7.1.2 The Relationship Between Specific Mental Disorders and Crime

The Relationship Between Specific Mental Disorders and Crime: Substance Misuse; Epilepsy; Schizophrenia; Bipolar Affective Disorder; Neuro-Developmental Disorders; Personality Disorders; and Learning Disability

There is a complex relationship between specific mental disorders and crime. Understanding this relationship is important for developing effective prevention and treatment strategies. In the UK, some of the most common mental disorders associated with crime include substance misuse, epilepsy, schizophrenia, bipolar affective disorder, neuro-developmental disorders, and personality disorders.

Substance Misuse:

Substance misuse is a common risk factor for crime, particularly violent crime. According to a study by Fazel and Bains (2006), individuals who misuse drugs or alcohol are at increased risk of committing a range of crimes, including assault, robbery, and theft. Effective prevention and treatment strategies for substance misuse may require a multidisciplinary approach that addresses both the underlying addiction and the risk factors for crime. Alcohol consumption is frequently reported prior to a wide range of offenses, including homicides, assaults, rapes, property crimes, and driving violations. On the other hand, there is minimal evidence to indicate that the use of cannabis leads to an increase in criminal behaviour, except in cases involving convictions for possession.

Epilepsy:

Epilepsy is infrequently a factor in criminal offences. Over 40 years ago, Gunn observed a higher rate of epilepsy among prisoners than in the general population. However, this was not the case when compared to socio-economically similar groups from which prisoners often come. Interestingly, Gunn’s research found no increased rates of violent crimes among prisoners with epilepsy. Recent studies indicate that only about 1% of prisoners have chronic epilepsy, aligning with its prevalence in the community’s 25-35 year-old male demographic. Instances of serious violence occurring as a direct result of an epileptic seizure are extremely rare.

On the other hand it has been reported that epilepsy is another mental disorder that may be associated with an increased risk of crime. According to a study by Pritchard and colleagues (2016), individuals with epilepsy may be at increased risk of committing impulsive and violent crimes, particularly when their seizures are poorly controlled.

Automatism, as understood differently by doctors and lawyers, can sometimes offer a full defence in criminal cases. Key features of automatism include involuntary action, inappropriateness, lack of judgement, complex and directed behaviour, and subsequent amnesia or confused memory. It may be organic, linked to brain disturbances, or psychogenic, aligned with underlying psychopathology. Legally, automatism is categorised as either sane or insane. Sane automatism stems from external causes like a head injury, while insane automatism arises from internal factors such as mental illness or brain conditions like encephalitis. Both types can lead to a successful defence, but insane automatism may result in similar outcomes to unfitness to plead, potentially leading to a hospital order. The concept is complex and rarely used as a defence

Schizophrenia

Individuals with schizophrenia have a lifetime risk of violence approximately five times higher than the general population. Factors associated with violence in this group are similar to those in people without psychosis, with alcohol and drug misuse playing a significant role. Although specific symptoms may contribute to violence, they are not sufficient on their own; otherwise, nearly all individuals with schizophrenia would exhibit violent behaviour. While threat control-override symptoms have been linked to violence, most patients with these symptoms remain non-violent. The impact of command auditory hallucinations on violence is uncertain. When people with psychosis commit violent acts, their victims are more likely to be known to them, particularly family members, as compared to non-psychotic individuals.

According to a study by Fazel et al. (2009), individuals with schizophrenia are at increased risk of committing violent crimes, particularly if they have a history of substance misuse or comorbid personality disorders. Effective prevention and treatment strategies for schizophrenia-related crime may require early identification, prompt treatment, and management of any comorbid conditions.

Bipolar affective disorder:

Bipolar affective disorder is another mental disorder that may be associated with an increased risk of crime, particularly during manic or hypomanic episodes. According to a study by Large and colleagues (2011), individuals with bipolar affective disorder may be at increased risk of committing impulsive and violent crimes, particularly during manic or hypomanic episodes. Effective prevention and treatment strategies for bipolar affective disorder-related crime may require a comprehensive assessment of the individual’s mood state, management of any comorbid conditions, and addressing any psychosocial risk factors.

Neuro-developmental disorders:

Neuro-developmental disorders, such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and intellectual disability, may also be associated with an increased risk of crime, particularly in untreated or poorly managed individuals. According to a study by Mandell and colleagues (2008), individuals with ASD may be at increased risk of committing impulsive and violent crimes, particularly if they have comorbid conditions such as ADHD. Effective prevention and treatment strategies for neuro-developmental disorder-related crime may require a comprehensive assessment of the individual’s neurodevelopmental profile, management of any comorbid conditions, and addressing any psychosocial risk factors.

Personality disorders:

Personality disorders, particularly antisocial personality disorder, are also associated with an increased risk of crime. According to a study by Black and colleagues (2015), individuals with antisocial personality disorder are at increased risk of committing a range of crimes, particularly violent crimes. Effective prevention and treatment strategies for personality disorder-related crime may require a comprehensive assessment of the individual’s personality disorder traits, management of any comorbid conditions, and addressing any psychosocial risk factors.

Learning disability:

People with milder forms of learning disabilities tend to offend more frequently than those with severe learning disabilities. The offences committed by individuals with learning disabilities are similar to those of non-disabled offenders and are often linked to family and social disadvantages. The reliability of data on sex offending and arson rates among this population is questionable, as it is based on highly selected patient samples from secure hospitals. Factors such as poor social development, low educational achievement, gullibility, and impaired communication abilities may contribute to offending in some learning-disabled individuals. While profound and severe learning disabilities may be associated with aggressive behaviour, these cases rarely come to the attention of the criminal justice system.

Mental Disorder	Relationship with Crime
Substance Misuse	Associated with various types of crime, especially property and drug-related offences.
Epilepsy	May be associated with violent behaviour during seizures.
Schizophrenia	Increased risk of violent crime, especially during psychotic episodes.
Bipolar Affective Disorder	Increased risk of violent behaviour, especially during manic episodes.
Neuro-developmental Disorders	May be associated with an increased risk of criminal behaviour, particularly in those with an intellectual disability or autism.
Personality Disorders	Increased risk of impulsive and violent behaviour, particularly in those with an antisocial personality disorder.
Learning Disability	People with milder forms of learning disabilities tend to offend more frequently than those with severe learning disabilities.

It is important to note that the relationship between mental disorders and crime is complex and cannot be fully explained by the presence of a single diagnosis. Environmental and situational factors, such as socioeconomic status and access to treatment, also play a significant role. Additionally, it is important to avoid stigmatizing individuals with mental health conditions as being inherently violent or criminal.

In conclusion, there is a complex relationship between specific mental disorders and crime in the UK. Effective prevention and treatment strategies for mental disorder-related crime may require a multidisciplinary approach that addresses both the underlying mental health issues and the psychosocial risk factors for crime.

References:

1. Black, D. W., Gunter, T., Allen, J., Blum, N., Arndt, S., Wenman, G., & Sieleni, B. (2015). Borderline personality disorder in male and female offenders newly committed to prison. Comprehensive Psychiatry, 60, 126-131. doi: 10.1016/j.comppsych.2015.03.007
2. Fazel, S., & Bains, P. (2006). Substance abuse and dependence in prisoners: A systematic review. Addiction, 101(2), 181-191. doi: 10.1111/j.1360-0443.2006.01316.x
3. Fazel, S., Gulati, G., Linsell, L., Geddes, J. R., & Grann, M. (2009). Schizophrenia and violence: Systematic review and meta-analysis. PLoS Medicine, 6(8), e1000120. doi: 10.1371/journal.pmed.1000120
4. Large, M. M., Kavanagh, B., & Ryan, C. J. (2011). Disturbingly increased risk of bipolar disorder and violence: A systematic review and exploratory meta-analysis. Bipolar Disorders, 13(1), 1-12. doi: 10.1111/j.1399-5618.2011.00893.x
5. Mandell, D. S., Walrath, C. M., Manteuffel, B., Sgro, G., & Pinto-Martin, J. A. (2008). The prevalence and correlates of abuse among children with autism served in comprehensive community-based mental health settings. Child Abuse & Neglect, 32(4), 345-355. doi: 10.1016/j.chiabu.2007.07.009
6. Pritchard, P. B., Winkleby, M. A., & Levitt, J. (2016). Neurological disorders and violence: Implications for neuropsychologists. Applied Neuropsychology: Adult, 23(3), 213-222. doi: 10.1080/23279095.2015.1009142