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Introduction
There are quite a number of research studies that have explored the association between mental illness on the one hand, and violence, on the other hand (for example, Paterson et al 2004; Friedman, 2006; Sirotich 2008). Even then, there those amongst the scholars who are of the opinion that such studies are often flawed, when it comes to selection criteria of the study subjects (Friedman, 2006). As such, an intense and controversial debate appears to surround the issue of the link between mental illness and violent behavior. Nevertheless, a majority of the researchers and scholars alike are in agreement that by and large, patients with psychiatric disorders are more likely to be violent, when compared to the general population (Bourget, el-Guebaly & Atkinson, 2002).
This assertion is further compounded by a study whose findings revealed that mental health professionals and psychiatrists were more likely to be assaulted by their patients, when compared with other workers (Crime Times, 2007). Furthermore there are certain mental illnesses that have since been shown to have an impact on the criminal behavior of mental patients, and these include delirium, anxiety disorder, impulse control disorders, mood disorders, schizophrenia, substance abuse and dependence (Shaw et al, 2006). This should not however, lead to a conclusion that by and large, all mentally ill individuals tend to be violent. On the contrary, even non-mentally ill individuals are also capable of committing acts of violence. This could be exacerbated by such factors as the socio-demographic elements of a population (for instance, racial disparities), and drugs, like alcohol.
Association of mental disorder and criminogenic behavior
The probable link between on the one hand, mental disorder and on the other hand, criminogenic behavior, has elicited extensive controversy and debate amongst scholars. As such, this is an area that has over the years attracted a lot of extensive research. For more than 15 years now, publications by scholars that seek to explore the relationships between crime and mental disorders, appears to have grown exponentially. A majority of the psychiatrists, especially those working in acute or emergency care settings have narrated encounters of violent behavior from patient under their care that are mentally ill (Modestin, 1998).
In Canada for instance, where violence amongst the member of the population is reportedly lesser in comparison with a majority of the other nations, most of the psychiatrists here are usually involved in treating and managing patients manifesting violent behavior. Additionally, about 50 percent of the psychiatrists talk of at least one violent encounter, with a patient (Bourget, el-Guebaly & Atkinson, 2002). On the other hand, it is important to note that violent experience at a clinical setting dos not fully symbolize the actual behavior of most of the individuals that are mentally ill. Thanks to social changes in as far as psychiatric practice is concerned, this has in effect ensured that just the patients characterized by an elevated risk of violence gains access to clinical treatment. As such, we can already see a serious limitation of the clinical association of violence with criminal behavior; such studies tends to lay more emphasis on the mentally ill as well as the mental illnesses, at the expense of contextual and social factors whose interaction results in the kind of violent behavior that patients exhibits at a clinical setting.
Separately, an article by Jeremy Coid that appeared on an April 1996 issue of Archives of General Psychiatry reported a strong association between crime and mental illness (Crime Times, 2007). The author, while noting that a majority of the individuals often diagnosed with a mental illness may not be criminal after all, nevertheless asserts that most of them tend to exhibit violent behavior. As Coid ahs noted, In the last decade, the evidence showing a link between violence, crime, and mental illness has mounted. It cannot be dismissed; it should not be ignored. (Crime Times, 2007).
Another study that sought to explore a possible association between criminal behavior and mental illness was a study that was carried out in Denmark by Sheilagh Hodgins and other researchers. In this study, followed a group of Danes that were born between 1944 (January 1) and 1947 (December 31), by using registries of population of the country. The subjects in this cohort study were followed for a period of 43 years. The researchers then sought to explore the hospitalization records of individuals, for psychiatric illnesses, vis-à-vis the individuals criminal records. According to the findings of this research study, individuals with a history of psychiatric hospitalization were more likely to have been convicted of a criminal offence than persons with no history of psychiatric hospitalization, (Crime Times, 2007).
These findings were true for women and men alike. On the basis of diagnostic categories and sex, those subjects that have a history of psychiatric hospitalization, according to this study, were found to be between three and eleven times more prone to having been convicted of a criminal offence, relative to their counterparts that were without any psychiatric hospitalization history. Researchers are of the opinion that the findings by Hodgins and colleagues (2000) are in agreement with two related Scandinavian research studies, as well as a study conducted in North America, that indicated elevated levels of significant mental disorders amongst offenders that had been incarcerated.
Are individuals diagnosed with mental disorders more likely to become criminally involved?
Friedman (2006) has reported the findings of a study dubbed, National Crime Victimization Survey that the United States Department of Justice conducted, between 1993 and 1999. According to theses findings, the rate of job-related, nonfatal, violent crime was found to be 12.6 percent pre annum, for every 1000 workers, from the various occupational settings. The crime victimization rating tended to be higher, amongst physicians, at 16.2 percent for every 1,000 workers. On the other hand, the number of assaults was even higher for the nurses, standing at 21.9 percent, for every 1,000 workers. For the mental health professionals and psychiatrists, this rate shot drastically upwards, to stand at 69 and 68 percent for every 1000 workers, respectively (Friedman, 2006). What these research findings appear to suggest is that there is as possibility that mental patients could be more violent, when compared with rest of the population. In addition, attacks of psychiatrists by psychotic patients have been on the increase of late.
Again, Friedman (2006) gives a classic example of a London-based forensic psychiatry, at the Redford Lodge Hospital, who was assaulted by a 19 year old male psychotic patient whom he was treating. According to the forensic psychiatry, I was talking with him in a room and telling him why he couldnt leave, when I was suddenly aware of a few blows to my head, recalled Tim Exworthy, the forensic psychiatry that was assaulted, The next thing I knew, I was at the nursing station wiping the blood off my face. I never saw this coming and hadnt anticipated that he would react like that. (Friedman, 2006). The increase in such attacks therefore begs the question: Are individuals diagnosed with mental disorders more likely to become criminally involved? If this is the case, there is a need to identify psychiatric illnesses that bear an association with violence, in addition to an assessment of the possible magnitude, on the basis of an elevated risk for violence.
Until a moment ago, a majority of the studies have tended to lay emphasis on mental illness rates of violence amongst those individuals that have been incarcerated, arrested, or convicted after committing violent crimes or, on the other hand, an assessment of the violent rates amongst those patients admitted to a psychiatric facility with a mental illness (Shaw, Hunt & Flynn, 2006). For instance, the findings of one national survey indicated that the risk of being diagnosed with schizophrenia, at least once in a lifetime, was 5 percent, for those individuals that had been found guilty of homicide (Swanson, Swartz & Essock, 2002). Clearly, such a prevalence is in fact way above the schizophrenic rates amongst members of the general population that have been published, thereby offering a suggestion that homicide convictions could bears an association with schizophrenia (Shaw et al, 2006).
Nonetheless, these studies have a limitation, in that they are biased when it comes to the selection of the participants. Those individuals that have been arrested, convicted, or even those that have been hospitalized with a psychiatric conditions, have a higher likelihood of either being very ill, or extremely violent and for this reason, these do not serve as a sound representation of the psychiatric patients that many be found within the general population. There is a need therefore, for researchers to undertake an assessment that is less biased and moiré accurate, with regard to the association of violence with patients that are mentally ill.
Researchers in favor of increased levels of criminal behavior amongst those individuals that have been diagnosed with mental illness have sounded a warning to the effect that a majority of the studies that seeks to address this topic are usually flawed when it comes to the issue of research methodology, research design and sampling (Sirotich, 2008; Paterson et al. 2004). There has been the argument that by and large, studies appears inaccurate and/or con-comparable as a result of variations with respect to the subjects that are being assessed, in addition to a lack of standardization on, inability to control the studys variables, as well as the absence of the right kind of techniques for exploring if mental disorder comes before criminality, or the other way round (Paterson et al. 2004; Sirotich, 2008).
What types of mental disorders are commonly associated with particular offences?
Practically any psychiatric symptom could very well be connected with criminal behavior. This is because symptoms have the potential to causes an impairment to an individuals judgment, thereby directly or indirectly infringing on those norms that are held in high regard by the society. For instance, a person characterized by insomnia and major depression could fall asleep at a time when he/she is driving, with the result that they end up causing death of a pedestrian. What this means is that such an individual stand being convicted of manslaughter. On the other hand, Brennan, Mednick and Hodgins (2000) Reports of a study that involved persons that had been diagnosed with psychotic disorders, and whose findings revealed that mental illness of the subjects was only responsible for a partly 5 percent of the total number of violent crimes committed.
However, there are still exceptional mental illnesses that have since been shown to have an impact on the criminal behavior of the patients that gets diagnosed with these. Some of the commonly diagnosed psychiatry disorders, and which are usually linked to criminal behavior, include delirium, anxiety disorder, impulse control disorders, mood disorders, schizophrenia, substance abuse and dependence. The above mentioned psychiatric disorders encompass the most important psychiatric illnesses often diagnosed amongst those individuals that are associated with the system that is criminal justice (Bourget et al, 2002).
Disorders that are identifiable by those behaviors that bears a more direct connection with criminality entails impulse control disorders (such would include kleptomania, pathological gambling, and intermittent explosive disorder), as well as paraphilias (for example, exhibitionism, pedophilia, voyeurism, and frotteuism). Nonetheless, persons that are diagnosed with such illnesses should not be regarded as criminals, on the basis of manifesting this disorder. Instead, persons exhibiting such disorders are regarded as more intimately associated with criminality, given that DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Forth Edition, Text Revision), diagnostic criteria for such disorders takes into account those symptoms which have a tendency to infringe on other peoples rights (Paterson et al, 2004).
Are non-mentally disordered individuals capable of violent behavior?
Even as a number of researchers (for example, Modestin, 1998; Paterson et al, 2004) have reported of a link between those persons diagnosed with a metal illness and a rise in terms of getting involved in violence and crime, this is in no way a suggestion that individuals that are free of a mental disorder, are not capable of violent behavior. By and large, the available literature appears to augment certain kinds of connections between violence and mental illness; on the other hand, such an argument has not been without its short comings. For example, the connection is usually significant, yet small in terms of scope.
In addition, the risk of individuals to becoming violent, thereby participating in criminal behavior, has been seen to increase with the increase in substance abuse by individuals. For this reason, someone under the influence of such a drug as alcohol may end up becoming violent, although from a psychological point of view, they are not mentally ill. Furthermore, social-demographic factors like racial segregation and disparities between the rich and the poor have also been seen to have an impact on the increase in the number of violent individuals (Patterson et al, 2004).
Conclusion
The issue of the relationship between mental illness and the act of violence is one that has elicited controversial debates amongst scholars and researchers alike. Even as a majority of such researchers concur that by and large, a many of these mentally ill patient tend to be by extension, also violent, nevertheless this should not lead us to conclude that by and large, all mentally ill patients are violent. There are also several scholars that have taken issue with the number of studies that have sought to address the link between mental illness and violent behavior (Sirotich, 2008; Paterson et al. 2004). These authors have argued that most of the studies are limited with respect to the selection criteria of their subjects, almost all of whom tend to be those who have been arrested or incarcerated for various crimes, or those already in a psychiatric facility. It is imperative therefore that future research studies embrace an all-inclusive criteria for the choice of subjects, to overcome such a limitation. This way, more conclusive research findings may be provided, in effect shedding more light on the true picture of the link between mental illness and violent behavior.
References
Bourget, D., el-Guebaly, N., & Atkinson, M.J. (2002). Assessing and managing violent patients. CPA Bull, 34, 2527.
Brennan, P. A., Mednick, S. A. & Hodgins, S. (2000) Major mental disorders and criminal violence in a Danishbirth cohort. Archives of General Psychiatry, 57, 494 -500.
CrimeTimes. (2007). Mental disorders and crime: the connection is real. Web.
Friedman R. A. (2006). Violence and Mental Illness How Strong is the Link? The New England Journal of Medicine, 355, 20, 2064-2066.
Hodgins, S., & Müller-Isberner, R. (2000). Violence among the mentaly ill. Effective treatments and management strategies. Boston: Kluwer Academic.
Modestin, J. (1998). Criminal and violent behavior in schizophrenic patients: An overview. Psychiatry and Clinical Neurosciences, 52, 6, 547-554.
Paterson, B., Claughan, C. & McComish, S. (2004). New evidence or changing population?
Reviewing the evidence of a link between mental illness and violence. International Journal of Mental Health Nursing, 13, 1, 39-52.
Shaw, J., Hunt, I.M., & Flynn, S, et al. (2006). Rates of mental disorder in people convicted of homicide: national clinical survey. Br J Psychiatry, 188, 143-147.
Swanson, J.W., Swartz, M.S., & Essock, S.M, et al. (2002). The social-environmental context of violent behavior in persons treated for severe mental illness. Am J Public Health, 92, 1523-1531.
Sirotich, F. (2008). Correlates of crime and violence among persons with mental disorder: An evidence-based review. Brief Treatment and Crisis Intervention, 8, 2, 171-194.
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