Wednesday, November 8, 2017

Mental illness and crime

The relationship between mental illness and crime has long been a subject of debate; however the psychological disease is not the primary cause of criminal behavior but its general course of concern within the mental health profession, the public, correctional systems, and the criminal justice systems. As a result, this has led to an increase in research being focused on why mentally ill people commit crimes. In analyzing the role of psychological symptoms in defining violence among personages with mental illness, John M.W Bradford (2008) proposed that there is a significant possibility of reducing the levels of violence by improved assessment and management intervention. In a research of 261 male patients with affective disorders and 282 male patients with schizophrenia and, Wuermle, Modestin (2005) found that 42 percent out of 261 patients with affective disorder and 34 percent out of 282 patients with schizophrenia had a criminal record and more than half of a total of 543 patients had co-occurring drugs abuse. It suggests that there is a link between psychopathology, mental illness, and crime. The illness afflicts 15 to35 million adults, which is about 10 to 20 percent of the population. “Approximately 20 million children or 10pc of the population in our country need attention from mental health practitioners,” chairperson of the department of psychiatry at the Aga Khan University.(2016) Dr. Ayesha Mian said the dishonor against mental disorder is rampant in Pakistan. It is continued by popular belief in mystical cures, experimenting with herbal cures, exorcising evil spirits, and reciting verses from the Quran, and a lack of awareness about mental illnesses (mental disorder) causes, symptoms, and cures. It has been estimated that on an international, comprehensive scale, the level of undiagnosed and unaddressed mental health issues is continuously increasing. An estimated 120 million people globally suffer from depression, 50 million from Epilepsy, 37 million from Alzheimer, and 24 million from Schizophrenia. Around 50 million people are suffering from common mental disorders in Pakistan. The illness afflicts 15 to35 million adults, which is about 10 to 20 percent of the population.

There are multi-layered possible reasons for mental illness comprise as parents having depression, genetic inheritance, or emotional instability or a propensity for high neuroticism. In depression, parenting risk factors include imbalanced parental treatment, and there is an association with high cannabis use. In anxiety risk, factors may include
·       Family history (e.g. of anxiety)
·       Temperament and attitudes (e.g., pessimism)
·       Parenting factors including lack parental warmth,
·       Parental rejection, harsh discipline,
·       Anxious childrearing, and drug-abusing behavior and child abuse (emotional, physical and sexual).
·       Environmental events neighboring pregnancy and birth have also been concerned
·       Traumatic brain injury may set up the risk of emerging certain mental illnesses
However, crime victimization is frequent among persons with mental disorders who live in the community. Like other vulnerable populations (e.g., homeless persons, persons with developmental disabilities, and public housing residents), persons with severe mental illness are a particularly high-risk group. Symptoms associated with psychiatric disorders such as impaired reality testing, disorganized thought processes, impulsivity, and poor planning and problem-solving, can compromise one’s ability to perceive risks and protect oneself. Moreover, factors correlated with victimization substance abuse, schizophrenia, Alzheimers, epilepsy, conflicted social relationships, poverty, and homelessness is prevalent among persons with mental illness.

The Keys to Way Forward
The question now is what is the way forward? And the probable answer will be to re-evaluate, remodel and restructure the policy based on the guiding principles of WHO. Still, we will need an evidence base to start formulating policies regarding mental illness and crime. The Government of Pakistan through Pakistan Medical and Research Council should play an important role in the field of research, especially mental health research. So mental health research especially policy-based research should be promoted with fundings or incentives. Similarly the major postgraduate degree awarding institute, College of Physicians and Surgeons Pakistan, should also encourage students to get involved in prevalence studies and their involvement in such studies should be promoted and supported through their supervisors. Small-scale research projects carried out with a limited population may also be important to gather evidence for effective strategies to be implemented throughout the country. This may also need auditing the previous work done in the same area. All the stakeholders (consumer and family groups; general health and mental health workers; health care providers; government agencies; academic institutions; professional institutions; traditional health workers; and religious organizations) should be taken on board and a positive political attitude created to foster an atmosphere of understanding and trust which will help in the implementation of the plans and policy. Development of local capacities, participation process and alliance with various stakeholders will definitely hold a key to success. Liaison with other countries and various authorities/ international experts to share their experience in formulating cost-effective interventions may also be helpful in answering the unsolved questions. The areas of action also need to be carefully identified and a simultaneous development of such areas should be considered. However, all these actions are unsuccessful without a political will. The will may be created by highlighting the importance of mental health on every concerned forum specially the print and electronic media. This may in turn lead to a trustworthy environment helpful in the formulation and implementation of mental health policy. All the main sectors require taking on specific roles and responsibilities to make the policy a success All this should lead to the development of a mental health service that delivers integrated, comprehensive community based care by incorporating it into general health services and reducing crime rates. Thus, increased number of people with mental disorders will receive treatment in primary care. It can only happen with proficiency, persistence, and motivation as developing a policy usually takes a couple of years, but the implementation of the policy may take a decade or more. Working on these lines may lead to the real implementation of a mental health policy in Pakistan.
The fact is that there is an urgent need of official policy and legislation to address the mental illness issues and cases concretely to reduce the risks of crime prevailing due to offenders of mental disorder in the society. The studies show that mental disorder leads to committing severe crimes which scatter the fabric of the society to some extent as well as the economic burden has also been boosting such mental diseases. It also highlights the lack of awareness regarding mental illness and stigmatization attached to the patients which hinder in getting the proper treatment of them. Although, without immense attention and well-organized policy and keeping special quotas for mental disorders person in annual budget is impossible to cut down the growth rate of mental diseases as well as offenders of crimes owing to them. To deal with priority this plight situation of mental health and its systems in Pakistan to make a healthy and crime-free nation.

The writer has done his MSc in Criminology and Security Studies. Currently, he is serving as a government official.
Mian Majid Ali


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