Mental Disorders and DSM-5

• Mental disorders significantly impair a person's ability to manage daily life.
• The DSM-5 is used in diagnosing mental disorders.
• There has been increased standardization across updated versions of the DSM.
• 46% of Americans may experience a mental disorder in their lifetime, which can lead to over diagnosis.

Prevalence of Mental Disorders (Males 18-44)

• Antisocial personality disorder: 8% in the community, 57% among offenders
• Substance abuse: 40% in the community, 87% among offenders
• Anxiety disorders: 5% in the community, 16% among offenders
• Depressive disorders: 12% in the community, 23% among offenders
• Schizophrenia: 0.5% in the community, 2% among offenders
• Substance abuse is the most common disorder in both community and offender populations.
• Schizophrenia is the least common disorder in both populations.
• The largest difference between community and offender populations is in antisocial personality disorder.
• 76% of women offenders have at least one current mental disorder.

Reasons for High Rates of Mental Illness in Offender Populations

• Increased risk factors such as child poverty and maltreatment
• Individuals are more likely to be arrested, tend not to evade police, and tend not to plan crimes carefully.
• Increased likelihood of pleading guilty and accepting responsibility
• Certain symptoms may lead to criminal behaviors.

Stigma and Mental Illness

• Stigma includes the perception that people with mental illness are dangerous, incompetent, unpredictable, and responsible for their condition.
• Stigma can lead to issues such as difficulty in getting hired or rented to, and lower standards of healthcare.
• Stigma results in experiences of lower self-esteem and self-efficacy, feelings of isolation, and a sense of hopelessness.
• The Forensic Stigma Scale (FSS) assesses stigma, exemplified by statements like "Most crimes committed by forensic patients are violent."

Challenging Forensic Stigma

• Knowing someone with a mental disorder can increase sympathy.
• Students in a forensic psychology course scored statistically lower on the FSS.
• A short educational video can reduce stigma.
• Indirect contact does not have the same impact as education in reducing stigma.

Mental Disorder and Violence

• Historically, it was believed that there was no link between mental illness and violent crime.
• The majority of individuals with mental illness do not commit violence.
• 10.7% of men and 2.7% of women with schizophrenia commit violent offenses.
• People with mental illness are more likely to be victims of violence.

Comorbidity

• The co-occurrence of a serious mental illness with risk factors, such as prior violence or substance abuse, increases the risk of violence.

Delusional Disorders

• Characterized by the presence of one non-bizarre delusion for at least one month. An example would be the delusion that a neighbor is trying to poison a dog.
• Persecutory type delusions involve beliefs of being spied on, followed, poisoned, harassed, or threatened.
• Delusional disorders can increase the risk of violence.
• 0.03% of the general population experiences delusional disorders.

Command Hallucinations (CH)

• Hallucinations involve a voice inside the head giving commands to do things such as kill someone or jump off a bridge.
• 50% of patients with auditory hallucinations experience command hallucinations.
• It is rare for people to be commanded to hurt themselves or others.
• It is even more rare for people to obey such commands.

Threat Control Override (TCO)

• TCO involves symptoms that override a person's sense of control.
• Examples include feeling that one's mind is controlled by an outside force or thinking that someone is planning to cause harm.

Link Between Mental Disorders (MD), Substance Abuse (SA), TCO, and Violence

• Substance abuse is linked to violence.
• Mental disorder and TCO are linked to 63% of violence.
• Mental disorder, substance abuse, and TCO are linked to 86% of violence.

Fitness to Stand Trial

• This concept addresses the question of whether someone is fit to proceed in court.
• A defendant may be "mute of malice" (refusing to answer) or "mute by visitation of God" (unable to answer due to a disease of the mind).
• A fair trial requires the defendant to communicate with their lawyer.
• An accurate trial requires the defendant to speak with their lawyer, for example, providing an alibi.
• Pretrial evaluations to determine fitness to stand trial occur in approximately 5,000 cases per year in Canada and an estimated 130,000 in the US.

Requirements to be Fit to Stand Trial

• Must have a mental disorder
• Understanding the nature of proceedings
• Understanding the consequences of proceedings
• Understanding the roles of everyone in the courtroom is essential for fitness to stand trial (lawyers, judge, jury, etc.).
• Everyone is presumed to be fit to stand trial.

Core Elements of Fitness to Stand Trial

• Focus is on the defendant's present ability.
• Focus is on capacity, not willingness.
• The defendant must possess a reasonable knowledge.
• Emphasis is on cognitive functioning, not just the presence of a mental disorder.

Treatment to Restore Fitness

• Individuals can be forced to undergo treatment if found unfit for trial.
• Individuals cannot be forced to undergo surgery or electroconvulsive therapy (ECT).

Competency Screening Test

• The Competency Screening test is a 22-item sentence completion test.
• Scoring is on a 3-point scale (2: competent, 1: unsure, 0: incompetent).
• Low scores, below 20, may indicate unfitness/incompetence.
• Low scores can be due to unfitness, cynicism, or depression.
• There is a high rate of false positives, approximately ~20%.

Insanity Defence

• Criminal guilt requires both:
  • Actus Reus: The wrongful act.
  • Mens Rea: Criminal Intent.

Not Criminally Responsible on Account of a Mental Disorder (NCRMD)

• Requires the presence of a mental disorder.
• The individual cannot appreciate the nature or quality of the act or know that it was wrong.
• The defense must raise the issue.
• A psychiatrist has 30 days to complete an assessment.
• It also requires that, in order to be criminally guilty, you must know the act was wrong.
• This defense is rarely used.