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Caribbean Probation Conference

Caribbean Probation Conference. Community Corrections: 21 st Century Approach. The Mentally Disordered Offender. Dr. George Leveridge MBBS DM (Psych). Quiz. a. A significant majority of persons who are mentally ill commit violent crimes.

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Caribbean Probation Conference

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  1. Caribbean Probation Conference Community Corrections: 21st Century Approach

  2. The Mentally Disordered Offender Dr. George Leveridge MBBS DM (Psych)

  3. Quiz • a. A significant majority of persons who are mentally ill commit violent crimes. • b. With appropriate treatment people with schizophrenia are at no greater risk of committing a crime than the general population. • c. When the mentally ill commits a crime against a person it is usually a stranger. • d. The greatest mental health issue associated with crime ,concerns the use of drug and other psychoactive substances.

  4. Objectives • i. To understand some of the salient features of Mental Disorders. • ii. To appreciate the relationship between mental illnesses and offences. • iii. To understand the relationship between mental disorders and criminal motivation. • iv. To consider/re-consider the emergent roles and needs of the 21st Century Probation Officer in the management of the mentally disordered offender in the community.

  5. The Community Any group of people who live together conduct various activities of daily living earn a living buy the goods and services they are unable to provide for themselves school their children transact their civic and governmental affairs etc.

  6. Offence – Commission of any act that a lawful government deems illegal and is punishable. • Offence damages and fragments communities (victims and offender alike) • Not a unitary concept. i. Violent versus not violent crimes ii. Premeditated versus non-premeditated iii. Understanding of what they are doing versus not understanding.

  7. iv. Understanding the consequence of what they are doing versus not understanding consequences. • v. Multiple factors to consider in dissecting the commission of an offence. Repeat offender (criminality) associated with psychopathology: • Deviations from the norm • Causes distress to self and others • Leads to impairment in suffering • Overlap with behaviours that are indicators of mental disorders • Are associated with biological dysfunctions

  8. The Brain

  9. Functions of the Brain • Provides awareness; the sensory functions • Controls all activities • Higher functions

  10. Brain Chemistry

  11. Brain dysfunction • Changes in perceptions • Changes in control of body function • Changes in social and occupational funtion

  12. The Mental Status Examination The description of the person’s/patient’s appearance, speech, actions and thoughts during the interview. • General description • Mood and Affect • Speech • Perceptual disturbance • Thoughts • Sensorium and cognition • Fund of information and intelligence • Judgment and insight • Reliablity

  13. Types of Mental Disorders • a. Psychosis • b. Non-Psychosis – i. Neuroses ii. Personality Disorders

  14. Psychoses • i. Schizophrenias • Delusional Disorder • ii. Depression • iii. Mania • iv. Bipolar Disorders • v. Substance Abuse Disorder

  15. Neuroses • i. Anxiety Disorder eg PTSD, Panic Disorder, OCD • ii. Somatoform Disorders • iii. Dissociative Disorder

  16. Posttraumatic Stress Disorder (PTSD) Exposure to trauma followed by evidence of symptoms from each cluster: • Re-experiencing symptoms eg. Intrusive memories, flashbacks, feeling that trauma is going to recur. • Avoidance/numbing symptoms eg. Amnesia for aspects of the event, avoiding thoughts associated with trauma, detachment, restricted range of affect. • Hyper-arousal symptoms eg. Difficulty falling asleep, exaggerated startle response, hyper-vigilance

  17. Multi-Axial Assessment • Axis 1 – Major Clinical (Syndromes) Disorders • Axis 11 – Personality Disorders Mental Retardation • Axis 111– General Medical Condition • Axis 1V – Psychosocial and Environmental problems • Axis V – Global Assessment of Functioning (GAF)

  18. Mental Disorders and Offences • i. Significant association between mental illness and crime (some cases violent crimes) • ii. 10-12% of persons with a psychosis compared to • iii. 2% of persons with no mental problems • iv. 25% of those with alcohol dependency

  19. Mental Disorders and Offences (cont’d) • v. 35% of persons substance dependency • vi. More frequent arrests among those with psychiatric disorders • vii. More likely to commit offence against family members then strangers • viii. The mentally ill were more likely to be homeless; homelessness was associated with greater prevalence of crimes.

  20. Some local statistics • More than 70% percent of incarcerated offenders had an Axis 1 diagnosis. • Types of offences: psychosis and substance abuse • Depression among high school students: 9% in the severe depression range. • Depression in the general Jamaican population: more than 25% • Depression and PTSD among the police population: more than 30% • Hijacking drama a few weeks ago.

  21. More local statistics • UHWI Child Guidance Clinic 2008 • 40% of children diagnosed with Conduct Disorder had either Mental Retardation or some severe Learning Disability • Appeared normal but picked up on special screening tests • Decreased abstract thinking, reflecting environment, patterns what they see, diminished appreciation for consequences of action, at risk for gangs • Associated with poor early stimulation, benefited from a structured calm environment.

  22. Category Schizophrenia Delusional Disorder Dysthymia/depression Alcohol & Drug Dependency Panic/Anxiety Obsessive-Compulsive Disorder Motivation Psychotic Psychotic, Jealousy Loss Intoxication Fear Relief of tension Axis 1 Disorders and Criminal Motivation

  23. Disorder Paranoid Narcissistic Antisocial Borderline Motivation Uncontrolled aggression, revenge, homicide, wounding Power, domination, control, blow to self esteem, homicide Hyperirritability, financial gain, gang/group activity Compulsive homicidal, revenge, relief tension, dysphoria, revenge, excitement, arson Axis 11Disorders and Motivation for Crime

  24. Deportees and Mental illness • Commission of crimes abroad • Returns with minimal possession • May or may not be mentally ill • May or may not be homeless • May or may not be employable

  25. The Recession and Mental illness • Loss – Depression • Increased demands – stress • Stress – relapses • Affordability, availability etc of access to help

  26. Management of the Mentally Disordered Offender • Role of the patient and his family • Role of the community • Role of agencies; police, health services, workplace, churches, schools

  27. The Role of the Patient & His Family • Understanding and taking charge of the illness • Compliance with medication • Recognizing early signs of relapse • Keeping appointments for review • Build and maintain a certain relationship with your police and health care provider.

  28. Role of the Community • Need to have an appreciation for who the mentally ill are within the community and their well/unwell states • Assist when the need arises; eg call the police or the mental health officer.

  29. Roles of Agencies • Drug Rehab • Health Services • Academic ‘Habilitation’ and Rehabilitation : - improving literacy • Vocational, social and people skills training • Police willingness to act on the knowledge of the Mental Health Act • Churches support of the individual • Workplace support of the individual

  30. Emergent roles/needs of the 21st Century Probation Officer • Identify and make early referrals (may mean more education in psychology) • Greater interagency collaboration • Continuous educational process to operate from an evidence-based position.

  31. iv. A place for greater networking with: - Magistrates (Association meetings) - Police (Divisional Meetings) - Creating and re-visiting the need for a new model to address the changing needs. - Connect with colleagues from overseas - Keep abreast with current approaches which are effective (journals, continuing educational programmes etc.) - Affiliations with international associations/groups.

  32. Conclusion • Most mentally ill persons do not commit violent crimes and may be better rehabilitated in the community. • Appropriate trend in the treatment of the mentally ill reduces the potential to offend and requires a multi-agency approach • All concerned/involved in this area must be proactive and utilize the evidence driven approach

  33. References • Skodol AE. Psychopathology and Violent Crimes. Review of Gen. Psychiatry 1998; 17: 65-101 • Kaplan HI, Sadock BJ, Grebb JA. Synopsis of General Psychiatry, Behavioral Sciences Clinical Psychiatry. 7th ed, Baltimore Maryland: Williams and Wilkins; 1994 • www.medpagetoday.com/Psychiatry/AnxietyStress/dh/8152 • American Psychiatric Association: Diagnostic and Statistical Manual. 4th ed, Washington DC: American Psychiatric Association; 1994

  34. THE END

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