Mental Illness & Crime

Zahiruddin Othman
 Lecture Outline
• Mental illness-Crime Relationships
– Crime in specific mental illnesses
• Criminal Responsibility
• Defenses for mental illness
– Insanity defense & diminished responsibility
• Malaysian’s Law
– Criminal Procedure Code (CPC)
Possible Relationship Between
Crime And Mental Disorder

Causal

Correlation

Coincidence
Prisoners in England and Wales
(Gunn et al. 1991)
Psychiatric diagnosis
14
12
10
8
6
4
2
0
Mental Psychosis Neurosis Personality Alcohol dep drug dep
retardation disorder
Psychiatric diagnosis
 Study by Hafner & Boker, 1982
• All homicides and attempted homicides in West
Germany 1955-64
• Mental disorder was associated with 5% of these
• The rate of mental disorder in the community
was 3-5%
• Homicidal violence rateschizophrenia = 5/10,000
– Schizophrenics were 100x more likely to commit
suicide than homicide
• Homicidal violence rateaffective = 6/100,000
– Affective disorders were 1000x more likely to commit
suicide than homicide
 Violence And Psychiatric Disorder In
The Community (Swanson et al. 1990)
Violence
35
30
25
20
15
10
5
0
schizophrenia (SCZ) Substance abuse (SA) SA + SCZ
Violence

Active psychotic symptoms are associated with an increased risk of violence

 Specific Mental Disorder & Crime
• Psychopathic disorder
– there is an increased likelihood of other
psychiatric symptoms and disorders
– homicide risk is increased 10x in someone
with an antisocial personality disorder
• Drug dependence
– Offences against property are associated with
the need to pay for drugs
– Rates of drug abuse are increased among
prisoners
 Alcohol dependence
• Alcohol and crime are related in 3
important ways:
– Alcohol intoxication may lead to charges
related to public drunkenness or to driving
offences
– Intoxication reduces inhibitions and is
strongly associated with crimes of violence,
including murder
– The neuropsychiatric complications of
alcoholism may also be linked with crime
 Mental retardation
• Most offences committed by those in the
borderline to mild ranges of learning disability
• The mentally retarded are more likely to be
caught
• They may commit offences because they do not
understand the implications of their behaviour,
or they are susceptible to exploitation by others
• Association with indecent exposure and arson
 Depression
• Severe illness may lead to homicide
– The depressed person is usually acting on
delusions
– Family member is usually the victim in
altruistic homicides
– The killer often commits suicide afterwards
• Sometimes associated with shoplifting
 Bipolar Illness
• Offending is more common than in
depression
• Manic patients may spend excessively,
hire cars and fail to return them, or steal
cars
• May be charged with fraud or false
pretences
• Prone to irritability and aggression, though
any resulting violence is seldom severe
 Schizophrenia
• more likely to commit non-violent as well as
violent crimes
• minor offences more likely than serious offences
• most criminal behaviour followed the onset of
schizophrenia, although crime is frequently a
result of personality difficulties and social
incompetence
• risk of homicide is moderately increased in
schizophrenia compared to the general
population
 • violence in schizophrenics may be
associated with any of:
– great fear and loss of self control
associated with non-systematized
delusions
– systematized paranoid delusions of
persecution
– irresistible urges
– instructions from hallucinatory voices
– unaccountable frenzy
• risk of violence is greatest where
delusions are accompanied by strong
affect, and when the person has made
efforts to try to confirm the truth of
the delusions
http://www.thestar.com.my/news/nation/2012/07/12/khalils-brother-fears-for-safety/
http://www.sinarharian.com.my/semasa/pengakuan-suami-isteri-saya-terjerat-dalam-fantasi-khalil-1.66517
http://www.sinarharian.com.my/semasa/amuk-pengakuan-suami-muhdalina-bahagian-ii-1.66562
http://www.sinarharian.com.my/semasa/muhdalena-percaya-lelaki-amuk-itu-imam-mahadi-1.250667
CRIMINAL RESPONSIBILITY

Evil intent Evil deed

CRIME
mens rhea actus rheus
 Events or state of the affairs of the crime

State of the mind of the crime

e.g. murder
Children below 10
McNaughten Determines whether the person The strictest test, and
understand the nature and the standard criterion in
quality of his actions, and if so, most jurisdiction
whether he knows that the action
was wrong
American Law •Cognitive prong – determines After the Hinckley case,
Institute (ALI) whether the person appreciate most jurisdiction that
the wrongfulness of his behavior used this test dropped
Model Penal
•Volitional prong – determines the volitional prong
Code
whether the person is able to
conform his conduct to the
requirements of the law

Durham Evaluates whether the person’s The most lenient test,

criminal behavior is the “product” it has been abandoned
of a mental illness in almost all jurisdictions
Reference: High-yield psychiatry, pg:146
e.g., if he believed that man was
attempting to kill him, and he kill that
man, as he thought, in self defence, he
would be exempt from punishment
 Main Points of McNaughton’s Rules
1. Every man is to be presumed to be sane and to possess a
sufficient degree of reason to be responsible for his crimes, until
the contrary be proved.
2. An insane person is punishable "if he knows" at the time of crime.
3. To establish a defense on insanity, the accused, by defect of
reason or disease of mind, is not in a position to know the nature
and consequences.
4. The insane person must be considered in the same situation as to
responsibility as if the facts with respect to which the delusion
exists were real.
5. It was the jury's role to decide whether the defendant was insane.
SANE
Everyman is to be presumed to be sane

INSANE
Defect of reason because disease of mind

“TEST OF KNOWING”
Not knowing nature or consequence of the act

RESPONSIBILITY
Is as if the delusions were real

JURY’S ROLE
Decide whether the defendant was insane
 Diminished Responsibility
• Charge of murder  manslaughter
• Abnormality of mind as substantially
impaired his mental responsibility for his
action
 AUTOMATISM
• If a person has no control over an act,
he cannot be held responsible for it –
the
• Concept is similar to being ‘briefly
insane’
• It is a legal term, and has no
connection with epileptic automatisms
• Verdicts of not guilty have been
returned when acts of violence were
judged to have been committed as
‘sane automatisms’
 Sane Automatism
• Leads to a full acquittal
• Seen to be due to an
‘external cause’
• Includes:
– absent-mindednesss (in
association with
depression)
 Insane Automatism
• Automatism thought to arise from a
‘disease of the mind’ – the appropriate
defence is then insanity and the
McNaghten rules apply
• Are due to an ‘internal cause’ because
the conditions may reoccur
• Includes:
– epileptic automatism
– hypoglycaemia, hyperglycaemia
– sleep-walking
– arteriosclerosis
 Fitness to Plead
• Understand the nature of charge
• Understand the difference between a plea
of guilty and not guilty
• Instruct counsel
• Follow evidence in presented in court
• Challenge jurors
 Treatment of Mentally Abnormal
Offenders
• In prisons
– 1/3 of sentenced prisoners have a psychiatric
disorder and 2% have a psychosis (Gunn et al
1991)
• In hospitals
– For indeterminate length of stay or under
ruler’s pleasure
• In the community
– When a non-custodial sentence is passed
 Criminal Procedure Code
Detention of offenders in psychiatric hospital

Section 342

• Person suspected of unsound mind to be examined

Section 344

• Person of unsound mind found not fit to stand trial

Section 348

• Person of unsound mind found not guilty by reason

of insanity
Mental Institutions in Malaysia

Hospital Bahagia Hospital Permai Hospital Sentosa

Hospital Mesra