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.     

Optimizing risk mitigation in management of sexual offenders: a structural model

Sexual violence is an insidious and pervasive problem that insinuates itself into all aspects of contemporary society. It can neither be mitigated nor adequately controlled through current socio-legal practices. A more promising approach must embrace four integrated elements: (1) public policy, (2) primary prevention, (3) statutory management, and (3) secondary intervention. In the present paper we tackle the 3rd and 4th elements by proposing an integrated model for reducing and managing sexual violence among known sex offenders. Relying on the highly effective Risk-Need-Responsivity (RNR) model as the core of our Sex Offender Risk Mitigation and Management Model (SORM³), we draw together evidence based practices from clinical interventions and risk assessment strategies. Developed by Andrews & Bonta (2006), RNR has a strong empirical track record of efficacy when applied to diverse samples of offenders, including sex offenders (Hanson, Bourgon, Helmus, & Hodgson, 2009). We offer a detailed structural model that seeks to provide a more seamless integration of risk assessment with management and discretionary decisions, including a primary focus on RNR-based post-release aftercare. We end with the mantra that sex offender treatment alone will never effectively mitigate sexual violence in society, since the problem is not confined to the handful of offenders who spend time in prison and are offered some limited exposure to treatment. Any truly effective model must go well beyond the management of those known to be violent and embrace a comprehensive and integrated approach that begins by recognizing the seeds of sexual violence sown by society. Such a public health paradigm places victims - not offenders - at the center, forcing society to come to address the full gamut of hazards that fuel sexual violence.     

Legal narratives as significant news sources about mental illness and violent crime

Media coverage about people affected by mental illness is an area of research that is extensively examined. Many scholars argue that the media depicts people with mental illness as inherently violent and dangerous within sensational narratives. These depictions are criticized for reinforcing the social stigma and disadvantages many of the mentally ill face. The media does, however, require news sources and, in the context of crime and mental illness, the courts are a significant source. Through qualitative content analysis of Australian newspaper articles, this research examines an under-researched and incompletely theorized area. In doing so, it demonstrates that media depictions of some mentally ill offenders reflect and heavily draw upon legal narratives and what is argued in court about these offenders in the context of criminal responsibility and legal insanity.     

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.     

Psychiatric disorders and management of sexual offenders in the prison psychiatric consultation unit of Marseille

Since 2017, complaints of sexual violence have increased in France. At the same time, the management of sexual offenders has been at the center of international public health policies. The prevalence of mental disorders among sexual offenders is an essential field of research. There are some published studies on the prevalence of psychiatric disorders in sexual offenders in detention, but there are few recent published studies among French individuals who were detained. Our objectives were to determine the prevalence of psychiatric disorders among persons detained for sexual offenses and the level of care received according to their diagnosis. For this purpose, we carried out a retrospective observational study from January 2017 to October 2021 of all adult sexual offenders, whether accused or convicted, who were seen in the psychiatric consultation unit of Les Baumettes prison, Marseille, France. The primary outcome measure was the psychiatric diagnosis entered in the medical records. One hundred forty-two patients were included in analysis. All patients were men, and the majority (n = 97, 68.3%) of these patients presented with at least one psychiatric disorder, principally a personality disorder (31.7%). 10.6% presented with a schizophrenic disorder, 4.9% a bipolar disorder, 3.5% a depressive disorder, 5.6% pedophilic paraphilia, and 25.4% an addictive disorder. Their management and comorbid addictions were analyzed in subgroups for each psychiatric disorder. Patients appeared to receive an appropriate level of care for their diagnosed disorder. It seems important to develop structured assessment of recidivism risk for better management of sexual offenders.     

Mentally ill offenders in prison: the Belgian case

According to the EUPRIS-study on mental health in prisons (2007), available data on mental disorders in prison are scarce. Therefore, this study aims at summarizing and discussing the available knowledge on incarcerated mentally ill offenders concerning: (1) the screening and assessment for detecting mental health; (2) the psychiatric expertise in order to evaluate the mental status; and (3) the development and provision of forensic psychiatric treatment and care. These findings will be applied to the current situation in Belgium, which is a particularly interesting case. Belgium is currently facing difficulties concerning a large population of interned mentally ill offenders residing in correctional establishments.Implications with regard to the penal code, general or mental health legislation, screening, assessment, and treatment could deliver interesting viewpoints on how this problem could be tackled more effectively. Therefore, the findings will be discussed with reference to the international scientific and policy debate, focusing on ethical implications.     

Juvenile sex offenders: a complex population

Individuals who engage in sexual offending behavior represent a heterogeneous population. Recent research has found some success in categorizing sexual offenders based on a number of variables, particularly the type of victim. For example, differences have been found between those offenders who victimize adults when compared with those who victimize children. However, the research in this area has been conducted predominantly with adult samples. As the adult sex offender literature has progressed, it has become evident that risk assessment, treatment effectiveness, and risk management are dependent on such offender characteristics. Unfortunately, the relevance to juveniles of characteristics deemed to be important with adult sex offenders is limited due to the complexity of developmental processes, particularly with respect to mental disorders and personality formation. As such, the formulation and implementation of treatment and risk management strategies that will be effective with juvenile sex offenders are challenging. The goal of this paper is to review some of the complexities inherent in the juvenile sex offender population by focusing on specific areas of complication, including: classification systems, comorbid paraphilias and other mental illnesses, and maladaptive personality traits.     

Risk,response, and mental health policy: learning from the experience of the United Kingdom

Policy makers in the United States and the United Kingdom recognize that mentally disordered offenders present special challenges to law enforcement, mental health, and social service systems, as well as the community. Although various policy initiatives have advanced over the past twenty years to improve the management of mentally disordered offenders, mental health policy has chronically failed in both countries. Because safety concerns have emerged as the mental health system has been "deinstitutionalized," debate is growing about whether the community-care approach works-for the community. This study argues that mental health policy fails because policy makers focus on the wrong risks and design policies that manage these risks in ways that increase the possibility of adverse clinical and economic outcomes. The argument made here uses the case of persons with severe mental illness in the United Kingdom as an example of the complex relationship between risk and policy making in democratic governance. Emphasis is on the nature of risk in mental health policy and how government responds to policy and political risks. Mental health policy in Britain is then analyzed in terms of its response to and management of risks. Mental health policy has historically mismanaged the risk issue in the United Kingdom and as such has set in motion the growing community-care backlash. The path to a better outcome lies in the responsible management of the right risks. Lessons from the United Kingdom experience can be usefully applied to mental health issues in many industrial democracies.     

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.     

Sexual offenders with learning disabilities: risk,recidivism and treatment

Abstract

While the literature on the assessment, treatment and management of non-learning disabled sexual offenders is well established, it is only in recent years that researchers and clinicians have focused on sexual offenders with learning disabilities. In contrast to mainstream sex offender treatment programmes, there are few evaluated community-based treatment programmes for sexual offenders with learning disabilities, and of the small number of published studies that describe treatment programmes, most are based on small samples and few have been validated empirically. Sexual offenders with learning disabilities differ from their non-disabled counterparts in several important ways, having implications for management and treatment. Due to methodological differences between studies, the prevalence of sexual offending by men with learning disabilities is not clear. However, in some studies, the sexual recidivism rate of offenders with learning disabilities is 6.8 times and 3.5 times that of non-disabled sexual offenders at 2- and 4-years’ follow-up, respectively. Sexual offenders with learning disabilities are also at greater risk of re-offending in a shorter time period. There remains an urgent need for further research into the assessment of risk and whether components from mainstream treatment programmes can be adapted to meet the needs of learning disabled sexual offenders. Approaches to working with sexual offenders with learning disabilities and programme development are discussed.     

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.     

Understanding how sexual offenders compare across psychiatric and correctional settings: examination of Canadian mentally ill sexual offenders

Abstract

Much of what is known about sexual offenders is based on correctional samples and then applied across settings based on the assumption that this group is homogeneous. In this study, 149 files were compared, including 108 cases from the forensic mental health system (FMH) and 41 cases from the correctional system (COR). Although many similarities were observed between the FMH and COR groups, the results also revealed important differences. The FMH group was characterised by more frequent hospitalisations, higher rates of major mental illness and single status. The COR group was characterised by a history of physical and sexual abuse, family history of addictions, more intrusive sexual offences and higher rates of offending. These results highlight different profiles for sexual offenders in forensic mental health and correctional settings and challenge us to consider the implications for assessment, treatment and risk management of this unique group of sexual offenders.     

Insane Sex Offenders: Psychiatric and Legal Characteristics of Sexual Offenders Found Not Guilty by Reason of Insanity

There is little known about sexual offenders hospitalized under forensic commitment statutes such as not guilty by reason of insanity (NGRI). We conducted a chart review to delineate the demographic, clinical, and legal characteristics of NGRI sexual offenders (n = 68) committed to the California Department of State Hospitals—Napa, including 41 found NGRI for a sexual offense and 27 found NGRI for a nonsexual offense. The two groups did not differ significantly in their demographics, psychiatric diagnoses, victim characteristics, or recidivism risk as measured by the Static‐99R. Those found NGRI for a sexual offense were older at the time of their first criminal and first violent offense, younger at the time of their committing offense, and had fewer prior total convictions and sexual offense convictions. These findings may indicate that sexual offenders found NGRI for a sexual offense are less antisocial than those found NGRI for a nonsexual offense.     

Characteristics that predict firesetting in male and female mentally disordered offenders

Few studies have adequately explored the characteristics of male and female mentally disordered firesetters and compared these to those of non-firesetting mentally disordered offenders. Furthermore, there is a paucity of research examining the characteristics which can predict repeat firesetting within this population. The current study aimed to examine similarities and differences in the characteristics of (1) male and female mentally disordered firesetters, (2) male and female mentally disordered firesetters compared to non-firesetting offenders, and (3) one-time and repeat firesetters. Furthermore, the ability of these characteristics to predict offence status (i.e. firesetter or non-firesetter) and repeat firesetting was explored. Information was collected from patient hospital records for 77 (43 firesetters, 34 non-firesetters) mentally disordered offenders; including sociodemographic, family and personal background, psychiatric, and offence history factors. The findings suggest that mentally disordered firesetters are similar to their non-firesetting counterparts on key characteristics; however, firesetters are more likely to have an expressed interest in fire/explosives and a diagnosis of a schizophrenic disorder and female firesetters are more likely to have a higher number of firesetting incidents than males. Furthermore, findings suggest that fire interest is the largest predictor of repeat firesetting. Clinical implications in terms of treatment and risk assessment are discussed.     

Review of point-of-reception mental health screening outcomes in an Australian Prison

The point-of-reception into prison is a critical juncture as it provides early opportunities to identify mental illness and initiate treatment. Although large numbers of mentally ill prisoners are received into prison each day, research investigating mental health screening outcomes at the point-of-reception is limited. This study aimed to address this gap by examining reception screening outcomes for all prisoners received into an Australian prison during 2009 (n?=?4229). Overall, 19% of all prisoners were mentally ill, and another 20% had a history of psychiatric illness that required ongoing care. Mentally ill prisoners had a higher risk of suicide or self-harm and required more observation than other prisoners. At reception, no mentally ill prisoners were transferred to the state’s forensic hospital and few were transferred to the prison’s mental health unit, or provided support service referrals. These findings highlight that outcomes made at the point-of-reception are heavily influenced by the availability of prison mental health resources.     

Employing the Mental Health System to Control Sex Offenders After Penal Incarceration*

In the 1930s, several states provided civil commitment in mental institutions for certain sex offenders. Civil commitment of these sex offenders abated after most states repealed their statutes in the 1960s. In the 1980s, however, these statutes returned, as outraged citizens deplored the offenses of repeated sex offenders. The author of this essay examines civil commitment statutes for sex offenders in Washington and Minnesota, two of the leading states in this area, as well as recent rulings from each state's Supreme Court upholding the constitutionality of these statutes. Particularly, the author focuses on the psychiatric or mental health discussions by the justices in the majority in both state rulings. Furthermore, the author criticizes the legislatively defined mental abnormality statutes that sanction these commitments, proposes use of the ordinary civil commitment statutes for individuals who are seriously mentally ill, and concludes that sex offenders who do not meet the criteria for traditional civil commitment should be handled by the criminal justice system.     

Eye movement desensitisation and reprocessing for offence-related trauma in a mentally disordered sexual offender

Abstract

Research demonstrates a high incidence of offence-related trauma in mentally disordered offenders convicted of violent and sexual offences. The adaptive information processing (AIP) model offers a theoretical framework for understanding the hypothesised relationship between offence-related trauma and reoffending. Evidence suggests that for a sub-population of offenders presenting with offence-related trauma: (1) therapy may retraumatise them, and (2) unresolved trauma severely blocks the positive benefits of talking therapies. Thus, it is postulated that traumatised violent and sexual offenders may be released into the community when they are still at risk of reoffending. A single case study is presented, which describes the application of eye movement desensitisation and reprocessing (EMDR) for a sexual offender presenting with offence-related trauma, whose offences occurred in the context of serious mental disorder. The identification of offence-related trauma and subsequent resolution of trauma symptomatology are discussed in regard to effective offender rehabilitation. Furthermore, the idiosyncratic nature of offence-related trauma and the application of the standard EMDR protocol for a single traumatic event are considered.     

The impact of judge–defendant communication on mental health court outcomes

Previous research has shown that mental health courts have been successful in reducing the rates of recidivism among mentally ill offenders. However, none of these studies, to date, have examined exactly what aspects of the courts reduce these rates of recidivism and what makes them successful. The current study utilized a sample of 291 mentally ill criminal offenders participating in a mental health court to examine whether those participants who were addressed by and communicated with the judge had a reduction in recidivism rates and the severity of new charges in comparison to those who did not. The hypotheses regarding greater judge–defendant communication and recidivism were not supported. This suggests that communication in and of itself is not sufficient to reduce recidivism. Future research of a qualitative nature is essential to identify if the frequency, tone, and valence of the communication results in improved outcomes. In addition, these results may indicate a necessity for more stringent training and guidelines for the maintenance of Mental Health Courts. Results of the current study suggested differences between genders, such that females were spoken to by the judge more frequently than were men.     

The relationship between schemas and offence supportive attitudes in mentally disordered sexual offenders

Abstract

The study of schemas in sexual offenders is a relatively new approach in attempts to understand the deviant beliefs and attitudes of sexual offenders. Emerging findings suggest that offence supportive attitudes may be the product of an offender's underlying schemas. This study aims to establish the relationship between offence supportive attitudes and schemas in a sample of mentally disordered sexual offenders (MDSOs). Thirty-one male sexual offenders held within low through high security forensic mental health units were assessed using the Young Schema Questionnaire - Short Version 3 and the Questionnaire on Attitudes Consistent with Sex Offending. Correlational analyses suggested a pattern of relationships in which Insufficient Self-control, Entitlement and Enmeshment arose as the schemas associated with most offence supportive attitudes. This supports a relationship between schemas and offence supportive attitudes in MDSOs and is consistent with the literature to date. Implications for further research and treatment are considered.