Mental Health and Forensic Psychiatry
Mental illness is quite common within Canada, with some 1 in 3 people affected during their lifetime. However, very few of these individuals will commit a crime or violent act. Certain types of mental illness are more closely associated with this type of behaviour, such as mood disorders—specifically bipolar disorder (previously called manic-depressive disorder) and psychotic disorders (such as schizophrenia). These disorders are often characterized by a loss of contact with reality, which can manifest as delusions (having beliefs that don’t correspond to reality, such as believing the government is spying on you), hallucinations (seeing or hearing things that others do not, like voices), and mood disturbances (overexcitement or depression). These symptoms cause the person in difficulty to have difficulty distinguishing between what’s real and what’s not, and may exhibit unusual or dangerous behaviour in response to these erroneous beliefs.
Psychotic and bipolar disorders are the two types of diagnoses most often encountered in forensic psychiatry (66% and 28% respectively, versus 1% each in the general population). Mental illness alone does not account for a person’s decision to commit a violent act. Individuals with mental illness in the legal psychiatry system often suffer from related issues (called concurrent disorders), such as substance-use disorders (addiction) or personality disorders (like borderline personality disorder). Substance abuse can, in fact, trigger an episode or aggravate mental-illness symptoms, as well as diminish inhibitions and self control. As well, personality disorders like borderline personality disorder are characterized by increased impulsiveness, greater emotional reactivity, and interpersonal difficulties, which can lead to violent behaviour. Individuals in the forensic psychiatry system often face multiple psycho-social challenges (homelessness or housing instability, poverty, difficulty maintaining social relationships, past victims of violence/abuse) that can also aggravate the issue. Most violent acts are not committed by individuals with mental illness, and when they are, it is often following a period where the person is not taking their medication, abusing drugs/alcohol, or experiencing undue stress. An individual suffering from a mood, bipolar, or psychotic disorder, who is not abusing drugs/alcohol, and who does not have antisocial personality traits is in general no more at risk of committing a violent act than anyone without a mental disorder.
The first victims of the person suffering from a mental disorder are usually those closest to them, such as family and care workers. This is not due to their weakness but rather to the fact that they are most often the social net for the affected person, and present during their most difficult moments. Family is therefore one of the key factors in the social reintegration of a patient, whether it’s in helping to manage grief or rebuild broken connections. This reintegration process may be difficult for the patient as well as their loved ones. There are resources available to help friends and family better understand mental illness, as well as information to help patients and their loved ones learn more about forensic psychiatry.
Resources are available. Learn more here.
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (5th ed.). Washington, DC: American Psychiatric Association.
Crocker, A. G., Nicholls, T. L., Seto, M. C., Charette, Y., Côté, G., & Caulet, M. (2015). The National Trajectory Project of individuals found not criminally responsible on account of mental disorder in Canada. Part 2: The people behind the label. The Canadian Journal of Psychiatry, 60(3), 106-116.
Hiday, V. A., & Wales, H. W. (2011). The criminalization of mental illness. In E. R. Vingilis & S. A. State (Eds.), Applied research and evaluation in community mental health services. An update of key research domains. McGill-Queen’s University Press.
Fazel, S., Gulati, G., Linsell, L., Geddes, J. R., & Grann, M. (2009). Schizophrenia and violence: Systematic review and meta-analysis. Public Library of Science Medicine, 6(8), e1000120. doi:10.1371/journal.pmed.1000120.
Moran, P., Walsh, E., Tyrer, P., Burns, T. O. M., Creed, F., & Fahy, T. O. M. (2003). Impact of comorbid personality disorder on violence in psychosis: report from the UK700 trial. The British Journal of Psychiatry, 182(2), 129-134.
Penney, S. R., Morgan, A., & Simpson, A. I. (2016). Assessing illness- and non-illness based motivations for violence in persons with major mental illness. Law and Human Behavior, 40(1), 42-49. doi:10.1037/lhb0000155.