TRENDS IN VIOLENT CRIME AMONG EX-MENTAL PATIENTS

A central component of the public's conception of the mentally ill is that they are dangerous. This belief receives support from recent studies of the arrest rates of ex-mental patients which suggest that arrests for violent crimes have increased. In order to investigate this issue, samples were taken at two points in time. Analysis of arrest rates revealed that very few ex-mental patients were subsequently arrested for violent crimes, although these rates were higher and increasing faster than these of the general population. Mast significant were the findings that subsequent arrests were best explained by the number of prior arrests and that the percentage of patients with a history of criminal behavior has increased dramatically over time. The implications of these trends in violent crime among ex-mental patients for the perceived link between mental illness and violence and for the social control functions of society are discussed.     

Instruction on the Procedure for Applying Compulsory Treatment and Other Medical Measures to Mentally Ill Persons Who Have Committed Socially Dangerous Acts,February 14, 1967 (1)

In accordance with the criminal legislation, the following compulsory medical measures may be applied to mentally ill persons who have committed socially dangerous acts:

(a) commitment to a general psychiatric hospital;

(b) commitment to a special psychiatric hospital.     

Applications for release by Australians in Victoria found not guilty of offences of violence by reason of mental impairment

Much research in relation to mental illness and the law has concentrated upon when accused persons are entitled to avail themselves of the defence of not guilty by reason of insanity or mental impairment. However, the decision as to when persons found not guilty by such pleas should be released step by step back into the community involves difficult analyses of the risk of recidivism by persons who have committed serious acts of violence whilst mentally ill. This article analyses some 70 cases heard by the Supreme Court of Victoria in Australia since the jurisdiction to make such decisions has been transferred from the executive arm of government to the judiciary. The jurisprudence generated by the Victorian Supreme Court constitutes Australia's most developed law in relation to prediction of dangerousness. This article evaluates the different and subtle dynamics that have influenced the judges in an increasingly sophisticated way to grapple with the phenomenon of mental illness in deciding when persons who have already killed can safely be released from involuntary detention status within the confines of a forensic psychiatric institution back into the general community.     

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.     

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.     

Reduced punishment in Israel in the case of murder: bridging the medico-legal gap

The psychiatrist's assessment of criminal responsibility of an accused in court for an act of crime has always been a matter of great difficulty. In 1997, clause 300a was incorporated into the Penal Code of Israel, thereby permitting a more lenient punishment for murder than mandatory life imprisonment. The clause includes the definition of what is meant by "severe mental disorder" and "significantly restricted capacity" by the defendant to understand the criminal nature of his or her act and to refrain from committing it. Usage of the concepts "disorder" and "significantly restricted capacity" in addressing the issue of diminished responsibility of the mentally ill is new to the Israeli legal code. The emergence and evolvement of the above concepts are presented through a historical review of the Israeli encoded law concerning mental illness, analyzed from a psychiatric perspective.     

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.     

A comparison of the community adjustment of mentally ill offenders with those from the general prison population

In an effort to understand the relationship between crime and mental illness, mentally ill offenders (MIOs) and those from the general prison population (non-MIOs) are compared on their postprison adjustment. MIOs are defined as those individuals who required psychiatric hospitalization during their incarceration. These 547 offenders (147 MIOs and 400 non-MIOs) were then followed for 18 months from date of prison discharge. Information on their adjustment came from several sources, including correctional data, parole reports, incidence of arrests and dispositions, and rates of psychiatric hospitalization. With the exception of drug offenses, no significant differences were found in the rates or types of rearrests between the two groups. Additionally, rearrest among MIOs was found to be associated with the same standard correlates of crime found in nondisturbed offenders: age and prior criminal record. Policy implications derived from these findings are discussed.This research was supported by NIJ doctoral grant NO. 86-IJ-CX-0073. I am indebted to the people of the NY Office of Mental Health, Departmental of Correctional Services, Division of Parole, and Division of Criminal Justice Services for providing me with access to these data. I would also like to thank Dr. Hans Toch and Dr. Ken Adams for allowing me to build on their reserach. Finally, I am very grateful for the helpful comments made on previous drafts by Dr. David Griswold, Dr. Ron Jemelka, Dr. Ellen Steury, and the anonymous reviewers at the journal.     

The character of danger in psychiatric practice: are the mentally ill dangerous?

This paper explores the question of dangerousness and the mentally ill. Research for this paper was stimulated by the death by homicide of two psychiatrists in Oregon in 1985. The paper reviews three distinct areas in the psychiatric literature: the arrests of mental patients, assaults against psychiatrists and other mental health professionals, and assaultive behaviors exhibited by patients in hospitals and other psychiatric settings. The author concludes that the risks are real but are dependent, for the most part, on setting and the acuteness of illness. Realism in regard to risk is critical for the mentally ill, their families, professional caregivers, and society in general.     

Severe Mental Illness,Somatic Delusions,and Attempted Mass Murder

A case of an attempted mass shooting at a large psychiatric hospital in the United States by a 30‐year‐old male with severe mental illness, somatic delusions, and exceptional access to healthcare professionals is reported. Six persons were shot, one died at the scene, and the shooter was then killed by the police. Data were gathered from court documents and media accounts. An analysis of the shooter's psychiatric history, his interactions with healthcare professionals, and communications prior to the shooting suggest a rare form of mass murder, a random attack by a documented psychotic and delusional individual suffering with somatic delusions. Despite his being psychotic, the killer planned the attack and made a direct threat 1 month prior to the shootings. This case highlights problems with the healthcare system, indicating that it might be ill equipped to appropriately deal with severe mental illness.     

Civil commitment in Turkey: reflections on a bill drafted by psychiatrists

Involuntary hospitalization of the mentally ill has been an issue that still remains outside the judicial system in Turkey. Despite the new Turkish Civil Code, which includes several articles relevant to involuntary psychiatric hospital admissions, there still appears to be a need for a comprehensive mental health law to address specific issues concerning civil commitment of the mentally ill. As a result of the lack of specific statutory regulation, an insufficient number of psychiatric hospital beds and limited appreciation of the safety risks involved in untreated mental illness, involuntary hospitalization remains an underutilized option by psychiatrists and the courts alike. In response to its concerned members, the Psychiatric Association of Turkey has appointed a task force to draft a proposed mental health law, entitled the "Psychiatric Patients' Bill of Rights." Although the draft suggests a model with emphasis on the right to psychiatric treatment, it also recommends close judicial oversight to prevent potential abuses of discretion by the system. However, this might present logistic problems in a country with already overburdened courts. Authors discuss the highlights of the draft within the context of Turkey's current cultural, social and judicial structure, and compare it to similar laws of other countries.     

Greek police officers' attitudes towards the mentally ill

The deinstitutionalization of the mentally ill and their shift into the community lead the police to play an important role in the management of acute psychiatric states. This study examines the attitudes of the Greek police towards the mentally ill, and the problems that arise during the transfer of mentally ill people to psychiatric emergency departments. Results highlight policemen misperceptions, and the difficulties encountered during transport procedures, which may be attributed to insufficient knowledge about mental illness and lack of training, respectively. Furthermore, this article discusses the need for police educational intervention, and the formation of specialized teams to improve the handling of mentally ill in crisis situations.     

The nature of police involvement in mental health transfers

During the course of their duties, police regularly have contact with mentally ill persons who are experiencing psychiatric crisis and require some form of mental health transfer. This study examined 2611 unique mental health transfers completed by police in the Australian state of Victoria over an eight-month period in 2009–2010. The overwhelming majority of mental health transfers performed by police during this period were the result of unplanned calls for assistance. Although police frequently requested assistance from other services, these were often not available. The study findings support a substantial body of anecdotal evidence from police citing lengthy involvement with people experiencing mentally illness, with the average mental health transfer consuming 2.5?h of police time. The frontline responses of police to people in psychiatric crisis need to be more formally acknowledged and creative solutions need to be sought with health and welfare services to better meet the needs of those who are falling between the cracks of community mental health care services.     

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.     

Homeless mentally disordered offenders and violent crimes

This study examines the prevalence of homelessness in a cross-sectional sample of 150 patients retained in a maximum-security hospital for mentally disordered offenders in New York City. The homeless mentally ill comprise only 2% of the city's mentally ill population, yet they account for 50% of the admissions to this forensic facility from the community. Compared to population base rate estimates, forensic patients are homeless at 25 times the rate found in the rest of the city's mentally disordered population and are 50 times more likely to be homeless than the general population. Further, there is a significant association between homelessness at the time of the instant offense and charges for violent crimes, after controlling for age, sex, race, and diagnosis. These data suggest that homelessness greatly increases the risk that mentally disordered persons will be forensically hospitalized and is closely associated with indictments for violent criminal behavior. Alternative explanations for these findings are discussed, emphasizing risk, vulnerability, and criminalization perspectives.Some of the data reported in this article were presented at the 42nd Annual Meeting of the American Academy of Forensic Sciences, February 24, 1990, in Cincinnati, Ohio. Thanks to Joel Dvoskin, John Monahan, Edward Mulvey, Charles D. H. Parry, Nancy Pruett, Henry Steadman, and three anonymous reviewers for their helpful comments on an earlier draft of this article.     

Chapter 2: The Legal Position and Organizational Forms of Forensic Psychiatric Expert Examination

The practical task of forensic psychiatry, which is one of the subdivisions of psychiatry, is to give an expert evaluation, on assignment from investigatory agencies and courts, and to devise and recommend measures for the prevention of socially dangerous acts by the mentally ill. Forensic psychiatric expert examination, like forensic medical, criminal, or any other type of expert examination, aids agencies of justice in establishing the facts in a case. Forensic psychiatric expert examination is called upon to assist the investigator and the court in determining whether an individual is a criminal or a legally irresponsible, mentally ill person; whether a person sentenced to a prison term should, because of mental illness, be released before his time is served; whether the investigator and the court may pursue the interrogation of a witness or victim with mental disorders, and whether the testimony of such persons may be used as court evidence. Such an expert examination is necessary in a civil suit in deciding the question of an individual's competence.     

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.     

A comparison of civil patients and incompetent defendants: pre and post deinstitutionalization

There has been a great deal of speculation that deinstitutionalization has resulted in the criminalization of the mentally ill. Using two samples of defendants found incompetent to stand trial (IST) and two samples of civil patients randomly selected from five states, pre and post deinstitutionalization, this research compares changes in their mental health and arrest histories. After deinstitutionalization, fewer and less dramatic differences in the arrest and mental health histories were evident between ISTs and civil patients. Both patient samples displayed significant increases in prior hospitalization and arrest histories. Among the civil patients there was a significant increase in the frequency and seriousness of criminal activity. There was no evidence that IST commitments are being expanded to hospitalize the nondangerous mentally ill no longer subject to civil commitment.     

Firearms regulation,violence and the mentally ill: A contemporary Antipodean appraisal

As recent cases of mass murder at Utoya Island in Norway, and in the United States (US) at Virginia Tech, Virginia; Tucson, Arizona; Aurora, Colorado; and Newtown, Connecticut all illustrate, acts of extreme violence involving high powered weapons and committed by persons with a presumed or confirmed mental illness tend to arouse intense public and political debates about the efficacy of firearm regulation and control. Following these tragedies, in the US at least, various law reform measures have been proposed and in some cases implemented designed principally to make it more difficult for mentally ill persons to gain access to firearms. In this article it is contended that measures like these are at best tinkering with the margins of gun control and also have the tendency to reinforce the stigma and discrimination experienced by persons with a mental illness, while perpetuating stereotypes of them as dangerous to themselves and others. Despite these limitations, and while firearm regulation policies and practices vary widely across the globe, most nations still seek in some way to limit access to guns by persons with a mental illness. This article explores in more detail how such policies and practices have been applied in the Australian State of New South Wales and the lessons to be learned elsewhere from this experience.     

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.