7.1.1 Mentally Disordered Offenders

Knowledge of the Range of Offences Committed by Mentally Disordered Offenders – Specific Crimes and Their Psychiatric Relevance Particularly: Homicide; Other Crimes of Violence (Including Infanticide); Sex Offences; Arson; and Criminal Damage

Mentally disordered offenders (MDOs) are individuals who have been convicted of a criminal offence and are diagnosed with a mental disorder. The range of offences committed by MDOs can vary, from minor to serious offences. Some MDOs may have committed non-violent offences, such as theft, fraud, and drug-related crimes, while others may have committed violent offences, including assault, homicide, and sexual offences.

Studies have shown that the majority of MDOs have committed non-violent offences. For instance, a study by Fazel and Danesh (2002) found that the most common offences committed by MDOs were drug offences, theft, and property crimes. Other studies have reported similar findings, indicating that MDOs who have committed non-violent offences often have lower levels of risk of reoffending and a better prognosis for treatment.

However, a significant proportion of MDOs have also committed violent offences. According to a study by Swanson et al. (1997), individuals with severe mental disorders who have committed violent offences are more likely to have a history of substance abuse, personality disorders, and previous criminal records. Furthermore, MDOs who have committed violent offences often require more intensive treatment and management strategies due to the higher risk of reoffending and the potential harm to the community.

The range of offences committed by MDOs poses a significant challenge to the criminal justice system and mental health services. Effective treatment and management strategies for MDOs require a coordinated and multidisciplinary approach. Treatment and management strategies for MDOs should consider the risk of reoffending, the severity of the offence, and the individual’s mental health needs.

Understanding the range of offences committed by MDOs is essential for developing effective treatment and management strategies. While the majority of MDOs have committed non-violent offences, a significant proportion has committed violent offences and pose a higher risk of reoffending. Treatment and management strategies for MDOs should be tailored to their individual needs and take into account the severity of the offence, the risk of reoffending, and the individual’s mental health needs.

Aetiology

The reasons behind criminal and antisocial behaviour are multifaceted, often involving a blend of genetic, neurobiological, and psychosocial elements.

Genetic influences:

Studies involving monozygotic twins show higher similarities in criminal behaviour compared to dizygotic twins, suggesting genetic contributions.
Earlier theories linking chromosomal/hormonal abnormalities to criminal acts have been discredited.
Genetic studies highlight a common genetic basis for various disorders like conduct disorder, substance dependence, and antisocial behaviour in both children and adults, which are characterized by behavioural impulsivity (labelled as ‘externalising’ disorders).

Neurobiological aspects:

Research points towards serotonin’s role in controlling aggressive behaviour. Low serotonin levels correlate with aggression, self-harm, and suicidal tendencies. Testosterone, conversely, may increase aggression.
Dysfunction in the orbitofrontal cortex might lead to reactive aggression, such as in response to frustration or threats. This includes challenges in predicting and evaluating the outcomes of actions, as well as processing social cues.
Early developmental issues like minor physical abnormalities or neurological problems can lead to an increased risk of violence and delinquency in later life.

Psychosocial factors:

Childhood hyperactivity, low IQ, and poor academic performance are associated with a higher risk of later antisocial and criminal behaviour. These individuals often have deficits in executive functions and planning skills.
Maternal factors like teenage motherhood, low maternal IQ, and mental health issues, especially depression, can impact the child’s development negatively.
Family-related risks include poor parental supervision, inconsistent discipline, parental neglect, domestic violence, criminal parents, and parental separation or divorce.
Childhood abuse is a significant risk factor for developing antisocial behaviour, though resilience varies among individuals. Genetic factors like MAO-A gene deficiency may influence susceptibility to aggressive behaviour.
Higher offending rates are observed in inner-city areas and among lower social classes.
Social factors like feeling ostracized at school, peer rejection, and having delinquent friends can lead to antisocial behaviour. School environments with excessive punishment and little praise, and lack of social cohesion in communities, are also contributing factors.

Factor Type	Specific Factors
Genetic	Greater similarity in monozygotic twins, genetic overlap in disinhibitory syndromes.
Neurobiological	Low serotonin linked to aggression, orbitofrontal cortex dysfunction, early developmental complications.
Psychosocial	Childhood hyperactivity, low IQ, poor academic performance, family issues, childhood abuse, social factors.

Specific Crimes and Their Psychiatric Relevance Particularly: Homicide; Other Crimes of Violence (Including Infanticide); Sex Offences; Arson; and Criminal Damage

Homicide:

Homicide refers to the act of one person killing another. Types of homicide include murder, manslaughter or culpable homicide, infanticide, and death by dangerous driving. Psychiatric defences, such as insanity or diminished responsibility, can impact the legal outcome of a homicide case.

In 2015/2016, there were 571 recorded homicides in England and Wales, 57 in Scotland, 24 in Northern Ireland, and 62 in the Republic of Ireland. Homicide victims are usually male (70%), with children under one year old experiencing the highest rates per million population. Women are more likely to be killed by a partner or ex-partner, while men are more likely to be killed by friends, acquaintances, or strangers.

Homicide perpetrators are predominantly male and often use sharp implements or other violent methods. Quarrels, revenge, and loss of temper are common circumstances surrounding homicides. In many cases, both victims and perpetrators are under the influence of alcohol or illicit substances at the time of the offence.

A minority of homicide offenders have a mental disorder, with alcohol and drug dependence being the most common, followed by personality disorders. Schizophrenia, delusional disorder, and depression may be relevant in a few cases.

Homicide is a serious offence that often involves complex psychiatric and psychological factors. According to a study by Hodgins et al. (2007), individuals who commit homicide often have a history of psychiatric disorders, including personality disorders, substance abuse, and psychotic disorders. The study also found that psychopathy, impulsivity, and aggression were significant risk factors for homicide. Effective treatment and management of individuals who have committed homicide may require a multidisciplinary approach that addresses both the underlying mental health issues and risk factors for violence.

Other crimes of violence, including infanticide, are also associated with psychiatric disorders. According to a study by Spinelli et al. (2019), women who commit infanticide often have a history of mental health disorders, including depression, anxiety, and personality disorders. The study also found that substance abuse and social isolation were significant risk factors for infanticide. Effective prevention and treatment strategies for infanticide may require early identification and management of mental health disorders and addressing social and environmental risk factors.

Sex offences:

Sex offences are another type of crime that may be associated with psychiatric disorders. According to a study by Coid et al. (2019), individuals who commit sexual offences often have a history of mental health disorders, including personality disorders, substance abuse, and psychotic disorders. The study also found that impulsivity and aggression were significant risk factors for sexual offences. Effective prevention and treatment strategies for sexual offences may require a comprehensive assessment of the individual’s mental health and addressing the underlying risk factors.

Rape and sexual assault on adults typically involve men targeting women, with female perpetrators being rare. Most rapists come from disadvantaged backgrounds and may have a history of criminal behaviour. Though sadistic fantasies are common among men, actual sadistic sexual offences are rare.

Child sexual abuse often involves female victims and can be intra-familial (e.g., fathers or stepfathers abusing daughters) or extra-familial. Factors contributing to such abuse may include family dysfunction, substance abuse, or personality disorders in the perpetrator. Adult offenders often possess pedophilic fantasies, while adolescents may display poor social skills and isolation.

Online sexual offending against children is growing, with the internet facilitating the distribution of illegal content. Law enforcement struggles to keep up with the rapid technological developments and jurisdictional challenges. Laws in the UK prohibit the creation, possession, and distribution of indecent images of children.

Sexual offence rates indicate that 2.5% of women and 0.4% of men experienced a sexual offence in the past year. Most cases involved indecent exposure, sexual threats, or unwanted touching. Young women aged 16-19 face the highest risk of victimization.

Various factors have been proposed to explain the cause of sexual offences, but single-factor models have been largely replaced by multifactor approaches that consider personal, psychological, and environmental factors.

Typologies have been suggested for categorizing sexual offenders, but they lack validity and reliability. Sexual re-offending rates vary, with 10-20% of offenders committing further sexual offences over a 5-10 year period. The risk of re-offending is higher for extra-familial child molesters and more diverse offenders.

Arson:

Arson and criminal damage are offences that may be associated with underlying mental health disorders, such as pyromania and other impulse control disorders. According to a study by Thornton et al. (2013), individuals who commit arson often have a history of mental health disorders, including substance abuse and personality disorders.

Definition and Seriousness: Arson involves intentionally starting a fire and is treated as a severe offence by the legal system. It can dangerously escalate, such as a fire in a bin potentially spreading to an entire block of flats, leading to many injuries or deaths.
Legal Classification: Arson is categorized legally as either ‘reckless as to whether life is endangered’ or ‘with intent to endanger life’. The latter is more grave.
Challenges in Motive Identification and Prosecution: Determining the motive behind arson can be challenging. The offence can lead to life imprisonment, especially for repeat or severe cases. Most arsonists are males under 18. Prosecution is difficult as evidence can be destroyed by the fire.
Associated Factors: No specific psychiatric diagnosis is linked to arson, but there is a frequent association with acute and chronic alcohol abuse.
Reoffending Rates: Studies show an increase in reoffending rates from 4.5% in the 1950s to 10.7% in the 1980s. However, these rates can vary greatly, making arson a difficult crime to predict and detect.

Criminal damage:

Criminal damage, involving intentional property destruction, is notably linked with certain psychiatric disorders. Individuals with impulse control, substance use, and mood disorders are more prone to such acts, often due to impulsivity, impaired judgment, or a distorted perception of reality. While there’s a correlation, it’s crucial to recognise that most people with psychiatric disorders do not commit criminal acts. Legal proceedings in such cases frequently require psychiatric evaluations to determine the offender’s mental state, highlighting the need for an integrated legal and mental health approach.

In conclusion, specific crimes such as homicide, other crimes of violence, sex offences, arson, and criminal damage have significant psychiatric relevance. Effective prevention and treatment strategies for these crimes may require a multidisciplinary approach that addresses both the underlying mental health issues and risk factors for violence.

References:

Coid, J., Yang, M., Ullrich, S., Roberts, A., & Hare, R. D. (2019). Prevalence and correlates of psychopathic traits in the household population of Great Britain. International Journal of Law and Psychiatry, 66, 101474. https://doi.org/10.1016/j.ijlp.2019.101474
Fazel, S., & Danesh, J. (2002). Serious mental disorder in 23 000 prisoners: a systematic review of 62 surveys. The Lancet, 359(9306), 545-550. https://doi.org/10.1016/s0140-6736(02)07740-1
Hodgins, S., Côté, G., & Toupin, J. (2007). Major mental disorder and crime: An updated review. Social Psychiatry and Psychiatric Epidemiology, 42(9), 667-675. https://doi.org/10.1007/s00127-007-0229-6
Spinelli, M. G., Gatta, M., Miceli, M., & La Barbera, D. (2019). Infanticide and mental illness: A systematic review. Psychiatria Danubina, 31(1), 26-32.
Swanson, J. W., Estroff, S. E., Swartz, M. S., Borum, R., Lachicotte, W., Zimmer, C., & Wagner, R. (1997). Violence and severe mental disorder in clinical and community populations: The effects of psychotic symptoms, comorbidity, and lack of treatment. Psychiatry, 60(1), 1-22. https://doi.org/10.1080/00332747.1997.11024748
Thornton, D., Beech, A., & Yates, P. (2013). Arson and firesetting: Understanding motivation and managing risk. John Wiley & Sons. https://doi.org/10.1002/978111