The Considerations When Designing Treatments for Mentally Disordered Offenders - Coursework Example

WHAT ARE THE СОNSIDЕRАTIОNS WHЕN DЕSIGNING TRЕАTMЕNTS FОR MЕNTАLLY DISОRDЕRЕD ОFFЕNDЕRS? NAME: UNIVERSITY: COURSE: INSTRUCTOR: DATE: © 2013 INTRODUCTION Mentally disordered offenders are currently increasing in numbers amongst our midst and seem to be in dire need of intervention. This form of intervention may be available in various forms including incarceration, hospitalization or social care in the community as noted by Hodgins and associates (2001). It is also noted with a lot of concern that the numbers of those people suffering from severe mental problems are constantly soaring. This on the one hand has put a lot of pressure on our criminal justice system as majority of these patients require incarceration as the only viable corrective measure. Since mentally disordered offenders have become so significant in our lives, it would therefore be very necessary for me to define their condition. According to McMurran et al (2009), mental disorder is defined as the “destabilization of the mind as a result of a number of factors”. Similarly, section 1(2) of the Mental Health Act 1983 defines the same as “any disorder of the mind” (Howitt, 2002). Based on these two definitions, mentally disordered offenders can be taken to refer to those individuals who have come into contact with the criminal justice system by either way of committing a felony or on mere suspicions of having committed a felony (Bartol & Bartol, 2008). Such individuals must meet the criteria laid down by the Mental Health Act 1983 about the threshold level of mental disturbance. In view of the foregoing, several mental disorders have been identified to be common amongst the world’s population. But amongst these mental disorders, the present essay concentrates on three namely Schizophrenia; Anti-social Personality Disorder; and Dangerous and Severe Personality Disorder (DSPD). In view of these three mental disorders, the author intends to look at the factors that are considered when designing treatment plans for the victims. To achieve this, the essay is thus divided into various sections discussed hereunder. Mentally Disordered Offenders As earlier indicated, mentally disordered offenders are those individuals who have found themselves in brush with the criminal justice for committing, or merely being suspected of engaging in criminal activities due to a suspected degree of mental disturbances (Davies & Beech, 2012). If their mental health inadequacies are within the criteria as stipulated under the Mental Health Act 2007 (formerly1983), then such individuals need serious interventions in the form of treatment plans. The three major conditions indentified for the purpose of this essay namely Schizophrenia; Anti-social PD and Dangerous and Severe Personality Disorder (DSPD) need not be subjected to different treatment designs as they are one and the same. For this reason, they can therefore be managed through similar treatment schema. To allay any fears as to how similar the three are, I firstly want to give a short description of each the three conditions before proceeding to outline the possible treatment schema available. I will then highlight the various challenges resident in these interventions and then end the essay with a short conclusion. Schizophrenia Schizophrenia has been effectively described using two major diagnostic classification systems namely: the DSM-IV and the International Classification of Disorders 10 (ICD-10) as observed by Canter & Youngs (2009). While using the DSM-IV, schizophrenia is defined as “a mixture of characteristic signs and symptoms (both positive and negative) that have been present for a significant period of time ranging from one month to at least six months” (Canter & Youngs, 2009). The signs and symptoms that are identified during this intervening period affect the victim adversely both socially and occupationally as noted by Holmes (2010). ICD-10 on the other hand illustrates schizophrenia as disorders that manifest themselves in greatly reduced thought process among the victims who end up having distorted and blurred memory (Jackson, 2008). According to Canter (2008); Holmes (2010) and Huss (2009), the most significant symptoms of schizophrenia include “hallucinations, delusions, forgetfulness, passiveness, increased phobia and general negative symptoms”. Research has variously demonstrated that schizophrenia is prevalent among adults in varying degrees based on gender. The DSM-IV scale illustrates that men have a slightly higher incidence rate of schizophrenia than women but oscillating at around 1% (Van Wormer, 2010). Other studies by Jackson (2008) report prevalence rate schizophrenia of about 4% among the world’s population; with no significant differences between the genders, places of residence or mixed variables. Incidentally, these studies reported that prevalence rates for schizophrenia seemed to be higher amongst homeless individuals, migrants and the developed countries (Huss, 2009). This was in contrast to the subjects drawn from developing countries who reported very low prevalence rates of schizophrenia. Based on the results of these studies, it therefore implies that intervention services need to be developed bearing in mind culture and gender considerations. Personality Disorders Personality disorders on the one hand have been defined by the American Psychiatric Association as “an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture” (quoted by Van Wormer, 2010). In addition, the said pattern has to be manifested in certain domains of the person including cognitive, affective, and psychomotor as well impulse control (Davies & Beech, 2012). Still using the DSM-IV scale, close to ten personality disorders have been identified and grouped into three clusters namely A, B and C based on their similar symptoms (Canter & Youngs, 2009). Cluster B comprises anti-social PD which forms a significant segment of discussion in this essay. Documented study findings have variously indicated that anti-social PD is a widespread problem amongst the UK population, with an incidence rate of between 4 and 11% of the general populace; and between 60 and 70% of those in prison (Harper & Chitty, 2005). This is in line with other study findings (Holmes, 2010) and McMurran et al (2009) demonstrating that people with Anti-social PD were 10 times more likely to have a criminal conviction and eight times more likely to have spent time in prison. For a long time, anti-social PD has been considered incurable and as such no viable intervention services have ever been developed in its favour. But thanks to the National Institute for Clinical Excellence for publishing guidance on management and treatment of anti-social PD because currently several intervention services are coming up. Symptoms of anti-social PD are numerous and varied but one thing is outstanding: the conditions must be “problematic, persistent and pervasive” (Van Wormer, 2010). From the outset, an individual suffering from anti-social PD will primarily present a sense of personal inadequacy while in the presence of others (Davies & Beech, 2012). Secondly, the victim will show such symptoms and behaviours associated with anti-social PD like anxiety and a tendency to avoid social situations respectively as noted by Canter & Youngs (2009). Apart from the foregoing symptoms, others may include but not limited to the following: “frequent mood swings, very hostile attitudes towards others, stormy relationships, very superior attitudes towards others, alcohol or substance misuse and deliberate self-harm” (Holmes, 2010). Dangerous and Severe Personality Disorder (DSPD) A more mild personality disorder that needs mention here is the Dangerous and Severe Personality Disorder (DSPD). It is also important to emphasise the fact that this condition is not a clinical classification according to Harper & Chitty (2005). For one to be classified as suffering from DSPD, then such an individual must presents a significant risk of serious physical harm that is nearly impossible to cure (Davies & Beech, 2012). Additionally, the same victim must satisfy one of the criteria listed below as cited by Canter & Youngs (2009) thus: A score of 30 or above on the Revised Psychopathy Checklist (PCL–R) or A PCL–R score of 25–29 plus at least one DSM–IV personality disorder diagnosis other than antisocial personality disorder or Two or more DSM–IV personality disorder diagnoses Research work on the prevalence rate of personality disorders report that DSPD is most common in adult prisoners, imprisoned juveniles and in mentally disordered offenders; although with very scanty published evidence (Howitt, 2002). Here, antisocial personality disorder is reported to be the most common category. More research work has established that offenders with personality disorders tend to have a higher risk for violent crime as compared to those without. Davies & Beech (2012) cite more evidence linking personality disorder to violent offending, especially in sexual offences which are committed by people with DSPD more often than others. TREATMENT SCHEMAS Treatment plans designed for addressing mentally disordered offenders may fall into a number of categories including but not limited to custodial, community based or medical. Harper and colleague (2005) categorically maintain that these treatment schemas are torn between two ideologies on the basis of law and welfare. But on the whole, Holloway et al (2005) state that the treatment of mentally disordered offenders must emulate the views, attitudes and approaches of society whether legally or otherwise. According to the rule of law, it is common knowledge that crime must be punished through the criminal justice system (Van Wormer, 2010) while the sick should seek solace from the health care institutions. Whether this is the right procedure or not, the essay is written in conformity with the requirements of the Criminal Justice Act 2003 which states that “offenders must be punished and rehabilitated with the aim of protecting the public from any harm the offender could cause” (Harper & Chitty, 2005). To be able to effectively do this, the essay discusses the three treatment plans namely incarceration, community placement and primary care for mentally disordered offenders. a) Custodial correction Custodial correction of mentally disordered offenders could take the form of imprisonment within defined area like a prison or simple confinement in some kind of an institution (Huss, 2009). This is the commonly applied method of treating mentally disordered offenders the world over and seems to bear some fruits. But before this form of treatment is affected, it is important for the implementers to establish whether the offenders are aware of their crimes (Hodgins & Muller-Isberner, 2001). The tricky part of this establishment is that mentally disordered people are not responsible for their actions as long as they remain disordered. For this reason therefore, they will need to be treated of their condition first so as to be able to admit responsibility of their crime. It is only after this that any meaningful rehabilitation of the offender can follow. Holloway et al (2005) suggest that a carefully planned therapeutic procedure in conjunction with the right psychiatric treatment can bring about the needed rehabilitation of the mentally disordered offender. It is from the Mental Health Act 2007 where it is stipulated that the mentally disordered offenders should be placed into a hospital at sentencing or while in prison after assessment if their capacity to take responsibility of their crime is in question. This provision is supported by section 37 of the Criminal Justice Act 2003 which demands that mentally disordered offenders be detained in a hospital at sentencing (Harper & Chitty, 2005). Similarly, the Mental Health Act 2007 also provides that mentally disordered offenders be placed in care institutions rather than prisons (Huss, 2009 and Van Wormer, 2010). The reason behind this provision is because the strained facilities in prisons that can be a source of further distress for mentally disordered offenders. The problem is further compounded by the meager funding allocated to these institutions which aggravate the living conditions therein. It is thus recommended that mentally disordered offenders with severe mental illness should be placed in healthcare institutions rather than incarcerations (Hollin, 2004). b) Community placement Apart from incarceration, the Criminal Justice Act 2003 also provides that mentally disordered offenders may be placed in the community for the purposes of rehabilitation. Jackson (2008) argues that this community placement “must be in line with the aims of ensuring public protection and rehabilitation”. Community placement on the one hand is only possible if, in the opinions of the courts the most suitable for the offender (Hollin, 2004). It can be applied to any offender in the ages of 16 years and above after conviction. In the community, the convicted offender may be put under any one of the following requirements: unpaid community work; curfew; supervised service; and or an attendance centre reporting (Huss, 2009). In fact, this community service is mandatory to all mentally disordered offenders because they need much more support and close supervision than any other category of patients. The Criminal Justice Act 2003 also provides that offenders streamlined for community placement must undergo mental health treatment as well as being punished like any other offender in their category. Sometimes it becomes pertinent to hold these offenders in care homes as opposed to holding them in high security psychiatric institutes (Hodgins & Muller-Isberner, 2001). This is deemed to facilitate supervision by a medical practitioner, particularly a psychologist as observed by Holloway et al (2005). Practically, this practice has not been followed to the letter as extant literature indicates only about 2% cases having been effected since 2006 (Van Wormer, 2010). c) Primary care Primary care in its simplest form is provided for by the family members of the mentally disordered offender and is thus considered to be the foundation for all health care for any population. Indeed, the role of family members or close associates of the offender are deemed critical in the treatment of mentally indisposed offenders (Harper & Chitty, 2005). These people are fundamental in establishing the root cause of the patient’s aggression. It is for this reason that the healthcare providers should establish the kind of relationship that exists between the family members and the offenders. If not very cordial, then mitigating measures should be sought to avert any further aggression from the offensive patient. It is also the responsibility of the healthcare providers to find out whether there are the necessary social welfare services that should be used by the patient. These social support services play a significant role in the treatment of mentally disordered offenders while in the community service. Other than the foregoing support to the mentally indisposed offenders from family members, it is prudent for the patient’s relatives to be guarded against any aggression that may be caused to them by the mentally ill offender (Hodgins & Muller-Isberner, 2001). This can be attained through constant guidance and counseling services from clinicians as well as teaching the victimised family members on how to defend themselves as well as recognising the early symptoms of recurrence of aggressive behaviour (Van Wormer, 2010). In my view, the best treatment plan for this category of offenders would be a mix of primary care and medical intervention. CHALLENGES INTO THE INTERVENTIONS There are a number of challenges that reside in the treatment plans for mentally disordered offenders. Firstly, studies have demonstrated that the healthcare providers who deal one on one with these offenders expose their lives a great deal. Similarly, these patients are known to have a high resistance to psychiatric treatment and as such may prove very problematic to handle (Huss, 2009). Moreover, the degree illness afflicting these people may pose a great danger to the community at large and may therefore need special attention and confinement facilities that are not always available. Funding has always been a challenge in most institutions, may they be correctional, community, or medical. This lack of funds has necessitated the sorry state of affairs found in these institutions which have further caused untold stress and suffering to the mentally disordered offenders, hence aggravating their conditions. This challenge is tied to the one on availability of inappropriate healthcare resources. CONCLUSIONS From the foregoing discourse, two terms namely mental disorder and mentally disordered offenders were clearly defined on the basis of this essay. For the purposes of this essay also, it was necessary to identify three common examples of mental disorders in the form of schizophrenia; anti-social personality disorder; and dangerous and severe personality disorder. Each of these three disorders was discussed at length including the factors to be considered when designing a treatment plan for the mentally disordered offenders. This task proved to be the most challenging even though the author came up with three treatment schemas namely custodial corrections; community placement; and primary care provision by family members and healthcare practitioners. Despite the viability of these three treatment plans, several challenges were identified during their implementation. References Bartol, C. R., & Bartol, A. M. (2008). Criminal behavior: A psychological approach, 9th ed. USA: Pearson Education. Canter, D. (2008). Criminal and Investigative Psychology. Oxford University Press Canter, D., & Youngs, A. (2009). Investigative psychology: Offender profiling and the analysis of criminal action. UK: Wiley & Sons. Davies, G., & Beech, A. (2012). Forensic psychology: Crime, justice, law, interventions. UK: Wiley & Sons Harper, G., & Chitty, C. (2005). The impact of corrections on re-offending: A review of ‘what works’. (3rd Ed). London: Home Office. Hodgins, S., & Muller-Isberner, R. (2001). Violence, crime and mentally disodered offenders: Concepts and methods for effective treatment and prevention. Canada: Wiley & Sons. Hollin, C. (2004). The Essential Handbook of Offender Assessment & Treatment. Chichester: Wiley. Holloway, K et al (2005). Systematic review of criminal justice and treatments programmes in reducing drug-related crime. Home Office On-line Report 26/05. Holmes, D. A. (2010). Abnormal, clinical & forensic psychology. UK: Pearson education. Howitt, D. (2002). Introduction to forensic & criminal psychology, 3rd ed. UK: Pearson Education Huss, M. T. (2009). Forensic psychology: Research, clinical practice, and applications.UK: Wiley & Sons. Jackson, R. (2008). Learning forensic assessment. UK: Routledge. McMurran, M., Khalifa, N., & Gibbon, S. (2009). Forensic menatl health. USA: Willan. Van Wormer, K. (2010). Working with female offenders: a gender sensitive approach. USA: Wiley & Sons Read More