Historical Overview of Mental Health and Criminal Offending
Historical Overview of Mental Health Treatment
Introduction
Being labeled as ‘mad or bad’ influences whether individuals are sent to prison or psychiatric hospitals.
Historical perceptions of 'madness' and 'badness' have evolved alongside societal changes.
Behaviors once deemed ‘mad’ or ‘bad’ (e.g., homosexuality, having children outside marriage) are now acceptable in many cultures.
In contrast, substances like opium and cocaine, once normalized in the Victorian era, are now considered illegal.
This chapter will provide a historical overview of:
Treatment of individuals with mental health issues.
Evolution of mental health institutions and therapies.
Development of the prison service and its changes over the years, including probation service and community sentencing.
Summary of the evolution of medical intervention regarding the mental health of offenders.
Unlike other chapters, this section refrains from contemporary debates, focusing solely on historical changes in mental health and criminality, particularly in the UK and USA.
A Brief History of Mental Health Treatment
Terminology
The term ‘mental health’ was rarely used before the 1900s; prevalent terms included ‘mad’, ‘lunacy’, and ‘insanity’.
The term ‘mental illness’ will also be referenced, as it was common historically, but modern terminology includes ‘mental health issues’ or ‘mental health problems’ to reduce stigma.
Early Institutions
St Marys of Bethlehem Priory in London was one of the first hospitals to accept the mentally ill, founded in 1247 for sick paupers.
By 1403, the hospital transformed into a ‘madhouse’ under Crown control; it was managed by the City of London from 1547 until 1948 (Kent, 2003).
The hospital's name evolved from Bethlehem to Bedlam, which connotes chaos and disorder.
In the 18th century, Bedlam was open to public visitation for entertainment, allowing visitors to observe patients.
William Tuke conducted a significant investigation of ‘madhouses’ in the late 18th century, highlighting the inhumane treatment of patients, often kept in chains and harsh conditions.
In 1796, Tuke established York Retreat, introducing kind treatment philosophy, opposing the cruel practices at the time.
This initiated a new era for the treatment of mental health patients across Europe and the USA (Kent, 2003).
Symptoms and Causes of Mental Illness
In 1810, William Blake documented various causes of insanity at Bethlem, including:
Grief, love, jealousy, pride, religion, study, alcohol, childbed, fevers, heredity, head injuries, and venereal disease (Appignanesi, 2008).
Blake's list contrasts sharply with contemporary diagnostics, emphasizing causes rather than symptoms and highlighting a lack of medical understanding at the time.
The York Retreat, established on Christian morals, emphasized kind treatment over punishment, using restraints only when necessary.
Other medical institutions arose in the early 19th century (e.g., St Luke’s hospital, Manchester Lunatic Asylum) with a medical focus towards treatment (Jones, 1993).
By 1914, over 100,000 patients were in more than 100 mental hospitals in the UK (The Timechamber, 2007).
Development of Treatment
Early hospitals concentrated on harsh physical treatments (e.g., cold water therapy, bloodletting).
Sigmund Freud's psychoanalysis (early 20th century) championed the ‘talking cure’, which emphasized uncovering unconscious desires and fears for symptom alleviation (Parker, 2010).
The psychodynamic movement emerged, significantly affecting psychiatric practices and therapy (Porter, 2003); however, Freud did not apply psychoanalysis for severe mental illnesses common in asylums (Kent, 2003).
Experimental treatments such as insulin coma therapy (ICT) for schizophrenia involved inducing comas with insulin, with significant risks, including brain damage; ICT was prevalent in the mid-20th century.
Electroconvulsive therapy (ECT) became a notable treatment method, inducing seizures to relieve symptoms of various mental disorders, though it carried side effects like memory loss (Dunne & McLoughlin, 2012).
Prefrontal Lobotomy and Drug Developments
Prefrontal lobotomy (1930s) severed nerves in the brain and led to mixed outcomes; while some patients showed improved behavior, many others suffered significant cognitive impairments (Kent, 2003).
By 1951, 12,000 patients in the UK underwent lobotomies, which declined significantly post-1970s due to shrinking effectiveness and ethical concerns (Barraclough & Mitchell-Heggs, 1978).
The 1950s and 60s introduced psychotropic medications (e.g., largactil, thorazine, lithium), allowing many patients to leave hospitals, albeit with negative side effects like tremors and fatigue.
The Diagnostic and Statistical Manual (DSM) of Mental Disorders, developed in 1952, provided descriptions for diagnoses but faced criticism for pathologizing normal emotions (Kent, 2003).
The enforcement of medication as primary treatment reduced long-term hospital stays and encouraged ‘care in the community’ policies, leading to the closure of many asylums; e.g., UK asylum population dropped from 150,000 in the 1950s to 30,000 in the 1980s (Porter, 2003).
Criticism and Current Context
By the late 20th century, mental health issues, including PTSD, increased in prevalence; community treatment had mixed efficacy, with some provisions lacking cohesion (Kent, 2003).
The prison population in the UK grew significantly, reaching 85,461 in 2016; overcrowding, reduced resources, and high recidivism rates (e.g., 45% within a year post-release) characterize modern facilities.
Alternatives, such as community sentences, have gained attention for potentially fostering rehabilitation over custodial sentences.
The Evolution of the Prison and Probation Services
Historical Context of the Criminal Justice System
The criminal justice system aims at crime detection and prevention, rehabilitation, and supporting victims.
The system is composed of various agencies (e.g., police, courts, prisons), overseen by the Ministry of Justice, Home Office, and Attorney General’s Office (McMurran, Khalifa & Gibbon, 2009).
Historically, prisons were mere holding facilities pending trials or severe punishments; by the 18th century, imprisonment with hard labor was deemed appropriate for minor crimes.
John Howard's The State of the Prisons (1777) brought public attention to poor prison conditions, leading to reforms.
The Penitentiary Act (1779) introduced state-run prisons with aims of reformation; solitary confinement combined with religious instruction and hard labor were emphasized.
Although implementation faced challenges, the Act established the foundation for future prison regulation and reform (Jewkes, 2011a).
Reform Movements
By the 19th century, British prisons showed varying local governance, leading to the 1877 Prison Act, which centralized control and reformed conditions.
The 1895 government report advocated for rehabilitation alongside punishment, separating younger from older offenders.
Prison populations surged post-World War II, resulting in overcrowded environments and substandard conditions (McGowen, 1995).
Statistics indicate significant increases in prison populations; for instance, from 15,000 in 1945 to 42,000 in 1978.
By January 2016, prisoner counts reached 85,461 in England and Wales (www.offendersfamilieshelpline.org/index.php/prisoner-category).
The present-day UK prison system, with the largest population in Western Europe, faces scrutiny for rising recidivism rates, high death, and assault rates (Prison Reform Trust, 2015).
National Probation Service
Established in 1907, responsible for supervising community offenders; it traces back to 1876 through community efforts to combat repeat offences (McMurran, Khalifa & Gibbon, 2009).
Probation officers are integral in risk assessments and community sentencing, collaborating with various agencies under MAPPA (Multi-Agency Public Protection Arrangements).
Reflections on Prisons and Rehabilitation
Various roles of imprisonment include punishment, deterrence, public protection, and rehabilitation.
The question remains: do modern prisons effectively rehabilitate offenders, or do they mainly serve punitive purposes?
Early statements (Oscar Wilde) criticized the lack of mental health understanding in prisons, contrasting with modern insights (Bradley Report, 2009) on dual diagnosis issues.
The Intersection of Mental Health and Criminal Justice
Forensic Mental Health
Forensic mental health encompasses offender assessment for courts and post-conviction treatment either in prisons or secure psychiatric facilities.
Historical issues persist, including defining criminal responsibility and addressing the risks posed by mentally ill offenders.
The Health of Prisoners Act (1774) marked beginnings of medical care provision; the 1877 Prison Act established a national prison service, reflecting early awareness of mental health assessments among prisoners.
Insanity and Legal Framework
The possibility of acquitting individuals on insanity grounds arose, prominently influenced by the McNaughtan Rules, established in 1843, which require proof of ‘disease of the mind’ impairing the ability to know right from wrong.
This standard remained until revised by the 1957 Homicide Act, introducing ‘diminished responsibility’ as a partial defense (more on this in Chapter 3).
Following the 1990s, the incidence of insanity pleas started to decline; the 2009 Coroners and Justice Act demanded a recognized medical condition for diminished responsibility claims.
The 1991 Criminal Procedure (Insanity and Unfitness to Plead) Act mandated psychiatric evidence in insanity trials, which previously lacked formal legal provisions for mentally ill criminals.
The Establishment of Secure Facilities
The 1800 Criminal Lunatics Act allowed indefinite detention of those acquitted on insanity claims, leading to the establishment of Broadmoor Criminal Lunatic Asylum in 1863.
Broadmoor was designed for violent offenders, where discharge is contingent upon staff assurance of non-reoffending.
Over the years, additional secure facilities (Rampton, Ashworth) were founded for treatment.
Treatment within Prisons
As awareness of mental health grew, recommendations (East-Hubert Report, 1939) prompted the creation of specialized prisons offering psychological treatment aimed to reduce reoffending.
Special psychiatric wards arose in various established prisons (e.g., Wormwood Scrubs, Wakefield Prison), leading to the establishment of Grendon Prison in 1962 for prisoners responsive to therapeutic interventions.
Conceptual Developments: Psychopathy and Personality Disorders
The interplay between psychopathy, personality disorders, and criminal responsibility reveals complexities around public safety and offender treatment within legal frameworks.
Early psychiatric theories regarded mental illness as a breakdown of faculties like reason or will, leading to the term ‘moral insanity’ for individuals exhibiting violent behaviors without cognitive impairment.
Treatment strategies evolved through documented understanding of psychopathic behaviors in the 20th century with legal implications of preventive detention post-1959 Mental Health Act.
The Mental Health Act 1983 defined psychopathic disorder as an aggressive or irresponsible conduct condition requiring treatment, allowing detention under certain conditions.
Conclusion
The chapter summarizes the transition from ‘madhouses’ to more humane approaches in mental health treatment, including community care and psychiatric wards, alongside the recognition of ongoing stigma.
Presently, challenges include rising recidivism rates and overstrained prison systems; discussions continue regarding effective rehabilitation versus punitive measures.
The history of mental health is intertwined with evolving legal definitions and societal attitudes toward treatment, evidenced by shifts in legislation and the emergence of personality disorder-specific services as contemporary priorities in prison settings.
Suggestions for Further Reading
Forrester, A., Ozdural, S., Muthukumaraswamy, A., & Carroll, A. (2008). The evolution of mental disorder as a legal category in England and Wales. Journal of Forensic Psychiatry and Psychology, 19, 543–560.
Creese, R., Bynum, W. F., & Bearn, J. (Eds.) (1995). The health of prisoners. Amsterdam and Atlanta, GA: Rodopi.