What makes people legally incompetent?

People who have committed crimes are sometimes judged to be not competent to stand trial because of their mental-health problems. Researchers from the City University of New York reviewed 68 studies carried out between 1967 and 2008 to determine which factors were most closely linked to being found incompetent to stand trial. The trials included a total of 26,139 people. Defendants diagnosed with psychosis were eight times more likely to be found incompetent and unemployed defendants twice as likely. The likelihood of being found incompetent was also double for defendants with a previous psychiatric hospitalisation. Those found to be incompetent were slightly older, mostly non-White and unmarried.

Suicide risk and criminal justice

Previous studies have shown that prisoners are substantially more likely to kill themselves but little is known about increased risk among other people who have a brush with the law. Researchers from the University of Manchester and the University of Aarhus in Denmark studied 552,118 people in Denmark 27,219 of whom committed suicide. More than a third of all the men who killed themselves had a criminal-justice history although the relative risk was higher among women with a criminal-justice history. Suicide risk was markedly increased among people who had been in jail but the risk was even greater among people who had been sentenced to psychiatric treatment and who had had charges conditionally withdrawn. The risk of suicide was greater even in people who had not been sent to jail or who had been found innocent and was especially high in people who had had recent or frequent contact with the law or who had been charged with violent offences.

Webb, Roger T. ... [et al] - National study of suicide in all people with a criminal justice history Archives of General Psychiatry doi:10.1001/archgenpsychiatry.2011.7

Child abuse and false confessions

Compliance involves people responding favourably to requests. In some cases this can be a good thing but in other instances it can lead to people making false confessions when pressure by the police, people being pressurised by their peers to commit crimes and people taking the blame for others' midemeanours. Some studies have shown a significant association between adverse events in people's childhoods, such as physical and sexual abuse, and the tendency to make false confessions and a team of researchers from King's College London and the University of Iceland looked into this further in a study of 113 people receiving outpatient treatment for substance misuse. They found that 64% of the sample reported more than one type of abuse and that compliance was significantly related to parental neglect and physical and sexual abuse. People who suffered from stress and low self-esteem were more likely to have suffered neglect as children while people who were more compliant were more likely to have been sexually abused. Suffering from more than one type of abuse had a multiplying effect on people's tendency to be compliant.

Gudjonssson, Gisli Hannes,  Sigurdsson, Jon Fridrik and Tryggvadottir, Hjordis Bjorg - The relationship of compliance with a background of childhood neglect and physical and sexual abuse The Journal of Forensic Psychiatry & Psychology DOI: 10.1080/14789949.2010.524707

Mental-health courts prove useful in U.S.

Mental-health courts aim to move people with a serious mental illness out of the criminal-justice system and into community treatment. The courts were first set up in the U.S. in 1997 and now there are around 250 of them. Treatment is usually a condition of appearing before the courts which reserve the right to punish defendants if they do not comply with their terms. Researchers from Policy Research Associates in New York studied 1,047 people in California, Minnesota and Indiana. 447 went through the mental-health courts while 600 appeared before the mormal courts. Those people who participated in the mental-health courts were significantly less likely (49% vs 58%) to be arrested again, had fewer arrests per year (1.3 vs 2.0) and spent less days in jail (82 days vs 152 days).

Bipolar disorder and violence

Previous research into bipolar disorder and violent crime has found that those with the condition are more likely to engage in acts of violence. However, it is unclear whether the disorder itself, or some of the problems that go with it are behind the link. Researchers from the Karolinska Institutet in Sweden and Oxford University carried out research in Sweden where the state keeps a huge amount of information about people. They compared 3,700 patients with bipolar disorder, cared for in Swedish hospitals between 1973 and 2004, with 37,000 unaffected people from the general public. They found that the number of people committing violent crime was about the same in people with bipolar disorder and no substance-abuse problem and unaffected people (5% vs 3%). However, people with bipolar disorder and a substance-abuse problem were much more likely (21%) to commit violent crimes. The findings mirror similar research into schizophrenia which also found that it was schizophrenic's drug problems not their condition in itself that lead to an increased risk of violence.

You can find out more about this research by clicking on the title of this post.

What makes a teenage sex offender?

Some researchers think that adolescent sex offenders commit crimes because they lack the social skills to form more conventional relationships and therapies for them often concentrate on providing such skills. However, a review of the research by Michael Seto of the Royal Ottawa Health Care Group and Martin Lalumiere of the University of Lethbridge in Alberta has questioned this view. The researchers looked at 59 independent studies comparing a total of 3,855 male adolescent sex offenders with 13,393 non-offending children. The study found that there was no difference in social competence or social skills between the two groups. The researchers also found that there was no evidence to support connections between family problems, parent-child relationships and attitudes and beliefs about women, and sex offending. Instead having atypical sexual interests such as desiring young children, wanting to rape people or to expose oneself to them were more closely linked with sex offending as were being sexually abused themselves, being exposed to sexual violence in their families and experiencing early exposure to sex or pornography.

You can find out more about this research by clicking on the link in the title of this post.

Studying the psychology of Perry Mason

A brilliant cross-examination that gets an innocent person off the hook or puts a guilty one behind bars is a staple of courtroom dramas and novels. A study by researchers at the universities of Liverpool and Leeds shows that schooling witnesses in the kind of questioning techniques used by lawyers can actually help improve the accuracy of their answers. The researchers showed more than 50 participants footage of a staged crime and then subjected them to the kind of questioning techniques that they might come across in court. They found that the participants who had been given prior guidance on cross examination techniques were able to respond appropriately and were less likely to make mistakes. The researchers thought that the use of complex questions containing multiple parts, double negatives and advanced vocabulary employed by lawyers taxes the brain making it less able to filter and organise information. By preparing the participants in advance they were able to devote less energy to understanding the lawyer and more to answering the question.

http://www.sciencedaily.com/releases/2010/06/100615093240.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily+%28ScienceDaily%3A+Latest+Science+News%29&utm_content=Google+Reader

What makes stalkers keep on stalking?

One of the most important factors in dealing with stalkers and protecting their victims is the likelihood of stalkers persisting in their behaviour. A team of researchers led by David V. James from the North London Forensic Service studied 275 people who had come to the police's attention for stalking members of the royal family and 211 people who had been referred to a community forensic mental health clinic as a result of their stalking. They found that the most important factors associated with persistence were psychotic illness, intimacy-seeking motivation and using multiple or intrusive forms of communication.

James, David V. ... [et al] - Persistence in stalking: a comparison of association in general forensic and public figure samples Journal of Forensic Psychiatry and Psychology April 2010, 21(2), 283-305

STAIR helps patients climb out of reoffending

The Service for Treatment and Abatement of Interpersonal Risk (STAIR) is a cognitive-behavioural therapy (CBT) programme originally designed for prisoners and adapted for offenders with chronic mental illness. A team of researchers led by Kathy F. Yates from the Nathan Kline Institute for Psychiatric Research in New York studied 145 patients who had completed the programme and who were followed for between six months and five years after being discharged. The team found that significantly fewer arrests, hospitalisations and days institutionalised occurred after people had been through the STAIR programme. Whether people continued to take their medication was the single most important factor associated with people staying well and the prevention of criminal behaviour.

Yates, Kathy F. ... [et al] - Psychiatric patients with histories of aggression and crime five years after discharge from a cognitive-behavioral program Journal of Forensic Psychiatry and Psychology April 2010, 21(2), 167-188

Politicians and their stalkers

Because of their high profile celebrities are more vulnerable to stalking than other people and politicans are no exception. A team of researchers from Canada surveyed 424 politicians from both the Federal (national) and Provincial (local) assemblies and found that 29.9% had experienced harassment. 87% of those who had experienced harassment thought that the perpetrator had a mental-health problem. Both Federal and Provincial politicians had experienced harassment and overt threats and subsequent physical approach. Harassers who did not overtly threaten but who both telephoned and wrote more frequently were more likely to approach politicians.

Adams, Susan J. ... [et al] - Harassment of Members of Parliament and the Legislative Assemblies in Canada by individuals believed to be mentally disordered Journal of Forensic Psychiatry and Psychology December 2009, 20(6), 801-814

Stopping sex offenders reoffending - how successful are treatments?

There is growing confidence in the ability of health professionals to predict reoffending by sex offenders but less optimism about the effectiveness of treatment. Researchers from Oxleas NHS Trust in south-east London studied 273 sex offenders who had been in the community for an average of nine years. 128 of them had received community treatment from the Challenge Project programme in south-east London. The study found encouraging results to suggest that higher risk and more psychologically-disturbed people who took part in the cognitive-behavioural treatment on offer were likely to complete the programme with high levels of attendance and were less likely to reoffend and breach their parole orders.

Craissati, Jackie, South, Rebecca and Bierer, Klive - Exploring the effectiveness of community sex offender treatment in relation to risk and re-offending Journal of Forensic Psychiatry and Psychology December 2009, 20(6), 769-784

Going straight - more help needed for people with mental-health problems

U.K. charity the Sainsbury Centre for Mental Health says that prisoners with mental-health problems are not being given the help they need to find work when they are released. The charity's policy paper - Securing Employment for Offenders with Mental-Health Problems - states that too many prison-based work-preparation schemes exclude mentally-ill people because they are not thought to be ready for work, even though having a job is the single biggest factor in cutting the reoffending rate. The charity said that prison schemes placed too much emphasis on learning skills and not enough on cultivating links with employers. It called for a wider adoption of policies based on individual placement and support - involving helping people to secure paid jobs and providing in-work support to both employer and employee as long as they need it.

You can download a copy of the Sainsbury Centre report at

http://www.scmh.org.uk/pdfs/securing_employment_for_offenders.pdf

Psychopaths often violate social norms, are manipulative, impulsive and sensation-seeking and appear to feel no empathy or remorse. Previous studies have found that the amygdala - a part of the brain that processes emotions - and the orbitofrontal cortex (which handles impulses and decision-making) are structurally and functionally different in psychopaths. Researchers from the Institute of Psychiatry in London used brain-scanning technology to compare the brains of nine criminal psychopaths (who had been convicted of a variety of offences including murder and rape) with nine normal, law-abiding people. They found that the connections between the amygdala and the orbitofrontal cortex were much weaker in the psychopaths. It is not known whether the brain differences are present from birth or whether they develop throughout the psychopaths' lives. More studies are needed but the psychopaths are not the most amenable of participants in research.

You can find out more about this study at

http://uk.reuters.com/article/idUKTRE5764NI20090810?feedType=RSS&feedName=healthNews&sp=true

Self-regulation and sex offenders

The self-regulation model is a theory used to explain why sex-offenders reoffend. It talks about two factors. The first one is avoidance or approach - whether the sex offenders want to avoid committing more crimes or to commit them again. The second part deals with how the offenders regulate their behaviour to achieve their goals - either passively with no clearly-thought-out strategy or actively taking more concrete steps to achieve their goals. This gives a total of four categories into which offenders can be placed: avoidant-active, avoidant-passive, approach-passive and approach-active. Avoidant-active offenders are the least dangerous (although this is relative and they can re-offend if their active strategies are of poor quality) and approach-active ones are the most dangerous. It is not known whether this framework can be applied to sex offenders with learning disabilities so researchers from Birmingham University and two local NHS trusts studied 28 sex offenders with a learning disability. They found that the offenders could be fitted into the four categories and that there were similar numbers of offenders in each category compared to offenders without learning disabilities. The offenders who used a passive self-regulatory style had a lower level of intellectual functioning than those with a more active style.

Ford, Hannah J., Rose, John and Thrift, Sue - An evaluation of the applicability of the self-regulation model to sexual offenders with intellectual disabilities Journal of Forensic Psychiatry and Psychology June 2009, 20(3), 440-457

Alcohol, glucose and violent crime

There is a strong link between alcohol intoxication and violent crime but not everyone who drinks becomes aggressive or violent. A Finnish study of 89 people compared impulsive, violent, antisocial male offenders to a non-offending control group. The participants' glycogen levels (which are connected to glucose metabolism) were measured at the start of the study and the participants were followed for eight years to see whether they committed any violent crime. 17 of the offenders re-offended over the course of the study and the average glycogen levels of these people were much lower than in those participants who stayed out of trouble.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/06/090601092149.htm

Mentally-ill murderers' modus operandi

The overall murder rate in England and Wales is low compared to other countries and people with mental-health problems only commit a small percentage of them. There has been no research into the kinds of murder committed by people with mental-health problems in England and Wales so researchers from the University of Manchester analysed 3,930 murders committed between 1997 and 2003. The use of firearms was rare and in 36% of cases a sharp instrument was used. Murderers with schizophrenia tended to use a sharp instrument and predominantly killed a family member or spouse in the home. Murderers diagnosed with an affective disorder were more likely to use strangulation or suffocation while alcoholics used hitting or kicking more often, mainly to kill acquaintances. Drug-dependent murderers were more likely to use 'non-violent' methods such as poisoning.

Rodway, Cathryn ... [et al] - Methods of homicide in England and Wales: a comparison by diagnostic group Journal of Forensic Psychiatry and Psychology April 2009, 20(2), 286-305

Where do they go to after the unit?

When secure forensic services are set up people often worry that service users - who can be drawn from a wide geographical area - will be discharged close to the unit leading to an increased burden on local health services and a rise in the crime rate. There has been no research into whether this actually happens or not so a study of service users at the Norvic Clinic in Norwich tried to find out. The study looked at the addresses service users had been discharged to between 1984 and 2006 and found that they lived considerably closer to the clinic on discharge than they had on admission and that this increase was concentrated in a few geographical areas. 76% of patients moved area at some point and this was more common after longer admissions and for patients admitted from high-secure hospitals. The study found that patients were discharged disproportionately to areas around the clinic.

Jones, Christopher N. - Community residence on discharge from a medium secure unit: where have all the patients gone? Journal of Forensic Psychiatry and Psychology April 2009, 20(2), 225-238

Naltrexone and kleptomania

Naltrexone is used to treat people with alcohol and drugs problems but it could also help people with kleptomania as well. Researchers at the University of Minnesota tested it for two months on 25 people who said they spent at least one hour a week stealing. Those who took naltrexone reported significantly less stealing behaviour compared to those given a placebo.

You can find out more about this research at

http://uk.reuters.com/article/healthNews/idUKTRE52U82820090331?feedType=RSS&feedName=healthNews&rpc=401

A Missed Opportunity

Courts in the U.K. can include a Mental Health Treatment Requirement (MHTR) in people's sentences when they give people a community punishment. However, according to a new report by the Sainsbury Centre for Mental Health - A Missed Opportunity - few people have been given them, despite the fact that two-fifths of people on community sentences have mental-health problems. The report found that the purpose of MHTRs and to whom they could be given were not clear to magistrates, probation officers or court officials. There were long delays in the production of court psychiatric reports and widespread confusion about the implementation of MHTRs. The report called on the Government to issue clear guidance on the use of the MHTR, and on the courts to take an active role in identifying people who could benefit from them. It also called for local health services to make services available to support people given the requirement.

You can download the full text of the report at

http://www.scmh.org.uk/pdfs/Missed_Opportunity.pdf

Helping sex offenders with learning disabilities

The Sex Offender Treatment Services Collaborative

www.sotsec.org

is a group of professionals who provide treatment for men with intellectual disabilities who are at risk of sexual offending. The group provides a forum for the discussion of treatment issues as well as training and support for clinicians who are delivering group cognitive behavioural treatments for men with intellectual disabilities who sexually abuse. One of the modules in the programme uses a four-stage model - motivation to abuse, overcoming internal and external inhibitions and overcoming victim resistance - to help offenders understand their steps to offending. An article in this month's British Journal of Learning Disabilities looks at the progress of four men going through this programme and discusses some of the issues around this work.

Goodman, Wendy ... [et al] - Group treatment for men with learning disabilities who are at risk of sexually offending: themes arising from the four-stage model to offending British Journal of Learning Disabilities December 2008, 36(4), 249-255