Mental retardation and crime

Learning disability is a synonym for the term "mental retardation" in the definitions of ICD-10 and DSM-IV. This classification is based on the coefficient of intellectual development (IQ), when the norm is taken as 100.

Mild learning disability is defined in IQ as 50-70, moderate learning disability - 35-49, severe learning disability - 20-34 and profound learning disability - below 20 The diagnosis is set according to the level of functioning and regardless of the cause of the condition. When using the IQ test, it is necessary to take into account some specific limitations, for example in the field of communication. In addition, the test should be appropriately validated taking into account the ethno-cultural identity of the person being examined. Mental retardation is acceptable as a diagnosis only if such disability occurs during development (up to 18 years).

In the presence of additional psychiatric disorders or evidence of physical illness or physical trauma, an additional diagnosis must be made. Mental retardation in itself does not mean lack of opportunities, nor does it imply that a person is not able to live independently in the community. The closure of hospitals for chronicles and the development of community assistance confirm that many people with mild and moderate mental retardation are able to lead a relatively normal life if they are provided with an appropriate level of support. Another consequence of de-institutionalization is that significantly more people with learning disabilities have come to the attention of the criminal justice system.

[1], [2],

Mental retardation and the commission of crimes

West studies prove that IQ is one of the five leading factors associated with the development of delinquent behavior. Persons with a pronounced inability to learn most often live in one of the resident institutions providing care for them, and therefore committing crimes in the community is unlikely. At the same time, most of the resident services now operate in close integration with the community, and thus, depending on the degree of supervision in the institution, there is more room for committing crimes than it was before, when the majority of persons with this degree of intellectual insufficiency were kept in hospitals of the National Health System. Hospitals were known for absorbing the criminal behavior of their patients with minimal police involvement - only when committing very serious crimes. Modern small-sized houses of residence run by social services, voluntary organizations and individuals in cases of crimes committed by their wards more often resort to police assistance and ask the local psychiatric services to send them to a forced placement in the hospital. However, often people do not want to start a formal judicial procedure if the suspect is a person with severe mental retardation, although the judicial procedure is often useful in establishing the facts of the case and determining the structure of any necessary assistance package.

It should be taken into account that not all persons with severe mental retardation can describe their actual actions, and therefore many decisions related to the reaction to the alleged criminal behavior are based on incoherent and unconfirmed information.

From this it follows that the decision not to hold court hearings, although it is taken from the best motives, can, in essence, deprive a person with a pronounced mental retardation of the presumption of innocence that underlies the criminal justice system when the reverse is not proven. It is for this reason that the Criminal Procedure Act of 1991 (Madness and the inability to participate in litigation) provides that first it is necessary to consider the facts, while observing the requirement for the burden of proof within "reasonable sufficiency", and then to proceed to the consideration of the question of sending a person who is unable to participate in the proceedings due to existing restrictions, to the relevant institution.

Persons with lighter degrees of mental retardation are usually not restricted in moving in the community and do so without any supervision, and for this reason they are more likely to come into contact with the criminal justice system in the case of crimes. The degree of their intellectual limitations may not be fully appreciated, especially if the weak ability to process information is covered by the mask of "social adaptation." In such cases, it is important to correctly assess the actual psychic ability of the subject, since this can have consequences, in particular, for the recognition of his testimony as reliable and recognizing his ability to stand trial. Criminals with mild degrees of mental retardation are often able to participate in court proceedings and are able to stand trial, but with regard to sentences, a wide range of their referral to community or hospital services, that is, measures alternative to criminal penalties, is possible here.

Special problems arise with persons with IQ in the range of 70-85. This group is usually described as a person with a person with a borderline intelligence level. Most of them are able to live on their own, but they suffer from various manifestations of inadequacy and personal problems that may predispose to antisocial behavior. They do not fall under the Mental Injury provisions of the Mental Health Act, but may fall within the scope of the Psychopathic Disorder. Psycho-social assessment and the identification of intellectual deficits can be of great importance for mitigating punishment and imposing an adequate measure on it.

Studies of child populations indicate a stable statistical relationship between low IQ and the occurrence of crimes. West found that 20% of people with IQ below 90 compared with 9% among those with IQ 91-98 and 2% among those with IQ above 110 are delinquents. On average, IQ delinquents are at least 5 units below the population standard. Population studies in the penal system give a wide spread (1-45%) in estimates of the frequency of subnormality, although they may reflect both the quality of diagnosis, the characteristics of the prisons surveyed, the years of assessment and the quality of services that could lead a person unable to learn from the criminal system justice. The data of prison research lead to rather controversial conclusions about the role of mental retardation in crime. And although it can be argued that the whole point is that people with mental retardation are easier to catch, a study by West and the work of other authors show that people with learning disabilities do commit crimes more often. It is noted that in this category of persons some criminal factors dominate, such as, for example, a large family, low social status and additional physical limitations, but, as shown by a careful comparison of samples, low IQ itself is also a crime factor. Low IQ creates behavioral problems before the age of 3, that is, before the manifestation of problems with learning. Bad school performance plus low self-esteem and a low level of frustration tolerance can be combined with certain personal characteristics and inability to learn from one's own experience, thus forming an increased inclination to antisocial ways of responding if things go wrong as originally expected.

In general, it is assumed that persons with mental retardation, although capable of committing any crime, most often commit sexual crimes or arsons. This statement is largely based on clinical practice data and studies of crimes committed by persons unable to learn and placed in a hospital, and therefore should be approached with a certain degree of caution. However, it is possible that persons who are not able to study and fall into the field of view of forensic psychiatric services will be charged or convicted for these types of crimes. This may be due to the existence of an informal threshold for the severity of crimes observed by social and law enforcement agencies when deciding whether to initiate a formal process for this category of persons.

Medico-legal assessment of persons with mental retardation

An adequate starting point in these circumstances is the evaluation of intellectual functioning. Specialists in mental retardation psychiatry are usually able to give a clinical assessment of the case, that is, to determine whether the person falls under the diagnosis of learning disability (mental retardation) according to ICD-10. If possible, the evaluation of a psychiatrist should be supported by the results of formal psychometric testing performed by a clinical psychologist who has experience with people who are not able to learn. In addition to evaluating intellectual functioning, it is also necessary to consider the possibility of having superimposed on the underlying condition of mental illness, chromosomal and other genetic abnormalities, acquired brain damage, and also specific disorders such as autism spectrum disorders. It is usually necessary to collect as much "background" information as possible, and from the most reliable sources. In particular, caution should be exercised in assessing the subject's story of the alleged crime. Persons with mental retardation often try their best not to contradict persons who represent the authorities, and so they can agree to some proposals during the conversation, without realizing the consequences of their answers. To avoid this, the Police and Criminal Evidence Act of 1984 presupposes the presence of an appropriate adult person when interviewing police officers with incapacity for training or suffering from illness.

Issues to consider

When assessing an individual accused of a crime that is allegedly suffering from mental retardation, the following should be taken into account:

1. Does this subject suffer from an inability to learn, and if so, to what extent?
2. Is the subject's behavior linked to his mental retardation, and does this behavior fall into the category of anomalously aggressive or largely irresponsible behavior?
3. Is there any reason to suppose that this person has, in addition to the inability to learn, the presence of some kind of mental disorder, and if there is one, does the fact of having such a disorder suggest specific recommendations?
4. Is the subject able to participate in the trial?
5. Should the issue of limited liability be raised in case of murder?

If one assumes that the subject falls into categories of mental defectiveness, severe mental impairment, mental illness, psychopathic disorder, inability to participate in litigation or limited liability, the next question will be the recommendation to the court about where to place such a subject. In the event that the subject is classified as a person mentally impaired or as a person suffering from a different mental disorder, the appropriate measure will be to place him in a hospital in accordance with art. 37 of the Mental Health Act 1983, which allows the individual to best meet the needs of therapy. In the case of severe mental disability, the requirement of curability, applied to mental defectiveness and psychopathic disorder, is removed, and then the option of referral to a specialized institution can be used as a more humane alternative to imprisonment.

In the vast majority of cases, there is no need to place such persons in the hospital. They are more suited to sanctions in the community. However, the courts are obliged to ascertain the adequacy of the measure of placing the person in the community, both from the point of view of therapy and from the point of view of public safety and appropriate prevention of repeated crimes. The following options are available in the community:

1. A probation order with the condition of observing the therapeutic regimen.
2. The warrant of custody in accordance with Art. 37 of the 1983 Mental Health Act.
3. A warrant for supervision in the community in accordance with the Criminal Procedure Act of 1991 (Madness and inability to participate in legal proceedings). These measures make it possible to offer a comprehensive package of assistance, as well as provide a structure to track these individuals and monitor their behavior. Such assistance packages usually involve the interaction of many services and the presence of a specialist who will deal with the organizational aspect of this interaction.

Sexual aggression and inability to learn

Mr. A. (age 20) was charged with committing a third crime for his life - an attempt to rape a 12-year-old girl. He led her into the field, forced to undress and was about to rape, but passers-by prevented it. He was arrested.

His first crime was the indecent touch of a woman in a supermarket, after which he was conditionally released early. The second crime was the woman's grip on the chest in the street. His behavior in court left no doubt about the existence of a psychiatric disorder.

A.'s difficulties in teaching are well documented: he attended a special school. His 1 () is 65. He never had a paid job. It is also known about the pronounced shortage of his social skills. It is known that at the place of residence he communicated with delinquent persons. There is evidence of alcohol abuse, and alcohol, according to the expert, was to a large extent the reason for the disinhibition of his behavior. The court accepted the recommendation on psychiatric treatment as a condition of probation. A. Regularly visited all the appointments, but it was difficult to involve him in the therapeutic relationship with the treating specialist.

Four months later, he was arrested for attempting to rape. A further evaluation at this stage revealed that he had for many years had fantasies about pedophilic rape. He admitted that he carried a knife, and he had fantasies about using a knife during the rape.

Features of the latest crime and troubling fantasies left no doubt about the necessity of placing A. In a hospital - for his further examination and treatment. Due to the absence at that time of free beds in the hospital, it was decided to put A. In prison, but due to his vulnerability in prison conditions, steps were taken to transfer him to a special hospital, in accordance with Art. 47 of the 1983 Mental Health Act and with the application of a restraining order in accordance with Art. 49 of the same Law.

It has been successfully applied therapeutic program of general and sexual education, as well as training of social skills and behavioral therapy aimed at countering unwanted sexual impulses. At the end of the sentence, the court order in accordance with Art. 47 was transformed into an order in accordance with Art. 37, without restrictions on movement, and subsequently A. Was discharged for further rehabilitation to a regional office with enhanced security regime.

A comment

This case illustrates the complexity of attempts to treat people with mental retardation. Ignorance in matters of sex, combined with poor social skills and the most unimaginable fantasies, can turn a mentally retarded person into a source of serious danger to society, and therefore this aspect should be a priority when a court decides to place a criminal in any of the services.

At the same time, sentences related to isolation from society, in themselves, are unlikely to affect the underlying basis of the crime. In this case, although the subject was eventually withdrawn from the criminal justice system, the subject was nevertheless isolated from society longer than it would have been in the case of imprisonment. But, on the other hand, the package of help applied to him in the special hospital and thoughtful rehabilitation can ultimately lead to his safer and more productive life in the community.

Theft and Mental Retardation

Ms. B., age 21, 10, = 67. Sent to the department of enhanced surveillance because of continuous theft, violence against others and self-harm. Attempts to treat and curb her behavior in the community and in the local department of examination and treatment have not been successful. B. Is placed in a compartment with an enhanced security regime in accordance with Art. 3 of the Mental Health Act on the basis of mental disability.

The history of developmental delay in B. Leaves in infancy. She studied in the system of special school education. Behavioral disorders were noted long ago, but became more pronounced after the death of her mother when she was 17 years old. Accordingly, the anomalous reaction of grief was diagnosed, and she was treated for depression. It is described as a self-centered person, prone to manipulating others, poorly tolerating frustration, impulsive, potentially anti-social and aggressive.

Conditions for enhanced surveillance suggested conducting a behavioral program under the guidance of a psychologist, during which she gradually became accustomed to taking responsibility for her actions. Such programs often cause temporary aggravation of undesirable behavior, and then the physical limitations existing in the department and the more favorable ratio of workers and patients allow to limit such an aggravation with sufficient security.

A comment

This case shows how mental retardation can protect the subject from the complete rigor of the criminal justice system, in the sense that none of the victims of her actions insisted on their accusations. The above behavior is usually for a number of syndromes of personality disorders, but in this case it is more correctly attributed to personal immaturity in the context of the overall developmental delay, and not to a personal disorder in its pure form. This case also illustrates the special problems of persons with mild learning disabilities due to their lack of ability to function in a society at a normal level, given their ability to understand that they are "losing" in comparison to their peers. As a result, frustration and anger are possible, which in an immature person can lead to serious manifestations of antisocial behavior.

Theft and Border Mental Retardation

Mr. V. Is one of five children in a full family, in which the father suffered from several chronic diseases, including epilepsy. In his anamnesis, there was no delay in development, except for nocturnal enuresis, which persisted until age 18. At school he was in the category of fast-food, and finished his school education at the age of 15 without documents confirming the successful completion of this stage of education. For four years he managed to stay at work and earn money, but later he could not find a new job.

Mr. V. Fell into the realm of psychiatry, while still a child - because of learning difficulties and enuresis. Then his 10 was estimated at 80. As an adult, he was hospitalized for recurrent depression, intentional self-harm, fetishistic attachment to female underwear. He also knew that he was overly abusing alcohol. The crime he committed was in the context of social inadequacy and probable alcohol dependence, and since he did not fall under the parameters of mental defectiveness, the court applied to him the usual sanctions in the community.

A comment

The group of people at 10, 70-85 is increasingly supported by special community brigades to work with people with learning disabilities. And although they can not be fully considered as incapacity for training, nevertheless, they need special support skills and the opportunity to offer them treatment, which exists not so much in the system of mental health services for adults as in services for the mentally retarded. Despite the apparent subnormality of their intelligence, courts tend to treat such individuals as ordinary defendants, unless there are special circumstances that mitigate their guilt.

[3], [4], [5], [6],

Violence, depression and mental retardation

Mrs. G. Is accused of deliberately inflicting bodily harm: attacking her mother using an element of decorative garden composition and causing her severe head trauma. During the attack, G. Unreasonably considered herself deadly sick and thought that it was better in this situation to "take the mother with her."

In general, her early development proceeded normally, with the exception of an irresistible school phobia. At school she was considered unsuccessful, and she completed her schooling at the age of 15 without documents confirming the successful completion of this stage of education. She never had a permanent job. G. Was twice married - first for a man 50 years older than her, who died after 10 years of marriage, when G. Was 31 years old. She immediately married again and again for a man 30 years older than himself, who died two years later. After the death of her second husband, G. Developed severe depression. She also complained of severe abdominal pain, for which no organic cause was found. This was the same "deadly disease" that she spoke of during the commission of the crime in question. Her description of the disease became increasingly bizarre, and she was diagnosed with a major depressive disorder with marked nihilistic delirium. In a subsequent study, she was set to 10, equal to 69. In accordance with Art. 37 of the 1983 Mental Health Act, she was placed in a hospital based on the presence of a mental illness, where she had been successfully treated for her illness.

A comment

This case illustrates well the comorbidity, which is often found in criminals with inability to learn. There is no doubt that G. Has an inability to learn, but at the same time her behavior is rather a consequence of her illness, rather than a stopped or incomplete intellectual development.

Treatment of criminals with mental retardation

Community Services

Most often, individuals with learning disabilities who have committed a crime or exhibiting a pronounced defiant behavior are sent to community services for treatment.

The law provides for the following opportunities:

• a probation order with the condition of treatment;
• supervision in accordance with the Criminal Procedure Act of 1991 (Madness and inability to participate in judicial proceedings);
• guardianship in accordance with Art. 37 of the Mental Health Act 1983;
• guardianship in accordance with Art. 7 of the 1983 Mental Health Act.

Regardless of the options provided by law, these persons are offered a package of comprehensive assistance, which includes the following elements:

• accommodation for a family or placement in a state, voluntary or independent service;
• providing an educational program;
• structured daytime employment;
• therapeutic interventions of the National Health Service, social services and / or probation services;
• monitoring of the state;
• coordination of the assistance package and monitoring of its implementation.

A key element is usually the involvement of a specialist in the field of mental retardation psychiatry and the availability of an adequate community aid team.

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Local fixed services

In cases where a program in the community is not very suitable for this person or if an additional survey is required, structured conditions for intervention are provided by local inpatient units.

The placement in these offices in connection with the requirement of an enhanced security regime is carried out in accordance with Art. 3 or 37 of the 1983 Mental Health Act. In the event of the application of an order under Art. 37, an order to restrict freedom of movement in accordance with Art. 41. With the closure of most hospitals for the detention of persons with mental disabilities, local inpatient services are not so much a long-term care facility as an element of support for existing community services. Accordingly, they are used for examination and therapeutic intervention attempts to form a community-based assistance program. In particular, they can be useful for creating a structured environment in the early stages of behavior change programs.

Departments with enhanced security mode

Most of the general departments with an enhanced security regime accept only those with the lightest forms of mental retardation. The need for specialized services with this level of security was reflected in the Oxford survey, and in recent years it has been mandated to create several such units both within the National Health System and in the private sector. The main reason for putting people in these offices is that local services can not cope with their behavior in their own security regime. In newly created services with a strengthened security regime, specific experience in the treatment of sex offenders already accumulates and they are able to offer such a level of security and a potential length of stay that can not be provided by local services.

[8], [9],

Special Hospitals

At present, the facilities for the maintenance of persons with mental retardation are provided by the hospitals of Rampton and Ashworth. At the same time, the survey of these services provoked rather contradictory reviews, and the opinion is growing that many mentally retarded patients hospitalized in these hospitals do not need such harsh security conditions.

It is possible that further study of the activities of special hospitals in relation to all types of patients will eventually lead to the construction of small target departments for people with learning disabilities that pose a serious and immediate danger to others.

Prison Service

Despite the fact that a significant number of people who have mental retardation and commit crimes still end up in prison, the prison service does not have special conditions for this very vulnerable group of prisoners. It remains to be hoped that improving the quality of pre-trial psychiatric expertise, combined with the guarantees of the Police Act and the Criminal Testimony of 1984, will help reduce the number of unreasonable premises in prison in this group of criminals.

Mental retardation and the Mental Health Act 1983

The society traditionally protects individuals with the inability to learn from the application of the law with all severity and allows to consider intellectual insufficiency as a mitigating factor, and at a fairly severe degree of its expression - as a basis for recognizing a person as innocent due to insanity. And although some people with lighter degrees of mental retardation can adapt in prison and do so, it is still obvious that ordinary criminal penalties are not acceptable to persons with more severe degrees of intellectual insufficiency. In addition, it is also generally accepted that in itself a learning disability is not a reason for being placed in a hospital, except when it improves the situation of that person. Parker found that more than half of the people designated as subnorms actually had IQ above the level to which they were assigned. There is a tendency in determining the level of intellectual functioning to take as a basis the social functioning of a person and not to apply more precise criteria of international classification systems.

The Mental Health Act 1983 introduced new terms, in particular mental impairment and severe mental impairment. This was done with a view to narrowing the scope of the law, that is, to use it only for people with learning disabilities who need to be hospitalized to treat or protect themselves or others, and when their placement in penal institutions is not a viable alternative .

Mental impairment is defined as the state of a stopped or incomplete development of the human mind (not reaching the degree of severe mental impairment), which includes a significantly reduced level of intelligence and social functioning and is associated with abnormally aggressive or largely irresponsible behavior. Severe mental deficiency is defined as a state of stopped or incomplete development of the human mind, which includes heavy levels of intellectual and social decline and is associated with abnormally aggressive or largely irresponsible behavior. Definitions of "severe" and "significant" are not given, but it is generally accepted to use IQ levels of 60-70 and, accordingly, below 60. Definitions of severe mental defectiveness are sufficient to recommend to the court to decide on placing such a person in a hospital. However, in the case of "mental disability", placement in a hospital for the purpose of treatment should improve a person's situation or prevent the deterioration of his condition.

Of course, if the offender with mental retardation suffers the same and mental illness, then such a disease can be the basis for a psychiatric recommendation for compulsory placement in a hospital.