Mentally Disordered

1
Mentally Disordered Violent Offenders

• Nipissing University
• Lecture 6
• 13 February 2007

2
MDO

• Insanity acquitees
• Guilty but mentally ill
• Unfit to stand trial
• Mentally disordered sex offenders
• Sexual predators
• Prisoners transferred to mental health facilities

Quinsey, V., Harris, G., Rice, M., Cormier, C.
(2001). Violent Offenders Appraising and
managing risk. American Psychological
Association Washington.
3
MDO

• 1978 survey.6.6 MDO

Quinsey, V., Harris, G., Rice, M., Cormier, C.
(2001). Violent Offenders Appraising and
managing risk. American Psychological
Association Washington.
4
Mental Illness

• Crime Symptom
• Prevalence rates diverse
• High rate of Substance Use disorder
• 77 alcohol
• 63 drug use

5
Mental Disorder Offenders

• Quebec
• 5 of inmates did NOT have a mental disorder
• ¼ - psychosis
• ½ - substance abuse problem / dependence
• ½ - APD
• USA
• Insanity defence attempted in 1 of felonies
• Successful 26 of time

Quinsey, V., Harris, G., Rice, M., Cormier, C.
(2001). Violent Offenders Appraising and
managing risk. American Psychological
Association Washington.
6
Comparison Insanity Acquitees Offenders
Quinsey, V., Harris, G., Rice, M., Cormier, C.
(2001). Violent Offenders Appraising and
managing risk. American Psychological
Association Washington.
7
NGRI and Length of Stay

• NGRI hospital (secure)
• Convicted Prison
• Often not significant difference
• Seriousness of index offence
• Offence History

Quinsey, V., Harris, G., Rice, M., Cormier, C.
(2001). Violent Offenders Appraising and
managing risk. American Psychological
Association Washington.
8
Overlap in Systems

• Mental Health System
• Criminal Justice System
• Penroses Law
• As the size of the prison population increases,
  the size of the mental hospital population
  decreases proportionally.and vice versa.

Quinsey, V., Harris, G., Rice, M., Cormier, C.
(2001). Violent Offenders Appraising and
managing risk. American Psychological
Association Washington.
9
Bus Therapy

• 1987 study of 571 accused
• In for pretrial psychiatric assessment
• At 2 year follow-up
• 61 imprisonment
• 49 psychiatric admissions
• 25 both

Quinsey, V., Harris, G., Rice, M., Cormier, C.
(2001). Violent Offenders Appraising and
managing risk. American Psychological
Association Washington.
10
Why is Difficult to Determine Criminal Insanity??

• Legal Concept
• Definitions vary
• Retrospective Assessment

Wrightsman, L. (2001). Forensic Psychology.
Wadsworth United States
11
Introduction to the Insanity Defence

• Why do we need one?
• Concept of Madness
• As an Exculpatory Mechanism?
• First recorded case 1505
• 16th century lack of a guilty mind
• 18th century wild beast standards

Schuller, R.A. Ogloff, J.R. (2002).
Introduction to Psychology and Law Canadian
Perspectives. Toronto, University of Toronto
Press.
12
James Hadfield 1800

• King George III / High treason / Delusions
• Jury remarked we find the prisoner is not
  guilty he being under the influence of insanity
  at the time the act was committed
• NGRI
• Criminal Lunatics Act
• Post acquittal detention of NGRIs
• Preventative detention
• 1991 Supreme Court of Canada

Pozzulo, J., Bennell, C., Forth, A. (2006).
Forensic Psychology. Toronto Pearson.
13
Definitions of Insanity

• McNaughton Rule
• Defect of reason, from a disease of mind
• Didnt know the nature and quality of the act
  
• Inquiry carried out.determine if he knew what
  he was doing was wrong
• Irresistible Impulse Standard
• Volitional aspect of insanity

Wrightsman, L. (2001). Forensic Psychology.
Wadsworth United States
14
Definitions of Insanity

• The Durham Test
• Not criminally responsible
• if his or her unlawful act was a product of
  mental disease or defect
• Initially viewed as progressive step
• Move from legal definition closer to psychiatric
• Apparent there were problems!

Wrightsman, L. (2001). Forensic Psychology.
Wadsworth United States
15
The ALI Standard (Brawner Rule)

• a person is not responsible for criminal conduct
  if at the time of the action, as a result of
  mental disease or defect, he (or she) lacks
  substantial capacity either to appreciate the
  criminality (wrongfulness) of his (or her)
  conduct or to conform his or her conduct to the
  requirements of the law

Wrightsman, L. (2001). Forensic Psychology.
Wadsworth United States
16
Guilty but Mentally ill Verdict

• GBMI
• John duPont
• Charged with killing staff member
• Calculated killing
• Paranoid schizophrenic psychosis

Wrightsman, L. (2001). Forensic Psychology.
Wadsworth United States
17
Jeffrey Dahmer

• 1992 trial
• Admitted to killing 17 young men over 10 years
• NGRI?

Wrightsman, L. (2001). Forensic Psychology.
Wadsworth United States
18
Not Criminally Responsible on account of Mental
Disorder (NCRMD)

• Canadian equivalent to NGRI
• A legal test
• Not a psychiatric
• diagnosis!

19
Section 16 Criminal Code

• No person is criminally responsible for an act
  committed or an omission made while suffering
  from a mental disorder that rendered the person
  incapable of appreciating the nature and quality
  of the act or omission or of knowing that it was
  wrong

Retreived 16Jan2004 from http//laws.justice.gc.ca
/en/C-46/40190.html
20
Example of NCRMD

• Confessed killer
• Found fit to stand trial
• found NRCMD
• Penetanguishene
• Released lt 10 years later
• Brians Law (Bill 68)
• Community Tx orders
• Medication
• Removal of imminent

Pozzulo, J., Bennell, C., Forth, A. (2006).
Forensic Psychology. Toronto Pearson.
21
Classification of Mental Disorders

• Diagnostic Statistical Manual of Mental
  Disorder (DSM-IV)
• Axis I clinical disorders
• Axis II personality disorders
• Axis III medical conditions
• Axis IV severity of stressors
• Axis V general functioning

American Psychiatric Association (2000).
Diagnostic Statistical Manual of Mental
Disorder-IV-TR. APA Washington.
22
Axis I Clinical Disorders

• Major Mental Disorders
• E.g. Schizophrenia, Manic Depression
• Often forms basis of
• Not fit to stand trial
• NGRI/NCRMD

American Psychiatric Association (2000).
Diagnostic Statistical Manual of Mental
Disorder-IV-TR. APA Washington.
23
Axis II Personality Disorders

• Clinical Scale
• Personality disorders
• Eg. Anti-social personality disorders

American Psychiatric Association (2000).
Diagnostic Statistical Manual of Mental
Disorder-IV-TR. APA Washington.
24
Axis III Medical Conditions

• Number of physical conditions
• Circulatory, respiratory, digestive
• RELEVANT to the understanding of the Mental
  Disorder

American Psychiatric Association (2000).
Diagnostic Statistical Manual of Mental
Disorder-IV-TR. APA Washington.
25
Axis IV Severity of Stressors

• Psychosocial Environmental Problems
• Problems with
• Primary support group
• Education
• Social environment
• Occupation
• Housing
• Economic
• Access to health care
• Legal system/crime

American Psychiatric Association (2000).
Diagnostic Statistical Manual of Mental
Disorder-IV-TR. APA Washington.
26
Axis V Global Assessment of Functioning (GAF)

• Rating given
• 0 -100
• Assessment of overall functioning
• Clear criteria for each score
• Need adequate data to make judgment

American Psychiatric Association (2000).
Diagnostic Statistical Manual of Mental
Disorder-IV-TR. APA Washington.
27
Relationship between MDO, Recidivism and
Dangerousness
28
Predictors of Recidivism by Sample

• Sample
• Risk Factor General MDO Sex
• Antisocial Support .21 nr nr
• Antisocial Personality .18 .18 .14
• Antisocial Cognitions .18 nr .09
• Criminal History .16 .22 .13
• Social Achievement .13 .04 .03
• Family Factors .10 .10 .08
• Substance Abuse .10 .11 .03
• Intelligence .07 .01 .09
• Lower-Class Origins .05 .00 .05
• Personal Distress .05 -.04 .01

Andrews, D. Bonta, J. (2003). The Psychology of
Criminal Conduct. Cincinnati Anderson
29
MDO Meta-Analysis Summary

• Criminal history variables are more important
  than many clinical variables
• Antisocial personality is the major predictor
  from the clinical domain
• Predictors for general offenders are similar for
  MDOs

Andrews, D. Bonta, J. (2003). The Psychology of
Criminal Conduct. Cincinnati Anderson
30
MDO Meta-Analysis Summary (cont.)

• A social-psychological perspective is important
• Neglected predictor domains are antisocial
  supports and attitudes
• Compared to general offenders, MDOs are less
  likely to recidivate

Andrews, D. Bonta, J. (2003). The Psychology of
Criminal Conduct. Cincinnati Anderson
31
Mental Disorder as a Predictor of Recidivism
(Bonta et al., 1998)

• General Violent
• NGRI -.06 -.02
• (1830) (1462)
• MDO -.19 -.10
• (3009) (2866)
• p lt .05
• p lt .001

NGRI Not Guilty by Reason of Insanity MDO
Mentally Disordered Offender
Andrews, D. Bonta, J. (2003). The Psychology of
Criminal Conduct. Cincinnati Anderson
32
Clinical/Psychopathological Models and Practice

• Assessment Treatment
• Anxiety ? Relaxation, medication
• Intellectual/ ? Educational/remedial
• Cognitive Deficits
• Self-esteem ? Counseling
• Depression
• Alienation
• Loneliness
• Schizophrenia ? Hospitalization,
• Manic-depression medication
• Hallucinations
• Delusions

(Andrews Bonta, 2003)
33
APD, Psychopathy, Antisocial Personality
Pattern
34
Cleckleys Characteristics
Andrews, D. Bonta, J. (2003). The Psychology of
Criminal Conduct. Cincinnati Anderson
35
Psychopaths

• Psychopaths appear normal
• Psychopaths dont seem to respond to social
  control
• Psychopaths are not necessarily criminals

Andrews, D. Bonta, J. (2003). The Psychology of
Criminal Conduct. Cincinnati Anderson
36
3. Psychopaths are NOT Necessarily
CriminalsCorollaries

• Not all criminals are psychopaths
• An etiological explanation of crime may not be
  useful as an explanation of psychopathy vice
  versa
• The assessment treatment of psychopaths
  criminals should differ (following from 2 above)

Andrews, D. Bonta, J. (2003). The Psychology of
Criminal Conduct. Cincinnati Anderson
37
Psychopathy

• Dr. Robert Hare
• PCL-R
• PCL-YV
• PCL-SV
• Qualifications
• Caution!

38
PCL-R

• 2 Factors
• Personality Traits
• Antisocial Lifestyle
• 20 Items
• Specific scoring criteria

39
PCL-R Items
40
Taxon or Continuum???
Psychopaths

• Criminal Psychopath

Criminals
41
PCL-R Prediction

• Results of Meta Analyses

Effect sized calculated by Bonta Andrews
using Predictive studies only
Andrews, D. Bonta, J. (2003). The Psychology of
Criminal Conduct. Cincinnati Anderson p.373
42
Noncriminal Psychopaths?

• Widom (1977)
• Got caught?
• Recruited group of psychopaths
• Non-criminal psychopaths?

Andrews, D. Bonta, J. (2003). The Psychology of
Criminal Conduct. Cincinnati Anderson p.373
43
Can Kids Be Psychopaths?

• Some interest in modifying the PCL-R
• for kids as young as 6
• Child Psychopathy Scale (Lynam 1997)
• 2 factors
• Callous/Deceitful and Conduct Disorder
• Concerns
• Diagnosis APD 18 years old
• Predictive validity?
• Methodological problems?
• Some Items describe many youth?

Andrews, D. Bonta, J. (2003). The Psychology of
Criminal Conduct. Cincinnati Anderson
44
Hares Latest Book

• Snakes in Suits When Psychopaths go to Work

Hares Latest Measure

• B-Scan

Whos really psycho? (2005, January 21) The
Toronto Star, p.A3.
45
Antisocial Personality Pattern

• Bonta Andrews
• Problems with conception of APD and Psychopathy
• No consensus on etiology or prognosis
• Problems with diagnostic approach
• Pessimistic attitudes
• Labelling
• Suggest break PCL-R into categories of Risk,
  Need, Responsivity

Andrews, D. Bonta, J. (2003). The Psychology of
Criminal Conduct. Cincinnati Anderson
46
The PCL-R PCC

• Static Risk (Criminal History)
• Parasitic lifestyle
• Early behavior problems
• Many short-term marital relationships
• Juvenile delinquency
• Revocation of conditional release
• Criminal versatility

Andrews, D. Bonta, J. (2003). The Psychology of
Criminal Conduct. Cincinnati Anderson
47
The PCL-R PCC

• Dynamic Risk (Criminogenic Needs)?
• Pathological lying
• Conning/manipulative
• Lack of remorse/guilt
• Callous/lack of empathy
• Poor behavioral controls
• Promiscuous sexual relations
• Lack of realistic long-term goals
• Impulsivity
• Irresponsibility
• Failure to accept responsibility

Andrews, D. Bonta, J. (2003). The Psychology of
Criminal Conduct. Cincinnati Anderson
48
The PCL-R PCC

• Responsivity
• Glibness/superficial charm
• Grandiose sense of self-worth
• Need for stimulation/prone to boredom
• Shallow affect

Andrews, D. Bonta, J. (2003). The Psychology of
Criminal Conduct. Cincinnati Anderson