MENTAL DISORDERS AND CRIME: THE CONNECTION IS REAL

In a landmark issue, the Archives of General Psychiatry recently focused largely on one controversial topic: are mental illness and crime strongly linked? The inescapable conclusion, according to Associate Editor Peter Marzuk, is "yes."

In his introduction to the issue, Marzuk notes that new studies of violence among the mentally ill are well designed and quite convincing. Although stressing that "most persons with mental illness are not criminals, are of those who are, most are not violent," Marzuk says, "In the last decade, the evidence showing a link between violence, crime, and mental illness has mounted. It cannot be dismissed; it should not be ignored."

Among the findings of studies presented in the journal:

--Using Denmark's highly detailed population registries, Sheilagh Hodgins and colleagues identified all individuals born between January 1, 1944, and December 31, 1947, and documented all psychiatric admissions in this group of 324,401 people up to the age of 43. Hodgins et al. then compared the criminal records of the individuals with a history of hospitalization for psychiatric illness to the criminal records of individuals without such a history.

The researchers found that "individuals with a history of psychiatric hospitalization were more likely to have been convicted of a criminal offense than persons with no history of psychiatric hospitalization," a finding that was true for both men and women. Depending on their sex and diagnostic categories, subjects with psychiatric hospitalization histories were three to 11 times more likely to have criminal convictions than those without such histories. Offenders with psychiatric hospitalization histories were convicted of all types of crimes, and, surprisingly, averaged the same number of convictions as never-hospitalized offenders of the same sex.

Hodgins et al. note that criminal convictions and psychiatric hospitalizations are independent processes in Denmark, meaning that their findings cannot be explained by the interactions between the criminal justice and mental health systems.

Their findings, the researchers say, concur with two similar Scandinavian studies, and with research from North America showing high rates of major mental disorders among incarcerated offenders.

--Markku Eronen and colleagues studied the psychiatric evaluations of 693 Finnish murderers. Their data showed that "schizophrenia increases the odds ratio of homicidal violence by about 8- fold in men and 6.5-fold in women." In addition, they report, "Antisocial personality disorder increases the odds ratio over 10-fold in men and over 50-fold in women." Antisocial personality disorder is a particularly strong risk factor for homicidal behavior, they say, when coupled with alcoholism.

--Two separate studies found a high incidence of psychiatric illness among incarcerated women. Linda Teplin et al., who studied a randomly selected sample of 1,272 female jail detainees awaiting trial, found that "over 80% of the sample met criteria for one or more lifetime psychiatric disorders," and that "70% were symptomatic within six months of the interview." B. Kathleen Jordan et al. studied 805 female felons entering prison, and report that "inmates were found to have high rates of substance abuse and dependence and antisocial and borderline personality disorders compared with women in community epidemiologic studies."

Hodgins et al. say they hope that studies revealing an increased rate of criminality among people with mental illness will not be used to further stigmatize this population.

"Rather," the researchers say, "these data can be used constructively to provide more adequate, appropriate, and humane care to individuals who, through no fault of their own, suffer from devastating disorders, and at the same time to protect society."

Physician Jeremy Coid agrees, saying in the British Medical Journal that the new findings suggest that "there needs to be better access to treatment for affected individuals, better methods in the health care system to identify and treat symptoms associated with violence, and greater powers to intervene. Legal recourse may not be as effective as improved mental health resources in preventing violence."

All studies cited appeared in Archives of General Psychiatry, Vol. 53, June 1996. Quote by Jeremy Coid is from the British Medical Journal, Vol. 312, No. 7036, April 13, 1996.

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