The Care of Mentally Disordered Offenders - Case Study Example

The care of mentally disordered offenders The Mental Health Act 1983 (MHA) defines mental disorder as one that is related to mental illness, psychopathic disorder, stunted or incomplete development of the brain (including mental challenges or subnormality which might range from less acute to highly acute mental impairment) and any other sort of mental disorder or disability (Laing, 1999, p. 5). However, this legal definition is deficient in the sense it does not offer real help in suggesting the criteria for different kinds of intervention by different agencies. Normally the ground for intervention is a mental disturbance which does not belong to the standards of the MHA (What do we mean by ‘mentally disordered offenders’?, n.d). These mentally disordered offenders require services and support of the Forensic Mental Health Services since they have a complex and diverse requirement. The special provisions of the Prison service scheme play a significant role in addressing to the special needs of the mentally disordered victims and their treatment. Sociological, cultural and historic perspectives Personality disorders, particularly, antisocial personality disorder have been recognized as strong conditions that lead to violent offending. Also the history of an individual plays a vital role in influencing the mental state of the person. The background and environment of an individual is again important to shape up the mind. The mental pressures or trauma suffered by a person can lead to mental disorders. Again, the fact that a section of the mentally disordered offenders are fascinated by the ideas of blood, morbid imaginations and lurid subjects like weapons, sex, torture, dead bodies and other forms of crime (Egan et al, 2003, p. 52-53). Mainly mentally disordered offence is caused and manifested by poverty and deprivation and racial discrimination. The victimization of people also induces mental illness which might manifest offending. Even psychological disorders and incoherent and absurd imaginations lead to the manifestation of crimes. An example of ethnic discrimination to cause mental disorders is seen in the case of the South London, where the Black population, due to the racial antagonism, are subjected to greater schizophrenic disorders and are more likely to commit a crime that the average white population (Guite, 2003). Anti-social personality disorder and DSPD Criminal behaviour is fundamental to the explanation of antisocial personality disorder, even though it is often the result of earlier and long-standing difficulties, like socioeconomic, educational and family troubles. Individuals with antisocial personality disorder show signs of traits of impulsivity, huge rate of negative emotionality, low carefulness and related behaviours including negligent and exploitative behaviour, recklessness and untrustworthiness. The condition is coupled with a wide extend of interpersonal and social disorder. Persons with antisocial personality disorder have mostly grown up in split families where parental conflict is usual and parenting is insensitive and inconsistent. Owing to parental insufficiencies and/or the kid’s difficult behaviour, the childs care is usually interrupted and transferred to groups outside the family. This in turn leads to malingering, having delinquent associates and substance abuse most of the times, which normally result in higher rates of unemployment, underprivileged and unstable accommodation situations, and inconsistency in relationships in later life. Most of the people possessing antisocial personality disorder undergo a criminal sentence and are jailed or die prematurely because of reckless behaviour. Individuals suffering from psychopathy and who meet conditions for dangerous and severe personality disorder (DSPD) correspond to a small proportion of persons with antisocial personality disorder. Nevertheless, they pose a very high risk of injury to other people in the society and use up a significant share of the services for persons with antisocial personality disorder (Antisocial personality disorder Treatment, management and prevention, 2009, p. 4-29). Models of offending, gender issues To have an effective treatment for the mentally disordered offenders, it is necessary to build up a coordinated model of offending. A latent class modelling framework has been used to study the gender related differences in offending trajectories from adolescence to adulthood by using a sample data collected over the course of a time-series analysis of 896 children aging from 0 to 21 in New Zealand. The investigation categorized five trajectory groups which were, a set of low-risk offenders, three sets of adolescent-limited offenders whose age and time varied with respect to the onset of offending (early, middle, and late onset), and the last group comprised of unremitting offenders. The same types of offending trajectories were used for males and females. Yet, probabilities of trajectory group attachment changed with gender. While the females were probably to show evidence of low-risk or early beginning of adolescent-limited offence, the males exhibited a late commencement coupled with unceasing offence. Inspection of the social, household, and individual factors related with these trajectories implied the presence of a string of common etiological aspects with regard to the family operation and early adjustment that differentiated the trajectory groups. These risk factors seemed to function in a similar manner for both the males and females (Fergusson and Horwood, 2002, p. 159-177). Again adolescence offending is often an outcome of victimization. A study based on the data collected from the National Longitudinal Study of Adolescent Health (Add Health) has been conducted to analyze the unseen heterogeneity bias by applying a fixed effects regression model. The bias arises out of the controversial nature of the mechanism that leads to the offending and victimizing relationship. The outcomes offer support for both the mechanisms. The offending-victimization association could be as a result of delinquent behaviour and delinquents’ regular activity or life styles. Again, it could be spurious due to the fact that unobserved continual heterogeneity may result in both offending and victimization. There is obvious evidence that delinquent behaviour leads to a number of different types of victimization. Nevertheless, the degree of the majority of the offending-victimization associations fell radically when unseen population heterogeneity was brought under control. (Chen, 2007). Treatment Approaches Mentally disordered offenders are quite diverse in nature with respect to places, diagnoses, typicality of the offence, risk, and clinical requirements. Treatment planning for mentally disordered offenders usually begins with an evaluation of the risk of violent behaviour on the society in the future and risk of violent behaviour toward oneself or others within an institution. The purposes of treatment for mentally disordered offenders comprises of treatments to diminish the risk of future violence and to improve the mental disorder. Significant measures of effect consist of criminal and violent manners, psychiatric symptomatology, access to correctional or psychiatric provisions, and quality of life. The clinical problems consist of violence and problems of institutional supervision, criminal inclination, life skills deficits, body abuse, vigorous psychotic symptoms, social abandonment and depression. Community treatment should always be opted given that the degree of risk and legal circumstances permit it. The services should provide protection under conditions of appropriate, although not more than that is necessary, security with suitable regard for public safety. They should also have proper quality of care and suitable attention to the requirements of individuals. Whenever possible, it is desirable to provide care and protection in the community instead of providing them in institutions. Care should be so provided that it would maximize rehabilitation and the person’s possibility of an independent life (Harris and Rice, 1997, p. 126-183). Legal Aspects Legal measures taken upon mentally disordered offenders are not like that of medical actions. The prison system was created to provide a penalty so as to get rid of offenders from society, implement utmost control over their regular lives and try to rehabilitate and prevent them from committing crime again on release. A closed and castigatory atmosphere like in a prison often has detrimental effects on offenders’ psychological welfare. The central part of the argument regarding mentally disordered offenders is the existence of two mutually exclusive and contradictory ideologies of the Prison Service, with principles of security and control, and the health service, with principles of welfare and care. Prisoners cannot be denied their human rights and hence they are entitled to the equivalent health care facilities as citizens in the broader society. It is often argued that the prison regime stresses more on security measures than health matters and hence, prisons deny mentally ill prisoners the health services they have need of and consecutively disregards their fundamental human rights (Knight and Stephens, 2009, p. 2-3). The Government has made policies stating that the people who are suffering from mental disorder and are in need of specialist medical treatment or social assistance should positively get it from the health and social service providers. The persons who are alleged of committing criminal offences should be put on trial whenever necessary, for the sake of public interest. While deciding on whether an individual should be incriminated, it is necessary to take into account the circumstances and severity of the offence as well as the information about the person’s earlier contacts with the criminal justice arrangement and the psychological and social services. Service Provision In 1992, the Health of the Nation policy paper acknowledged services for mentally disordered offenders as one of the main concerns. There is a substantial diversity in the number and type of services provided for mentally disordered offenders all across the United Kingdom and hence the level of care received by an individual will depend greatly on where the offender resides. A number of services are at a premature stage of development and moreover, the amount and complexity of requirements that the mentally disordered offenders have for health care, job, accommodation, domestic support and other essentials imply that the assistance given to them can turn out to be a low priority in certain service sectors. All these aspects make it difficult to offer solutions to the correct and best sort of service that could be achieved. A specific problem faced by commissioners is to strike the correct balance in service provision. The general services need to be equipped so as to identify and respond to the needs of mentally disordered offenders and also provisions for highly specialized services should be made. A fine balance needs to be pulled off between providing the right amount and kind of secure housing and community care services. Commissioners need to be equipped enough to take care for the small amount of mentally disordered offenders who pose a serious risk to the society without neglecting the huge numbers of mentally disordered offenders who have psychiatric requirements, but who do not pose a risk to other people. Again deciding precisely on the mentally disordered persons who do present a risk is an additional complication (Drewett and Shepperdson, 1995). There has been a significant development of services for mentally disordered offenders in recent years relating a wider range of groups in the health and community care segment, the non-statutory segment and the criminal justice system. To realize the complete benefit from these additional services, it is necessary to develop helpful care pathways and expert networks (Antisocial personality disorder Treatment, management and prevention, 2009, p. 30). Prison services try to address to all these issues. Prison services, like the Scottish Prison Service is entrusted to provide health services, which involves mental health services that are similar to those offered to other citizens, although, within the restraints of imprisonment. Their primary goal is to provide a mentally disordered offender access to a constant and an integrated provision of healthcare treatment by means of community based services as much as possible. Mentally disordered prisoners require to be provided with psychiatric care whether in prison or hospital along with a suitable level of security. Prison supervisors should ascertain that provisions are in position with health boards to evaluate and transfer inmates who are suspected of mental disorder and that there is proper treatment facility for an inmate coming back to the prison (Mentally Disordered Offenders In Scotland, 1999, p. 3). The Government introduced a consultation process to inspect the provision of mental health and social work services for mentally disordered offenders in 1999 that implied to Wales, England and Scotland. The policy identified the huge number of agencies that were engaged in organizing services for mentally disordered offenders and made an effort towards taking a holistic outlook to treatment and promoted the formation of new working associations. It gave emphasis to the significance of multi-agency and multi-disciplinary evaluation of the offender’s health and social care requirements which considered all the aspects of health, criminal justice, collective care, accommodation, education and work and benefits advice (Mentally Disordered Offenders In Scotland, 1999, p. 2). The service also ensures staffs are trained well so that they are equipped to handle such cases efficiently. These provisions make sure that staff supervision is made a part of the routine functioning of the service and that it is suitably resourced inside local systems as well as properly administered. Forensic services also ensure that systems for each of the staffs working with mentally disordered offenders are in position and also provide an encouraging and open environment that promotes reflective practice and truthfulness about individual difficulties (Antisocial personality disorder Treatment, management and prevention, 2009, p. 32-33). The prisons have facilities to provide police surgeons and psychiatrists to diagnose individuals suffering from mental disorders suspected of committing a crime. Again, there are arrangements to access mental doctors from local health care centers into the prison. The Scottish prison service ensures that criminal justice social work team inside the local authority should have prime responsibility for pre-release scheduling of disordered prisoners to help out with re-settlement within the community. The Prison Service has built up service level understanding with local authority social work agencies for all types of community work provision in prisons. The State Hospital situated at Carstairs Junction is a high-security organization that takes care of mentally disordered offenders who have been recognized as particularly dangerous to themselves and/ or to others. They take care of patients admitted under the Mental Health Act 1984 and the Criminal Procedure Act 1995 of Scotland. It works as a special hospital for Scotland and Northern Ireland and have room for around 250 patients. The Hospital accepts referrals of patients who cannot be put back in a local prison or where local services become incapable to take back those patients that hospital wants to be released into the society (Disordered Offenders In Scotland, 1999, p. 3-5). Hence, the prison services focus on an all round caring and treatment facility for the mentally disordered offenders. The times when the proceedings are instituted, the right to treatment facility or care should be so that it is not deferred or prevented. Also the requirements of the mentally disordered people need to be properly met. Say for instance, the exercise of bail with a provision of dwelling at a hostel or a hospital, by remanding to infirmary, by shift from prison to hospital or by the creation of a hospital or supervision order. However, care should be taken so as not to involve mentally disordered persons into the criminal justice scheme unnecessarily, say just for the hope of restricting the treatment in prison. Detention in prison is likely to be damaging to the mental health of a mentally disordered individual, and the Prison Service is not set to provide treatment which is the same as that offered in hospital (Inter-Agency Working, 1995). References 1. Laing, J. M, 1999, Care or custody?: mentally disordered offenders in the criminal justice system, Oxford University Press. 2. What do we mean by ‘mentally disordered offenders’?, n.d, “Mental health FAQs”, Available from: http://www.nacro.org.uk/criminal-justice-expertise/mental-health/mental-health-faqs/what-do-we-mean-by-mentally-disordered-offenders,161,NAP.html (Accessed on Jan 18, 2010). 3. Egan, V. et al, 2003, “Personality traits, personality disorders and sensational interests in mentally disordered offenders”, Legal and Criminological Psychology, Vol. 8, No. 1 4. Fergusson, D. M.and Horwood, L.H., 2002, “Male and female offending trajectories”, Development and Psychopathology, Vol. 14 NO. 1. 5. Chen, X, 2007, “Offending-Victimization Linkage: New Evidence from Fixed Effects Regression Models”, American Society Of Criminology 6. Guite, H, 2003, “South East London Mentally Disordered Offenders Needs Assessment”, Available from: http://www.selphnet.nhs.uk/document_view.php?PID=0000000002&DID=00000000000000000129 (Accessed on Jan 18, 2010). 7. Knight, L and Stephens, M, 2009, “Mentally Disordered Offenders In Prison: A Tale Of Neglect?”, Internet Journal of Criminology 8. Mentally Disordered Offenders In Scotland, 1999, “The Scottish Parliament”, Available from: http://www.scottish.parliament.uk/business/research/pdf_res_notes/rn99-34.pdf (Accessed on Jan 18, 2010). 9. Inter-Agency Working, 1995, “Mentally Disordered Offenders”, Available from: http://noms.justice.gov.uk/news-publications-events/publications/guidance/disorder-offender-inter-agency?view=Binary (Accessed on Jan 18, 2010). 10. Drewett, A and Shepperdson, B,1995, “A Literature Review Of Services For Mentally Disordered Offenders ”, Available from: http://www2.le.ac.uk/departments/health-sciences/extranet/research-groups/nuffield/project_profiles/alrosfmdo.html (Accessed on Jan 18, 2010). 11. Antisocial personality disorder Treatment, management and prevention, 2009, “National Institute for Health and Clinical Excellence”, Available from: http://www.nice.org.uk/nicemedia/pdf/CG77NICEGuideline.pdf 12. Feeney, A, 2003, “Dangerous severe personality disorder”, Advances in Psychiatric Treatment, vol. 9, 349–358 13. Rice, M. E. and Harris, G. T., 1997, “The treatment of mentally disordered offenders.”, Psychology, Public Policy, and Law. Vol. 3 No. 1, 126-183 Read More