The criminalisation of the mentally ill: does dangerousness take precedence over need for treatment?

Abstract

The current emphasis on dangerousness as a criterion for both civil and criminal commitments in the USA results from a confluence of political and legal factors which have little to do with the provision of appropriate treatment to mentally disordered persons. These factors have resulted in significant changes in the types of persons involuntarily hospitalised, and the stages of their disorders when interventions are to be permitted. As a result, hospitalised patients are more likely to have personality disorders, to have criminal histories, and to be resistant to treatment than was the case prior to deinstitutionalisation. The rising proportions of such patients consumes scarce resources and complicates treatment for those patients who are potentially responsive to treatment. This situation is unlikely to change as long as society expresses a preference through its laws for short‐term protection from harm over the provision of effective treatment.

Schizophrenia, Delusional Symptoms, and Violence: The Threat/Control-Override Concept Reexamined

“…The search for reliable predictor variables for future violence of mentally ill subjects is one of the most important topics of forensic psychiatry, not only because of the special public interest, and the prejudices against and the stigmatization of psychiatric patients, but also because of the consequences on general mental health care (e.g., civil commitment laws) (Miller 1993; Beck 1996; Beck and Wencel 1998; Schanda 1999, 2001).…”