Mentally disordered young offenders

Young people who commit serious criminal offences and who have significant coexisting mental disorders are a group of particular concern for forensic mental health services. Whether they come to the attention of forensic services depends not only on their mental state but also on the character of the alleged offence, legislative procedures, local practices, and forensic resources. As in all forensic mental health practice, the nature and severity of an offence will strongly influence a decision to request a forensic evaluation. Felonies, sexual offending, and repetitive violent behaviour are more likely to be referred for a forensic psychiatric assessment. However, the threshold for requesting such referrals varies considerably between courts, jurisdictions, cultures, and countries.

Offending in adolescence is uncommon among girls and the literature on young female offending is relatively scarce. Thus, this text will mainly refer to males unless otherwise stated.

There are several reasons for focusing on the forensic mental health management of young serious offenders.

1. Many adult forensic psychiatric patients have begun offending when still adolescents. Earlier intervention may alleviate or prevent a life of psychiatric impairments as well as of offending.

2. Abnormal behaviour among teenagers tends to be dealt with solely as a social and/or moral deviation, which results in psychiatric signs and symptoms being overlooked.

3. The risk of being injured, killed, or committing suicide is high among young serious offenders, thus constituting a public health issue. (7 ,71)

4. Psychiatric treatment regimes for adolescents differ from those for adults.

5. The peak age for offending is around 17 to 18 years.(71)

It needs to be emphasized that self-report studies on male teenagers consistently show that not breaking the law is abnormal in adolescence.(72) Most unlawful acts that take place in these years go undiscovered (as do most adult criminal acts). Of particular relevance for policy and research is that a limited number of persistent delinquents commit the majority of crimes. In a Swedish prospective follow-up study of 709 boys, 14 per cent of the subjects with a criminal record had participated in 62 per cent of all registered crime occasions.(73)

Even when it is clear that an adolescent offender is suffering a psychiatric disorder it often remains a considerable problem to assign a correct diagnosis. In part this is because many psychiatric disorders in adolescence follow unmapped pathways and/or present with symptoms that are common for the early stages of a number of disorders/74) Such difficulties invite a simplified diagnostic practice. Unfortunately, at least in the past, conduct disorder has proved to be a dubious category and a number of adolescents with this diagnosis have subsequently been found to have psychotic symptoms or mental retardation.(75)

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