MENTALLY DISORDERED OFFENDERS

Mentally Disordered Offenders

Mentally Disordered Offenders

Question: Over 90% of prisoners had one or more of the five psychiatric disorders studied (psychosis, neurosis, personality disorder, hazardous drinking and drug dependance (ONS 1998). Why are so many mentally disorderd offenders in prison?

Introduction

Crime by mentally ill people has become a matter of heightened public concern in recent years. The inpatient population of mental hospitals in the United States shrunk from a peak of 550,000 in 1955 to 70,000 in 2000. As a result, many severely mentally ill people who in earlier decades would have spent much of their lives as mental hospital patients now live elsewhere. Many cycle through periods of homelessness, brief psychiatric hospitalization, and incarceration in jail or prison.

The relationship between crime and mental illness is complex. Most crime is committed by people who are not mentally ill. Similarly, most people with mental illness do not engage in criminal behavior, as illustrated in Figure 1.

For a small percentage of people, mental illness so distorts their perception or judgment that it causes them to commit crimes. Most crimes caused by mental illness are public order offenses such as vagrancy and public intoxication, minor property destruction, and minor assaults. Unfortunately, infrequent and highly publicized violent offenses by mentally ill people capture the public imagination and distort perceptions of mentally ill offenders and mentally ill people generally.

Lord Bradley Report

Health Policy

We know that socially excluded groups are historically poor at accessing services, not least in engaging with primary care services which are in effect the gateway to secondary mental health services. The NHS has recognised this link and several recent initiatives focus strongly on addressing health inequalities in socially excluded groups.

The White Paper Our health, our care, our say18 built on the foundations of Choosing health19 and identified issues affecting and arising from health inequalities. This White Paper set out a vision of good-quality social care and NHS services available to people in the communities where they live. To achieve these aims, family doctors, primary care trusts and local authorities that have direct contact with patients and service users have increasing discretion in how best to plan and buy services for local communities.

The challenge to service commissioners and providers is to ensure that the goals set out in Our health, our care, our say are implemented for the whole of their population, including offenders and those at risk of offending. They will need to work in partnership to ensure that community-wide approaches are developed to more effectively meet the needs of excluded and deprived groups. Lord Darzi's recent review of the NHS20 sets out in more detail how NHS services might be configured in order to achieve this. The focus will be on six key goals, which include reducing alcohol harm, treating drug addiction and improving mental health - three areas that are extremely relevant to the potential offending/re-offending population.

Mental Health

The Mental Health Act 200721 has made several significant changes to the Mental Health Act 1983, which is the main legislation governing the care and ...