Is there a relationship between mental illness and delinquency? That was the keynote topic presented by Sarah M. Manchak, PhD, University of Cincinnati at the 30th Inter-court Conference held in Columbus last week. Her short answer is: ‘No, not as much as the press would have you think, in fact, very little’. Manchak distinguished serious mental disorders vs. behaviorally based-disorders. She showed photos of four of the recent school shooters, along with a study from 1999 which compared public perception of the link between violence and mental illness with a 2012 study of probation officer perceptions. About 60% of the public and over 50% of the officers believed there was an association between violence and schizophrenia; over 80% of the public and 50% of the officers between violence and cocaine addiction.
For those in the audience who recall a recent presentation of research data that, ‘Within juvenile and family court detention and incarceration facilities, two thirds of males (conduct disorder & ADHD) and three quarters of females (depression, anxiety, & PTSD) meet the criteria for at least one mental health disorder‘ (Maltreatment, mental health problems, and learning disabilities in the juvenile courts- Christopher Mallett, PhD, Esq., LISW Assoc. Prof Cleveland State University- several separate source citations), this came as a surprise. [We ask, are criminals actually victims of a violent society, difficult circumstances, and untreated mental illness?]
The New York Times Feb 8th, 2014 Nicholas Kristof article, ‘Inside a Mental Hospital Called Jail’, and the Feb 18th article by Bridget O’Shea, ‘Psychiatric Patients With No Place to Go But Jail’, reported that in the words of Kristof, ‘Psychiatric disorders are the only kind of sickness that we as a society regularly respond to not with sympathy but with handcuffs and incareration . . . More than half of prisoners in the United States have a mental health problem, according to a 2006 Justice Department study. Among female inmates, almost three-quarters have a mental disorder.’
A study by Skowyra & Cocozza 2007 Blueprint for Change. National Center for Mental Health and Juvenile Justice; Policy Research Associates, Inc. reported that ‘Seventy percent of youth in juvenile justice systems have at least one mental disorder with at least 20 percent experiencing significant functional impairment from a serious mental illness.’ http://www.ncmhjj.com/Blueprint/default.shtml
Manchak cited one study by Bonta, Law & Hanson from 1998 which showed a higher connection between personal demographic factors than clinical factors. Personal demographic factors include things like poverty and high criminality in a neighborhood. Manchak presented findings from a book, ‘Rethinking Risk Assessment’ (Skeem et al. 2006) which evaluated 132 cases; 26 weekly assessments. None of the traditional psychiatric diagnoses (depression, anxiety, somatization) predict violence within the next week except for the presence of hostility- which is not unique to mental illness. The other correlation to violence within the next week, is exposure to a high poverty neighborhood.
Manchak presented dynamic risk factors for crime: criminal history, education/employment, family/marital situation, leisure/recreation time, pro-criminal attitudes, anti-social pattern, alcohol/drug problems, and criminogenic companions (known as ‘the essential 8’ in the literature). Another study by Steadman et al  of 1,136 patients looked at other factors such as co-occurring/substance abuse and incidence of any aggression, but found mental illness alone does not increase violence risk. [A recent zip code analysis project at Pomegranate does seem to imply a connection of socio-demographic factors with behavioral health diagnosis.]
Manchak said that the implicit belief that if we target mental illness then youths will stop offending, is not correct, and is an empirically unsupported policy model. Reduced recidivism is not because of mental health care, but because of effective correctional intervention- which addressed the known risk factors as well as the overlap of behaviorally-based disorders. A study from Gendreau, French and Taylor  showed reduced recidivism when 4-6 of the criminogenic needs are addressed together, and positive behaviors are reinforced. Assertive community treatment ACT along with modeling and behavioral reinforcement, and problem-solving strategies for compliance is effective. She referred to the research guide, A Guide to Research-Informed Policy and Practice: http://consensusproject.org/downloads/community.corrections.research.guide.pdf underwritten by the MacArthur Foundation and Justice Center, The Council of State Governments.
Journalist Andrew Solomon in a recent TED talk/blog post http://blog.ted.com/2013/12/18/how-should-we-talk-about-mental-health/ would agree that the correlation between mental illness and crime works against a productive conversation about mental health. He says, “The tendency to connect people’s crimes to mental illness diagnoses that are not in fact associated with criminality needs to go away. ‘This person murdered everyone because he was depressed.’ You think, yes, you could sort of indicate here this person was depressed and he murdered everyone, but most people who are depressed do not murder everyone.” [By extrapolation, if said depressed person grew up in impoverished circumstances with criminal behavior modeled in the family, experienced PTSD from prior abuse, was truant, ingested meth, hung out with a bad crowd and got into a really hostile state with access to weapons, the potential for crime is probably higher.] Whatever the connection/s are, between the stigma of mental illness, media reporting, the rush to a convenient explanation for violence, the evidence (sometimes contradictory) from prisons and the mental health community, and variable inconsistent public policy, a whole lot of lives hang in the balance.
[photo credit for psychotic woman with knife by Jeff Wasserman/Dreamstime #32428121]