Forensic psychiatry 1

There are a number of important topics associated with the theory behind forensic

psychiatry which will be covered. These are as follows:

1. Criminology

2. Crime in the UK

3. Antisocial behaviour – epidemiology and aetiology

4. Psychiatric aspects of offending behaviour

5. Offending amongst those with mental disorder

6. Sexual offences

7. Risk assessment

8. The UK criminal justice system

9. Mental disorder in prison

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What is Forensic Psychiatry?
Forensic psychiatry has two main components:
· Clinical assessment and treatment of individuals in a variety of settings and under a
range of circumstances. Patients are frequently involved in the criminal justice system,
either awaiting trial or having been convicted of an offence. Forensic services also offer
advice to general psychiatric services concerning patients suffering from severe mental
disorder in association with severe behavioural disturbance or if there are concerns about
the level of risk posed..
· Application of the law to clinical practice, presenting relevant psychiatric information
and conclusions to various legal and statutory agencies. This is frequently in the form of
expert opinion given in court reports, in which psychiatric issues which may prove of
importance in the case can be considered in detail. This may be in civil or criminal cases.
There are a number of important topics associated with the theory behind forensic
psychiatry which will be covered. These are as follows:
1. Criminology
2. Crime in the UK
3. Antisocial behaviour ­ epidemiology and aetiology
4. Psychiatric aspects of offending behaviour
5. Offending amongst those with mental disorder
6. Sexual offences
7. Risk assessment
8. The UK criminal justice system
9. Mental disorder in prison
Detailed knowledge of mental health legislation is not covered, and it is slightly different in
Scotland and Ireland as compared to England and Wales. A new Mental Health Act for
England and Wales was passed in 2007, but it is not likely to come into force until late 2008.
Criminology is a general term for the study of crime. It has traditionally been sociologists
who have studied crime, but in recent times lawyers, psychologists and other professionals
have become involved. There are a wide range of theories underlying why individuals
commit crime, but there remains little consensus. Crime is by nature a difficult subject to
study, as those directly involved are the least likely to report their activities. Similarly,
understanding the prevalence of crime is difficult. There are two main approaches used to
estimate the extent of crime in the UK:
· Police data concerning crimes reported, investigated and concluded
· Population questionnaires asking about individual experiences of crime
The first approach might be thought to be more robust, as the police exist specifically to deal
with crime and offending behaviour and they have a range of mechanisms for identifying
and investigating.1 However, generally this relies on crime being reported to them in the
first place, and this frequently does not occur, especially for petty offences. Also, not all
crime reported to the police is officially recorded. This is only done for so called `notifiable
offences', which have to be reported to the Home Office. There are a variety of complicated
rules for police concerning how a crime is recorded. For example, if three items are stolen
should it be recorded as one crime or three? If a house is burgled and a wide variety of items
taken, how many crimes should be recorded? As a general rule, crimes are counted
according to the number of victims on a `one crime per victim' basis.2
The second approach is that taken by the British Crime Survey (BCS) which is published

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It collects information about crime independently of that recorded by the police.
The BCS estimates that 11.3 million crimes were committed in the year 2006 2007, of which
5.4m were reported to police. An even smaller proportion will therefore have been
investigated and convictions secured. The overall amount of crime appears to be remaining
stable although the amount reported to police is diminishing slightly. However, the BCS
looks at a more limited range of offences than those recorded by the police (predominately
violence and theft).…read more

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· Twin studies show genetic overlap of disinhibitory syndromes: conduct disorder, alcohol
and drug dependence and child and adult antisocial behaviour. It is postulated that
there is an underlying genetic vulnerability factor to these disorders (termed as
`externalising' disorders) related to behavioural under control. 5
Neurobiological factors
There has been a considerable body of research directed at examining the role of serotonin in
driving aggressive behaviour.…read more

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Psychiatric Aspects of Offending Behaviour.
The relationship between psychiatric disorder and criminal behaviour is far from
straightforward. Few psychiatric patients are offenders and few offenders have a psychiatric
disorder (Gunn, 1977). The public image of mental illness is generally poor, and media
portrayal of certain illnesses (particularly schizophrenia) has led to high public anxiety and
poor understanding. However, the previously accepted view that those with mental illness
were no more dangerous than anyone else is not entirely true either.
Acquisitive Crime.…read more

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· Birth cohort studies
o There have been a number of studies conducted using this design, and most
have broadly supported the hypothesis that major mental illness is associated
with an increased likelihood of violence (or arrest for violence). This is
particularly so amongst women, who are less likely to be convicted of violent
offences than men.
· Prevalence studies amongst violent populations
o There has been a considerable amount of work aimed at investigating
populations of those who have committed violent acts.…read more

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England and Wales.
· 34% had a mental disorder: most had not attended mental health services
· 5% had a diagnosis of schizophrenia
· 10% had mental illness at the time of the offence
· 9% received a diminished responsibility verdict
· Most perpetrators with a history of mental disorder were not acutely ill when they
killed, and most had never received mental healthcare, suggesting that services could
not have prevented their offences (Shaw et al 2006).…read more

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Those who have committed numerous crimes are almost by definition antisocial,
but simply being a criminal alone is not enough to warrant the diagnosis . 19
Recent political debate has introduced the concept of `dangerous and severe personality
disorder' (DSPD). This is not a diagnosis as such, but is used by politicians to refer to
particularly high risk individuals.…read more

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There is little evidence to suggest that criminal
behaviour is higher in cannabis users (with the obvious exception of convictions for
possession). 80% of opiate users have at least one conviction.25
Organic disorders
Disinhibition and impaired judgement, characteristic of organic brain disease, may lead to
minor crimes of dishonesty or sexual offences. The few elderly offenders who are convicted
of crimes have high rates of alcohol misuse. In younger men, offending may be associated
with any cause of organic brain disease.…read more

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Magistrates Court. Most sexual
offenders do not have a mental illness and are dealt with by the criminal justice system.
Rape is a violent sexual offence, in which an individual has unlawful sexual intercourse with
a man or woman who is not consenting, and when the perpetrator either knows that they are
not consenting or is reckless to whether or not they consent. Most rapists are known to their
victims, and most rapes take place in the home.…read more

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This refers to arousal to symbols of sexuality, which may develop into the predominant or
exclusive form of sexual outlet. It is a learned response and is therefore amenable to
behavioural treatment such as aversive conditioning, reconditioning and counterconditioning.
Exhibitionism and indecent exposure
Indecent exposure is the legal term for the offence of indecently exposing the genitals to
other people. In England and Wales it is one of the most common sexual offences. It is most
common in men aged between 25 and 35.…read more


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