Management of Mentally Disordered Offenders - Literature review Example

Chapter 2 For the general public, right or wrong, MDOs are seen as particularly dangerous individuals. Their behaviour and motives appear incomprehensible and unpredictable, and they provoke fear among members of the general community. Clinicians and researchers have struggled with understanding the behaviour of the mentally disordered offender, and explanations of the mentally disordered offenders behaviour have relied on models of psychopathology. This reliance, we argue, has come with a cost. More empirically defensible social psychological explanations have been ignored; this has restricted developments in the assessment and treatment of the mentally disordered offender. This article focuses on the mentally disordered offender; that is, individuals who have a mental disorder and who have also committed acts that triggered intervention by the criminal justice system. Although many mentally disordered individuals may commit criminal acts, not all of them are brought to the attention of criminal justice authorities. Instead, many are treated as civil patients in the mental health system. For the most part, these civil patients have committed less serious offences and are judged to be “in need of treatment” rather than incapacitation (Dix, 1976, 318–334; Monahan, Caldeira, & Friedlander, 1979, 509–518; Teplin, 1985, 593–599). The present review, therefore, deals with a group of individuals who are at a particularly high risk to re-offend and who have a mental disorder. This chapter discusses the issues surrounding mentally disordered offenders (MDOs) and the extensive amount of literature as well as the ‘grey’ literature that tries to address the debates mentioned within the academic research literature. It also aims at discussing the implications of improper and inefficient management of MDOs within the Criminal Justice System (CJS) [mainly with reference to the police management skills]. 2.1 Literature Review of Mental Health, Care and Management of Mentally Disordered Offenders It is a major challenge when addressing MDOs because there is such a large ‘grey’ area and such individuals who belong to this categorically awkward group create many problematic issues concerning the services involved in their management. It is a difficult task to assess how to deal with these types of offender, especially concerning the dual task of treatment for their disorder and punishment for the offence committed. There is a varied amount literature based on assessing current policies, services and the different aspects of management of MDOs. From the initial contact with the Criminal Justice System, like the police service to further processing of MDOs, like Community Care schemes, problems with effective management arise. However, reports in dealing with MDOs throughout the Criminal Justice Service are continuously reviewed in order to establish direct progress and possible developments. It is also important to understand and discuss the continuing improvements within the provisions set out relating to MDOs in order to provide efficient guidelines and procedural management schemes. In the literature referring to MDOs and the Criminal Justice System, there is a commonly established set of management issues that are assessed, discussed and evaluated. However, the universal topical questioning relates to the effective management of MDOs and how the law and policies affect the current procedures, management and care of MDOs. Badger et al. (1999) believes that the government has made a concerted effort in placing more attention to the needs of MDOs and also in encouraging positive communication between relevant agencies and services involved with the processing of MDOs. The government have been actively encouraging partnerships with state services and researchers in order to enhance better services, policies and the whole matter of management in relation to Criminal Justice Services (DoH/ HMPS, 2001). In the past, the policy for MDOs placed a great emphasis on diversion, from the Criminal Justice System to psychiatric and health services. Past policies in Britain, have aimed at being applicable to all levels on the Criminal Justice Service and designed to implement a national approach to planning services that was consistent with the needs of MDOs, (Badger et al., 1999). Public services following the policies on MDOs have always been problematic especially concerning the Prison Service because MDOs information about health has always been a separate service given to inmates. Communication between health services and the prison service in relation to sharing information and effective (if any) communication has been poor. It was left to the individual prison doctors and the National Health Service doctors to take initiative in communicating. Such problematic issues have been discussed and reports have been made concerning past policies. Academic literature reviews of policy and practice have been most influential in improving current policies in place because it consistently encourages evaluation of existing provisions (NACRO, March 2005). However, the statistical data of offenders in prisons with some sort of mental illness or disorder has been a constant increasing figure. According to Gunn et al (1991), in 1990 there were 37 per cent of MDOs within the Prison System. However, from assessing the Home Office Statistical data report of 2005, there has been an incredible rise, such reports suggest that there were 87 per cent of offenders with some sort of mental disorder. The Policy Exchange Report (2008) states that 90 per cent of MDOs in prisons have one or more disorders relating to their current mental health. However, popularity of the subject of psychology within modern culture has changed. People are more likely to be emotionally open and accept when they have some sort of mental illness or disorder than they would twenty years ago (Birmingham, 2003). Depression is one of the major disorders that are common throughout UK prisons. However, in the early 1990s, there was still an apparent stigma related to having a mental disorder. Although, society’s views may have relaxed, it still brings to question what is the cause for such a high rate of offenders in prison experiencing mental disorder and are the majority of offenders with such issues being managed correctly. Leading on, Court Diversion schemes are debatably the most likely causal link towards the fluctuation of MDOs in prisons. There has been an on going decline of court diversion schemes since 1997, such declines of redirecting MDOs to a suitable place for care is the most likely related affect to the current overcrowding of the UK prison population (Nacro, 2005). The effectiveness of court diversion schemes are proportionately linked to whether the schemes are adequately resourced and organised (HMIP, 2007). The NACRO 2005 report found that there was an insufficient number of court diversion schemes in place and the schemes were not proficiently managed. According Winestone & Pakes (2007) the schemes did not have an organisational framework, therefore considerably affecting such schemes potential for efficiency and effectiveness. It has been suggested that the lack of success of the court diversion schemes reflected the lack of funding and the clarity of guidance given from the government; such issues have lead to significant gaps in the provision of the services for MDOs (Policy Exchange Report, 2008). Brooker et al. (2008) completed a systematic literature review of research studies in relation to mental health services and prisoners through reviewing the interventions and service delivery. The variation in quality and quantity of the available services to MDOs differed as attempts at improving the interventions throughout the offender’s mental health care journey, such as court diversion, reception screening, primary mental healthcare, transfer to secure health unit, release and resettlement. Overall, it was found that improvements had been made in the screening process, although, inter-agency communication had not improved. This may be due to the guidelines and the policy of information sharing within the Prison Service. However, with the amendments within the Mental Health Act 2007 possible improvements with such issues of inter-agency information sharing could be seen when the Act has been fully implemented. 2.2 Police Management, Procedures and Safeguards The Criminal Justice System is not in place to judge whether an individual has a disorder, although it is necessary to have safeguards in place in order to question whether it is necessary to assess an offender’s mental health so that criminal justice proceedings can continue accordingly (Draine et al., 2002). It is considerably relevant to have mental health care professionals who have training and experience within the criminal justice system in order to provide valuable advice to the police, courts and prisons on how to deal with the individual offender. However, provisions relating to managing MDOs do not refer one particular individual to one specific mental health care professional or agency. Such responsibility of management often changes regionally as there are no national operations in place. A key focus in the research literature supports the method of managing and treating MDOs individually instead of managing as a generic group (Jeffrey et al., 2000). Dessureault, Cote & Lesage (2000) also provide research evidence that MDOs initial contact with the criminal justice system largely contributes to the MDOs subsequent management and treatment; whether it be towards the mental health system or the criminal justice system, such systems differ in their management programmes and schemes. Dealing with the MDOs as individual cases has been a key focus in dealing with offenders with mental health issues, as research evidence supports this focus management ideal (Jeffrey et al., 2000). According to Jeffrey et al. (2000), research support has been recognised by the Home Office, although further research in this field is needed in order to evaluate current policies at hand. However, drawing back to the changes made to the Mental Health Act 2007, the government do not employ instant changes to policies, they prefer a gradual transformation in order to avoid callous decisions. However, it is important that police officers are aware of the strategic arrangements in place. Nacro (2005) produced a series of standards for the initial point of contact between MDOs and the police. Although, such standards aim at producing a checklist for agencies and services such as the police, the standards for measuring the skills, resources and operations are only a guideline that the police have the choice to use. NACRO (2005) suggest that a standard national approach should be incorporated to all police stations in order for consistent management of MDOs across the UK. 2.3 Police Identification and Training The management of MDOs in general is difficult to handle effectively by both the criminal justice system and the mental health system according to research evidence by Eaves, Tien & Willson (1997). There is a wide opinion that the procedures implemented in recognising mental disorders from the point of arrest or interrogation in police station are not set out in a clear format, thus better police training about the procedure guidelines of MDOs should take place (Peay, 2002). The existence of diversion schemes in police stations whereby the use of an ‘appropriate adult’ was put into action under the 1984 Police and Criminal Evidence Act (PACE) in order to advise and protect MDO’s and other vulnerable individuals. The proper use of appropriate adults (AA) is not always the case because the choice of whether to bring in an AA is down to the discretionary powers of the police (Dessurealt, Cote & Lesage, 2000). According to the research literature, performance reports consistently emphasises the failures in firstly identifying those in need of such services and secondly the failures in redirecting offenders to appropriate places of care or the contact of an AA (Roberson et al., 1995). Therefore, the safeguards in place are inconsistently implemented because of the lack of good mental health training amongst police officers and police surgeons. Moreover, it highly undermines the policy safeguard’s effectiveness in police stations, Peay (2002). If the police cannot successfully identify MDOs, then the appropriate management cannot occur until such identification takes place. This could possibly be one causal relationship towards the high rates of MDOs in the prison system. 2.4 Expert Opinions Problems arise when deciding whether a MDO have the ability of control and if they have any hold over their choice to commit the offence. Differences in psychiatric opinions can be seen in the case of the serial killer Jeffrey Dahmer in 1992, whereby contrasting psychiatric expert opinion occurred (Schmalleger, 1999). One psychiatrist believed that he had control of the decision to commit murder, whilst another psychiatric expert opinion believed that his urges were uncontrollable. Moreover, the problematic differences of expert’s opinions need to be addressed. Mental health professionals assessing MDOs need to be in absolute agreement with one another so that MDOs can be dealt with clearly in order for the criminal justice system to make the best response. Therefore, clear guidelines need to be set for not only the criminal justice system but also the mental health system and the practitioners involved with assessing and guiding the criminal justice system towards the best way to manage such individuals. 2.5 Care in the Community Programmes (Community Mental Health Teams, CMHT) (majority of sentences are short, thus after care needs to be established) Since 1990, it has been UK government policy to promote the diversion of mentally disordered offenders (MDOs) away from the criminal justice system into the care of health and social services. This study describes the development and formative evaluation of an inter-agency assessment and referral scheme - based on the less commonly used DAPA (Diversion At the Point of Arrest) model - and implemented for the first time in Northern Ireland in June 1998. Although the present Criminal Justice Act 2007: Mentally Disordered Offenders, the directors of Social Services have been given directions and guidelines for dealing with offenders suffering from severe mental health disorders. Such guidelines also address the changes that affect the courts and the proceedings. However, the guidelines still do not address efficiently the ways that continuous psychological findings can be applied effectively. Such research findings that suggest that reoffending rates of MDOs would significantly decrease if after-care programmes continued until the mental health practitioner felt necessary. The Health Minister Jacqui Smith believes that the Mental Health Bill ensures a new directed focus upon the individual as a patient and not treating them depending on the type of category of mental disorder possess (Department of Health, 2002). However, in relation to MDOs, Draine et al., (2002) claims that official reports from the Department of Health as well as the Home Office are addressing such issues of guidance with MDOs especially in the community (Winstone & Pakes, 2005). Recent development within this area have been given more focussed attention, this can be seen by the application of Community Mental Health Teams (CMHT). Although CMHT schemes were developed as an alternative to hospitalisation for treatment for both non-MDOs and MDOs, it seems that when applied efficiently, then positive outcomes are possible. NACRO (2008) discuss building a stronger partnership of CMHT and other agencies and thus advocating the same access options as those who receive such treatment with in the community. Therefore not only offenders can receive the same amount of care and treatment for their mental health needs on par to those who are non-offenders. Current research suggests that the ability to implement schemes at an operational level requires understanding their roles and responsibilities with MDOs and also about inter-agency communication so that the agencies involved all agree towards the best approach to treatment and management. For further implementation of such communication, there should be regular meetings arranged in order for clear and consistent communication, such advice upon improving operations of CMHT was suggested by NACRO (2008), However, such recommendations have not been backed up with research. It would be constructive if research case studies were carried out so that assessments of the possible practical significances and problematic issues can be reviewed. Therefore, perhaps it would be beneficial to put pilot schemes into action in order for the government to support better operations of CMHT schemes. 2.6 Review of International Literature - Policy, Management and Treatment of MDOs Roesch, Olgoff & Eaves (1995) believe that it is important to consider international literature, especially in Western Countries because when looking at research studies from Canada and the USA, it is useful to compare the UK’s approach with other countries as it can provide some common parallels within the data and research. Regarding international literature, such research can provide possible solutions to the issues that the UK [Regarding England and Wales] actually experience. Thus it is important to assess the ways in which other countries have amended laws, policy and provisions. However, it is also important to also understand the diversity of other country’s State systems in comparison to the UK like the CJS and Mental Health Systems (MHS). References Dix, G. E. (1976). “Civil” commitment of the mentally ill and the need for data on the prediction of dangerousness. American Behaviour Scientist, 19, 318–334. Monahan, J., Caldeira, C., & Friedlander, H. D. (1979). Police and the mentally ill: A comparison of committed and arrested persons. International Journal of Law and Psychiatry, 2, 509–518. Teplin, L. A. (1985). The criminality of the mentally ill: A dangerous misconception. American Journal of Psychiatry, 142, 593–599. Read More