Crime and mental disorder a problematic relationship

Psychiatric disorder and offending are both common phenomena; overlap of the two is therefore to be expected and may be due to chance. People with a psychiatric disorder may behave in a criminal manner, and some offenders have psychiatric disorders. The area of overlap is a legitimate area for psychiatric study, but attempts to understand the nature and degree of the relationship between psychiatric disorder and offending are fraught with problems. There are six principal reasons.

Crime is a man-made concept; it is whatever a society chooses at any particular time to decree as unlawful. It is subject to changing attitudes over time within a given society, and to international differences between societies. For example, murder may be almost universally unlawful, except at times of war, but wilfully ending the life of a terminally ill person may be legally permitted in some countries and a crime of murder in others. The classifications of crime, particularly sexual offences, change within the same country over time. Homosexual acts that were previously criminal in the United Kingdom were legalized in 1957, and the age of consent for homosexual acts has recently been lowered to 18 years. Carrying out an abortion was a crime in 1966 but is legal today. In recent years research has attempted to examine offending behaviour, irrespective of whether or not the behaviour results in a criminal offence. There are inherent methodological problems with this approach but the findings are of more value.

Psychiatrists see a limited and highly selected proportion of offenders. They do not have routine contact with those who are responsible for the greatest amount of crime, namely those whose criminal acts are not reported, detected, prosecuted, or punished. Offenders responsible for hidden crime may have biologically determined advantages (for instance, intelligence or cognitive skills or physical agility) of potential medical interest but, like their crimes, they remain hidden and largely beyond research.

Historically, research has been undertaken on captive populations of offenders in prisons (and patients in hospitals) because this is more easily conducted. There are no systems for the routine psychiatric examination of court-based samples. Extrapolating findings from captive samples may be misleading. Offenders who reach captivity are likely to include those with characteristics that disadvantage them in the criminal justice system, for example ethnic status, race, low economic status, homelessness, unemployment, and mental illness. Thus an apparent relationship between psychiatric disorder and an offence, particularly one where only a minority reach custody (for instance, arson and shoplifting), may be an artefact, the result of unrepresentative sampling. Studies based on self-report and criminal surveys of community samples are of greater value and are beginning to be reported.

It is unwise to generalize findings from one population to another. The relationship between offending and psychiatric disorder is affected by overall rates of crime and psychiatric disorder in a given population, the operation of the criminal justice system, social policy in respect of offenders, and the nature and provision of health and social care for mentally disordered people. These factors differ between countries and in different areas of the same country; they also change over time within individual countries. For example, reductions in the numbers of inpatient psychiatric beds and the extent of community resources for the mentally ill may have local effects that are not generalizable.

There has been insufficient emphasis on the use of standardized diagnostic criteria in research on offender populations. In particular, diverse diagnostic groups have been grouped together (e.g. personality disorders, functional psychoses, and substance misuse disorders). Some studies have not separated male and female cohorts, though we know there are major differences between the sexes in offending.

The use of criminal records as a measure of a person's offending is unreliable. Aside from the problems of hidden crime which does not appear in criminal statistics, it is impossible to determine the nature and gravity of an offence simply from its statutory description. Indecent assault, for example, may be the merest contact between perpetrator and victim or a sexual attack of homicidal intensity. Similarly, the recording of the severity of violent crimes is based on statutory criteria that may or may not reflect behaviour that took place.

These difficulties in research demonstrate the complexity of the relationship between psychiatric disorder and offending, but they do not serve to diminish its existence. We are learning of the ways in which the mentally ill offend, although we know much less about the extent to which psychiatric disorder contributes to the wide range of behaviours that could be deemed criminal. Not surprisingly, offending by people with psychiatric disorders is as ubiquitous as psychiatric disorder itself. In any population a proportion of people with psychiatric disorder will present through criminal justice agencies, a fact apparent from the increasing worldwide literature now emerging on mentally disordered offenders. For example, facilities for mentally ill offenders are provided in countries as diverse as Ghana and Papua New Guinea;(!2) in those countries, as elsewhere, schizophrenia in association with substance misuse is a common finding in mentally ill offenders.

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