Mental Illness

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Mental Illness Crime

• Schizophrenia The Personality Disorders

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Schizophrenia in a Nutshell

• Most common psychosis, 1 life risk.
• Law of thirds.
• Starts on average m 20-25 f 25-30 yrs.
• Delusions, hallucinations, thought insertion,
  paranoia, word salad, ANXIETY, etc. ve.
• Apathy, slowing, flat emotion, etc. ve.
• Sz PD Psychopathy danger.

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Schizophrenia Crime

• Sz more likely to commit crimes. 3 offenders vs
  1 population.
• All psychosis 3.5 offenders3.5 population
• Police divert Sz from CJS.
• Violence Sz gt 4x violence of non-Sz.
• Sz at risk violence,12x theft 140x property
  crime 4x rape 20x general pop.
• In prison, etc victims of staff inmates.
• Sz in prisonmore needs less care!
• Sz substance misuse danger (17x).

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Schizophrenia The Police

• Training inadequategttragedies.
• Sections 135 136 place of safety for own sake
  or if committed crime.
• Fear of uniforms, being grabbed, etc.
• Pepper spray, tear gas, etc do not subdue!
• Keep them as calm as possible, get CPN, Mind,
  etc, family, Crisis Intervention Team.
• Peter Sutcliff types very rare.

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Still Crazy After All These Years

• Mad, bad sad always been confused.
• Need to get MI out of CJS.
• Prison perfect design to send mad madder.
• Staff make things worse (cruel unkind).
• You need to stand up for those you are
  responsible for.
• Read the refs relevant to your interests.

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What is Personality Disorder (PD)
Definition National Mental Health Association,
2001

• A deeply ingrained inflexible pattern of
  relating, perceiving and thinking serious
  enough to cause distress or impaired functioning.
  Usually recognizable by adolescence or earlier,
  continuing throughout adulthood and becoming less
  obvious throughout middle age.
• Those with a PD have great difficulty dealing
  with other people. They tend to be inflexible,
  rigid and unable to respond to the changes and
  demands of life. Although they feel their
  behaviour patterns are normal and right, people
  with PD tend to have a narrow view of the world
  and find it difficult to participate in social
  interactions.

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PD Types

• DSM 1V lists 10 specific Personality Disorders
  divided into 3 clusters
• A Odd or eccentric (Paranoid, Schizoid,
  Scitzotypal).
• B Dramatic, emotional or erratic (Antisocial,
  Borderline, Histrionic, Narcissistic)
• C Anxious, fearful (Avoidant, Dependant,
  Obsessive-compulsive)

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Cluster B PDs (Functional link to crime)

• Antisocial The irresponsible, often criminal
  behaviour of these people begins in childhood or
  early adolescence with truancy, running away,
  cruelty, fighting, destructiveness, lying and
  theft. In addition to criminal behaviour, as
  adults they may default on debts, or otherwise
  show irresponsibility, act recklessly or
  impulsively and show no remorse for their
  behaviour.
• Borderline - These impulsive people make
  recurrent suicide threats or attempts.
  Affectively unstable, they often show intense,
  inappropriate anger. They feel empty or bored,
  and they frantically try to avoid abandonment.
  They are uncertain about who they are, and lack
  the ability to maintain stable interpersonal
  relationships.
• Histrionic - Overly emotional, vague, and
  attention-seeking, histrionic people need
  constant reassurance about their attractiveness.
  They may be self-centred and sexually seductive.
• Narcissistic -These people are self-important and
  often preoccupied with envy, fantasies of
  success, or ruminations about the uniqueness of
  their own problems. Their sense of entitlement
  and lack of empathy may cause them to take
  advantage of others. They vigorously reject
  criticism, and need constant attention and
  admiration.

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Prevalence of PD
PD Studies (Singleton et al, 2001, Fazel, 2002),

• 5.4 of males suffer from PDs (general
  population)
• 65 male prisoners (population 18,530)
• 42 female prisoners (population 4,260)

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PD other disorders (Prison Population)
Prison Studies (Males v Females) (Fazel et al,
2002).
Antisocial PD approx 10 times higher than in
general population.
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Psychiatric Disorders Offenders (UK)

• Only 1 in 10, no evidence of mental disorder.
• No more than 2 in 10 had only one.
• 7 in 10 gt1 disorder (those with functional
  psychosis were likely to have 3 4 other
  disorders (Reed, 2003)
• PDs most frequently identified psychiatric
  disorders among offenders and are commonly
  associated with problems of aggression, sexual
  offending substance abuse.
• 2/3 forensic psychiatric population meet
  criteria for 1 PD (Blackburn et al, 1990)

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PD Terminology
Various terminolgies used

• Categorisations?
• Severe Personality Disorder (SPD)
• Dangerous and Severe Personality Disorder (DSPD)
• Psychopathic Disorder/psychopathy?

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The Fictional Psychopath
Recognise this fictional sufferer?
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Legal Definition
Psychopathic Disorder

• In England and Wales, the 1983 Mental Health Act
  describes psychopathic disorder as a persistent
  disorder or disability of mind (whether or not
  including significant impairment of intelligence)
  which results in abnormally aggressive or
  seriously irresponsible conduct s. 1 (2).

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The Clinical Term
Psychopathy

• The clinical term psychopathy and the legal
  term psychopathic are distant relatives.
• Historically, psychopathy has limited links to
  the concept of moral insanity.
• The term psychopath was first used by Koch
  (1891) as a collective label for Personality
  Disorders.

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The Psychopathic Personality
Blackburn, 2001, Reed, 2003

• The traits associated with Psychopathic
  Personality also associated with other
  personality disorders (Histrionic, Narcissistic,
  Borderline Antisocial).
• Those meeting criteria for APD are likely to
  meet the criteria for other PDs (e.g.
  narcissistic, borderline).
• Psychopathic personality a higher order
  category.

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Psychopathy and Crime
Hare et al, 1988, Serin, 1996)

• Psychopaths Persistent and highly serious
  offenders.
• Compared to mainstream offenders, psychopaths gt
  convictions (particularly violent crime), engage
  in wider range of types of criminal activity,
  attract gt convictions, spend gt time in prison.
• Blackburn (1982) Two types of psychopaths (
  primary (violent offences) secondary (sex
  offences).

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Cleckley and Psychopathy
Defining characteristics

• A lack of guilt or remorse for their crimes.
• Egocentricity
• Impulsiveness
• An inability to form close relationships
• A failure to learn from experience.

an individual who is marked by an emotional and
social emptiness in their interactions with other
people (Cleckley, 1964),
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Hare and Psychopathy
Defining characteristics, (Hare, 1980)

• An inability to develop warm, empathic
  relationships.
• An unstable lifestyle.
• An inability to accept responsibility for
  antisocial behaviour.
• An absence of intellectual and psychiatric
  problems.
• Weak behavioural control.

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Synopsis of the PCL-R

• Superficial charm
• Grandiose sense of self-worth
• Need for stimulation/easily bored
• Pathological lying
• Manipulative
• Lack of remorse or guilt
• No emotional depth
• Callous
• Parasitic lifestyle
• Poor behavioural control
• Promiscuous sexual behaviour
• Early behaviour problems
• Lack of long-term planning
• Impulsive
• Irresponsible
• Failure to accept responsibility for own actions
• Frequent marital failures
• Delinquent as a juvenile
• Poor record on probation or other conditional
  release

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PD Assessment and PCL-R

• PD assessment instruments and procedures
  Inconsistent (poor reliability/validity).
• PCL-R intensively researched validated
  (Maden et al, 2004)

Although not originally designed as a risk
assessment device, the PCL-R has gradually come
to be used to assess likely future recidivism and
violent offending.
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Recommended Reading

• Shriver, L. (2005) We need to talk about Kevin,
  London Serpents Tail.