Here are three reasons
First, some of the problems in a person’s development that are associated with offending (broken families, poverty, substance abuse in the home, physical and emotional abuse experience) are also problems that increase the risk of suffering a serious mental illness. Therefore people with problems of criminal behaviour may well also have problems of mental illness, but the illness is not the cause of their criminality. In this case, under the criminal law such people will often be sent to prison if their offending is serious enough. Still, addressing their mental health needs may help them turn their life around.
Second, people who have mental health problems may have higher rates of unemployment and/or live on social assistance. They may struggle financially, may live in conditions of poverty, in poorer neighborhoods with more crime and drug and alcohol problems. They also may have problems in coping with day to day life, and have disruptive or intrusive behavior problems. These problems may lead to conflict with the law, as may crimes of poverty or ones related to drug or alcohol addiction.
Crime and arrest rates in poorer communities are higher than in others. The more we get ‘tough on crime,’ the more people from these communities with these types of problems will be incarcerated, over-representing those with mental illness. This is seen most strikingly in the United Sates, but is also evident in most western countries.
Third, sometimes the symptoms of the mental illness itself will cause the criminal offending. The heightened fear and suspiciousness of paranoid delusions, or the labile, irritable and grandiose ideation of manic episodes are both examples of mental states that may motivate aggressive behaviour. Often the police recognise the problem is a mental health one and will call for mental health care. If the offending is serious, however, criminal charges will follow.
Here are three things we can do about it
So how should we respond to these facts − as members of society, or as people like me who provide care for people with mental illness?
First, not with fear. Most people with mental illness, most of the time, present no increased risk to others.
Yes − as discussed in an earlier blog − there is a heightened risk of violence with one specific mental illness if it reaches a critical point: during the acute phase of a psychotic illness. But these symptoms respond readily to understanding and treatment. Good services should be readily available for people with a psychotic illness. Good care planning and support allows people with psychosis, and their families and support people, to plan for periods when symptoms worsen and get the right care and support early before police involvement is needed. Well resourced, sensitive and responsive services, reduction in stigma and policies of social inclusion are the strategies that will improve outcomes for people with psychotic illness, reduce symptoms of illness, and thereby make society safer.
Second, to prevent people becoming involved in the criminal justice system, strong services, good housing, income support and addressing poverty are all crucial. The scourge of serious drugs of abuse in our society must also be addressed.
Third, once someone with a mental illness becomes involved in the criminal justice system, we have a responsibility as a society to ensure we provide them with care and support. Police, who are often called at times of mental health crisis, need training and support from the mental health sector to help people in times of crisis.
If the criminal offending is minor and related to mental health problems, diversion back into mental health services may be the best response. If the person is currently unwell, courts must ensure forensic psychiatric assessment occurs early to ensure the person is assessed as to whether they are fit to go through the court process and whether they have a defence of Not Criminally Responsible available to them.
Should they enter the correctional system, there are three responsibilities:
- First, to screen for mental health problems and distress, as many people are reluctant to come forward to seek help or don’t realize there is help available.
- Second, to offer mental health care for people that is appropriate to their needs and support them through their incarceration.
- Third, actively plan for supporting the person during their process of release and re-integration into society. This includes addressing issues like housing, financial support, linkage with community mental health services (professional support, medication etc.) and family and social support. Bail, probation and parole services should be attuned to these needs.
If we fail to do these things well, people with mental illness will have a high rate of recidivism coming out of prison. If we do them well, they are at much lower risk than offenders without a mental illness. Good care is better for everyone.
Continue the conversation – follow Dr. Sandy Simpson on Twitter: @DrSandySimpson
For more information on mental health and the criminal justice system, check out CAMH's Mental Health and Criminal Justice Policy Framework.