The arguable nature of insanity

When Anders Breivik bombed the summer camp of the labour party in Norway everyone declared that he was insane. This was an insane act, no one would kill all those people, those children and yet he did, so therefore he was insane. The question of his sanity was quickly brought up when he was arrested and the ensuing tests and evaluations first declared him insane and then sane but really which is he?

This article claims the judgement flawed http://www.guardian.co.uk/world/2012/aug/26/flawed-judgment-breivik-case but doesn’t really explain why it thinks it flawed. I may have misunderstood but really his diagnosis is not relevant to his sanity but his medical treatment, and once embroiled in the system, treatment can then commence. The difficulty here is what is insanity and how do you judge if someone is, or is not insane?

The legal systems are different throughout the world however they seem to work upon the same basic principles as the UK. It can be defined as

 http://legal-dictionary.thefreedictionary.com/insanity 1) mental illness of such a severe nature that a person cannot distinguish fantasy from reality, cannot conduct her/his affairs due to psychosis, or is subject to uncontrollable impulsive behavior. Insanity is distinguished from low intelligence or mental deficiency due to age or injury...

As you would imagine this is a very messy area to define and peoples motivations and fears can alter how we comport ourselves for such assessments. I really wouldn’t want to be the one making the decision. Training aside this issue is arguable and in some sense a bit arbitrary and also meaningless, or at least I think it should be.

At a point where you are deciding whether someone is insane and not responsible for the crimes or not, it seems quite obvious that regardless of the decision this person will be detained in an environment where treatment is available for a long time to come and isn’t that what they and us really need; them to get treatment. It is I would think very clear that the person in question is severely mentally ill and removal to a unit that can provide for their care is the important factor and so long as this happens does it really matter.

However the prison system being what it is and the provision of care for those with mental health problems seemingly poor I feel it becomes a question of whether a person will get the treatment they need to recover and control. And whether sane or not anyone within the system can be moved to a secure unit for treatment. That this happens as part of sentencing and of petitions to the courts makes the process a bit protracted but it still means that Mr Breivik may be sent to a hospital as opposed to a prison.

You might note that the prison system contains a higher than average number of people with mental health problems and moves by the government to increase access to mental health treatment have been underway for some time. http://www.mentalhealthcare.org.uk/forensic_mental_health_services Despite having looked for statistics sadly I haven’t yet to find any that report on the success or otherwise of this new system. What can be seen is that

The latest criminal justice statistics show nearly a third (31.2%) of defendants convicted of serious offences (crown court offences) last year had 15 or more previous convictions or cautions.

The number is the highest since 2001 when it was 17.9% and has risen steadily...

While the number of people with 15 or more cautions has risen steadily, the number of first time offenders has dropped since 2001 - from 11.9% to 10.1% in 2011

http://www.independent.co.uk/news/uk/crime/reoffending-rates-at-record-high-7785077.html

So something is certainly not working. However it seems likely that treatment of mental health problems would reduce the number of people reoffending, but I fear there are other issues here.

In all my reading no one has yet been able to define why people become mentally ill and really the research just points to several reasons why many of the people committing crimes might do so. In fact the biggest reasons appear to be because of crimes committed against them earlier in their lives. Not only that but poverty and separation from parents can also play large parts. It seems the entire system may be breeding a population of offenders and that really needs to be addressed.

But back to Breivik and his treatment, or rather him not being treated? It seems clear that he needs treatment however it may be that the biggest problem is convincing him that he needs treatment, insane or not, locked up or not forcing someone to loose their liberty until you say they are fit won’t necessarily make them adhere to treatment or be honest about what is going on in their heads but then you can of course keep them locked up but it won’t help with people who are not deemed a risk to public safety. So are people getting treated, these figures suggest that actually people are engaging with treatment

The most recent available figures from the Ministry of Justice show that 1,501 people were admitted to forensic services (high and medium secure hospitals) in England and Wales in 2008. More than half (926, or 62%) were transferred from prisons. In the same year, 1,255 people were discharged or died. Of these, 499 (40%) were to the community. Most others were discharged to other hospitals (186, 15%) or back to prison (167, 13%). http://www.centreformentalhealth.org.uk/criminal_justice/forensicservices.aspx

However like the NHS outside of prison this site reports the same problems for the prison service.

A transfer from a prison to a secure hospital is often a very slow process. The government instigated a pilot project to bring waiting times down to 14 days, but often it takes several months for a transfer to take place. We have received numerous reports that prison transfer times are rising but the available statistics do not provide sufficient information to give a clear picture of what is happening on the ground.

Which is not really surprising given that the NHS have problems meeting the needs of those outside the system let alone those that might require more secure handling, from within.

So maybe we should be worried about Breivik and whether he will get treatment but would declaring him insane help? I don’t think so, locking people up for indeterminate amounts of time because the health system is failing is a tragedy. Public safety is paramount but still I worry that him being locked up is tantamount to throwing away the key and not even trying... but maybe I still fear a system that has already been gotten rid of. A system that does not look at itself, have outside regulators or review patients, a system that fears mental health far more than seems reasonable. And given what some of these people have done it might be wise to be very, very cautious to the point of never letting them out but I worry about the people who have to make the decisions for that to happen. I worry that they might be wrong.