Mental or criminal?

Abstract

Jeffrey Draine has focused on people with psychiatric disabilities and the services and the services provided for them. He is studying involuntary outpatient mental health treatment and the interaction of mental health and criminal justice systems. Stories of random killers and hostage-takers are in the headlines on a regular basis and disturb our sense of predictable order. In suburban Philadelphia, a story broke in the local tabloid newspaper. While I waited for my train I read: “It was mental… not criminal” on the front of the Delaware County Daily Times. The news was about Kelli Chapman–a woman aged 33 years who had battled against qong bouts of psychiatric illness and addiction. The stow was also about Vincent Williams (aged 9 years) whom Kelli set ablaze with 87 cents' worth of gasoline. The boy sustained second-degree bums, but survived. When I hear such stories in the media, I wait a silent beat for the familiar phrase “the assailant is known to have a history of mental problems”. This phrase is often spoken with an air of scepticism—the same tone of voice that the announcer uses for the word alleged in “alleged killer”. Just 10ok at the quotation marks around the word voices in the inside headline (figure). The editors play on skepticism about symptoms of mental disease. This is part of the inherent difficulty societies have in responding to behaviour that could be mental, criminal, or both. Because it is disturbing, there is a desire to eize controlof the deviant behaviour by putting it into a category, and to ask: “who will be responsible for controlling this behaviour?” Unfortunately, this means that mental illness is more likely to be managed than to be treated. Governments have compartmentalised their response to crime into two specialised systems: criminal justice and mental health. When people seem to belong in both systems, making sense of any response to deviant behaviour becomes difficult. If Kelli is treated primarily as a person with a psychiatric problem, then mental-health professionals appear unsympathetic to the community's need for criminal accountability. If Kelli is treated primarily as a criminal, then officers of the court appear unsympathetic to her as a person with psychiatric illness and addiction. A further complication is the tendency of service systems to palm undesirable clients off on one another. Undesirable clients are frequently the people who have many problems and are difficult to compartmentalise. Some advocates of mental-health care have encouraged policymakers to decide that one system, the mental-health system, is the most appropriate for addressing criminal behaviour linked to mental disorders. This way of thinking has created much trouble. By putting the onus on the mental-health system, the criminal-justice system is absolved from responsibility. Furthermore, can the distinctions between criminal and mental be so clean-cut? People with mental illness do end up in jail. To say that these arrests are primarily linked to mental illness is an oversimplification. When we pay attention to the social lives of people with mental illness, we see a greater prevalence of substance use, low educational attainment, poverty, and a lack of social attachments. These factors are linked to both mental illness and criminal arrest. Thus, the sheer increase in incarceration has a disproportionate effect on people with mental illness. Both systems should respond to the mental-health needs of individuals–as well as to their addiction and social difficulties. Rather than fretting over whether or not Kelli Chapman's behaviour was mental or criminal, we should strive to be prepared for cases like hers. We should expect responsive, coordinated, and effective treatment at the point where her life intersects with trouble–be it mental or criminal. Therefore, both the mental-health system and the criminal-justice system can respond to people with mental illness who become involved in crime. Jail services should focus their mental-health services on aftercare planning for individuals released into the community after a jail sentence. With this approach, both systems would be prepared to the best of their ability for a person's release. Mental-health workers should strive to work with their patients in adhering to criminal-justice mandates, such as probation and parole. They should also be prepared to work with probation and parole officers in enforcing such mandates. These officers, in turn, should be prepared to work with mental-health workers. They should also be willing to take into account clinical implications when using their discretion to enforce the law. In other words, it is not about deciding whether an action is mental or criminal–it is about responding to both mental problems and criminal problems on an individual basis. Mentalhealth systems had their opportunities with Kelli Chapman. The news article says that “for nearly two decades, Kelli Chapman shuffled between drug rehabilitation programmes and mental hospitals in three states–a life of drug abuse, halfway houses, abandoned buildings, and associations with friends involved with drugs andprostitution”. In the fourth decade of her life, she is in jail. Is this another revolving door? It could be her chance for help.