A Review of the "Mental Illness" Definition Might Prevent Crime

An anonymous reader writes "Following a BBC report showing abnormal variation in the number of people taken into police custody with mental health problems, concerns have been raised about the legal definition of "mental illness". Prof. Steve Fuller argues that a much sharper legal distinction is required to ensure criminals with mental disorders are not released without appropriate treatment. Fuller distinguishes between two cases: a 'client', who pays a therapist and enjoys a liberal, level-playing field in face-to-face interactions, and a 'patient' who is being treated by a doctor for a particular disorder. If the former relationship cannot be established due to person's mental state, then the latter one should be enforced. Thus, Fuller calls for 'a return to institutions analogous to the asylums of the early 19th century.'"

Comments

Need more mental health centers not prisons

[Joe_Dragon]

Need more mental health centers not prisons with 23/7 lock down

Re:Need more mental health centers not prisons

[lgw]

Well, they easily serve the same purpose. How long until "disagreeing with the politics of the ruling party" becomes a mental illness? No, no, we're not locking up millions in prison camps, that would be fascism, we're just confining them in mental health institutions, it's really for their own good!

Re:Need more mental health centers not prisons

[AlphaWolf_HK]

The trouble with mental health is that there isn't any kind of magic bullet treatment like there can be with just about any other disease.

Usually the best treatments come from medication, and if the person stops taking their medication (this is very often the case, they think they don't need it anymore, especially due to the stigma attached to it which often makes them WANT to stop taking it) then they go back to how they were before, only this time going back on the medication doesn't solve the problem and the psychologist has to keep trying different medications until one works, assuming they can ever find one.

Or they can also come from therapy (depends on the exact condition) and if you keep them in these places until they are "treated", it may as well be a prison sentence. I've seen these places, they very much remind me of a prison: The windows are barred, the doors are all locked and only visitors and/or staff are allowed through them, and visitors can't bring plastic or metal inside. The patients are forced to sit around doing nothing all day long, maybe get to play backgammon with some derp who was born without a personality, or if they're lucky he'll be a nut and somewhat entertaining to talk to.

Re:Need more mental health centers not prisons

[TemperedAlchemist]

It's exacerbated by a society that doesn't take it seriously.

No, really, no one takes the fact you have a mental illness seriously until you do something completely batshit crazy like shoot up a school. If I had a nickel for every time someone told me I didn't have a reason to feel depressed...

You are ignored, basically, until you commit a crime. THEN people care. Until then you're not ill, you're just a lazy loafer.

Re:Need more mental health centers not prisons

[squiggleslash]

How long until "disagreeing with the politics of the ruling party" becomes a mental illness?

Probably in the same timeframe as "disagreeing with the politics of the ruling party" becoming a crime.

Seriously, this is not a particular reason to object to "mental illness" definitions, any more than putting criminals in prison is a reason to object to laws. Any power can be abused. But some abusable powers are necessary. The question is whether you're willing, as an honest citizen, to be vigilant.

Re:Need more mental health centers not prisons

[pla]

There's almost never a magic bullet treatment, for any disease, mental or physical.

I have to disagree... If I get strep or pneumonia, they give me a z-pack and bam, it magically goes away. If I have a broken finger, they give me vicodin and bam, I magically don't care about the pain (though yes, the finger itself just takes time to heal). If I have insomnia, they give me ambien and bam, I can magically sleep again. When my knees or hips eventually wear out, they give me new ones and bam, I magically get to walk for another 20-30 years. And keep in mind that many of our "magic bullets" work on a larger scale and longer term scale - Vaccination, water sterilization, sewage treatment, annual physicals, etc.

Even for the things that still tend to kill us, like cancer and heart disease, we have a lot of magic bullets that let us live far, far longer than we would have a century ago. Case in point, we wouldn't have various religiots arguing over their "right" to murder (as in the case from last week) their 10YO daughter by refusing treatment for a 95% survivable form of leukemia. She would simply have died, no moral issues involved.

But for mental diseases, it gets a lot messier. There, I would have to at least partially agree with you. We have plenty of ammo, but precious few we would dare call "magically" effective. Perhaps more like "napalm", where they might get the job done, but with so much collateral damage that you have people going off their meds because the cure sucks almost as much as the symptoms (to give my metaphors a good stir there).

Perhaps more to the point of TFA, I would have to agree with its author. We need to get over this societal PC BS that every sociopath and drooler can, with the right care, grow up and lead a productive life as a rocket surgeon. Some people will never manage more than wiping their own ass, and some people will never grasp why they can't "earn" their living pointing a gun at convenience store clerks. Simple as that. Best for us, and best for them, to keep them off the streets until such time as we can cure "criminal" with a magic bullet - Preferably starting the process before they take a real bullet from an armed victim or a cop or a partner crossed.

Re:Need more mental health centers not prisons

[Hatta]

We stopped being vigilant a long time ago. We stopped being honest citizens a long time ago. Many will sing the last line of our national anthem without a hint of irony, despite the fact that we imprison more people than any country in the world.

The crimes we need to be afraid of are not the crimes committed by people behind bars. They are the crimes committed by men in suits, in government or corporate board rooms. Most people in prison are victims, either of unjust laws, or an economy deliberately engineered to work against the common man. We need to focus on the real problem. It's not the schizophrenics on the street corner, it's the sociopaths in DC and NYC.

Re:Need more mental health centers not prisons

[gtall]

You do realize that until the 60's, the U.S. had a fair number of asylums. Then it was determined that the mentally ill had rights and they were promptly discharged with many finding the street life fit them better than anything else. It turned out the mentally ill had a right to be homeless.

What is needed is a more sane approach to mental illness, especially now with so many vets suffering from PTSD. The discrimination should stop, but for that to stop people would need to be educated about mental illness....well, I guess the mentally ill are screwed then.

The prisons are filled with people that simply run into the law enforcement system before they run into a mental health system. The law enforcement system cannot force one onto meds, so the poor souls get warehoused in the prisons. When they are let out, their neuroses are that much worse because mental illness frequently does not get better on its own. Left untreated, it gets worse. By that time, the mentally ill think of prison as a refuge, so they commit another crime to back.

Re:Need more mental health centers not prisons

[gallondr00nk]

How long until "disagreeing with the politics of the ruling party" becomes a mental illness?

Perhaps, but more likely is how long before we start lowering the threshold for which someone requires "help". Especially if the facilities were private, which is 99% certain these days.

In 2008 in Pennsylvania two judges were convicted of accepting bribes from Robert Mericle, who owned private youth detention facilities. In return, they would sentence kids to incarceration in his facilities for such heinous crimes as shoplifting a DVD from Wal-Mart, trespassing, or in one case making a video on Myspace mocking the principle of a school.

Considering that mental health is so subjective and still poorly understood, could you imagine the amount of abuse that would occur? I would measure in seconds the time between such a facility opening and doctors being bribed to incarcerate patients, "for their own good".

This is a problem which has become endemic in private prisons. When it becomes profitable to incarcerate someone, the last real barrier to simply incarcerating anyone deemed undesirable is removed.

It has been long argued that drug laws in the US are mainly only used to convict unemployed, poor and predominantly black men in large cities, for whom there are few prospects and no jobs. With meth, this has extended to white people in the same position, in the same way opium laws did to the Chinese in the past.

How long before a new system of mental health facilities serve precisely the same purpose?

Re:Need more mental health centers not prisons

[Antique Geekmeister]

Many of the asylums were horrible and without hope, due to longstanding medical orders for which there was no effective treatment. The advent of effective psychopharmacology changed that: people with bipolar depression, for example, devastating post-traumatic stress based depression,, devastating post-trautmatic stress, and numerous other problems became treatable and could be treated as outpatients or with short stays to stabilize their medication, then released. Care really did improve in the 1960's and early 1970's, when the psychoactive medications were better understood and seized upon with great joy by doctors and patients who'd before felt quite hopeless. Unfortunately, this became coupled with cost-saving "return to the community" programs and policies, and we wound up with _enormous_ numbers of ill people who could not safely live on their own, turned out without structure to remember to take their medication by themselves.

The results have been predictable: numerous confused, somewhat insane people were left without the help they needed because their smaller, modern, fragmented families could not possibly fill in the gap of providing residential care. When coupled with the strain on the prison systems from the "war on drugs", the threshold for providing residential care has been raised so high that facilities willing to work with modest mental disorders have been overwhelmed by even more profound cases, an. And the quality of care for both has dropped, harshly.

I'm afraid that I'm old enough to know relatives and colleagues with such members. When their need for treatment leads them to self-medicate with illegal drugs, they then wind up snared in the "war on drugs" and "zero tolerance" policies, and become even more difficult to help.

Re:Need more mental health centers not prisons

[Anonymous Coward]

As somebody who had spent enforced two months in a mental ward after being conned into "self-admittance" (and later threatened with being shipped to a state institution unless I signed another set of papers claiming I committed myself voluntarily), I'd say the current system already needs rework.

My family was told outright by one of the orderlies that because I had no insurance, I'd be kept for a while because that's they way the hospital gets money from the government (via Medicare).

My "doctor" did everything possible to launch me into an anger spiral that would help them keep me locked up for a longer time. I was not the only one - I personally witnessed how they set up a young guy that came in through the emergency room after drunk drug overdose (at a party) - he did snap after being lied to and promised to be released on several occurrences (I witnessed two of those firsthand, being nearby - the place was that small), and when I finally fought my way out of there he had already been shipped to state "mental institution."

From what I heard, that meant at least six months of being locked in.

My "doctor" did nothing whatsoever to even pretend he cared for his patients. All were prescribed a cocktail of medications (with varying side effects), and that was it. No counseling, no sessions. My "welfare worker," the person supposedly assigned to protect the patients, was fully cooperating to keep me in (overheard their exchange waiting for the first and only "interview" I had with both of them).

I got out because a member of my family knew somebody wealthy and connected enough to start causing problems for the "doctor" in charge. Otherwise I might as well have still been confined, for all I know.

In the end, I declared bankruptcy rather than have them get around $34,000 of taxpayers' money for my "treatment." Consisting of involuntary confinement to a small shared room with two beds, two night-tables, a small bathroom, one corridor, and a TV room. If not for the books my family brought over, I'd probably go insane from boredom alone.

I was merely an incidental victim. Somebody being thrown into that system on purpose would have even worse chances of getting out unscathed (if that's what I did). There was an article recently about New York policeman who ended up in a mental ward after speaking out about criminal behavior in his division.

So, no. You are already there, it's just that few people realize it.

Re:Need more mental health centers not prisons

[noh8rz10]

Most people in prison are victims, either of unjust laws, or an economy deliberately engineered to work against the common man.

[citation needed] times infinity. this is an extraordinary claim that is false on its face.

The problem is...

[TWX]

...who decides. We've all exhibited behavior at one time or another that could be interpreted as antisocial, and with our paycheck-to-paycheck lifestyle and less institutional family connections, it's very possible that someone involuntarily committed may find literally all of their worldly possessions gone when they come out. Such involuntary confinement could be used when someone in authority finds something otherwise noncriminal to be abhorrent. There are numerous examples of countercultures throughout our fairly recent history that were investigated by the authorities, and it was bad enough without those people having to particularly worry about involuntary confinement attributed to supposed mental illness.

Who decides, what they can compel, and how that person's life is managed while they're institutionalized are all very, very important factors in if it's even possible to use involuntary medical-based confinement or not.

And that doesn't even begin to address costs. While I don't care for it, it's possible for prisons to get some return on their costs by using prison labor to do things that don't really pay the prisoners but do pay the prison. If someone's committed for what's supposed to be a mental illness problem, it's doubtful that using that person for profit for the institution would really be possible.

Re:Does Slashdot

[dale.furno]

Until it is you being put away, Mr. Coward.

Foundation question

[Okian Warrior]

Apropos of nothing, let me ask a question.

Can people be cured of mental health problems?

I recall a study comparing the rates of people getting off drugs while on psychotherapy with those getting off drugs on their own.

I also recall a study where completely sane people were checked into a mental institution (under a false name, as a test case) with instructions to pretend symptoms for awhile, but then pretend to be completely cured. Their status was never set to "cured", rather it was "condition, under remission".

So have there been any studies showing that mental health treatment is effective, or is psychotherapy more akin to lie detectors and phrenology?

(A related question, is there good sensitivity between the various mental health diagnoses with different treatments? Meaning, if the condition A treatment is different from condition B, is there a sharp, easily-recognized distinction between the symptoms for A and B?)

Re:Foundation question

[swillden]

I, unfortunately, have had far too much exposure to the mental health system, due to mental illness in my immediate family. I'll give you my perspective on your questions, based primarily on my anecdotal experience, plus some research-based discussions with practitioners.

I think the answer is a qualified yes, people can be made better, though "cured" may be too strong.

Mental health treatment is, I think, much where medicine was shortly after the discovery of the germ theory of disease. It's beginning to become a capable, scientific endeavor, and it is very useful within the areas that it works, but there's lots we don't understand, about what goes wrong, about why it goes wrong, about what will and won't work to fix it, and even about why the stuff that does work, works.

My daughter's condition is a good example. She has Borderline Personality Disorder (which is a really terrible, inaccurate name, and everyone knows it, but that's the label that got stuck on it). There is no cure but time; most BPD sufferers eventually achieve fairly normal functioning by their mid 30s. There are some treatments that help, though. Sometimes. The best one is a particular form of psychotherapy called Dialectical Behavioral Therapy, which is at root mindfulness training. It's effectiveness is definitely better than nothing, but whether or not it will help a person become a functional member of society is very hit or miss. My daughter's doing okay, but has real challenges.

My sister's son, on the other hand, has Bipolar Disorder. There are great meds that almost completely fix the problem for a large percentage of sufferers, including him. In addition, it appears that specific dietary restrictions can do just as much as the meds. I understand that schizophrenia is eminently treatable with medication, though the severe side effects often discourage its use.

I have ADD, and so do all three of my sons. There are very effective medications for it, but there are also learned habits that can be used to work around it. My older sons and I use the latter plus a little self-medication with caffeine. My youngest takes Concerta.

Depending on the disorder, sometime diagnoses are clear and incontrovertible, and proof of "cure" (or management) is equally incontrovertible. Sometimes it's really fuzzy. Sometimes treatment is effective and well-understood. Sometimes it isn't.

The answer, I think, is to be very clear about what we can and cannot do, and to do what we can. And, of course, to continue research into improving our ability to understand and treat.

This raises a question they try to avoid

[erroneus]

Are we responsible for the crimes we commit? If we are mentally ill, then surely we're not responsible. And if we're not responsible, then surely we need to have another "protected class" of people defined to prevent harassment, discrimination and unjust punishment. What they are attempting to do is reduce and even remove freedoms and rights which are both natural and constitutionally guaranteed. I'm not going to say that mentally unstable people should have access to dangerous things such as cars, knives, heavy bludgeoning devices and especially not firearms. If someone is indeed a "danger to society" we need to be serious about it -- very serious and very consistent. To deny someone their rights such as the right to self defense while at the same time not affording them appropriate protections under the law to compensate creates an extremely unfair situation.

Re:Who's hurting who?

[Anonymous Coward]

I'm a schizophrenic who has repeatedly been a victim of violence. However, as far as I know, it has nothing to do with people not understanding my behavior, and more to do with the situations I've gotten myself into, such as mental hospitals and group homes. It's been my observation that most of the people who work in those types of places want to help, but some see it as a means to exert power, sometimes violent, over others and get away with it.

Watch out for caffeine

[dixonpete]

I spent 25 years in the mental health system regarded as a seriously bipolar person. Turns out it was caffeine and to a lesser extent chocolate and a host of medicines that was causing the effect. I've been 5.5 years now symptom free. Never forget to eliminate environmental causes for mental and physical health issues!

An ex-convict's view....

[Anonymous Coward]

As someone with major mental illness who also spent time in gaol for a heinous crime, this is a terribly thorny issue. Due to the trend of "community based care", many patients stuff up their meds, and so end up committing crimes. As there is a lack of proper care facilities, we end up incarcerated in prison. This is a hell of a scary place for anyone, let alone someone with mental illness. Prison Mental Health is a joke, as it concentrates on the use of Seroquel for behaviour management, and there is absolutely no focus on life skills or therapy. Furthemore, prison officers are not mental health nurses, yet in the facility I was incarcerated in, about 2/3 of inmates were on psych meds.

In many respects, the old 19th century model of asylums (i.e. secured hospitals) could well be a better way to reduce recidivism, and to help patients learn to manage their disease and life. Prison certainly doesn't help - I came out more unstable than when I went in, as well as being traumatised by the rapes, stabbings and suicides.

Yes, prison is a consequence of action, but for those who commit a crime when unwell, but fail the test for diminished responsibility (it can be hard to prove you didn't know you were doing wrong, let alone deal with how you might know that society/law judges your actions wrong, but due to delusional thinking you think you're justified in your actions) it usually only makes things much worse. Hence the suicide rate in prison and amongst parolees.