How has our integrated knowledge of mental illness and crime impact on the way the health and

criminal justice system diagnose and treat offenders/patients?

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2
CHAPTER FOUR
DATA ANALYSIS AND DISCUSSIONS
Introduction
"Mental Illness is an umrella term that alludes to numerous di!erse illnesses that influence the
mind" "esearch has demonstrated that around one in fi!e people will encounter some type of
mental illness at some stage in their li!es# going from mild# moderate or se!ere conditions$
%pecifically there is a de!eloping pattern that a high rate of those at present and inside the
criminal e&uity frameworks are e'periencing a manifestation of mental illness$ "Indi!iduals with
se!ere mental illness are more prone to e indicted crimes than their mentally sound partners#
and are imprisoned for more times of time$"
Link between Menta Ine!! and Incarceration
The criminal justice framework has encountered generous de!elopment in incarcerations lately$
In (ugust )**+# ,ails in (ustralia housed )#-.- detainees yet starting / ,uly )**/ that figure had
mo!ed to /#01/$ 2ith these figures hinting at no aating# now like ne!er efore it is asic that
the criminal justice framework sur!eys its policy and project impro!ements inside health# group
and remedial administrations to guarantee that it has an e'panded concentrate on gi!ing
enhanced measurale mental health administrations$
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%tudies ha!e demonstrated that "the relationship etween mental issue and wrongdoing is a
fundamental one to e in!estigated# to recogni3e causes and impact and to create fitting
approaches and administrations in like manner$" (n in!estigation of .** psychiatric patients
disco!ered just a 4 5 lifetime wrongdoing per!asi!eness# demonstrating that there is "no natural
link etween mental illness and wrongdoing"# yet there remains a "solid causal link etween
mental illness and incarceration" ( study directed in )**/ found that "lifetime capture rates for
indi!iduals with a mental illness range from 4)6half" $
( study directed y a Mental Health 7rgani3ation recorded the accompanying as eing reasons
why8 indi!iduals with mental illnesses are o!er spoken to in jails9
+$ The asence of assets distriuted to help the end of psychiatric foundations# which
prompt high ha3ard !ariales for culpale# for e'ample# homelessness# unemployment and
po!erty
)$ The courts judge or judge ha!ing constrained choices# despite the fact that numerous
indi!iduals in care with a mental illness are accused just of rundown offenses or generally minor
criminal acts
/$ Inade&uate susidi3ing of group mental health administrations and a nonattendance of
assigned offices inside the justice framework lead to judges proposals for treatment not eing
actuali3ed
4
4$ ( 3ero tolerance methodology to medication wrongdoings conse&uently rings
indi!iduals with doule determination inside the criminal justice
Dua Dia"no!i!
(n audit which occurred in +11/ inspected the clinical relationship etween mental illness and
crime$ The study tried to find the presence of an alternate !ariale or !ariales that may ha!e a
relationship with oth mental illness and detainment other than crime$ It was oser!ed that
"indi!iduals with a mental illness are at a higher than normal danger of culpale# not as a result
of mental illness fundamentally# ut since of the higher than normal commonness of sustance
ause in this population$" ( later study directed in )**+ of indi!iduals with a mental illness in
jail demonstrated that "-:5 of the specimen had a history of sustance ause and 0:5 had a
dynamic sustance ause on capture$" %trikingly# two thirds of the test;s crimes were identified
with their sustance use# normally peaceful$ These rates of sustance ause issue far surpass
those for indi!iduals inside the o!erall pulic8 "for schi3ophrenics# a type of insane illness# the
chances of sustance ause are 4$: times higher than those in the all inclusi!e community not
e'periencing the mental illness$"
(s a general rule# mental illness and sustance ause go as an inseparale unit$ "<ragmentation
of mental health administrations and the going with danger components of mental illness 6
po!erty# poor training# unemployment# poor social aptitudes and family help" # fre&uently lead
the mentally sick to circumstances of e'panded introduction to psychoacti!e sustances$
(dditional confirmation proposes that "among indi!iduals with se!ere mental illness# sustance
ause associates with e'panded rates of !iolence and suicide# homelessness# censuraility#
5
detainment# and e'panded rates of ackslide and hospitali3ation$" <actored together# it makes an
endless loop that is tricky to escape$ =i!en that the impacts of mental illness regularly lead those
influenced towards sustance ause# without the essential treatment at an early stage# guiltiness
has all the earmarks of eing an unimportant custom$
"eproduce crippled# indi!iduals with a dual diagnosis are maye the most dangerous of all
mentally sick indi!iduals gi!en that reports demonstrate that "there is a diminishment in the
!iaility of medication# increased sides impacts of medication# e'panded eha!ioural issues and
potential decrease in the correctness of judgments$" This presents maye the est test to the
criminal justice framework and rectification offices# ecause of the sectioned nature of the
current administrations and the ramifications of dual diagnosed people groups; illness for
recepti!eness to treatment$
Indi!iduals with dual issue face numerous clinical oundaries which keep them from ha!ing
entry# e!aluation and est practice treatment from the administrations and projects that do e'ist$
( )**+ study noted a portion of the issues for the treatment of the dual diagnosed$ The concerns
were descried y constrained administrations and firm &ualification criteria yet included9
+$ >oth Mental health administrations and li&uor and medication administrations present
restricti!e models of forethought# seeing them as working autonomously
6
)$ ?ach administration gathering knows minimal aout the part and practices of the other$
/$ Mental health administrations and li&uor and medication administrations are intended to
treat single$
Treatment of mental personality disorders oth inside and outside of prison
(ccording to the 2orld Health organi3ation @)*+*A personality disorder is defined as the
prolematic e'tension of the normal personality characters$ In most cases# personality disorder
starts from ordinary healthy performance indi!iduals and this leads to some prolematic traits
that can as well increase to many prolematic characters that can finally results in a personality
disorder$ The character and the eha!iour can said to e a personality disorder if they follow the
three Bs$ The three Bs are the prolematic6 which is unusual causing distress to self and others$
There is also the persistent who also regarded as the progression from the adolescence to
the adulthood and finally there is the Ber!asi!e which is when it has started$ >ean @)**-A in his
analysis oser!ed that personality disorders is an aspect of an indi!idual character that de!elops
in a way that makes it difficult for such people to li!e with themsel!es or with other people in the
society$ In addition to it# they are characterised y unimagined way of thinking and reasoning$ In
most cases# such people always a ad feeling and eha!ing that cause prolems in getting on or
controlling the eha!iour$ Bersonality disorders can e noticed form the childhood or from early
teens$
7
The study carried out y >ewely @)**-A on the impact of prison on the mental health of
those within prison found that it is negati!e howe!er8 this is not always the case$ The study
found out that young people especially those in the secure estates had etter health including the
mental health than the offenders who were on community sentences$ The study as well re!ealed
that foe some offenders8 prison life introduces chaotic li!es to them$ <or the prisoners with drug
addiction# there is the prospect for deto'ification$ ?!en though this is case# many prisoners are
introduced to the opiates for the first time in prison and in most cases8 they will continue to
misuse these drugs while still in prison$ Most of the prisoners who ha!e een inter!iewed ha!e
re!ealed that at the ha!e ecome users of these drugs within short time in the prison$
Treatment
(ccording to =ideon @)*+/A there are different treatments a!ailale for the treatment for
mentally disordered offenders$ The author noted that the mentally disordered offenders were
locked away from the society in the past$ They were percei!ed as the community outcasts$
Howe!er things ha!e changed o!er the past years and currently# the criminal justice system tries
to engage memers of the community as well as the mental healthcare professionals within the
mentally disordered offenderCs treatment which include community sentences and all ser!ing
custodians$ Durrently# there are rehailitation programmes that are a!ailale for oth in and
outside prison$ The programme includes the treatment of drug and alcohol which are the
fundamental cause of crimes that are committed y the mentally disordered persons$
The high rate of comoridty relating to the sustance ause is tackled to help the mental
disorder persons e more manageale$ Medication is also important to them at this particular
8
stage$ It is assumed that with the medications# they system will no longer ha!e the need to
commit the crime$
( community ser!ice plays an important role in restoring ack the li!es of mental
personality disorders$ These are treatment that in!ol!es the local community ser!ices$ The
ser!ices are majorly for the people and their families within the community$ The ser!ices range
from the mental healthcare and support to end of life care$ These ser!ices are always gi!en when
offenders are outside the prison$ The treatments gi!en to them are important especially for the
offenders who ha!e left the prison and are with the memers of the community$ 2hen the
offenders are in prison# there is a long term treatment programme called the community
democratic therapeutic$ They are the group ased programmes that encourages the offenders to
participate$ This kind of treatment is therefore helpful as they help to restore ack the li!es of the
offenders$
(ccording to Hollin @)**+A Bsychotherapy is another form of treatment gi!en to mental
disordered persons$ This type of treatment in!ol!es communication with the patients to impro!e
and regulates the patient thoughts and emotions$ This type of treatment is done y professionals
who ha!e the knowledge and the e'periences in dealing with these kinds of disorders @National
Health %er!ice )*+)cA$ In addition to this# the psychotherapists are likely to concentrate more on
trying to influence the mentally disordered person to help them reflect on their eha!iours and
their attitudes in a way that will make them act out of the group eha!iour$ @ *A oser!ed that for
mentally disordered persons# group therapy is important ecause it will help them focus on
making the patients form a social relationship so that when they come out from the prison# they
will e ale to sociali3e freely with other memers of the community and e ale to form the
9
relationship with those other people around them for e'ample their mental health professionals
or e!en their family memers$

"esearch done y (merican Bsychiatric (ssociation @)*+/A showed that the primary
function of ha!ing the therapy for the mentally disordered persons is for democratisation that is
the modelling of healthy society# there is the permissi!eness that is the freedom to e'pression of
eha!iour# there is also the confrontation of reality that is the dealing with of dealing with the
peer support and peer pressure and finally there is the patients confidentiality which imply that
there should e no secrets etween the group and the therapists$ These types of treatment are
therefore important ecause they help offenders accept the responsiility for what they ha!e done
within the community and within the group therapy session$ In addition to this# the therapy helps
such patients enefit from an outside decision making in the hope that the offenders will make
the right decisions without necessarily ha!ing to go ack to crime in oth the short and long run$
This implies that therapy is the most appropriate method of treatment to e gi!en for the
offenders$
(fter analy3ing the situation it is important to note that the mentally disordered persons#
should e protected while in prison$ There are for e'ample organi3ations that are trying to work
closely to treat the mentally disordered offenders and the implications that must e put in place
to help protect the offenders$ <or e'ample# when they are fit to stand trial and when they need to
e in prison or when they need to e in a healthcare facility then they must e protected$
(ccording to (merican Bsychiatric (ssociation @)*+/A there are many offenders within the
prisons who ha!e the symptom of mental illness and the personality disorders as well$ In most
cases howe!er# such patients always go unnoticed$ This implies that the treatment is necessary
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for them ecause if they had the treatment# they needed the risk of reoffending to help them
o!ercome the prolem$ Howe!er# the mental health care pro!iders and the prison staff as well
must come together to determine and diagnose the offenders so that the offenders gets an
opportunity they need to help them reco!er if they ha!e a serious mental illness like the
personality disorder $ Ha!ing this people put in a mental healthcare facility is important ecause
it helps them ser!e out their time rather than eing put in a prison en!ironment$ This should e
the most important priority to e gi!en to such patients$
Department of health @)*+/A 7ser!ed that there are !arious reasons as to why most
offenders might seek help and guidance from the prison staff and from the healthcare
professionals$ The author noted that if they come to such people they might get the help that
they need and ecome diagnosed$ 7n the other hand# the author noted that offenders are likely to
stay undiagnosed if they do not seek the help with the criminal justice system ecause they might
not otain the help that they need$ Inade&uate prisons mental health facilities ha!e also made it
difficult for the offenders to get diagnosed$
Beay @)**+A in his study# the treatment of mental illness oser!ed that there is a prolem
with the diagnosis especially where some people are trying to fake mental illness$ He noted that
when people fake their mental disorder# they sentence gi!en to them might e light hence
majority are taking ad!antage ased on this$ He added that most prisons do not ha!e all the same
accessiility that means that they do ha!e the same method of treatment a!ailale for most of the
offenders with the personality disorders$ The a!ailale group sessions might e important only
when they are surrounded y other offenders with the same disorders making the area under
&uestion rele!ant to all of them$
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In conclusion# it is important to understand that the treatment of mental personality
disorders can e done in groups or indi!idually$ Depending on the offenders in the prison# they
could either work as a group to help one another ecome important responsile people in the
community$ There are numerous enefits a!ailale for the treatments mental personal disorder as
discussed ao!e and they are essential and effecti!e in treating the mental illness$
Treat#ent and under!tandin" o$ !c%i&o'%renia
%chi3ophrenia is one of the major serious mental illnesses that commonly affect the rain
and mind$ It is howe!er# treatale$ The treatment process is actually in!ol!ing# eing that there is
no specific cure for it$ The est way of treating schi3ophrenia is through the use of antipsychotic
medication and psycho-social therapies. The two methods ha!e een useful oth in and out of
the prison and ha!e the highest success rate @(merican Bsychiatric (ssociation# )**:A$ New
strategies of treating schi3ophrenia are close to +. ut up to )*+/# schi3ophrenia drug was still
not at large and doctors e'pect new forms of medications from researches y iotech and
pharmaceuticals companies$ (mong the methods eing put into use currently apart from the
initial two are psycho-social treatments and cognitive therapies$ De!elopments of schi3ophrenia
as agreed on y e'pert# is as a conse&uence of interaction of iological predispositions$ (n
e'ample is specific gene inheritance coupled with the nature of surrounding imposed on a
person$ (ccording to research y @(merican Bsychiatric (ssociation# )**:A genetic
predisposition with situational stressors are the factors that often interfere with rain
de!elopment at the point of pregnancy$ It thus leads to slight alterations within the rain making
a person susceptile to ecoming schi3oid$ ?'perts conform to the fact that en!ironmental
factors during child de!elopment stages ha!e possiilities of aggra!ating rain damage and
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accelerating or lessening the mo!es towards ac&uiring schi3ophrenia$ Durrent research y
doctors @Department of health# )*+/A elie!es that a comination of iological# psychological
and social factors is what is responsile for the upsurge of schi3ophrenia$
( !ast numer of schi3ophrenia culprits e'ist in jail as a result of ha!ing committed
offences$ In E%# )* percent of the total )$+ millions in jail or prison suffer from mental illness$ It
is a numer that is eyond the once that are found in mental hospitals @Human "ights 2atch#
)**:A$ The (merican Bsychiatric (ssociation# @)**:A gi!es an estimate of one to fi!e as the
numer of serious mentally ill to moderate mental illness and among these# . percent suffers
from schi3ophrenia$ Many of those affected with schi3ophrenia are found to e held in jails#
shelters and hospitals$
Treat#ent o$ Sc%i&o'%renia
(ntipsychotic medications as a major form of medication to schi3ophrenia e'isted since
early +1.*s$ The medication impro!es greatly the physical attitude for a gi!en patients$ They
minimi3e the symptoms related to schi3ophrenia and make the patients to perform duties in a
more effecti!e and appropriate way$ >eing recogni3ed as the est treatment that e'ists# they
howe!er# do not e'plicitly cure schi3ophrenia and cannot affirm the possiility of patients
inhiiting future psychotic episodes$ The manner that treatment occurs primarily relies on the
hands of accredited physician with e'perience in mental disorders$ Brescription of the dosage is
personali3ed for e!ery patient ecause people ha!e great !ariance in the ratio of drug needed to
minimi3e symptoms with no negati!e effects @National Health %er!ice# )*+)A$
( larger numer of schi3ophrenia patients always indicate positi!e changes with use of
antipsychotic drugs$ There are also other patients that show little or no impro!ements with the
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medication while some do not necessarily need antipsychotic drugs$ It is a challenging task for
the doctors to identify these kinds of patients from the !ast majority of eneficiaries of
antipsychotic drugs$
Many forms of inno!ati!e antipsychotic drugs dued Fatypical antipsychoticsG ha!e
come into place since +11*$ The first one is clo3apine @Dlo3arilA consistently shows to e !ery
effecti!e as to other antipsychotics howe!er# could e'hiits with it the side effects of
agranulocytosis a situation that occurs due to reduction of the numer of white lood cells per
lood count$ Therefore# when doctors administer clo3aphine# they do monitor the patientsC lood
y carrying out lood tests after one to two weeks to ensure that these patientsC immune systems
are not affected at great length$ New antipsychotic drugs like risperidone @"isperdalA and
ola3anpine @Hypre'aA are regarded as eing safer to patientsC than older ones like clo3apine
ecause of their high le!el of toleration$ The only difference is that they may not e as strong as
clo3apine ut all the same# there are many impro!ed antipsychotic under ad!ancement stage$
(ntipsychotic drugs are found to e effecti!e on treating specific symptoms of schi3ophrenia
preferaly hallucinations and delusions howe!er# it rarely tackles symptoms related to reduced
moti!ation or emotional e'pressi!eness @>ewely# )**-A$ In fact# older antipsychotic like
haloperidol @HaldolA and chlorproma3ine @Thora3ineA sometimes may generate side effects often
seen as the hardest symptoms to treat$ ( etter remedy for such negati!e effects necessitates
doctors to limiting the dose or shifting to other forms of medicines$ ?'amples of newer medicine
that presents lesser side effects include8 olan3apine @Hypre'aA# &uestiapine @%ero&uelA or
risperidone @"isperdalA$ 7n some occasion# when a schi3ophrenia patientsC undergoes depression
mode other symptoms may seem to ha!e intensified$ In comating such cases# antidepressant
medication would pro!e effecti!e in impro!ing such symptoms @2orld Health 7rgani3ation#
14
)*+*A$
In some circumstances# families of the patients may worry much aout the kind of
antipsychotic medication eing used in treating schi3ophrenia$ Berhaps with the inclusion of side
effects# more worries are inflicted into the erea!ed patientsC and their respecti!e families$ It is
howe!er# noted that antipsychotic medication ne!er ignites addicti!e eha!iors in patients$
15
The other misconception on antipsychotic drugs is that they are seen as agents that controls
mind$ To a!oid misappropriation of these drugs# appropriate dosage is necessary so that
the drugs ne!er control a personCs mind$ The main aim of these drugs is to help the
patientsC understand and deal with daily issues in a more rational manner$ It is true that
sometimes the drugs maye sedating# it is an effect that possily helps during the
process of initiating medication proaly if the person has an allergic reactions$ The use
of these drugs mainly is to reduce the cases of hallucinations# disturance# delusions and
misunderstanding during the process of psychotic @%tojko!ic# )**.A$
T%e 'eriod t%at it take! w%ie takin" anti'!(c%otic dru"!
(ntipsychotic medication always emphasi3es on reduction of future psychotic
incidences among patients$ The period of acute episode is always hectic and e!en as the
patientCs undergo treatment# those who ha!e een treated could still ha!e their
conditions deteriorate$ %uch cases are notorious among patients who discontinues from
taking medication$ In that case# it is often seen that it is etter to continue taking drug to
minimi3e the magnitude and occurrence of acute effects$ 2hile treating harsh psychotic
symptoms doctors uses stronger doses than the once used as a maintenance treatment$ In
situations where symptoms re6emerge with lesser dosage# the patients are re&uired to
increase dosage intake to a!ert cases of e'tensi!e relapse$
16
7ther measures taken in place to a!ert relapse include consistent consultations among
doctors and patientsC family memers$ The degree of drug adherence is supposed to
conform to doctorCs re&uirement$ Broper medication adherence include intake of
prescried portion of the drug at the recommended times of the day# regular consultation
and cautiously following treatment guidelines$ Treatment adherence has een a major
low to the health sector fraternity for almost a decade and to patients of schi3ophrenia#
it is more difficult @Mcmurran, 2013A$ It is why in!ol!ing other memers of the family
would work as a etter strategy towards impro!ing the health of the patients$
The reasons that often result for cases of non adherence among schi3ophrenia
patients is that they may fail to accept that they are unwell and so reject the possiility
for medication$ (nother fact is that they may ha!e improper thinking that cannot allow
them to recall daily dosage$ The family memers on the other side may ha!e less
understanding on schi3ophrenia and wrongly ad!ise the patients from undergoing
treatment if any case the patients reco!er aruptly$ Bhysicians too sometime neglect to
&uestion patients on how they take medications$ 7thers also may a!oid from
participating in the treatment process intentionally$ It thus frustrates the patients and
stops them from sharing their reco!ery ordeal$ In cases where the patients in!ol!es
themsel!es in sustance ause# it would e hard for them to respond to effecti!e
treatment eing that such sustance limits the functions of the antipsychotic drugs$
Domplicating the treatment plan also is a major factor that always inhiits effecti!e
treatment$ Doctors must consider designing of none challenging plans so that patients
are made to feel medication adherence as a normal process in their daily chores$ %ome
17
patients too ha!e got complains that they do not feel more uncomfortale and that their
conditions worsen more than when they do not take drugs$
(ntipsychotic drugs do present with themsel!es array of side effects and these are always
in conjunction with the good effects$ Batients of schi3ophrenia do reali3e drowsiness#
restlessness# dry mouth# tremor# or lurring !ision as the main side effects of the drugs$
Iowering the dosage is a measure that pre!ent such cases or using other form of treatment$ It is
recommendale that a patient can do etter when they use one kind of the drugs$ %ome effects
seem to of long6term durations and these are the ones that cause more serious technicalities$
Most of the current antipsychotic drugs do not e'hiit such kind risk that could impose Tardi!e
dyskinesia @TDA where the patients suffers from spontaneous mo!ements of ody parts like
tongue# lips and legs$
18
"eferences
(merican Bsychiatric (ssociation @)*+/A The Diagnostic and statistical manual of mental
disorders @D%M6JA$ (merica$ (B($
(merican Bsychiatric (ssociation$ @)**:A. American Psychiatric Association practice guidelines
for the treatment of psychiatric disorders. (rlington# Jirg# (merican Bsychiatric
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>ean# B$ @)**-A Madness and crime$ De!on$ 2illan Bulishing
>ewely# T$ @)**-A Madness to mental illness$ ( history of the royal college of psychiatrists$
Iondon$ "DBsych Bulications
>ewely# T$ @)**-A Madness to mental illness$ ( history of the royal college of psychiatrists$
Iondon$ "DBsych Bulications
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Inc$
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K(ccessed ./+/+4L
National Health %er!ice$ @)*+)A Treating a personality disorder$ Bersonality disorder treatment$
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disorder/Bages/Treatment$asp' K(ccessed +4/+/+4L
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Beay# ,$ @)**+A Mental health and crime$ Iondon$ "outledge
%tojko!ic# %$ @)**.A$ Managing special populations in ails and prisons. Ningston# N,# Di!ic
"esearch Institute$
Jaughan# B$ O >adger# D$ @+11.A 2orking with the mentally disordered offender in the
community$ Iondon$ Dhapman O Hall$
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21
2orld Health 7rganisation$ @)*+*A International %tatistical Dlassification of Diseases and
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