Crime and punishment

Another tragic violent crime in America and many are now talking about mental health and violence. Are those with mental health problems more violent, well that remains to be seen as far as I’m concerned however it does seem that people have pegged us ‘nutters’ as violent.  I guess the first thing for me is that violence is often described in many ways and so it is not simply a matter of tarring  crimes as violent without explaining exactly what is meant. In the same way I would not want to say all problems with mental health are the same as clearly they are not.

And here in lies the problem for me. On the one hand I would say there is a clear indication that problems with mental health make it more likely that a person will be violent than someone who doesn’t, except, and this is an important exception, those who are under the influence of drugs or alcohol for whom I would put at more risk. In fact I would put them at a lot higher risk; however it makes life very difficult since how can you assess accurately whether someone is under the influence. In some cases it is remarkably easy in others not so.

 If you look at MINDS page on dangerousness you’ll see that they claim we no more violent than the general population however I would caution anyone from taking these figures at face value and not because they are not accurate but just because they seem woefully incomplete.

• ·         For instance they quote figures on homicides but homicides aren’t the only violent crimes.
• ·         Estimates of how many people suffer from a mental illness came from the household morbidity survey which although robust is not without its flaws and covers the common mental health problems and some of their freedom of information data.
• ·         Current research suggests that about 4% of people experience some of the characteristic symptoms of bipolar disorder at some point in their life. 03-0.7% of people suffer with schizophrenia, and about 1% of people suffer from psychosis during their lives (from Wikipedia and otherwise insourced), grand total ~5%  so the question is what percentage do common mental health problems contribute to the overall total?

With 10% of the homicides being attributed to people who had mental health problems at the time of the offence this doesn’t look like the clear cut we are no more violent than the general population, however this definition of mental illness encompasses all mental health problems not just the big 3 and therefore doesn’t really tell you if there is an increase. However

• ·        More than 70% of the prison population has two or more mental health disorders. (Social Exclusion Unit, 2004, quoting Psychiatric Morbidity Among Prisoners In England And Wales, 1998) 

And although not all crime is violent it does kind of suggest that actually there is a far bigger picture to consider here.

My biggest bind with things is that actually I don’t think the population associate increased risk of violence with all mental health issues. They may say this but then most people have no idea of the range of problems that are encompassed within mental health. Personally I think most people associated mental illness with just 3, psychosis, Schizophrenia and bipolar disorder and I say this because in general people can’t name more than these as mental illnesses and so frequently do I hear ‘oh depression that’s so sad I’ve been there’ that I don’t believe they even consider it a mental illness even though it is the most commonly recognised. I think it occupies a strange place in peoples heads where it is a mental illness but also it isn’t. It’s an odd one and I certainly think it is most commonly considered a suicide risk rather than violent. So when they talk about mental illness it only encompasses the 3 and there prejudice is also limited to just the 3.

That having been said this study in the journal of the American medical association is quite good although it does have some recognised weaknesses; namely in identifying all people with schizophrenia from the population which could skew the results.  It does conclude that people with schizophrenia are more likely to commit violent crime.

I find it interesting that the studies have used convictions but there seems to be no mention of how much violent crime goes convicted and even less about unreported. People can be violent without getting caught.

The other thing that it notes that so frequently is ignored is that an association is not a causal link, ie being ill does not make them more violent. It’s an oddity but because of the nature of mental health people don’t always think about how you become ill. They don’t think about how that could also mean that other things that might predisposed a person to become violent may also have been present in their lives as a confounding factor and hence I think why they looked at siblings without schizophrenia.

In practical terms it doesn’t really matter why someone might be more of a risk of being violent since they would be treated exactly the same however whether this is reasonable is another thing.

It was clear that the biggest underlying factor affecting the risk of violence was alcohol found in both the control group and as a comorbid problem.