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NDRN joined over 20 national organizations including disability rights, civil rights, education, and privacy groups to express concerns about the Restoring, Enhancing, Strengthening, and Promoting Our Nation’s Safety Efforts (RESPONSE) Act, legislation introduced by Senator Cornyn

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NDRN joined over 20 national organizations including disability rights, civil rights, education, and privacy groups to express concerns about the Restoring, Enhancing, Strengthening, and Promoting Our Nation’s Safety Efforts (RESPONSE) Act, legislation introduced by Senator Cornyn

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“We believe it is urgent to address incidents of mass violence in our country,” said Curt Decker, Executive Director of the National Disability Rights Network. “However, those efforts should focus on real solutions rather than on mental health reforms that will have little impact on gun violence.” “Wrongly blaming people with psychiatric disabilities for gun violence sows prejudice and fear, undermining the opportunities for people with psychiatric disabilities to live, work and be full participants in their communities,” said Jennifer Mathis, Director of Policy and Legal Advocacy at the Bazelon Center for Mental Health Law.

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source 4e: Mass Violence Legislation Scapegoats People with Mental Illness

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source 4e: Mass Violence Legislation Scapegoats People with Mental Illness

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Today, NDRN joined over 20 national organizations including disability rights, civil rights, education, and privacy groups to express concerns about the Restoring, Enhancing, Strengthening, and Promoting Our Nation's Safety Efforts (RESPONSE) Act, legislation introduced by Senator Cornyn.

In the letter sent to Senator Cornyn, the coalition applauds the recognition of the need for a federal effort to address mass violence, but expresses serious concern about focusing that effort on people with mental health disabilities. The organizations urge that mental health reform legislation be separated from legislation addressing mass violence, pointing out the clear evidence that mental health disabilities are not predictors of gun violence, and that only 4% of gun violence is committed by people with mental health disabilities.

"We believe it is urgent to address incidents of mass violence in our country," said Curt Decker, Executive Director of the National Disability Rights Network. "However, those efforts should focus on real solutions rather than on mental health reforms that will have little impact on gun violence." "Wrongly blaming people with psychiatric disabilities for gun violence sows prejudice and fear, undermining the opportunities for people with psychiatric disabilities to live, work and be full participants in their communities," said Jennifer Mathis, Director of Policy and Legal Advocacy at the Bazelon Center for Mental Health Law.

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Mass Violence Legislation Scapegoats People with Mental Illness - NDRN

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Today, NDRN joined over 20 national organizations including disability rights, civil rights, education, and privacy groups to express concerns about the Restoring, Enhancing, Strengthening, and Promoting Our Nation's Safety Efforts (RESPONSE) Act, legislation introduced by Senator Cornyn.

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The violent police response to Mr. Wallace’s crisis could have been avoided had the City of Philadelphia taken steps to reform its emergency response system. In several jurisdictions from Eugene, Oregon to Denver, Colorado to New York City, communities have developed, or are in the process of developing, non-police emergency response systems so as to avoid violent or coercive outcomes. Development and implementation of such a new emergency response system should be an immediate priority.

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In the evening of Monday, October 26, 2020, 27-year-old Walter Wallace, an African-American man and father, was shot and killed by police in the street in front of his home. Mr. Wallace had for years struggled with his mental health, a fact known to the police as they had been to the Wallace home three times on Monday.

Mr. Wallace’s family members, who witnessed the horrific shooting scene, have stated they had called 911 for an ambulance to get him help with a mental health crisis, not for police intervention. Rather than sending an emergency responder who could work to de-escalate the situation and safely transport Mr. Wallace for mental health treatment, the police responded, with tragic consequences.

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source 4d: NDRN Executive Director Curt Decker’s Statement on the Death of Walter Wallace

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source 4d: NDRN Executive Director Curt Decker’s Statement on the Death of Walter Wallace

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In the evening of Monday, October 26, 2020, 27-year-old Walter Wallace, an African-American man and father, was shot and killed by police in the street in front of his home. Mr. Wallace had for years struggled with his mental health, a fact known to the police as they had been to the Wallace home three times on Monday.

Mr. Wallace's family members, who witnessed the horrific shooting scene, have stated they had called 911 for an ambulance to get him help with a mental health crisis, not for police intervention. Rather than sending an emergency responder who could work to de-escalate the situation and safely transport Mr. Wallace for mental health treatment, the police responded, with tragic consequences.

The violent police response to Mr. Wallace's crisis could have been avoided had the City of Philadelphia taken steps to reform its emergency response system. In several jurisdictions from Eugene, Oregon to Denver, Colorado to New York City, communities have developed, or are in the process of developing, non-police emergency response systems so as to avoid violent or coercive outcomes. Development and implementation of such a new emergency response system should be an immediate priority.

Additionally, and in parallel with the development of alternative emergency response systems, communities also need to plan for and develop a network of robust community services to help prevent similar crises from developing.

People with disabilities, particularly people of color with disabilities, are vastly and disproportionately impacted by police violence, with dozens of similarly tragic and avoidable police shootings of people with disabilities occurring in the last few months alone. In addition to holding police officers and political leadership accountable, long-term solutions for avoiding violent episodes like this one are to develop effective non-police emergency response systems while building up a robust system of community services to prevent the kind of violence that took Mr. Wallace's life.

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NDRN Executive Director Curt Decker's Statement on the Death of Walter Wallace - NDRN

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In the evening of Monday, October 26, 2020, 27-year-old Walter Wallace, an African-American man and father, was shot and killed by police in the street in front of his home. Mr. Wallace had for years struggled with his mental health, a fact known to the police as they had been to the Wallace home three times on Monday.

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idea: find examples, integrate into other research! those are more powerful

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idea: find examples, integrate into other research! those are more powerful

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the ability of capital defense lawyers to ask sentencing jurors to consider a defendant’s mental illness as mitigating has often proved unavailing in light of the common misperceptions that lay jurors have about mental illness.

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the ability of capital defense lawyers to ask sentencing jurors to consider a defendant’s mental illness as mitigating has often proved unavailing in light of the common misperceptions that lay jurors have about mental illness.

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"Common misperceptions that lay jurors have about mental illness. The Supreme Court has recognized as a constitutional matter that offenders with intellectual disability may face a special risk of wrongful conviction and
death sentencing because of their impaired ability to consult with counsel, their potentially inappropriate affect in court, and the risk that juries will consider them more dangerous because of their disability.64 Defendants with severe
mental illness face similar risks for similar reasons, and thus an exemption would increase the accuracy of the capital justice system. In addition, the Supreme Court has recognized that the execution of offenders with intellectual disability and juvenile offenders does not serve the retributive or deterrent purposes of capital punishment because of the reduced culpability of such offenders and
their lessened susceptibility to deterrence.65 Exactly the same considerations apply to offenders with severe mental illness, and thus an exemption would remove from the ambit of the death penalty those for whom the punishment would least serve any legitimate penological purposes."

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many prosecutors, argue that the exemption is unnecessary because of existing protections afforded by competency reviews, the insanity defense, and the availability of mitigating evidence. 

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many prosecutors, argue that the exemption is unnecessary because of existing protections afforded by competency reviews, the insanity defense, and the availability of mitigating evidence. 

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HOWEVER "The standard for competency to stand trial is an extremely low one, and many defendants are cleared as competent for the purposes of trial despite undeniably suffering from severe mental illness. Moreover, the competency determination addresses the defendant’s mental state only at the time of trial or the time of execution and does not address the defendant’s mental state at the time of the offense."

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Although the U.S. Supreme Court has constitutionally exempted juvenile offenders and offenders with intellectual disability from the ambit of the death penalty, it has not extended a similar exemption to offenders with severe mental illness, despite similarities in the limitations faced by all three groups of offenders

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Although the U.S. Supreme Court has constitutionally exempted juvenile offenders and offenders with intellectual disability from the ambit of the death penalty, it has not extended a similar exemption to offenders with severe mental illness, despite similarities in the limitations faced by all three groups of offenders

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"The ABA resolution’s accompanying report explains that this paragraph is meant to apply only to those with “severe” mental disorders and disabilities, such as schizophrenia and schizoaffective disorder, bipolar disorders, major depressive disorder, and post-traumatic stress disorder (PTSD). The report specifically excludes from this exemption those whose conditions are manifested primarily by criminal behavior or voluntary substance use. The resolution also recommends exempting from execution some capital defendants who develop a severe mental disorder or disability after a death sentence has been imposed.61"

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Four national organizations—the American Psychiatric Association, theAmerican Psychological Association, the National Alliance for the Mentally Ill,and the American Bar Association—have taken formal positions opposing theexecution of defendants with severe mental illness

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Four national organizations—the American Psychiatric Association, theAmerican Psychological Association, the National Alliance for the Mentally Ill,and the American Bar Association—have taken formal positions opposing theexecution of defendants with severe mental illness

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"Defendants should not be executed or sentenced to death if, at the
time of the offense, they had a severe mental disorder or disability
that significantly impaired their capacity (a) to appreciate the
nature, consequences or wrongfulness of their conduct, (b)
to exercise rational judgment in relation to conduct, or (c) to
conform their conduct to the requirements of the law. A disorder
manifested primarily by repeated criminal conduct or attributable
solely to the acute effects of voluntary use of alcohol or other drugs
does not, standing alone, constitute a mental disorder or disability
for purposes of this provision.60"

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mb add something explaining the difference between intellectual disabilities and mental illness?

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jail often makes mental conditions worse, needs not taken into consideration

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jail often makes mental conditions worse, needs not taken into consideration

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"Once in jail, many individuals don't receive the treatment they need and end up getting worse, not better. They stay longer than their counterparts without mental illness. They are at risk of victimization and often their mental health conditions get worse."

"After leaving jail, many no longer have access to needed healthcare and benefits. A criminal record often makes it hard for individuals to get a job or housing. Many individuals, especially without access to mental health services and supports, wind up homeless, in emergency rooms and often re-arrested. At least 83% of jail inmates with a mental illness did not have access to needed treatment."

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distinction between violent and nonviolent criminals

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distinction between violent and nonviolent criminals

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"The vast majority of the individuals are not violent criminals—most people in jails are have not yet gone to trial, so they are not yet convicted of a crime. The rest are serving short sentences for minor crimes."

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rather than getting the medical help needed, those in crisis usually end up in the hands of law enforcement

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rather than getting the medical help needed, those in crisis usually end up in the hands of law enforcement

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"In a mental health crisis, people are more likely to encounter police than get medical help. As a result, 2 million people with mental illness are booked into jails each year. Nearly 15% of men and 30% of women booked into jails have a serious mental health condition."

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source 4b: Jailing People with Mental Illness

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source 4b: Jailing People with Mental Illness

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In a mental health crisis, people are more likely to encounter police than get medical help. As a result, 2 million people with mental illness are booked into jails each year.

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certain psychiatric conditions do increase a person’s risk of committing a crime. however, this is not the same as every person who commits a crime having a mental illness

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certain psychiatric conditions do increase a person’s risk of committing a crime. however, this is not the same as every person who commits a crime having a mental illness

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"Research suggests that patients with mental illness may be more prone to violence if they do not receive adequate treatment,[8] are actively experiencing delusions, or have long-standing paranoia.[9] Such patients are often under the influence of their psychiatric illness such as command hallucinations."

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many people struggle to get access to mental health care

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many people struggle to get access to mental health care

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"Many individuals do not receive the appropriate and timely treatment needed. Budget overruns and cuts in funding for public health and mental health in many cities further put people with mental illness in situations where they are involved in criminal activity.  Further complicating the picture is the lack of mental health treatment facilities. Despite greater awareness and effort to increase access to mental health treatment facilities, mental hospital beds per capita in the U.S. are lower than they have been since the 1850s."

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lack of awareness and resources about how to handle these ppl -> arrested more often

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lack of awareness and resources about how to handle these ppl -> arrested more often

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"People with mental illness are arrested and sent to prison in disproportionate numbers,[5] often due to a lack of awareness and resources in handling these individuals. The police often arrest these individuals for petty crimes such as jaywalking or wandering behavior as a preventive law and order measure.[5] "

"The closure of state psychiatric hospitals which began with the deinstitutionalization drive in 1960 forced many psychiatric patients on the streets, forced to fend for themselves.[6] As a result, these patients came into contact with the police and the courts more often. The situation is exacerbated by a lack of training and staffing in the court system, potentially accounting for persons with mental illness comprising an ever-larger fraction of the jail and prison population. Many of the symptoms of psychiatric illnesses are behaviors considered antisocial or criminal such as wandering behavior.[7] The result has been the false perception of a causal relationship between psychiatric illness and criminality."

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a lot of illnesses are commonly mislabeled/other things are fabricated

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a lot of illnesses are commonly mislabeled/other things are fabricated

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"The high levels of reported mental illness in jail and prison populations is primarily due to false labeling of criminals as having a psychiatric illness. These figures are not always based on thorough medical and psychiatric evaluation and diagnosis, but rather as a result of social factors."

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common misconceptions about  people with mental illness committing acts of violence and aggression more often

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common misconceptions about  people with mental illness committing acts of violence and aggression more often

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"The public perception of psychiatric patients as dangerous individuals is often rooted in the portrayal of criminals in the media as “crazy” individuals.  A large body of data suggests otherwise. People with mental illness are more likely to be a victim of violent crime than the perpetrator.[1] This bias extends all the way to the criminal justice system, where persons with mental illness get treated as criminals, arrested, charged, and jailed for a longer time in jail compared to the general population.

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source 4a: Psychiatric Illness And Criminality

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source 4a: Psychiatric Illness And Criminality

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Continuing Education Activity

The relationship between psychiatric illness and criminality has been the topic of intense debate and scrutiny in the recent past in light of multiple mass shootings in the United States. While the renewed focus and media attention on the importance of mental health in the aftermath of such tragedies is a positive development, the relationship between mental illness and criminality is too often conflated. The popular belief is that people with mental illness are more prone to commit acts of violence and aggression. The public perception of psychiatric patients as dangerous individuals is often rooted in the portrayal of criminals in the media as "crazy" individuals. A large body of data suggests otherwise. People with mental illness are more likely to be a victim of violent crime than the perpetrator. This bias extends all the way to the criminal justice system, where persons with mental illness get treated as criminals, arrested, charged, and jailed for a longer time in jail compared to the general population. This activity reviews psychiatric illness and criminality and the role of the interprofessional team in caring for afflicted patients.

Objectives:

Explain misconceptions regarding mental illness and criminality.

Discuss the evidence that describes the frequency of untoward criminal events in psychiatric patients.

Discuss the negative consequence of misconceptions regarding persons with mental illness and criminal violence.

Outline psychiatric illness and criminality and discuss the role of the interprofessional team in evaluating patients with this condition.

Access free multiple choice questions on this topic.
Introduction

The relationship between psychiatric illness and criminality has been the topic of intense debate and scrutiny in the recent past in light of multiple mass shootings in the United States. While the renewed focus and media attention on the importance of mental health in the aftermath of such tragedies is a positive development, the relationship between mental illness and criminality is too often conflated.

The popular belief is that people with mental illness are more prone to commit acts of violence and aggression. The public perception of psychiatric patients as dangerous individuals is often rooted in the portrayal of criminals in the media as "crazy" individuals. A large body of data suggests otherwise. People with mental illness are more likely to be a victim of violent crime than the perpetrator.[1] This bias extends all the way to the criminal justice system, where persons with mental illness get treated as criminals, arrested, charged, and jailed for a longer time in jail compared to the general population.[2]

Function

An essential element that plays into the false equivocation of psychiatric illness and criminality is the incorrect labeling of all criminals as persons with mental illness. Society at large views behavior and conduct problems as a symptom of a psychological disorder, which has led to the false public perception that equates criminality with psychiatric illness. The high levels of reported mental illness in jail and prison populations are primarily due to false labeling of criminals as having a psychiatric illness. These figures are not always based on thorough medical and psychiatric evaluation and diagnosis, but rather as a result of social factors.[3]

Antisocial personality disorder (ASPD) is one such diagnosis that is widely and arbitrarily applied to many in the prison populations. As a result, there is a debate as to whether ASPD is even a psychiatric illness or just a societal moral judgment. The label is increasingly used to paint criminals as victims of psychiatric illness.[4] Thus, it is imperative for clinicians to ensure that diagnoses are applied only when characteristic traits are extant, to not let criminals use the cover of psychiatric diagnoses to evade criminal punishment.

Issues of Concern

People with mental illness are arrested and sent to prison in disproportionate numbers,[5] often due to a lack of awareness and resources in handling these individuals. The police often arrest these individuals for petty crimes such as jaywalking or wandering behavior as a preventive law and order measure.[5] According to one study, 12 percent of adult psychiatric patients receiving treatment in the San Diego County health system had prior incarcerations, while 28 percent of Connecticut residents treated for schizophrenia and bipolar disorder had been arrested or detained.

The closure of state psychiatric hospitals which began with the deinstitutionalization drive in 1960 forced many psychiatric patients on the streets, forced to fend for themselves.[6] As a result, these patients came into contact with the police and the courts more often. The situation is exacerbated by a lack of training and staffing in the court system, potentially accounting for persons with mental illness comprising an ever-larger fraction of the jail and prison population. Many of the symptoms of psychiatric illnesses are behaviors considered antisocial or criminal such as wandering behavior.[7] The result has been the false perception of a causal relationship between psychiatric illness and criminality.

Clinical Significance

Certain psychiatric conditions do increase a person's risk of committing a crime. Research suggests that patients with mental illness may be more prone to violence if they do not receive adequate treatment,[8] are actively experiencing delusions, or have long-standing paranoia.[9] Such patients are often under the influence of their psychiatric illness such as command hallucinations. Other comorbidities include conditions such as substance use disorder,[10] unemployment, homelessness, and secondary effects of mental illness such as cognitive impairment, compound the risk of committing a violent crime.

The most important and independent risk factor for criminality and violence among individuals with mental illness is a long-term substance use disorder.[10] In patients with a major psychiatric illness, comorbid substance use disorder, there is a four-fold increase in the risk of committing a crime or violence.[11] Studies have shown that the rise in violent crime committed by individuals with mental illness, may entirely be accounted for with a history of alcohol and/or drug use.[11]

Individuals with a severe mental illness that fall through the cracks or for one reason or another are non-adherent to treatment are particularly at higher risk of committing grave acts of violence. Untreated profound mental illness is particularly significant in cases of homicide-the zenith of the criminal spectrum, and such illness is even more significant for mass murders of strangers. Still, these cases are a smaller proportion to senseless acts of violence committed by criminals who act out of sheer criminal intent.

Many individuals with mental illness face an uphill battle when trying to access mental health treatment. Many individuals do not receive the appropriate and timely treatment needed. Budget overruns and cuts in funding for public health and mental health in many cities further put people with mental illness in situations where they are involved in criminal activity. Further complicating the picture is the lack of mental health treatment facilities. Despite greater awareness and effort to increase access to mental health treatment facilities, mental hospital beds per capita in the U.S. are lower than they have been since the 1850s.

Other Issues

A far-sighted national mental health policy with expanded availability and access to treatment, while costly in the short run, could be a cost-effective and sensible approach. By some estimates, a ninety-day treatment in a mental hospital might prevent the 10-year imprisonment of an individual with mental illness. Expanded availability and access to mental health treatment would provide significant savings to society and crime victims. More importantly, it would improve a person with mental illness' quality of life and transform these individuals into productive members of society.

The link between psychiatric illness and criminality is complex and has profound societal implications. There is a great need for in-depth research and imaginative solutions for access and availability to mental health treatment. Currently, there is scant evidence to suggest that mental illness can independently predict criminal behavior. On the contrary, there is ample evidence that shows that persons with mental illness are far more likely to be the victim of violent crime rather than the perpetrator.

Enhancing Healthcare Team Outcomes

To break the links between mental illness and criminality requires an inter-professional team of psychiatrists, social workers, and patient advocates to detect and reduce or eliminate risk factors that lead persons with mental illness to commit a crime. This team approach includes a multi-tiered system that would identify at-risk patients early on and provide resources to prevent situations that bring the persons with mental illness in contact with the criminal justice system such as medical non-compliance and lack of food and shelter. For those individuals already inside the criminal justice system, there needs to be a targeted approach that includes rehabilitation, education, and empowerment. Finally, a concerted effort is required to educate the public at large and those in the criminal justice system, in particular, to dispel misperceptions and prevent mischaracterization, mislabeling of criminals as persons with mental illness and vice versa.

References

Disclosure: Noman Ghiasi declares no relevant financial relationships with ineligible companies.

Disclosure: Yusra Azhar declares no relevant financial relationships with ineligible companies.

Disclosure: Jasbir Singh declares no relevant financial relationships with ineligible companies.

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The relationship between psychiatric illness and criminality has been the topic of intense debate and scrutiny in the recent past in light of multiple mass shootings in the United States. While the renewed focus and media attention on the importance of mental health in the aftermath of such tragedies is a positive development, the relationship between mental illness and criminality is too often conflated.

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Argument no. 4: The manner that those with mental health struggles are treated in the criminal justice system is a dangerous reflection/consequence of misinformed people with power.

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Argument no. 4: The manner that those with mental health struggles are treated in the criminal justice system is a dangerous reflection/consequence of misinformed people with power.