Task 1 mental disorders and violence
LITERATURE :
· Trestman (2007) Current and Lifetime Psychiatric Illness Among Inmates Not Identified as Acutely Mentally Ill at
Intake in Connecticut’s Jails
· Appelbaum, P. S. (2006).Violence and mental disorders: Data and public policy (editorial). American Journal of
Psychiatry, 163, 1319-1321.
· Elbogen, E. B., & Johnson, S. C. (2009). The intricate link between violence and mental disorder: Results from the
national epidemiologic survey on alcohol and related conditions. Archives of General Psychiatry, 66, 152-161.
· Silver, E., & Teasdale, B. (2005). Mental disorder and violence: An examination of stressful life events and impaired
social support. Social Problems, 52, 62-78.
· Kingston, D. A., Olver, M. E., Harris, M., Booth, B. D., Gulati, S. & Cameron, C. (2016) The relationship between
mental illness and violence in a mentally disordered offender sample: evaluating criminogenic and
psychopathological predictors. Psychology, Crime & Law, 22, 678-700
· Samuels, A., O'driscoll, C., & Allnutt, S. (2007). When killing isn't murder: psychiatric and psychological defences to
murder when the insanity defence is not applicable. Australasian Psychiatry, 15, 474-479.
· Van Marle, H.J.C. (2002). The Dutch Entrustment Act (TBS): Its principles and innovations. International Journal of
Forensic Mental Health, 1, 83-92.
· Edworthy, R., Sampson, S., & Völlm, B. (2016). Inpatient forensic-psychiatric care: legal frameworks and service
provision in three European countries. International Journal of Law and Psychiatry, 47, 18-27.
· McSherry, B. (2003). Voluntariness, intention, and the defense of mental disorder: Toward a rational approach.
Behavioral Sciences and the Law, 21, 581-599.
LEARNING GOALS :
1. What is the prevalence for mental disorders in forensic settings?
People with a mental disorder are at higher risk to behave violent, but only a small part of all
criminals have a mental disorder (we often think the opposite due to stigma’s). One study however,
states that 2 in 3 prisoners do have a mental disorder but are not diagnosed with it.
2. What is the relation between mental disorders and violent behavior?
Mental disorder itself does not predict violent behavior, but when people with a mental disorder are
exposed to factors like substance abuse, environmental stress, abuse, they have a high chance to
become violent.
3. Which factors can contribute to the expression of violent behavior in people with a mental
disorder?
When people with a mental disorder experience stressful life events and/or have limited social
support, violent behavior can increase. Also other environmental factors like substance abuse is a
factor that highly contributes to violent behavior and recidivism in people with a mental disorder.
4. Which punishments are there for mental disorders?
People with a mental disorder who break the law, are sentences to prison. After they served their
prison sentence, they are transferred to a forensic psychiatric clinic (also known as TBS clinics in NL).
In the TBS clinics they receive treatment, if they do not cooperate in treatment programs, they will
not get out. TBS does not have an end date, it is up to the patient how long the sentence will be
based on cooperation and success.
5. When can someone not be held criminally responsible?
Someone can be seen as legally insane (insane automatism), this is the case when someone acted
due to internal processes. This can be because of a mental disease (e.g. a psychosis), whereby the
defendant did not know what he was doing was wrong due to a defect of reasoning (McNaughton
rules). In this case, the offender is not held criminal accountable.
1
,CAUSES OF VIOLENCE IN MENTAL DISORDER:
Stressful life events and limited social support
- Can start or make mental disorder worse and can incite violence
o If under control association between mental disorder and violence reduced
o E.g.: Schizophrenia produces violence as a reaction on their disturbed reality
(psychosis)
- 2 types of social support
o Instrumental support= involves the relationship as a means to an end in which the
individuals involved seek out information, advice, guidance, material aid, or financial
assistance
o Expressive support= involves the relationship as an end itself, in which the
individual; seek out intimacy by sharing love and affection, venting frustrations, and
mutually affirming each other’s worth and dignity
- Theories:
o Social stress model= stressful life events increase mental disorders, social support
decreases mental disorders
o Theory of general strain (algemene spanning)= stressed persons are more likely to
experience negative affect which creates internal pressure leading to violence as
seen as an alternative to achieve goals
o Social bond theory= the more social support, the less criminality occurs.
- Prevalence:
o People with psychosis have higher risk for violent crimes but is only a small
percentage of total violence in register
o Mental disorders in forensic settings occurs not that often as we think, only a small
amount of prisoners is mentally ill
we think it occurs much, but mental disorders are often exaggerated by the media
(stigmatized)
CONVICTION OF PEOPLE WITH MENTAL DISORDERS:
- Mens rea (mind)= (fault element) if the suspect did or did not had the intention
Actus rea (act)= (external element) the physical acting that resulted in the event. And if this
was voluntary or involuntary
- Automatism= acting without the knowledge of acting and the conscious awareness of what
you did
o Sane automatism= by external factors (e.g. hit on the head)
Low chance of repetition
E.g. hypoglycemia (external insuline overdosis) or because of medication
o Insane automatism= by internal factors (e.g. mental illness)
McNaughton rules= it must be proven that, at the time of committing the
act, the accused was handling under defect of reason, from disease of the
mind, that he did not know the nature and quality of the act or did not know
what he was doing was wrong.
Suspect needs to fulfill these requirements to establish an insanity
defense
High chance of repetition
E.g. cerebral tumor, hyperglycemia (internal diabetic condition), epilepsy
They see sleepwalking as sane and insane sane if you use drugs which can cause
sleepwalking
Murder: when there is actus rea + mens rea
Reduced responsibility
2
,Reduced responsibility= area between guilty and not-guilty. There must be an underlying condition
that leads to substantial abnormality of the mind (SIAM), that influenced judgement, capacity for
control and understanding.
- Is the case when you do not fulfill the insanity defense, but still have significant mental
problems that could have contributed to the offense (mad but not legally insane)
- SIAM: can be a temporary mental state
o Often psychotic illness or mood disorders
o E.g.: sleepwalking due to drugs of which you knew it could cause sleepwalking
- Offender can get TBS sentence if there is a connection between the disorder and the offense
o Must be examined by 2 experts (incl. psychiatrist)
o The stronger the connection, the less responsibility
o First sit out prison sentence, then transferred to TBS
- Sliding scale model: 5 levels of responsibility (5: 100% by mental disorder – no responsibility)
Other defenses:
- Duress (dwang): killed someone to prevents worse mostly not applicable in murder
because no life is more worth than someone else’s life
- Provocation= works as a partial defense for murder offender had temporary control loss
due to specific circumstances
o Controversial defense excuse for irresponsibility, justifies the act
o Doctrine of provocation= a concession to human vulnerability
o E.g.: adultery (overspel)
o Elements for provocation:
There must be provocative behavior
Suspect needs to have lost control
Provocation must have led to a normal person to lose his control
Provocation must have occurred in sight and hearing of the suspect
- Self-defense= if there is appropriate force applied to deal with imminent threat, and that a
reasonable person would have acted in the same way in such situation to protect
themselves.
FORENSIC PSYCHIATRIC CLINIC (TBS) FOR MENTALLY ILL OFFENDERS:
Terbeschikkingstelling (TBS)= a forensic psychiatric clinic which gives treatment to mentally ill
offenders after they finished their prison sentence
- To protect society by reducing recidivism
o 10-20% reoffend in 5 years after release of TBS
- Use risk assessment instruments HKT-30
- No end date
- Patient needs to corroborate in treatment, otherwise they only receive nursing care
o No corroboration, no freedom
o Risk to themselves/other patients they receive mandatory medication
- Different patient units
o E.g.: Transmuralization patients are placed near TBS, they work half in TBS and
half outside but remain in treatment in TBS
- Treatments
o Aggression management, rehab programs, empathy training, recidivism prevention
o Limited evidence for the effectiveness of treatment in mentally ill offenders, long-
term outcomes are poor
Forensic psychiatric care in other countries:
- Admission criteria
3
, o England: mental disorder offenders (MDO) belongs to mental health legislation in
NL and Germany it belongs to criminal legislation
- Review of detention
- Dismissal (ontslag) processes
o Germany: treatment is reduced from jail time
- Concept of criminal responsibility
o England/Wales: only the one’s with severe mental disorders can benefit (only with
accusation of murder)
o NL/Germany: can be administered to all offending’s and not just murder more
people with mental illness are recognized and treated better
- Service commissions
o England/Wales: separate security levels
o NL/Germany: all security levels within one hospital better/faster patient flow
- Treatment philosophy
o England/Wales: almost all responsibility for the recovery depends on the clinics
o NL/Germany: patients are responsible to participate in treatment
PREVENTION OF VIOLENT CRIMES IN PEOPLE WITH MENTAL DISORDER
- Outpatient commitment (ambulante inzet)
- Fire arm restrictions
o But only a few of these offenses is done by someone with mental disorder so not
very useful
- Prevent/decrease substance abuse (see study 3)
STUDIES:
Mental disorder & violence
Study 1: to see if mental disorder and violence occurs due to stress and limited social support
- Method:
o Measured people with mental disorder by giving them questions about health, family
etc. and about social support.
- Results:
o Limited social support and stressful life events increase violence in mental disorder
Study 2: to see if a mental disorder can lead to violence, and which predictors there are
- Method:
o 2-wave study (first in 2001-2003, second in 2004-2005) 34653 participants
completed both interviews
Wave 1: lifetime and recent diagnoses of mental disorders and/or substance
abuse
Wave 2: they were asked similar questions as wave 1, to once more measure
violence
o They were classified in 8 categories (1: no mental disorder+ substance abuse, 2:
schizophrenia etc.)
o Risk factors were divided into 4 domains (dispositional, historical, clinical, contextual)
- Results:
o Mental disorder on itself did not predict violence but mental disorder combined
with predictors did show greater violence
Predictors: substance abuse, environmental stressors, history of violence
and/or dependance
So factors that they cross paths with will increase violence
4
LITERATURE :
· Trestman (2007) Current and Lifetime Psychiatric Illness Among Inmates Not Identified as Acutely Mentally Ill at
Intake in Connecticut’s Jails
· Appelbaum, P. S. (2006).Violence and mental disorders: Data and public policy (editorial). American Journal of
Psychiatry, 163, 1319-1321.
· Elbogen, E. B., & Johnson, S. C. (2009). The intricate link between violence and mental disorder: Results from the
national epidemiologic survey on alcohol and related conditions. Archives of General Psychiatry, 66, 152-161.
· Silver, E., & Teasdale, B. (2005). Mental disorder and violence: An examination of stressful life events and impaired
social support. Social Problems, 52, 62-78.
· Kingston, D. A., Olver, M. E., Harris, M., Booth, B. D., Gulati, S. & Cameron, C. (2016) The relationship between
mental illness and violence in a mentally disordered offender sample: evaluating criminogenic and
psychopathological predictors. Psychology, Crime & Law, 22, 678-700
· Samuels, A., O'driscoll, C., & Allnutt, S. (2007). When killing isn't murder: psychiatric and psychological defences to
murder when the insanity defence is not applicable. Australasian Psychiatry, 15, 474-479.
· Van Marle, H.J.C. (2002). The Dutch Entrustment Act (TBS): Its principles and innovations. International Journal of
Forensic Mental Health, 1, 83-92.
· Edworthy, R., Sampson, S., & Völlm, B. (2016). Inpatient forensic-psychiatric care: legal frameworks and service
provision in three European countries. International Journal of Law and Psychiatry, 47, 18-27.
· McSherry, B. (2003). Voluntariness, intention, and the defense of mental disorder: Toward a rational approach.
Behavioral Sciences and the Law, 21, 581-599.
LEARNING GOALS :
1. What is the prevalence for mental disorders in forensic settings?
People with a mental disorder are at higher risk to behave violent, but only a small part of all
criminals have a mental disorder (we often think the opposite due to stigma’s). One study however,
states that 2 in 3 prisoners do have a mental disorder but are not diagnosed with it.
2. What is the relation between mental disorders and violent behavior?
Mental disorder itself does not predict violent behavior, but when people with a mental disorder are
exposed to factors like substance abuse, environmental stress, abuse, they have a high chance to
become violent.
3. Which factors can contribute to the expression of violent behavior in people with a mental
disorder?
When people with a mental disorder experience stressful life events and/or have limited social
support, violent behavior can increase. Also other environmental factors like substance abuse is a
factor that highly contributes to violent behavior and recidivism in people with a mental disorder.
4. Which punishments are there for mental disorders?
People with a mental disorder who break the law, are sentences to prison. After they served their
prison sentence, they are transferred to a forensic psychiatric clinic (also known as TBS clinics in NL).
In the TBS clinics they receive treatment, if they do not cooperate in treatment programs, they will
not get out. TBS does not have an end date, it is up to the patient how long the sentence will be
based on cooperation and success.
5. When can someone not be held criminally responsible?
Someone can be seen as legally insane (insane automatism), this is the case when someone acted
due to internal processes. This can be because of a mental disease (e.g. a psychosis), whereby the
defendant did not know what he was doing was wrong due to a defect of reasoning (McNaughton
rules). In this case, the offender is not held criminal accountable.
1
,CAUSES OF VIOLENCE IN MENTAL DISORDER:
Stressful life events and limited social support
- Can start or make mental disorder worse and can incite violence
o If under control association between mental disorder and violence reduced
o E.g.: Schizophrenia produces violence as a reaction on their disturbed reality
(psychosis)
- 2 types of social support
o Instrumental support= involves the relationship as a means to an end in which the
individuals involved seek out information, advice, guidance, material aid, or financial
assistance
o Expressive support= involves the relationship as an end itself, in which the
individual; seek out intimacy by sharing love and affection, venting frustrations, and
mutually affirming each other’s worth and dignity
- Theories:
o Social stress model= stressful life events increase mental disorders, social support
decreases mental disorders
o Theory of general strain (algemene spanning)= stressed persons are more likely to
experience negative affect which creates internal pressure leading to violence as
seen as an alternative to achieve goals
o Social bond theory= the more social support, the less criminality occurs.
- Prevalence:
o People with psychosis have higher risk for violent crimes but is only a small
percentage of total violence in register
o Mental disorders in forensic settings occurs not that often as we think, only a small
amount of prisoners is mentally ill
we think it occurs much, but mental disorders are often exaggerated by the media
(stigmatized)
CONVICTION OF PEOPLE WITH MENTAL DISORDERS:
- Mens rea (mind)= (fault element) if the suspect did or did not had the intention
Actus rea (act)= (external element) the physical acting that resulted in the event. And if this
was voluntary or involuntary
- Automatism= acting without the knowledge of acting and the conscious awareness of what
you did
o Sane automatism= by external factors (e.g. hit on the head)
Low chance of repetition
E.g. hypoglycemia (external insuline overdosis) or because of medication
o Insane automatism= by internal factors (e.g. mental illness)
McNaughton rules= it must be proven that, at the time of committing the
act, the accused was handling under defect of reason, from disease of the
mind, that he did not know the nature and quality of the act or did not know
what he was doing was wrong.
Suspect needs to fulfill these requirements to establish an insanity
defense
High chance of repetition
E.g. cerebral tumor, hyperglycemia (internal diabetic condition), epilepsy
They see sleepwalking as sane and insane sane if you use drugs which can cause
sleepwalking
Murder: when there is actus rea + mens rea
Reduced responsibility
2
,Reduced responsibility= area between guilty and not-guilty. There must be an underlying condition
that leads to substantial abnormality of the mind (SIAM), that influenced judgement, capacity for
control and understanding.
- Is the case when you do not fulfill the insanity defense, but still have significant mental
problems that could have contributed to the offense (mad but not legally insane)
- SIAM: can be a temporary mental state
o Often psychotic illness or mood disorders
o E.g.: sleepwalking due to drugs of which you knew it could cause sleepwalking
- Offender can get TBS sentence if there is a connection between the disorder and the offense
o Must be examined by 2 experts (incl. psychiatrist)
o The stronger the connection, the less responsibility
o First sit out prison sentence, then transferred to TBS
- Sliding scale model: 5 levels of responsibility (5: 100% by mental disorder – no responsibility)
Other defenses:
- Duress (dwang): killed someone to prevents worse mostly not applicable in murder
because no life is more worth than someone else’s life
- Provocation= works as a partial defense for murder offender had temporary control loss
due to specific circumstances
o Controversial defense excuse for irresponsibility, justifies the act
o Doctrine of provocation= a concession to human vulnerability
o E.g.: adultery (overspel)
o Elements for provocation:
There must be provocative behavior
Suspect needs to have lost control
Provocation must have led to a normal person to lose his control
Provocation must have occurred in sight and hearing of the suspect
- Self-defense= if there is appropriate force applied to deal with imminent threat, and that a
reasonable person would have acted in the same way in such situation to protect
themselves.
FORENSIC PSYCHIATRIC CLINIC (TBS) FOR MENTALLY ILL OFFENDERS:
Terbeschikkingstelling (TBS)= a forensic psychiatric clinic which gives treatment to mentally ill
offenders after they finished their prison sentence
- To protect society by reducing recidivism
o 10-20% reoffend in 5 years after release of TBS
- Use risk assessment instruments HKT-30
- No end date
- Patient needs to corroborate in treatment, otherwise they only receive nursing care
o No corroboration, no freedom
o Risk to themselves/other patients they receive mandatory medication
- Different patient units
o E.g.: Transmuralization patients are placed near TBS, they work half in TBS and
half outside but remain in treatment in TBS
- Treatments
o Aggression management, rehab programs, empathy training, recidivism prevention
o Limited evidence for the effectiveness of treatment in mentally ill offenders, long-
term outcomes are poor
Forensic psychiatric care in other countries:
- Admission criteria
3
, o England: mental disorder offenders (MDO) belongs to mental health legislation in
NL and Germany it belongs to criminal legislation
- Review of detention
- Dismissal (ontslag) processes
o Germany: treatment is reduced from jail time
- Concept of criminal responsibility
o England/Wales: only the one’s with severe mental disorders can benefit (only with
accusation of murder)
o NL/Germany: can be administered to all offending’s and not just murder more
people with mental illness are recognized and treated better
- Service commissions
o England/Wales: separate security levels
o NL/Germany: all security levels within one hospital better/faster patient flow
- Treatment philosophy
o England/Wales: almost all responsibility for the recovery depends on the clinics
o NL/Germany: patients are responsible to participate in treatment
PREVENTION OF VIOLENT CRIMES IN PEOPLE WITH MENTAL DISORDER
- Outpatient commitment (ambulante inzet)
- Fire arm restrictions
o But only a few of these offenses is done by someone with mental disorder so not
very useful
- Prevent/decrease substance abuse (see study 3)
STUDIES:
Mental disorder & violence
Study 1: to see if mental disorder and violence occurs due to stress and limited social support
- Method:
o Measured people with mental disorder by giving them questions about health, family
etc. and about social support.
- Results:
o Limited social support and stressful life events increase violence in mental disorder
Study 2: to see if a mental disorder can lead to violence, and which predictors there are
- Method:
o 2-wave study (first in 2001-2003, second in 2004-2005) 34653 participants
completed both interviews
Wave 1: lifetime and recent diagnoses of mental disorders and/or substance
abuse
Wave 2: they were asked similar questions as wave 1, to once more measure
violence
o They were classified in 8 categories (1: no mental disorder+ substance abuse, 2:
schizophrenia etc.)
o Risk factors were divided into 4 domains (dispositional, historical, clinical, contextual)
- Results:
o Mental disorder on itself did not predict violence but mental disorder combined
with predictors did show greater violence
Predictors: substance abuse, environmental stressors, history of violence
and/or dependance
So factors that they cross paths with will increase violence
4
