Mental Patients In Prisons
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Mental conditions usually affect cognitive, emotional and volitional aspects and functions of the personality, which are also functions of interest in law, as they are essential at the time of adjudicating guilt, labeling the accused a criminal, and proffering a sentence.
A relationship between mental illness and criminality has, thus, been described and given as one of the reasons for large number of mental patients in prisons. Whether this relationship is one of causality or one that flows through many other variables is a matter of debate, but there is no debating that prisons have become a de facto part and an important one, of mental health systems in many countries. This paper deals with the issue of the relationship and provides estimates of prevalence of mental patients in prisons culled from many studies in different countries. It also provides some direction for the management of mental patients as they crowd correctional systems.
The association between some mental conditions and an increased risk for criminal behavior has been repeatedly reported. In a series of 100 murderers, 29% had a diagnosis of “psychosis” (21% of schizophrenia and 8% of affective disorders) and 35% had a diagnosis of substance abuse. Among alcoholics, the prevalence of violent behavior is much higher than among non-alcoholics. Psychopathy is strongly associated with a high risk for criminal and violent behavior. Factors that seem to mediate the interaction between mental illness and crime include gender, age, socio-economic status, previous criminality, and previous forensic psychiatric involvement. In a 30-year follow-up of a birth cohort in Sweden, men who had a mental disorder were 2.5 times more likely to have been registered for a criminal offense and 4 times more likely to have been registered for a violent offense, compared to men not mentally ill or intellectually handicapped.
The level of convergence, however, varies according to the mental condition. Firstly, there are mental disorders whose very behavioural manifestations are ipso facto criminal offenses, such as in the case of paraphilias, pyromania, kleptomania and others. In these cases, the relationship between mental disorder and criminality is one-to-one.
Secondly, disorders such as psychopathic personality, antisocial personality, borderline personality, pathological gambling, and impulse control disorders connote a criminological element, but the degree of convergence is not one-to-one, in that symptoms could be expressed without necessarily breaking the law. For example, alcoholism carries a high risk of law breaking in the form of victimization at the time of intoxication, and drug dependencies are known to lead to income-generating crimes in order to finance the habit, but only if the addicted person does not have the financial means to support it.
Finally, the level of convergence is less straightforward among some other mental conditions. For example, persons suffering from schizophrenia may get involved in serious unexplainable violent crime, and persons suffering from major depression may display violent behaviour against self or others. However, the relationship between these conditions and criminal offenses is not a one-to-one, as many mentally ill persons suffering from schizophrenia or major depression never commit a criminal offense, in spite of the high prevalence of these mental disorders in the general population.
Looked at from a different angle, it may be that the association between criminality and mental illness flows not from a causal relationship, but is only the result of inadequate health systems. Lack of adequate number of hospital beds and inexistent community alternatives would be expected to create pressures in the alternate systems of correction and community crime of the mentally ill may be reactive and defensive within the context of exposure to victimization.
Finally, while the relative risk is elevated for some mental conditions, it should be remembered that, for public health purposes, the measure to be concerned about is the attributable risk. Despite a high relative risk, violence due to mental illness is not that frequent once all other causes of violence in society are taken into account. This risk has been estimated at about 3% and, when substance abuse and alcoholism are included, at about 10%. Other estimates place the risk at 4.3% or as low as 1%.
Furthermore, when a mental condition is suspected in relation to a crime, the unstated assumption is that the condition preceded the crime, and hence, may have actually caused the crime. In reality, it could have been that the mental condition that was present much earlier in life was not a factor in the present crime, or the mental condition developed after the crime had been committed.
