Foundations in Forensic & Criminal Psychology

Week 2

Key problems to consider with Criminality and Mental Health

• Rule transgression

• Social exclusion

Definition of MH - Law

(Pilgrim, 2000)

No technical meaning as it is defined by the court or jury under particular circumstances

Definition of MH - Psychiatry

(Kleinman, 1988)

MH is present or absent, reductionist view, fixed on diagnosis, medical model

Definition of MH - Psychology

• Considers what constitutes normality

• MH is on a continuum.

• This approach is used in the assessment and intervention of mental illness.

Link between mental health and offending (Birmingham, 2003)

90% of prisoners have MH disorder BUT weak link between symptoms and criminal behaviour at a group level

Link between mental health and offending (Peterson et al., 2014)

Coded 429 crimes

• 4% - related to psychosis

• 3% - related to depression

• 10% - related to bipolar disorder including impulsivity

Evaluate research finding a link between MH and offending

Methodological issues

• Mediating variables, such as substance misuse, have a stronger explanatory value

Types of mental health disorder and offending

• Stronger link between personality disorders and serious crimes compared to other mental illness

Needs for mental health in the criminal justice system - Commissioning

CCGs need to take a lead role in commissioning health services for people leaving custody

Needs for mental health in the criminal justice system - Training

Government departments need to ensure that professionals in criminal justice system receive mandatory mental health awareness training

Needs for mental health in the criminal justice system - Transfer

Process from prison to secure psychiatric care needs to happen faster

Needs for mental health in the criminal justice system - Release from prison

Should be treated as ‘time of crisis’ and ‘through the gate’ support should be offered

Needs for mental health in the criminal justice system - Reports

Court psychiatric reports should be provided by psychiatrists who work with offenders, understand the court system, and work locally

Needs for mental health in the criminal justice system - Prisons

All should work towards achieving the Royal College of Psychiatrists’ Enabling Environments standard

Needs for mental health in the criminal justice system - Framework

A national framework is needed to set standards for prison mental health care

Needs for mental health in the criminal justice system - Probation providers

Should have access to MH support (such as consultation surgeries)

Aspects that need to be addressed to improve MH care in the criminal justice system

• Commissioning

• Training

• Transfer

• Release from prison

• Reports

• Prisons

• Framework

• Probation providers

Definition of a mental disorder

A cluster of "abnormal" thoughts, emotions, and behaviours

Criteria of a mental disorder

Tend to be:

1. Statistically infrequent

2. Violate social norms

3. Cause distress

4. Cause impairment

Definition of classification

The act of constructing groups (classes) and assigning things to these classes on the basis of their shared attributes

Classification of MH disorders

Classified on the basis of shared patterns of symptoms

• Emil Kraepelin (1856-1926): Defined 15 categories of mental disorders based on common patterns of symptoms

Should we classify mental disorders? Common vocabulary

Reduces complex info on symptom profiles to better enable communication between clinicians and researcher

Should we classify mental disorders? Standardisation

Provides a guide for treatment and prognosis

Should we classify mental disorders? Third party considerations

Insurance companies require diagnosis before paying out; some early intervention programs require diagnosis

Should we classify mental disorders? Validity

Program of discussion and argument when they're developing each new DSM.

Definition of a mental disorder (DSM-5)

A syndrome characterised by clinically significant disturbance in an individual’s cognition, emotion regulation, or behaviour that reflects dysfunction in the psychological, biological or developmental processes underlying mental functioning

Definition of mental illness (DSM-5)

• Health conditions involving changes in thinking, emotion or behaviour

• Can be chronic or acute

(APA, 2022)

Categorical models of mental disorders (examples)

• DSM-5

• ICD-11

Role of the ICD-11

Allows the systematic recording, analysis, interpretation, and comparison of mortality and morbidity data collected in different regions and at different times.

(WHO, 2022)

Strength of the ICD-10

Ensures semantic interpretability and reusability of recorded data for different uses beyond

health statistics, including:

• Decision support

• Resource allocation

• Reimbursement

• Guidelines.

Limitations of categorical models

• Considers all mental disorder categories

• Limited reliability

• Diagnostic categories are very heterogeneous

• High co-occurrence/comorbidity

• Significant impairment without diagnosis

Categorical models of mental disorders (examples)

• Research Domain Criteria (RDOC)

• Hierarchal taxonomy of psychopathology (HITOP)

What is the Research Domain Criteria (RDOC)?

• Research framework for investigating mental disorders.

• Not a diagnostic guide

• Fosters new research approaches that will lead to better diagnosis, prevention, intervention, and cures.

(Insel, 2013)

What is the aim of the Research Domain Criteria (RDOC)?

• The aim is to understand the nature of mental health and illness in terms of varying degrees of dysfunction in fundamental psychological/biological systems.

(Insel, 2013)

Components of the Research Domain Criteria (RDOC) Framework

• Lifespan and Development

• Units of Analysis

• Environment

• Domains

Domains of the Research Domain Criteria (RDOC) Framework

1. Arousal/Regulatory

2. Sensorimotor

3. Cognitive

4. Social Process

5. Negative Valence

6. Positive Valence

Background of Hierarchical taxonomy of psychopathology (HITOP)

• Established in 2017 from a group of nosologists (categorise diseases) from various mental health disciplines

• Aim to improve the organisation, description, and measurement of psychopathology.

What is the Hierarchical taxonomy of psychopathology (HITOP)?

An empirically derived descriptive system arranging continua of psychopathology from normative to maladaptive in a hierarchy, including:

• Superspectra

• Spectra

• Subfactors

• Syndromes (as per DSM)

• Symptoms/traits.

HiTOP - Superspectra

Broad categories that group several related "spectra" (major dimensions of psychopathology) to describe higher-order patterns of mental disorder

• Emotional Dysfunction

• Psychosis

• Externalising

HiTOP - Spectra

Broad dimensions of psychopathology that organise related symptoms and syndromes into higher-order groups

• Somatoform,

• Internalising

• Thought Disorder

• Detachment

• Disinhibited Externalising

• Antagonistic Externalising

HiTop - Subfactors

• Narrower dimensions that comprise broader spectra

• Serve to organise and reduce symptom heterogeneity in a more coherent structure

What are the three types of Disruptive Behaviour Disorders?

• Oppositional Defiant Disorder

• Conduct Disorder

• Limited Prosocial Emotions/Callous Unemotional (CU) Traits

Symptoms of Oppositional Defiant Disorder

1. Angry/Irritable Mood

2. Argumentative / Defiant Behaviour

3. Vindictiveness

(APA, 2013; Frick et al., 2014)

Symptoms of Conduct disorder

1. Aggression toward people and animals

2. Destruction of Property

3. Deceitfulness or Theft

4. Serious violations of the Rules

(APA, 2013; Frick et al., 2014)

Symptoms of 'Limited Prosocial Emotions'/Callous-Unemotional (CU) Traits

1. Lack of remorse or guilt

2. Callous lack of empathy

3. Unconcerned about performance

4. Shallow or deficient affect

(APA, 2013; Frick et al., 2014)

Key Discussion about Disruptive Behaviour Disorders

Most parents could identify these features in their child

Important to focus on the degree to which it is maladaptive

Neurodevelopmental conditions (DSM-V)

1. Attention - deficit/hyperactivity disorder

2. Autism spectrum disorder

3. Communication disorders

4. Global developmental delay

5. Intellectual disability (intellectual

6. developmental disorder)

7. Motor disorders

8. Specific learning disorders

(Kim-Cohen et al., 2003)

Discussion for Diagnosis of Neurodevelopmental Conditions

Need to be identified and supported because, as an individual gets older, more disadvantages become apparent.

Symptoms of Inattentive ADHD (Kim-Cohen et al., 2003)

1. Careless mistakes at school or work

2. Difficulty sustaining attention

3. Does not seem to listen

4. Does not follow through on instructions

5. Difficulty organizing tasks

6. Often loses things

7. Easily distracted

Symptoms of Hyperactive ADHD (Kim-Cohen et al., 2003)

1. Often fidgets

2. Often leaves seat

3. Unable to play quietly

4. Often talks excessively

5. Often has difficulty waiting for turn

6. Often interrupts others

Why focus on childhood disorders?

"Most adult disorders should be reframed as extensions of juvenile disorders"

What is personality? (American Psychological Association, 2013)

1. A characteristic way that a person behaves, thinks, and feels

2. "individual differences in characteristic patterns of thinking, feeling, and behaving” e.g., ‘shy’, ‘suspicious’, ‘sensitive’

3. Refers to behaviour across situations – many times, places

Key Features of Personality Disorders

Characterological (“enduring”) forms of psychopathology

1. They must be present from adolescence or early adulthood into adulthood

2. Influence the course or outcome of other mental disorders.

Key Discussion around Personality Disorders

Are personality disorders an extreme variant of normal personality, OR distinctly different disorders?

What is a Personality Disorder? (American Psychological Association, 2013)

Difficulties of degree rather than kind – i.e:

• Extreme versions of problems many people experience temporarily (e.g. shy, suspicious)

• Degree of problems = dimensions, Kind of problems = categories.

Constellation of extreme manifestation of personality traits results in a disorder.

Difficulties in Diagnosing Personality Disorders

Personality traits must be distinguished from characteristics that emerge in response to:

• Specific situational stressors OR

• Transient mental states (e.g., mood or anxiety disorders)

Supplementary information from informants may be helpful (e.g. Ethnic, cultural, religious, and social background must be considered)

Only when personality traits are inflexible, maladaptive, and cause functional impairment and/or distress do they = personality disorders