Criminal law and mentally ill offenders in comparative perspective

Abstract

In this stick we compare legal arrangements dealing with mentally disordered offenders in the criminal law systems ct Belgium, Canada, Germany, the Netherlands, Norway, Sweden, and the United Kingdom. To describe relevant diffesenoes and similarities in the arrangemeats, we used a checklist containing antral aspects of adjudication, assessment and treatment of mentally ill offenders. These aspects concern: (1) the legal classifications of mental illnesses that can lead to exclusion of criminal responsibility: (2) the acceptance of diminished capacity as a partial excuse; (3) the possibilities for imposing security measures of compulsory treatment instead of or next to criminal punishment; (4) the conditions for their imposition in terms of seriousness of crimes committed and dangerousness of offenders; (5) the available hospitals or special clinics for executing security measures; (6) the role and task of forensic mental health professionals in assessing the offender's state of mind and in advising compulsory treatment; (7) the rules for duration, prolongation and termination of the measures. The findings of this comparative analysis are evaluated in light of legal protection for mentally disordered offenders.     

Integrating risk,the Good Lives Model and recovery for mentally disordered sexual offenders

Abstract

Personality disordered and mentally disordered sexual offenders (MDSOs) with complex diagnoses such as schizophrenia, developmental disorders and mood disorders face challenges of restoring their mental health, living more safely with personality- and offence-related risks, while addressing concerns about their capacity to reintegrate into society; this has been termed “secure recovery”. This paper reviews the literature on recovery, demonstrating its commonality with the Good Lives Model (GLM) as applied to MDSOs' offending treatment. GLM appears to provide a better fit with the recovery needs of MDSOs than the Risk–Need–Responsivity model because it emphasises approach goals, enhanced responsivity and skills acquisition. Recovery needs to integrate coping with mental disorders with risk management and a healthy, future lifestyle. Both secure recovery and GLM support the need for client–clinician collaboration, promoting self-determination and a shared narrative about coping with enduring risk and the hope of sustained well-being.     

Origins of the "Third psychiatric revolution": the Community Mental Health Centers Act of 1963

In recent decades the community mental health movement has achieved a dramatic reduction in the census of state and county mental hospitals in the United States, and hundreds of federally-funded community mental health centers have been established nationwide. At the same time, national controversy has arisen in response to what in places has seemed the haphazard process of implementing "deinstitutionalization" and the fate of many chronically mentally ill persons who are without needed social services and psychological care. Despite the widespread attention that this contemporary program has received, theoretical analysis of the complex social, scientific, intellectual, and political origins of America's community mental health policy remains deficient. This article examines the background and development of the Community Mental Health Centers Act of 1963, tracing how an important shift in national policy toward the mentally ill grew out of changing perceptions--among policymakers, professional groups, and the general citizenry in the post-World War II era--of the nature of the problem of mental illness.     

Sexual offenders with serious mental illness: prevention, risk, and clinical concerns

Individuals with serious and persistent mental illness who have also engaged in illegal sexual behavior present a unique challenge for our legal and clinical systems. Frequently, these individuals may engage in problematic sexual behaviors which result in hospitalization rather than incarceration, and an overburdened and resource-deficient public community mental health system is ill-equipped to address the seriousness of these sexual behaviors. We have a rather limited understanding of how prevention programs, intervention strategies, and risk assessment would work with this population. Here we evaluate data from a sample of 245 inpatient psychiatric sexual offenders in a forensic mental health setting and compare these with what information has already been presented in some of the literature. Through an examination of seriously mentally ill sexual offenders and their clinical presentation, legal history, and risk management concerns, we illustrate a variety of tertiary prevention needs. Future directions in the area of prevention and risk management for seriously mentally ill sexual offenders are also discussed.     

The relationship between mental illness and violence in a mentally disordered offender sample: evaluating criminogenic and psychopathological predictors

The importance of mental illness as a risk factor for violence has been debated with significant implications for mental health policy and clinical practice. In offender samples, psychopathology tends to be unrelated to recidivism, although some researchers have noted that this relationship may be dependent upon certain moderating factors. In the present, prospective investigation, psychopathology is examined as predictors of recidivism in 121 provincially sentenced (i.e. less than 2 years) mentally disordered offenders. Results indicated that psychopathological predictors were generally poor predictors of recidivism in univariate and multivariate analyses. Consistent with our hypotheses, age of onset of criminal activity was a significant moderating factor on the relationship between mental illness and recidivism, although results were not in the expected direction for certain classes of mental illness. Results are discussed in the context of a social learning model of crime and in terms of the treatment of mentally disordered offenders.     

Prevalence of Criminal Thinking among State Prison Inmates with Serious Mental Illness

To examine the prevalence of criminal thinking in mentally disordered offenders, incarcerated male (n = 265) and female (n = 149) offenders completed measures of psychiatric functioning and criminal thinking. Results indicated 92% of the participants were diagnosed with a serious mental illness, and mentally disordered offenders produced criminal thinking scores on the Psychological Inventory of Criminal Thinking Styles (PICTS) and Criminal Sentiments Scale-Modified (CSS-M) similar to that of non-mentally ill offenders. Collectively, results indicated the clinical presentation of mentally disordered offenders is similar to that of psychiatric patients and criminals. Implications are discussed with specific focus on the need for mental health professionals to treat co-occurring issues of mental illness and criminality in correctional mental health treatment programs.     

Dangerous mentally disordered criminals: unresolvable societal fear?

The average person fears dangerous criminals, especially those suffering from mental illness. Existing mental health and criminal justice systems provide social control for some of these dangerous individuals, but may be inadequate to deal with those mentally disordered offenders who were not found not guilty by reason of insanity (NGI). In California, innovative laws have attempted to address this problem. However, putative lack of efficacious treatment of mentally ill criminals, insufficient economic support, and individual liberty concerns loom as limiting factors in solving the criminal and psychiatric recidivism problem posed by non-NGI dangerous mentally disordered offenders.     

A profile of mentally disordered offenders admitted to inpatient psychiatric services in the United States

This research note presents data about mentally disordered offenders (MDOs) treated in inpatient psychiatric services. Data are derived from 1980 admission surveys by the Survey and Reports Branch, National Institute of Mental Health (NIMH). These data report for the first time inpatient services provided to MDOs by non-Federal general and private hospitals. A total of 31,773 MDOs were admitted, with 85% going to state and county mental hospitals. The largest group, including admissions for evaluation, was ISTs (58%), followed by mentally disordered prisoners (32%), NGRIs (8%), and MDSOs (3%). Women and whites tended to be overrepresented among MDOs as compared to prison and jail inmates. Clear diagnostic differences by legal status were found, with schizophrenia predominant among NGRIs (81%) and alcohol and drug abuse disorders more frequent among ISTs. Overall, state and county hospitals in both 1967 and 1980 were the primary locus of care for mentally disordered offenders.     

Redefining mental health law

Mental health law traditionally focuses on preserving the civil and constitutional rights of people labeled mentally ill. However, because of fundamental changes in the public mental health system. most people labeled mentally ill no longer reside in state psychiatric hospitals. As a result, the core policy issue in mental health today is assuring access to community based services, supports, and housing which enable people to live successfully in the community. Because of this different environment, the definition and scope of mental health law must be expanded dramatically if those interested in the subject are to continue to influence mental health policy. This article examines five contemporary mental health policy issues, including changes in reimbursement systems and the growth of the consumer and family movements, that illustrate the legal, policy, and research questions which will emerge in an expanded and redefined mental health law agenda. The author thanks Ingo Keilitz, Thomas Hafemeister, and Pamela Casey for their review of earlier drafts of this article.     

Sex offender risk assessment: Consideration of human rights in community protection legislation

Objectives. Risk assessments provided to judicial decision makers as a part of the current generation of legislation for protecting the public from sexual offenders can have a profound impact on the rights of individual offenders. This article will identify some of the human rights issues inherent in using the current assessment procedures to formulate and communicate risk as a forensic expert in cases involving civil commitment, preventive detention, extended supervision, or special conditions of parole. Method. Based on the current professional literature and applied experience in legal proceedings under community protection laws in the United States and New Zealand, potential threats to the rights of offenders are identified. Central to these considerations are issues of the accuracy of current risk assessment measures, communicating the findings of risk assessment appropriately to the court, and the availability of competent forensic mental health professionals in carrying out these functions. The role of the forensic expert is discussed in light of the competing demands of protecting individual human rights and community protection. Conclusion. Actuarial risk assessment represents the best practice for informing judicial decision makers in cases involving sex offenders, yet these measures currently demonstrate substantial limitations in predictive accuracy when applied to individual offenders. These limitations must be clearly articulated when reporting risk assessment findings. Sufficient risk assessment expertise should be available to provide a balanced application of community protection laws.     

Mental illness in the eyes of the law: examining perceptions of stigma among judges and attorneys

In response to the increasing numbers of mentally ill persons placed under the care of correctional institutions, community-based diversion programs have been established to address the unique needs and challenges of this vulnerable population. Given that legal personnel may serve as gatekeepers in placement decisions, and the lack of existing research examining their attitudes toward offenders with mental illness, the present study aimed to evaluate perceptions of dangerousness and treatment need among a sample of judges, prosecutors, and public defenders across the state of Mississippi. While controlling for age, results of a factorial MANCOVA revealed that public defenders, relative to both judges and prosecutors, endorsed more compassionate attitudes about defendants with mental illnesses. Furthermore, political ideology did not significantly influence attitudes toward mentally ill offenders. While judges and prosecutors endorsed more negative stereotypes about mental illness and perceived mentally ill defendants as a greater risk to the community, mean scores across groups suggested moderately positive attitudes overall. Study limitations, implications for correctional mental health providers, and directions for future research are discussed.     

The age of risk: risk perception and determination following the Mental Health Act 2007

Reforms to the mental health law framework for England and Wales, which were introduced by the Mental Health Act 2007, are now having a practical effect on day-to-day mental health decision-making. The 2007 Act amends the Mental Health Act 1983, which governs the compulsory hospitalisation and treatment of people with mental disorder; and represents the culmination of a protracted and controversial reform process which has spanned much of the last 15 years. One of the key foci in the 2007 Act is the question of the risk posed by the patient, primarily to others; a result of both the social and political impetus behind the reform process and mounting public anxiety at the management of the mentally disordered. The new Act seeks, as with past legislation, to find the elusive balance between protecting and facilitating the individual's autonomy while also providing an effective framework for the wider public right to protection. The 2007 Act solidifies the dominance of risk by providing a legitimating framework in which risk can be assessed, monitored, and managed. This attitudinal change is demonstrated by the gradual and almost insidious adoption of risk terminology within the practical decision-making setting and the increasing use of risk assessment and management tools. This article is informed by an empirical study which examined individual professional and institutional responses to the mental health legislation in relation to risk. It examines whether the amended legislative framework amplifies risk as an increasingly dominant concern within decision-making. The paper then goes on to consider how decision-makers use risk to assist with their daily roles. Extrapolated from data obtained through the study, several models of risk determination are then discussed. Finally, some thought is given to whether the extension of the risk concept has the potential to become more fundamental within the organisation and legitimisation of mental health care.     

Making Monsters: The Polygraph,the Plethysmograph,and Other Practices for the Performance of Abnormal Sexuality

This article addresses the use of the polygraph, penile plethysmograph, and other practices for the management of sexual offenders as part of the ‘Containment Approach’, a strategy increasingly common in the United States which is, in part, being trialled in the United Kingdom. The polygraph has a tangled history with abnormal sexuality, as we describe in the context of homosexuality in the 1960s. We examine how these strategies target sex offenders as malleable in regard to sexual performances but also, through notions of risk management, paradoxically constitute offenders as fundamentally incurable and thus permanently risky. Using Foucault's notion of the ‘abnormal’, we investigate the implications of this risk management/ performance paradox. We conclude that it reveals a certain anxiety about the relationship between abnormal and normal sexual behaviour in contemporary sex‐offender management discourse, which can help explain the emergence of these practices.     

Mentally disordered offenders and the European Court of Human Rights

Mentally disordered offenders find themselves at the intersection of the healthcare system and the criminal justice system in most European countries. Decisions on their care often involve lengthy discussions in relation to care versus control in society. In this article, the focus is on one aspect of this debate — that of human rights. An analysis of cases, taken to the European Court of Human Rights by mentally disordered offenders, demonstrates the difficulties inherent in ensuring appropriate care to individuals and safeguards to the public at the same time. The issues raised include the problems raised by indeterminate sentences, the use of detention for preventive purposes, and debates about treatment.The countries represented in this selection of cases are Belgium, Norway, Poland, the Netherlands, Russia and the United Kingdom.     

Detention under the Mental Health Act: balancing rights,risks and needs for services

Mental health law has to balance considerations of both justice, and health and welfare. In the political climate of the 1990s mental health services have become targeted on those with serious mental illness, to address the objectives of containing risks and limiting service expenditure. This paper identifies that increasing rates of detention under the Mental Health Act through the 1990s in a particular region, disproportionately involve longer-term detentions (under section 3), men, and people with serious mental illnesses. Those detained are likely to experience social difficulties. Changes in legislation are imminent, and the paper concludes that thought should be given to the amount of statutory intervention in the lives of seriously mentally ill people, and to the principle of reciprocity in relation to those coerced for lesser periods. Services should seek to address the issues of social exclusion which are reflected in the circumstances of those detained.     

The referral decision scale with mentally disordered inmates

Correctional facilities are increasingly burdened with mentally disordered offenders and are faced with the formidable task of effectively screening inmates for major mental disorders and suicide potential. Teplin and Swartz (1989) developed the Referral Decision Scale (RDS) as a rapid screen for schizophrenia and major mood disorders in jail populations. However, more recent research by Hart, Roesch, Corrado, and Cox (1993) has called into question the effectiveness of the RDS. In this study, we examined the convergent and discriminant validity of the RDS with the Schedule of Affective Disorders and Schizophrenia—Change Version (SADS-C) and the Personality Assessment Inventory (PAI) on a sample of 108 mentally disordered inmates. The RDS provided moderate evidence of convergent validity but failed to demonstrate acceptable discriminant validity, because of high intercorrelations on RDS subscales (heterotrait-monomethod coefficients). In comparison, the SADS-C yielded similar evidence of convergent validity and excellent discriminant validity.The authors would like to thank the Research Opportunities Program, University of North Texas for its grant support and Captain James Moore for his active cooperation.Tarrant County Mental Health and Mental Retardation Services.     

Courting Compliance: Case Managers as “Double Agents” in the Mental Health Court

An ethnographic study of four Midwest mental health courts was focused on how case managers influence the judicial response to offender noncompliance. Mental health courts, which bear little resemblance to traditional work group models, are staffed by teams of legal and social service professionals working collaboratively toward reducing recidivism and community reintegration for high‐risk offenders. Few studies, however, have explored how treatment providers practice their trade in this new court organization. I investigate how case management professionals, working at the intersections of the social welfare and criminal justice systems, leverage courtroom decision making that results in greater leniency or enhanced punishment. The findings suggest that mental‐health‐court case managers act as boundary spanners in terms of their strategic use of resources to facilitate treatment goals. I conclude that case managers act as “double agents” challenging the state to advocate for clemency while enforcing client rules to uphold the integrity of the court.     

Are the mentally retarded and learning disordered overrepresented among sex offenders and paraphilics?

A sample of 2,286 male sex offenders and paraphilics and 241 nonsex offenders was evaluated for the prevalence of mental retardation and learning disorders, using the full Wechsler IQ scales. The sex offenders were generally of average intelligence, and the mentally retarded were not overrepresented among them, but the learning disordered were. There were no differences among sex offenders and controls in overall IQ or in the percentage of mentally retarded or learning-disordered cases, suggesting that the learning difficulties are not peculiar to sex offenders. There was a bias in referral source, with more mentally retarded, borderline-retarded, and/or learning-disordered cases being referred by the Children's Aid Society, prisons, and the Crown, suggesting that referral source may play a significant role in evaluating intelligence and mental retardation among sex offenders; but the overrepresentation of learning disorders among criminals appears to be a significant phenomenon, regardless of referral source.     

Assessing the Needs of Women Recently Released From Prison

The growing number of females incarcerated in the United States suggests that greater importance needs to be placed on preparing practitioners and communities for their eventual release from prison. Female offenders present a unique set of needs, including greater mental health, substance abuse, and medical health problems than their male counterparts. Furthermore, women may possess unique needs at various points of their involvement with the criminal justice system (i.e., before, during, and following a period of incarceration). The current study examines the needs of female offenders while they are reentering the community from the perspective of community service providers who work directly with recently incarcerated women. Survey results reveal that community service providers identify needs in 7 domains. Prevalence and urgency measures provide unique profiles of the needs of female offenders, and respondent reports of the effectiveness of the existing community-based service sector lead to numerous implications and suggestions for future research.     

The social,relational and mental health characteristics of justice-involved men in the south-west England

The aim of this article is to describe the social, relational and mental health characteristics of a sample of offenders serving prison or community sentences in the south-west England. About 100 adult male offenders were screened for anxiety and depressive disorders, post-traumatic stress disorder (PTSD), drug and alcohol dependence, and likely personality disorder using validated instruments. Fifty-eight per cent of the sample reported at least one common mental health problem, of these only 26% reported receiving treatment. Participants exposed to traumatic events and/or participants with past mental health problems were more likely to score positive for current common mental health problems. Our study identified factors that may increase the risk of a first episode or recurrent anxiety and/or depression for offenders. Health and criminal justice services should create partnerships and develop interventions that address the risk factors which lead and/or contribute to offenders' mental health difficulties.