How Has Our Integrated Knowledge of Mental Illness and Crime Impact on the Way the Health and...

8/11/2019 How Has Our Integrated Knowledge of Mental Illness and Crime Impact on the Way the Health and Criminal Justic

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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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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


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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$ "


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detainment# and e'panded rates of ackslide and hospitali3ation$"


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)$ 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$


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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$


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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


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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$


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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 andpsycho-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 arepsycho-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$ urrent 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 @lo3arilA 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 @ypre'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 @ypre'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#


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)*+*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$


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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$


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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$

omplicating 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


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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$

owering 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$


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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

(ssociation.

>ean# B$ @)**-A Madness and crime$ De!on$ 2illan Bulishing

>ewely# T$ @)**-A Madness to mental illness$ ( history of the royal college of psychiatrists$

ondon$ Bsych Bulications

>ewely# T$ @)**-A Madness to mental illness$ ( history of the royal college of psychiatrists$

ondon$ Bsych Bulications

Department of Health @)*++A Transforming community ser!ices$ K7nlineL (!ailale from9

http9//wearchi!e$nationalarchi!es$go!$uk//www$dh$go!$uk/en/Healthcare/T%/inde'$htm

K(ccessed ./+/+4L
http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Healthcare/TCS/index.htmhttp://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Healthcare/TCS/index.htm


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National Health %er!ice @)*+)aA ogniti!e eha!ioural therapy$ K7nlineL (!ailale from9

http9//www$nhs$uk/conditions/ogniti!e6eha!ioural6therapy/Bages/Introduction$asp'K(ccessed

./+/+4L

National Health %er!ice$ @)*+)A Treating orderline personality disorders$ K7nlineL (!ailale

from9 http9//www$nhs$uk/onditions/>orderline6personality6disorder/Bages/Treatment$asp'

K(ccessed ./+/+4L

National Health %er!ice$ @)*+)A Treating a personality disorder$ Bersonality disorder treatment$

K7nlineL (!ailale from9 http9//www$nhs$uk/onditions/Bersonality6

disorder/Bages/Treatment$asp'K(ccessed +4/+/+4L

National Health %er!ice$ @)*+)cA Treating orderline personality disorders$ K7nlineL (!ailale

from9 http9//www$nhs$uk/onditions/>orderline6personality6disorder/Bages/Treatment$asp'

K(ccessed ./+/+4L

Beay# ,$ @)**+A Mental health and crime$ ondon$ outledge

%tojko!ic# %$ @)**.A$Managing special populations in ails and prisons. ingston# N,# i!ic

esearch Institute$

Jaughan# B$ O >adger# D$ @+11.A 2orking with the mentally disordered offender in the

community$ ondon$ hapman O Hall$

2orld Health 7rganisation$ @)*+*A International %tatistical lassification of Diseases and

elated Health Brolems +*th e!ision$ K7nlineL (!ailale from9

http9//apps$who$int/classifications/icd+*/rowse/)*+*/enK(ccessed +)/+/+4L
http://www.nhs.uk/conditions/Cognitive-behavioural-therapy/Pages/Introduction.aspxhttp://www.nhs.uk/Conditions/Borderline-personality-disorder/Pages/Treatment.aspxhttp://www.nhs.uk/Conditions/Personality-disorder/Pages/Treatment.aspxhttp://www.nhs.uk/Conditions/Personality-disorder/Pages/Treatment.aspxhttp://www.nhs.uk/Conditions/Borderline-personality-disorder/Pages/Treatment.aspxhttp://apps.who.int/classifications/icd10/browse/2010/enhttp://apps.who.int/classifications/icd10/browse/2010/enhttp://www.nhs.uk/conditions/Cognitive-behavioural-therapy/Pages/Introduction.aspxhttp://www.nhs.uk/Conditions/Borderline-personality-disorder/Pages/Treatment.aspxhttp://www.nhs.uk/Conditions/Personality-disorder/Pages/Treatment.aspxhttp://www.nhs.uk/Conditions/Personality-disorder/Pages/Treatment.aspxhttp://www.nhs.uk/Conditions/Borderline-personality-disorder/Pages/Treatment.aspxhttp://apps.who.int/classifications/icd10/browse/2010/en


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2orld Health 7rganisation$ @)*+*A International %tatistical lassification of Diseases and

elated Health Brolems +*th e!ision$ K7nlineL (!ailale from9

http9//apps$who$int/classifications/icd+*/rowse/)*+*/enK(ccessed +)/+/+4L
http://apps.who.int/classifications/icd10/browse/2010/enhttp://apps.who.int/classifications/icd10/browse/2010/enhttp://apps.who.int/classifications/icd10/browse/2010/en

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