you should not be culpable - House of Lords developed the so-called M’Naughton rules (M’Naughton Standard): in order for verdict of not guilty by reason of insanity (NGRI) to be returned it must be shown that at the time of the commission of the offense, the defendant was labouring under such a defect of reason from disease of the mind, as not to know the nature and quality of the act he was doing, or if he did know it, that he did not know he was doing what was wrong” o Several US states expanded the definition to include volitional considerations. Some people may be aware of the nature and quality of their criminal act and known that it is wrong, but may not be able to control their behaviour - Individual must possess the capacity to understand that his or her behaviour was wrong in order to be found guilty of an offence - But simply having a mental disorder does not mean exemption from criminal responsibility - Section 16 of Criminal Code, person should be found NCRMD (Not Criminally Responsible on account of a Mental Disorder): o No person is criminally responsible for an act committed or an omission made while suffering from a mental disorder that rendered the person incapable of appreciating the nature and quality of the act or omission or of knowing that it was wrong - The mental disorder must be a direct cause of the person’s inability to appreciate that their behaviour is wrong - If the person has a mental disorder but it does not affect their inability to appreciate that the behaviour is wrong then the presence of the disorder is irrelevant to the person’s responsibility - 3 issues must be considered in order to find a person NCRMD: o 1. Defendant must suffer from a mental disorder o 2. Defendant must fail to appreciate the nature or quality of their act o 3. The person may understand what they are doing but might not believe it is wrong - In Ontario review board is chaired by a judge or lawyer and comprises four other members, one of which must be a psychiatrist - Board or court can give an absolute discharge, a conditional discharge, or order detention in a hospital - If given a conditional discharge, the most common conditions imposed include: o must abstain from illegal drugs and/or alcohol, must reside in a particular place, must submit to urinalysis testing for prohibited substances, must abide by a specified treatment plan, must report to a designated person on a scheduled basis, must refrain from possessing weapons The Public’s Belief in the Insanity Defence - Public tends to have a negatively skewed view of the insanity defence - Public often focus on high-profile defendants - Common misconception about the insanity defence is the view that it is used as a way to avoid legal penalties - Individuals who use NCRMD are usually successful - Public believes that NCRMD defendants use the defence as a way to obtain release into the community much sooner than if they had gone to prison and also believe they are at a higher risk to reoffend than other offenders Characteristics of People found NCRMD and UST - Substantial increase occurred in the number of individuals found NCRMD/UST between 1992 and 2004 - The UST and NCRMD were slightly older than the average age involved in the criminal justice system (median age =31) - There was not an overrepresentation of Aboriginal accused as has been reported in the criminal justice system - Refer to table 10.4 on page 338 - Most common diagnosis was schizophrenia, followed by affective disorders o Small percentage of individuals found NCRMD were diagnosed with a personality disorder o NCRMD accused were more likely to have been diagnosed with an affective disorder and personality disorders whereas UST accused were more likely to have been diagnosed with mental retardation or organic brain disorders o Those diagnosed with organic brain disorder or mental retardation were more likely to be charged with a sexual offence o Those diagnosed with an affective disorder more likely to be charged with a non-violent offence - Accused charged with non-violent offences were more likely to be given an absolute discharge as compared to those charged with violent or sexual offences - Those charged with violent offences were more likely to receive detention as compared to sexual or non-violent accused Link Between Mental Illness and Crime and Violence - Some researchers have found a link between mental disorder and criminality/ violence and others report that use of alcohol and drugs is responsible for the elevated base rates of criminality and violence in individuals with mental disorder - Denmark is one of the few countries in the world with the ability to keep and access records that permit tracking of the entire population to determine the prevalence of criminality o Hodgins et al did a follow-up study of all Danes born between 1944 and 1947 – a total of 358,180 individual o Tracked to determine if they had ever been diagnosed with a mental disorder and then checked against their criminal records o In both men and women the presence of a mental disorder substantially increased the risk for criminality and violence - Conclude from current literature on serious mental disorders and violence: o Majority with serious mental disorders do not engage in violence o Likelihood of committing violence is greater for people with a serious mental disorder than for those with no mental disorder o People with serious mental disorders are more likely to be a victim of violence than those with no mental disorder o People with co-occurring mental disorders and substance abuse are at an elevated risk for violence o The causal mechanisms that are responsible for the link between metal disorder and violence are not clearly understood. It may not be that factors unique to the mental illness lead to criminal behaviour but rather factors associated with mental illness such as poverty, substance use, unemployment and homelessness Risk Assessment of Mentally Disordered Offenders - Depending on the type of mental disorder are offenders more likely to reoffend once released - Psychopaths, offenders with substance abuse problems and people with specific types of psychotic disorders are at a higher risk - Prisoners with bi-polar mental disorder were 3.3 times more likely to have four or more incarcerations over a 6 year period then were other non-mentally disordered offenders Police Attitudes Toward the Mentally Ill - labelled police as “street corner psychiatrists” or “amateur social workers” - police have considerable discretion in deciding how to manage a crisis and whether to arrest a person - may decide to informally resolve the problem arrest the person or take the person to a hospital for evaluation - Community Attitudes Toward Mental Illness scale assesses attitudes across 4 scales: o Authoritarianism (belief that the mentally ill should be institutionalized or controlled) o Social Restrictiveness (belief in the dangerousness of the mentally ill) o Social Benevolence (feelings of responsibility for the mentally ill) o Orientation (beliefs supportive of community integration of mentally ill) - Average scores indicated that Canadian police officers did not endorse negative attitudes toward the mentally ill o Dealing with mentally
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