crime psych 3

Question 1

Deinstitutionalization (1950s – 1970s)

Answer 1

• Re-integration of people with severe mental health problems into society
• There was a corresponding increase in number of
  prisoners
• ‘Fitness and criminal responsibility test’ for potential diversion to forensic mental health system

Question 2

Mental disorder

Answer 2

• Syndrome characterized by clinically significant disturbance in cognition, emotion regulation, or behaviour
• Reflects psychological, biological, and/or developmental dysfunction
• DSM often ignores environmental or sociocultural factors

Question 3

DSM Multi-axial system

Answer 3

DSM’s prior multi-axial system included:

Axis I: Clinical disorders, including schizophrenia and dissociative and substance-related disorders
* Most likely to lead to diversion into mental health system
* Due to disconnection with reality
* Most likely to be detected by police, courts, and corrections

Axis II: Personality disorders (e.g., antisocial personality disorder and psychopathy) and intellectual disability
* Person with a PD ‘knows right from wrong’
* ASPD is extremely common among incarcerated offenders

Question 4

when is DSM used…

Answer 4

Symptoms do not directly ‘cause’ crimes but should be considered in court process

Assessed:

(1) at time of alleged crime to assess responsibility
* i.e., by police and then a mental health professional for treatment
* Person may then be involuntarily admitted to a psychiatric hospital due to risk of harm

(2) during court proceedings to assess fitness
* i.e., person is arrested and then referred for psychiatric assessment
* May be assessed as unfit to stand trial (UFST) or not criminally responsible on account of mental disorder (NCRMD) = transfer to psychiatric hospital
* If UFST, goal is to stabilize until fit to stand trial

(3) when in prison
* May be transferred to correctional psychiatric hospital if problems continue
* 700 treatment beds in Canada for federally sentenced mentally disordered

Question 5

Unfit to stand trial (UFST)

Answer 5

Accused is unable to participate in their defence due to mental disorder;

Unable to:
* understand the nature or objective of the proceedings
* understand the possible consequences of the
proceedings, or
* communicate with counsel

Accused is diverted to mental health system until sentencing
* e.g., 2018 shooting in Fredericton by Matthew Raymond
* In 2019, jury found him unfit; schizophrenia
* Reassessed after 60 days of treatment in facility
* In 2020, deemed fit to stand trial and found not criminally
responsible; sent to psychiatric hospital
* 2021: Denied request for escorted trips outside hospital
* 2023: Granted supervised outings for treatment purposes

Question 6

Not criminally responsible on account of mental disorder (NCRMD)

Answer 6

Criminal responsibility cannot be established; person was incapable of appreciating the nature and quality of the act

• Defense was only applied to fewer than 1 out of 1000 court cases from 2005 – 2012
• e.g., Vince Li (2008 murder of Tim McLean)
• Found NCRMD in 2009 and granted absolute discharge in 2017

Person is committed to psychiatric hospital until risk to the public can be managed in the community

Provincial or territorial Criminal Code Review Board of mental health and legal professionals and citizens decide on
(1) Continued detention
(2) Conditional discharge
(3) Absolute discharge

Crocker et al. (2015) study on 1,800 cases with NCRMD status 2000 - 2005
* Main offences: uttering threats (27.4%); assaults (26.5%); property crimes (16.9%); homicide (6.9%); sexual offences (2.3%)
* Main diagnoses: psychotic disorder like schizophrenia (70.9%); substance use disorder (30.8%); mood disorder (23.2%); personality disorder (10.6%)
* *Not mutually-exclusive; unlikely to get NCRMD status with PD or SUD alone
* 57.6% were experiencing psychotic symptoms; 23.1% were under influence

Question 7

mental illness stigma

Answer 7

Stigma is a major barrier to treatment
* The mentally ill are assumed to be violent and/or
unpredictable

Public stigma; due to bias in media portrayals
* 40% of news articles negatively associate crime, violence, danger with MI
* 17% included the voice of someone with MI
* 25% included the voice of an expert
* 19% discussed treatment
* 18% discussed recovery or rehabilitation

Self-stigma: when people with MI accept and agree with negative stereotypes
* May feel ashamed, blameworthy, try to conceal their illness

Question 8

clinical risk factors for crime

Answer 8

Contact with police is common among the mentally ill
* 2/5 people with MI have been arrested
* 3/10 have had the police involved in care pathway
* Police are becoming less reactive and more proactive in Canada

Why?
* Co-occurring substance abuse
* Treatment non-compliance
* Social and systemic factors
* Improper deinstitutionalization/lack of treatment
* Homelessness
* Poverty
* Community disorganization
* Poor mental health and social services

Question 9

Antisocial personality disorder

Answer 9

Pervasive pattern of disregard for and violation of the rights of others, occurring since 15 years of age

Question 10

Prevalence of mental
disorders among offenders
in Canada

Answer 10

Beaudette and Stewart (2016)
* Diagnostic survey of 1,1110 federally sentenced men and women
* More serious disorders are more prevalent, Esp. substance use and ASPD
* Over 80% lifetime prevalence
* Almost ¾ of sample currently met criteria for a disorder
* <5% lifetime prevalence for psychotic and bipolar disorders
* Compared to 1% in community samples
* 1/3 lifetime or current prevalence of anxiety disorder, esp. PTSD or panic disorder
* Almost half had a diagnosis of ASPD
* 15.9% had borderline PD
* 2/3 lifetime prevalence alcohol and substance use disorder

Question 11

Prevalence of mental
disorders among types
of offenders in Canada

Answer 11

Wilton & Stewart (2017)
* Robbery most likely to be associated with substance use and co-occurring disorder

England et al. (2008)
* 1,396 incarcerated male violent offenders
* 73% met criteria for any personality disorder
* 65% for antisocial personality disorder
* 22% paranoid personality disorder
* 18% borderline personality disorder

Question 12

Schizophrenia

Answer 12

A broad spectrum of cognitive and emotional dysfunctions leading to significant emotional and behavioural difficulties

• Including delusions and/or hallucinations and/or disorganized speech
• Can include grossly disorganized or catatonic behaviour and/or negative symptoms like diminished
  emotional expression or avolition

Question 13

Alcohol or other substance use disorder

Answer 13

A problematic pattern of alcohol or other substance use leading to clinically significant impairment or distress

Question 14

Bipolar disorder

Answer 14

Major depressive episodes alternating with hypomanic or full manic episode

Question 15

Borderline personality disorder

Answer 15

Pervasive pattern of instability in interpersonal relationships, self-image, and affects…

• …and marked impulsivity, all beginning by early adulthood across a wide range of context

Question 16

Paranoid personality disorder

Answer 16

Pervasive distrust and suspiciousness of others beginning by early adulthood

• e.g., hostile attribution bias

Question 17

Why might mental illness be prevalent among offenders?

Answer 17

Major mental illnesses represent responsivity issues that clearly reflect the Central Eight risk factors

• Psychopathological perspective: some mental health symptoms have criminogenic potential
• Psychosis was associated with 49% - 68% increase in odds of violence (Douglas et al., 2009)
• Particularly schizophrenia involving active hallucinations and/or delusions

Psychosis provides:
* (1) Motivation for violent behaviour
* e.g., paranoid delusions
* Delusions: fixed beliefs that are not amenable to change in light of conflicting evidence
* Bizarre (e.g., aliens controlling thoughts) or non-bizarre (e.g., police are constantly watching you)
* (2) Destabilization of decisions and behaviour, leading to disorganized and impulsive acts
* e.g., command hallucinations: voices that instruct a person to act in specific ways
* (3) Disinhibition of factors that normally inhibit violence
* e.g., negative affect

TCO (threat/control override) symptoms: cause someone to feel threatened or involve the intrusion of thoughts that can override self-controls
* Perhaps the only psychotic symptoms with strong link to violence
* Most command hallucinations are non-violence

Question 18

Lowering risk of violence among persons with mental illness

Answer 18

Increased risk of violence in justice-involved persons with mental illness is likely when the following are present:

(1) Active psychotic symptoms with a substance use disorder, and a history of violence or current attitudes supportive of violence

(2) The presence of a delusional belief (TCO)

(3) Command hallucinations to commit violence

Question 19

Factors associated with crime, violence, and recidivism in persons with mental illness

Answer 19

Bonta et al. (2008/2014)
* Longer hospital stays associated with decreased violent and general recidivism
* Personality disorders, specifically ASPD, moderately associated with violent and general recidivism
* Psychosis, specifically schizophrenia, and mood disorders unrelated or even inversely related to recidivism
* Dual diagnosis; substance use disorder combined with another mental health condition strongly associated with violent and general recidivism

In some studies (e.g., a large correctional sample), mental illness was only associated with recidivism when catalyzed by a substance use diagnosis

Question 20

Assessment
Approaches

Answer 20

Corrections agencies screen mental illness upon intake to prison
* e.g., The Brief Jail Mental Health Screen
* Screens for mental health symptoms and suicide risk, can be administered by non mental health staff
* Takes 2.5 minutes

e.g., since 2009, Computerized Mental Health Intake Screening System
* Self-report measures of mental health symptoms
* In a sample of 500 federally sentenced men 264 federally
sentenced women:
* 46% of women reported high psychological distress
* 58% of indigenous versus 30% of non-Indigenous women reported history of suicidal ideation, suicide attempts, and self-harm
* 50% of men required follow-up evaluation
* 36% of these men required mental health services
* 12% of men had a confirmed major mental disorder
* The most prevalent problems were substance use
disorders
* 70% of women with mental health problems also scored
high on measures of substance use

Question 21

Assessment
of Risk for
Suicide

Answer 21

Suicide rates are higher than in general population
* e.g., 96 suicides per 100,000 prisoners vs. 14 per
100,000 (1959 – 1975)
* 211 federal inmates committed suicide 1994 – 2024

• Leading cause of unnatural death among federal inmates (20% of all deaths)
• When high risk for self-harm or suicide, usually placed
  on a watch in an isolation cell
• Mental health assessment required for a person to
  be taken off watch

Question 22

historical context of psychopathic offending

Answer 22

Historically, psychopathy was a ‘wastebasket category’ used to define antisociality

• ‘Madness without delusions’ (Pinel, 1801); impulsive and
  violent acts
• ‘Moral insanity’ (Prichard, 1883); know their illegal and
  immoral acts are wrong but don’t care
• Don’t respond to punishment
• ‘Psychopathic inferiority’ (Koch, 1888); a orimarily
  biologically predetermined personality disorder
• Types of psychopathy (Kraeplin, 1908):
• Born criminals without sense of morality or remorse
• Morbid liars who enjoy lying and deceiving
• Spendthrifts who use/rely on others for money
• Vagabonds who live day-to-day with few plans and
  who take off on a whim

Question 23

psychopathy

Answer 23

The first DSM (1952) included ‘sociopathy’
* “a chronically antisocial person who lacks loyalty to anything or anyone and is callous, lacking judgment, immature, and often able to rationalize their antisocial behaviours”
* The term ‘sociopathy’ was coined in 1928 (Partridge)

DSM-II (1968): ‘Antisocial personality’

DSM-III (1980): ‘Antisocial personality disorder (ASPD)’
* Diagnostic criteria focus on behavioural rather than personality symptoms

DSM-5 (2013)
* ASPD: Manipulativeness, deceitfulness, hostility, callousness
(antagonism traits), and impulsivity, risk taking, and irresponsibility (disinhibition traits)
* Must have had conduct disorder before age 15 with 3 of 7 adult symptoms

Question 24

Hare psychopathy checklist

Answer 24

20-item symptom measure using a 3-point scale

Glibness, egocentricity, proneness to boredom, parasitic lifestyle, lack of remorse, lack of emotional depth, etc.

Question 25

prevalence of psychopathy

Answer 25

71% of one UK sample had no psychopathic traits
* 1.2% of a US sample scored as ‘potentially psychopathic’
* <1% in general community score high on psychopathy measures
* Much more likely to engage in violence

• More common among upper-level corporate
  managers
• 8 out of 203 scored in diagnostic range
  (4.9%)
• Coworkers are more likely to be bullied and harassed, have less career success and job satisfaction, and more work-family conflict and overall psychological distress
• 10-25% of incarcerated adult offenders classified as high on psychopathic traits

Question 26

impact of psychopathy on society

Answer 26

Impact on society is significant
* e.g., 3 studies substantial levels of emotional, financial, and physical harm

Kirkman (2005) interviewed 20 females who had been involved for 6 months of longer with a man they described as psychopathic

Forth et al. (2022) used a sample of 457 females (90%) and men (10%) who had been romantically involved with a partner they described as psychopathic
* Participants reported experiencing depression, PTSD symptoms, anxiety, trust problems, and physical health problems

Humeny et al. (2021) found that the frequency, severity, and number of types of abuse was predicted with the abusers’ psychopathic traits

Question 27

psychopathic themes

Answer 27

8 common themes identified by Kirkman (2005):
* Talking victim into victimization
* Lying
* Economic abuse
* Emotional abuse/psychological torture
* Multiple infidelities
* Isolation and coercion
* Assault
* Mistreatment of children

People with psychopathic traits are better at identifying people who have experienced prior violence based on gait cues/walking style
* e.g., Wheeler et al. (2009) and Book et al. (2013)
* Viewers with higher psychopathy and Factor 1 scores
(interpersonal and affective traits) were more accurate at
classifying ppl who had experienced sexual or violent
crimes
* More recent research finds that Factor 2 might be more
strongly related

Question 28

Affective Deficits Models of psychopathy

Answer 28

General emotional deficit
* Poverty of emotions such that they can’t experience emotions and therefore can’t appreciate the emotional reactions of others

Specific emotional deficit
* e.g., lack of compassion?
* e.g., lack of fear (e.g., in face of punishment; low-fear
hypothesis)
* e.g., integrated emotion systems theory: inability to recognize sadness or distress in others
* e.g., violence inhibition theory: Can’t recognize sadness or distress in others

Question 29

Attention Model of psychopathy

Answer 29

Response modulation deficit: can’t focus attention to modify (i.e., inhibit) initial responses

• e.g., once they decide to retaliate, they don’t change their minds

Poor passive-avoidance conditioning/they fail to learn how to inhibit their behavioural responses

Question 30

Developmental Models

Answer 30

• e.g., do not have the emotional capacity (i.e., guilt, empathy) necessary to develop a conscience in response to discipline

From as young as 30 months, healthy children learn to inhibit behaviours that have negative consequences on others
* And to have their own negative emotions in response to other people’s distress
* Children and adults with psychipathic traits show reduced autonomic responses to the distress of others and reduced recognition of sad and fearful expressions

In comparison with children with other conduct problems,
children with psychopathic traits are less responsive to parental socialization…
* …display less distress over actions that hurt others
* …and have reduced overall emotional responses to emotional stimuli

Question 31

genetic theories of psychopathy

Answer 31

Twin studies: strong genetic component among children,
adolescents, and adults

Moderate to strong genetic influence for all psychopathic traits

Interventions need to start early

Question 32

neurological theories of psychopathy

Answer 32

Reduction in prefrontal grey matter
* e.g., problem-solving, self-control

Less grey matter in right superior temporal gyrus
* e.g., perception of emotion

Less hippocampal volume
* e.g., response inhibition, learning/memory

Less amygdala volume
* e.g., storage of memory of emotional events (e.g., contextual fear conditioning), moral emotions

Increase in callosal white matter, hyperconnectivity
* e.g., intellect, reduced lateralization of functions (e.g., areas important for emotional processing, remorse)

Question 33

Psychopathy and other psychiatric disorders

Answer 33

Psychopathy is often comorbid with substance use disorder

Psychopathic traits are strongly related to antisocial and narcissistic personality disorders, and moderately related to paranoid, borderline, and histrionic personality disorders

In youth, psychopathic traits have a strong association with conduct disorder and moderate association with ADHD

Question 34

Psychopathy and Crime,
Violence, and Recidivism

Answer 34

Psychopaths often begin criminal careers at an early age and persist in violence across the lifespan

Engage in both proactive/reactive and predatory/instrumental
violence

Psychopathy predicts all types of recidivism
* Small to moderate relationship with sexual recidivism and institutional violence

Why do psychopaths engage in crime?
* Sensation-seeking and risk-taking; prone to being in high-risk situations
* Impulsive; fail to consider alternatives to, or consequences of, crime
* Unemotional; can’t appreciate the emotional consequences of crime
* Suspicious; perceive hostile intent in others
* Selfish and arrogant; want to have power and control over others