Mental Health and Crime
Dr Jayanth Srinivas, Consultant Forensic Psychiatrist
and Clinical Director, Forensic Mental Health Service
Sue Havers, Consultant Forensic Clinical Psychologist
Mark Smith, Senior Nurse, Forensic Directorate
Lisa Agell, Head of Mental Health Services
• What link is there between mental health and
crime?
• What services are available locally for people with
mental health difficulties who may come into
contact with the police, courts or prison?
• What are the key issues in keeping the mental
health service user and the public safe?
Mental Health in the General
Population
• 1 in 4 people will experience a mental
health problem in any year
• At any time 1 in 10 people will be
experiencing depression and / or anxiety
Prevalence of mental disorders in
general adult population
Phobias
Eating disorders
Obsessive Compulsive
Personality disorders
Bipolar
Schizophrenia
2.6 %
1–3%
1.3 %
2 – 13 %
1 % lifetime
0.2 %
(1 % lifetime)
Prevalence of mental disorders in
prison population
• 72 % male prisoners
• 70 % female prisoners have 2+ diagnosed
mental disorders
• Compared to 2 % and 5% of general
population
Prevalence of mental disorders in
prison population
• 7 % male prisoners
• 14 % female prisoners have psychosis
• Compared to 0.4 % of general population
• Although rates of mental illness in the prison
population are high
MENTAL ILLNESS DOES NOT CAUSE
OFFENDING BEHAVIOUR
Prevalence of substance misuse in
prison population
• 50% remand prisoners
• 40 % sentenced prisoners
have substance misuse problem
Prevalence of mental disorders in
prison population
• Risk of suicide is 10X higher for prisoners
People with mental health problems are at
higher risk of self harm
and more likely to be victims of crime
Risk of being killed by someone with
mental illness
• 700 homicides annually
• 8 % by mentally disordered offender
• 5 – 6 % people in contact with mental health
services
• 92% homicides by people with no mental
disorder
Risk of being killed by someone you
know
• 60 % victims killed by person they know
• 24% killed by a stranger
• Homicides by strangers more likely to be
linked to substance misuse
To summarise:
• 1 in 4 people have mental disorder at any time
• Incidence of mental disorder and substance
misuse are much higher in the prison population
• 92 % of homicides are by people with no mental
disorder
• 60 % of victims are killed by someone they know
• ‘Stranger’ homicides are more likely to be linked to
substance misuse than mental illness
The way forward ?
• Address stigma about mental health
problems so that people can ask for and
receive the help they need at an early stage
in their illness
The way forward ?
• Address societal issues regarding drug and
alcohol abuse
• People with substance misuse alone cannot
be detained or treated under the Mental
Health Act
Mental Health Act 2007
• The Mental Health Act 1983 (which was substantially amended in
2007) is the law in England and Wales that allows people with a
‘mental disorder’ to be admitted to hospital, detained and treated
without their consent – either for their own health and safety, or for the
protection of other people.
• The decision to detain someone in hospital or to put someone on
supervised community treatment is taken by specially trained doctors
and other mental health professionals who are approved to carry out
certain duties under the Act and follow specific procedures.
• Covers areas such as Civil admissions to hospital, Criminal Justice
system diversion, Public orders, Consent to treatment and supervised
treatment in the community
• Diversion from the Criminal Justice system- DAPA, Pre-trial, Trial,
Remand and sentence
• Insanity Defence, Diminished responsibility
Mental Health Services for prisoners
• Prison In Reach services to 8 local prisons
• Healthcare organisation in prison- equity of
care
• Role of prison in-reach- managing patients,
diversion and aftercare
• Interagency and Multiagency workingMAPPA
Secure services
• For prisoners requiring treatment
• For people sent by the Courts
• For people who cannot be safely managed
by local services
Forensic Mental Health Service
• Serves Staffordshire & Shropshire and part
of Wolverhampton in West Midlands
• 47 bed medium secure service in Stafford –
The Hatherton Centre
• 32 bed low secure service in Shrewsbury –
Clee unit (12 acute + 20 rehab. beds)
• Prison In Reach to 8 local prisons
Forensic Mental Health Service
• Range of Community Services:
– Court Diversion
– Criminal Justice Mental Health Liaison Scheme
– Forensic Liaison Schemes in Wolverhampton and
Shropshire
– Psychology & Psychiatry Outpatients for Staffordshire
– Community Personality Disorder services with
Probation
Examples of service users
• The tragedy of someone with undiagnosed
schizophrenia who kills parent due to voices
• Prisoner transferred to hospital for treatment
of severe depression or psychosis
• Person who commits offence in context of
psychosis and maladaptive coping
strategies
How we manage risk
• Focus on risk assessment and management
• Dual responsibility to patient and public
safety
• Work with MAPPA
Probation service
local services
Careful rehabilitation programmes
Mental health Services for local people
Community Services:
• Primary Care Mental Health Services (PCMH)
• Early Intervention in psychosis (EIP)
• Community Mental Health Teams (CMHT)
• Crisis Resolution & Home Treatment Services
(CRHT)
• Assertive Outreach services (AOT)
• Dementia Services
• Community Substance Misuse Teams (CSMT)
Mental health Services for local people
In-patient Services - Stafford:
• 12 bedded Dementia Unit
• 14 bedded older peoples assessment unit
• 12 bedded PICU
• 35 Acute beds
• 6 MOD beds
• Section 136 Assessment Unit