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A Companion to Criminal Justice, Mental Health and Risk

Table of contents :
Actuarial Risk Assessment
Actus Reus
Adversarial Justice
Advocacy in Mental Health Care
Alcohol and Risk
Anti-Psychiatry Movement
Appropriate Adult
Approved Mental Health Professional
Assessment, Care in Custody and Teamwork Approach
Attention Deficit Hyperactivity Disorder
Autism Spectrum Disorder and Criminal Justice
Aversion Therapy and Homosexuality
Battered WomAN Syndrome
Bethlem Royal Hospital
Bipolar Disorder
Black Report
Bradley Report
Butler Report and Medium Secure Mental Health Services
Care in the Community
Care Programme Approach
Care Quality Commission
Carers and Carers’ Rights of Mentally Disordered Offenders
Carceral Society
Children and Adolescent Mental Health Services
Circles of Support and Accountability
Clinical Governance and Risk Management
Clinical Risk Assessment
Cognitive Behaviour Therapy
Community Forensic Mental Health Teams
Community Treatment Orders
Compulsory Hospitalisation
Conduct Disorder
Consent to Treatment
Controversial Treatments in Psychiatry
Criminal Justice
Criminal Justice Act 2003
Crisis Intervention
Critical Criminology and Critical Criminologies
Cultural Criminology
Dangerous and Severe Personality Disorder Programme
Dangerousness and Mental Disorder
Defence of Insanity
Department of Health
Deprivation of Liberty Safeguards
Deviancy Amplification
Diagnostic and Statistical Manual of Mental Disorders
Dialectical Behaviour Therapy
Diminished Responsibility
Disability Hate Crime
Domestic Violence, Crime and Victims Act 2004
Dual Diagnosis
Due Process
Emotional CPR
Expert Witness
Extended Sentences for Public Protection
Fallon Inquiry
Female Sex Offender Assessment and Management
Film and Mental Illness
Folk Devil
Gender, Mental Health and Offending
High-Security Hospitals
Hospital Order
Hostage/Crisis Negotiations
Human Rights and Mentally Disordered Offenders
Independent Monitoring Boards
Indeterminate Sentences for Public Protection
Insanity and Defect of Reason
Intelligence Quotient and Delinquency
Just Deserts
Justice for All
Knowledge (Sociology of)
Knowledge–Power Nexus
Labelling Perspectives
Learning Disabilities and Criminal Justice
Long-Term Imprisonment and Mental Health
Loss of Control
M’Naghten Rules
Magdalen Asylums
Media Representations and Mental Disorder
Medicalisation and Social Control
Mental Capacity
Mental Capacity Act 2005
Mental Disorder
Mental Distress
Mental Health Act 2007
Mental Health First Aid
Mental Health In-Reach Services
Mental Health Review Tribunal
Mental Health Treatment Requirement
Mentally Disordered Offenders
Missing Patients
Missing People
Multi-Agency Public Protection Arrangements
National Confidential Inquiry into Suicide and Homicide by People with Mental Illness
National Offender Management Service
National Service Framework
National Suicide Prevention Strategy
New Penology
New Poor Law 1834
Offender Assessment System
Organic Disorders
Pains of Imprisonment
PCL-R™ (Psychopathy Checklist-Revised Assessment Tool)
Penal Abolitionism
Penal Crisis
Personality Disorder and Offending
Personality Disorder Pathway
Police and Criminal Evidence Act 1984
Policing and Duty of Care
Political Participation
Populist Punitiveness
Post-Traumatic Stress Disorder
Prison Privatisation
Psychiatry and Surveillance
Qualitative and Quantitative Inquiry in Mental Health Research
Race Equality and Mental Health Policy
Rational Choice Theory
Recovery and Mental Health Policy
Rehabilitation and Mentally Disordered Offenders
Report on the Select Committee of the House of Commons on Madhouses 1815
Responsible Clinician
Restorative Justice
Restricted Patient
Risk Society
Second Opinion Appointed Doctor
Section 136 of the Mental Health Act 1983 (as amended 2007)
Sex Offenders Risk Appraisal Guide
Sex Offender Treatment Programmes
Sexual Offending
Social Control Theory
Social Exclusion
Social Justice
Social Model of Disability
Solitary Confinement and Mental Illness
Solution-Focused Therapy
Stigmatisation and Mental Disorder
Structured Professional Judgement Risk Assessment
Substance-Related Violence
Third Way Politics and Crime Control
Transfer from Custody
Underclass (Social Construction of)
Unfitness to Stand Trial (Criminal Procedure (Insanity and Unfitness to Plead) Act 1991)
Universal Declaration of Human Rights
Vagrancy Acts
Veterans, Mental Disorder and Criminal Justice
Victims of Crime
Violence and Mental Disorder
Violence Risk Appraisal Guide
Woolf Report
Women’s Enhanced Medium Secure Services
York Retreat
Youth Custody and Mental Disorder
Youth Justice Board
Youth Offending Team
Zito Trust

Citation preview

a companion to

criminal justice, mental health & risk


Paul Taylor Karen Corteen Sharon Morley

A COMPANION TO CRIMINAL JUSTICE, MENTAL HEALTH AND RISK Edited by Paul Taylor, Karen Corteen and Sharon Morley

First published in Great Britain in 2014 by Policy Press North America office: University of Bristol Policy Press 1-9 Old Park Hill c/o The University of Chicago Press Clifton 1427 East 60th Street Bristol BS2 8BB Chicago, IL 60637, USA UK t: +1 773 702 7700 t: +44 (0)117 954 5940 f: +1 773 702 9756 [email protected] www.press.uchicago.edu www.policypress.co.uk [email protected] © Policy Press 2014 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record for this book has been requested ISBN 978 1 44731 034 1 paperback ISBN 978 1 44731 033 4 hardcover The right of Paul Taylor, Karen Corteen and Sharon Morley to be identified as editors of this work has been asserted by them in accordance with the 1988 Copyright, Designs and Patents Act. All rights reserved: no part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise without the prior permission of Policy Press. The statements and opinions contained within this publication are solely those of the authors and not of the University of Bristol or Policy Press. The University of Bristol and Policy Press disclaim responsibility for any injury to persons or property resulting from any material published in this publication. Policy Press works to counter discrimination on grounds of gender, race, disability, age and sexuality. Cover design by Andrew Corbett Front cover image: Evgesha/Fotolia Printed and bound in Great Britain by CPI Group (UK) Ltd, Croydon, CR0 4YY Policy Press uses environmentally responsible print partners

A companion to criminal justice, mental health and risk Subject index

Contents Contributors vii Acknowledgements xxv Preface xxvii

Care Quality Commission Carers and Carers’ Rights of Mentally Disordered Offenders Carceral Society Children and Adolescent Mental Health Services Circles of Support and Accountability Clinical Governance and Risk Management Clinical Risk Assessment Cognitive Behaviour Therapy Community Forensic Mental Health Teams Community Treatment Orders Compulsory Hospitalisation Conduct Disorder Consent to Treatment Controversial Treatments in Psychiatry Criminal Justice Criminal Justice Act 2003 Crisis Intervention Critical Criminology and Critical Criminologies Cultural Criminology

A Actuarialism 1 Actuarial Risk Assessment 3 Actus Reus 4 Adversarial Justice 5 Advocacy in Mental Health Care 7 Alcohol and Risk 8 Altruism 10 Anti-Psychiatry Movement 13 Appropriate Adult 14 Approved Mental Health 15 Professional Assessment, Care in Custody and 17 Teamwork Approach Attention Deficit Hyperactivity 19 Disorder Autism Spectrum Disorder and 20 Criminal Justice Automatism 22 Aversion Therapy and 23 Homosexuality B Battered WomAN Syndrome 25 Bethlem Royal Hospital 26 Bifurcation 28 Bipolar Disorder 29 Black Report 31 Bradley Report 32 Butler Report and Medium 34 Secure Mental Health Services C Care in the Community Care Programme Approach

40 42 43 45 46 48 49 51 52 54 55 57 59 60 62 63 65 66 68

D Dangerous and Severe Personality 71 Disorder Programme Dangerousness and Mental Disorder 73 Defence of Insanity 75 Department of Health 76 Deprivation of Liberty Safeguards 78 Desistance 79

37 38


A companion to criminal justice, mental health and risk Infanticide 126 Inquiries 127 Insanity 129 Insanity and Defect of Reason 131 Intelligence Quotient and 132 Delinquency Intermediary 135

Deviance 81 Deviancy Amplification 82 Diagnostic and Statistical Manual 84 of Mental Disorders Dialectical Behaviour Therapy 85 Diminished Responsibility 87 Disability Hate Crime 89 Domestic Violence, Crime and 90 Victims Act 2004 Dual Diagnosis 92 Due Process 93

J Just Deserts 137 Justice 138 Justice for All 140

E Emotional CPR 95 Ethnicity 96 Essentialism 98 Expert Witness 99 Extended Sentences for 101 Public Protection F Fallon Inquiry Female Sex Offender Assessment and Management Film and Mental Illness Folk Devil

K Knowledge (Sociology of) Knowledge–Power Nexus L Labelling Perspectives Learning Disabilities and Criminal Justice Long-Term Imprisonment and Mental Health Loss of Control

103 104 106 108

115 116 118 120

I Independent Monitoring Boards Indeterminate Sentences for Public Protection

123 125

147 148 150 152

M M’Naghten Rules 155 Magdalen Asylums 157 Media Representations and 158 Mental Disorder Medicalisation and Social Control 160 Mental Capacity 162 Mental Capacity Act 2005 163 Mental Disorder 165 Mental Distress 167 Mental Health Act 2007 169 Mental Health First Aid 170 Mental Health In-Reach Services 171 Mental Health Review Tribunal 173 Mental Health Treatment 175 Requirement 175 Mentally Disordered Offenders 176 Missing Patients 178

G Gender, Mental Health and 111 Offending Governmentality 113 H High-Security Hospitals Hospital Order Hostage/Crisis Negotiations Human Rights and Mentally Disordered Offenders

143 145


A companion to criminal justice, mental health and risk Contents Subject index 179 181

Q Qualitative and Quantitative Inquiry 227 in Mental Health Research

N National Confidential Inquiry into 183 Suicide and Homicide by People with Mental Illness National Offender Management 185 Service National Service Framework 186 National Suicide Prevention 188 Strategy New Penology 189 New Poor Law 1834 191 Normalcy 192

R Race Equality and Mental Health 229 Policy Rational Choice Theory 231 Recidivism 232 Recovery and Mental Health Policy 234 Rehabilitation and Mentally 236 Disordered Offenders Remand 237 Report on the Select Committee 238 of the House of Commons on Madhouses 1815 Resettlement 240 Resilience 241 Responsible Clinician 243 Restorative Justice 245 Restraint 246 Restricted Patient 248 Risk Society 250

Missing People Multi-Agency Public Protection Arrangements

O Offender Assessment System Organic Disorders

195 197

P Pains of Imprisonment 199 Parole 200 PCL-R™ (Psychopathy 202 Checklist-Revised Assessment Tool) Penal Abolitionism 203 Penal Crisis 205 Personality Disorder and Offending 206 Personality Disorder Pathway 208 Police and Criminal Evidence 210 Act 1984 Policing and Duty of Care 211 Political Participation 213 Populist Punitiveness 216 Post-Traumatic Stress Disorder 217 Prison Privatisation 219 Probation 221 Psychiatry and Surveillance 222 Punishment 224

S Safeguarding 253 Schizophrenia 255 Seclusion 257 Second Opinion Appointed Doctor 258 Section 136 of the Mental Health 260 Act 1983 (as amended 2007) Self-Harm 261 Sex Offenders Risk Appraisal Guide 263 Sex Offender Treatment 264 Programmes Sexual Offending 266 Social Control Theory 268 Social Exclusion 269 Social Justice 271 Social Model of Disability 272 Solitary Confinement and Mental 273 Illness Solution-Focused Therapy 275


A companion to criminal justice, mental health and risk Stigmatisation and Mental Disorder 276 Structured Professional Judgement 278 Risk Assessment Substance-Related Violence 280 Surveillance 282 T Third Way Politics and Crime Control Transfer from Custody

W Woolf Report Women’s Enhanced Medium Secure Services

X Xenophobia 309 285 Y York Retreat Youth Custody and Mental Disorder Youth Justice Board Youth Offending Team


U Underclass (Social Construction of) 289 Unfitness to Stand Trial (Criminal 291 Procedure (Insanity and Unfitness to Plead) Act 1991) Universal Declaration of 292 Human Rights V Vagrancy Acts Veterans, Mental Disorder and Criminal Justice Victims of Crime Violence and Mental Disorder Violence Risk Appraisal Guide

305 307

311 313 314 316

Z Zemiology 319 Zito Trust 320 Appendix: International campaign 323 groups and sources of interest Legislation and policy index 325 Subject index 327

295 296 299 300 302


A companion to criminal justice, mental health and risk

Contributors Gareth Addidle is a lecturer in criminology and criminal justice studies at Plymouth University, UK. He has previously worked for the Open University and Glasgow Caledonian University. His current research focuses on the development of community planning, policing and community safety policies within Scotland. Stuart Agnew is the finance director of the Institute for Social, Educational and Enterprise Development (iSEED) and a senior lecturer in criminology at University Campus Suffolk, UK. Recent research projects include investigating the prevalence of urban street gangs in Birmingham, educational experiences of young people in Suffolk and youth unemployment in Ipswich, and the evaluation of a diversionary programme for Suffolk Youth Offending Service. Andy Alaszewski is emeritus professor of health studies at the University of Kent, UK. His academic research has focused on the formation and implementation of health and social care policy and on the construction and management of risk in health and social care. He is editor of the international journal, Health, Risk & Society. James R. Álvarez is a consultant clinical and forensic psychologist with West London Mental Health Trust, UK. Prior to that, he worked in the private kidnap for ransom insurance industry and is the only consultant ever used by both Scotland Yard and the New York Police Department’s (NYPD’s) hostage negotiation teams. He is an honorary police surgeon with the NYPD and is the former operations director for the International Association of Hostage Negotiators. Vici Armitage is a research associate and part-time lecturer at the University of Leicester, UK. She is currently working on an Economic and Social Research Council-funded project exploring policy implementation in the youth justice system in England. She completed doctoral research into youth anti-social behaviour at Durham University, UK, in 2012 and has previously worked as a volunteer Youth Worker. Jac Armstrong is a lecturer within the School of Law at the University of Chester, UK, where he teaches across undergraduate and postgraduate courses. His research interests include restorative justice, criminal justice and jurisprudence. An accredited restorative justice facilitator (International Institute for Restorative Practices [IIRP]) and commercial and civil mediator (ADR-Group [Alternative Dispute Resolution]), the Honourable Society of Inner Temple called him to the Bar of England and Wales in 2013.


A companion to criminal justice, mental health and risk

Lisa Armstrong is a senior lecturer in social work at the University of Portsmouth, UK. She has previously worked as an approved social worker in the community and as a forensic social worker within a medium secure unit in England. Linda Asquith is a senior lecturer in criminology at Nottingham Trent University, UK. Her recently completed PhD was in the field of the re-establishment of life after genocide. She has previously worked in the Universities of Leeds and Huddersfield, UK, and prior to that, was a high school teacher. Helen Baker is a senior lecturer in criminology in the Department of Law and Criminology at Edge Hill University, Ormskirk, UK. She previously worked at Liverpool University, UK, and Lancaster University, UK. Helen is an interdisciplinary researcher with long-standing interests in women’s and children’s experiences of male violence, and the legal and policy responses to them. Currently, her research focuses on child-to-parent violence. David Balsamo is dean of social science at the University of Chester, UK. His teaching interests include the political economy of professional work and the sociology of deviance as applied to organisations. He is a former probation officer, and while in practice, he developed expertise working with sex offenders and drug users. Peter Barham is a psychologist and a social historian of mental health. He is a fellow of the British Psychological Society. His books include Schizophrenia and human value (1984), Relocating madness (with Robert Hayward, 1993), Closing the asylum (1997) and Forgotten lunatics of the Great War (2004). Mark Bendall is a senior lecturer in politics and criminology at the University of Chester, UK. He has published on corporate social responsibility and state power, and has given conference papers spanning identity politics and criminalised identities. In 2007, he was shortlisted for Marketing Initiative of the Year at the Times Higher Awards. Emma Bond is a senior lecturer in applied social sciences at University Campus Suffolk, UK, and deputy director of the Institute for Social, Educational and Enterprise Development (iSEED). She has extensive teaching and social science research experience and is a senior fellow of the Higher Education Academy. Matt Bowen is a senior lecturer in mental health nursing at the University of Chester, UK. He has previously worked as the clinical specialist at the Henderson Hospital, a centre of excellence in the psychosocial treatment of people with a diagnosis of personality disorder. His current research is in the representations of personality disorder in UK newspapers. viii

A companion to criminal justice, mental health and risk Contributors

Avi Brisman is an assistant professor in the School of Justice Studies at Eastern Kentucky University, USA. Charlie Brooker is an honorary professor of mental health and criminal justice at the University of Lincoln, UK. Patrick Brown is an assistant professor in the Department of Sociology and Anthropology at the University of Amsterdam, The Netherlands. He previously lectured at the University of Kent, UK, and has published widely on research into risk and trust within a range of health policy contexts. Lol Burke is a senior lecturer in criminal justice at Liverpool John Moores University, UK. Prior to this, he worked as a probation officer and manager, holding a range of posts involving the supervision of offenders in both community and prison settings. He is co-author with George Mair of Redemption, rehabilitation and risk management: a history of probation (2012) and is currently Editor of Probation Journal. Rob Canton is professor of community and criminal justice at De Montfort University, Leicester, UK. He worked in the Probation Service for many years and has taught, researched and written on a number of probation and penal topics, including mental health. Nicola Carr is a lecturer in criminology at the School of Sociology, Social Policy and Social Work, Queen’s University Belfast, Northern Ireland. She has previously worked as a probation officer with adults and young people in the UK. Andrew Carroll is an adjunct associate professor at Swinburne University of Technology, Australia, senior lecturer in forensic psychiatry at Monash University, Australia, a senior fellow at Melbourne University, Australia and a consultant psychiatrist with the Victorian Institute of Forensic Mental Health and in private practice. He has worked in clinical and academic forensic psychiatry since 1998. Helen Codd is a reader in law and criminal justice at the Lancashire Law School, University of Central Lancashire, Preston, UK. She has published widely on issues in relation to women, prisons, children and families and is the author of In the shadow of prison: families, imprisonment and criminal justice (2008) and co-author of Controversial issues in prisons (with David Scott, 2010). Her current research relates to prisoners’ families, prisoners’ reproductive rights and feminist perspectives on sentencing. Roy Coleman teaches criminology and sociology at the University of Liverpool, UK. His research interests centre on surveillance, state formation, social order, crime, space and the city. His work can be found in several journal articles and ix

A companion to criminal justice, mental health and risk

book chapters that deal with these themes and issues. His first book, Reclaiming the streets: surveillance, social control and the city (Willan Publishing, 2004), won the Hart Socio-Legal Book Prize in 2005. His latest book is Surveillance and crime (Sage, 2011), written with Dr Michael McCahill. Tony Colombo is a senior lecturer in criminology and clinical psychology at Coventry University, UK. He has published widely on matters concerning the intersection between mental health and criminal justice. His current research interests include: methods of risk assessment; multi-agency working; and the victimisation of people with learning difficulties and mental health problems Vicki Coppock is reader in social sciences, childhood studies and mental health at Edge Hill University, UK. She is also a qualified psychiatric social worker and has previously worked with both adults and children and young people in mental distress. Helen Corteen currently works for Brook Young People’s Charity managing services in Lancashire, UK. Helen is a Mental Health First Aid trainer and is currently working with the team in Lancashire to develop new approaches to motivate young people to improve their health and well-being. She has formerly worked as a youth and community worker, specialising in sexual health and lesbian, gay, bisexual and transgender (LGBT) provision. Karen Corteen is a senior lecturer in criminology at the University of Chester, UK. She has published in the areas of victimology, critical criminology and sexuality. Her research and teaching interests are victimology, zemiology and harms of the powerful. She has previously worked as a youth and community worker. Ian Cummins is a senior lecturer in social work at the University of Salford, UK. He has previously worked as a probation officer and approved social worker in the north-west of England. Michael Daffern is professor of clinical forensic psychology at Swinburne University of Technology, Australia, and principal consultant psychologist with the Victorian Institute of Forensic Mental Health (Forensicare), Australia. Suki Desai works as an independent academic. She is currently undertaking teaching work with the University of Bristol, UK. Suki has previously been employed as a social worker and regional director with the Mental Health Act Commission. Conor Duggan is emeritus professor of forensic mental health, University of Nottingham, UK, and head of research and development partnerships in care.


A companion to criminal justice, mental health and risk Contributors

He has previously worked within the National Health Service (NHS) as a clinical academic in Nottingham and Leicester, UK. Kathryn Dutton is a lecturer in law in the Bradford University Law School, UK. Her current research interests and teaching responsibilities lie in the fields of criminal law, criminology (with a particular focus on domestic violence), youth justice and academic practice. Barbara Edge is a senior lecturer in counselling skills at the University of Chester, UK. She is also a person-centred therapist and is particularly interested in the interface between counselling, spirituality and healing. Her work as a therapist has included women and young offenders within the prison system. Other research interests include trans-cultural counselling, loss and grief, and the facilitation of students’ capacity for reflexive practice. Geoff Elvey is the head of policing provision and development at the University of Chester, UK. He has previously worked as a senior police officer with Cheshire Police in a number of diverse roles, mainly within the business areas of intelligence and major crime investigation, and while working for the Home Office and Association of Chief Police Officers (ACPO) lead for burglary, developed a National Good Practice and Tactical Options Guide. John Foster is a reader in alcohol policy and mental health studies in the Centre for Applied Health Research, University of Greenwich, UK. He previously worked as a mental health nurse in the UK and his research interests include home drinking and risk in adults. Theresa A. Gannon is professor of forensic psychology and director of the Centre of Research and Education in Forensic Psychology (CORE-FP) at the University of Kent, UK. She also works as a forensic practitioner assessing and treating mentally disordered offenders for Kent Forensic Psychiatry Service, Kent, UK. Sarah Gladden has worked within a variety of forensic services including low, medium and high secure services, prison in-reach, secure adolescent, and learning disability services. She is currently employed as a senior clinical psychologist at Broadmoor Hospital, West London Mental Health National Health Service (NHS) Trust, UK, and within specialist neuropsychology services in Berkshire Healthcare Foundation NHS Trust, UK. Kris Gledhill is an academic lawyer in New Zealand and was the inaugural director of the New Zealand Centre for Human Rights Law, Policy and Practice. He was previously a barrister in London, and worked particularly in the areas of


A companion to criminal justice, mental health and risk

mental health law and prison law. He has written on various aspects of mental health law, including in the criminal context. Barry Godfrey is professor of criminology at the University of Liverpool, UK and head of research in the School of Law and Social Justice. He has published a number of books on the history of crime, on sentencing and on habitual offending. Rachel Goldhill is a senior lecturer in the Institute of Criminal Justice Studies (ICJS) at the University of Portsmouth, UK, where she currently teaches on the Probation Qualifications Framework (PQF). Prior to 2004, Rachel worked as a probation officer and was a facilitator on the Thames Valley Sex Offender programme. Kate Gooch is a lecturer in law at the Birmingham Law School, University of Birmingham, UK. Her research and teaching interests centre on criminal law, criminal justice, youth justice and child law. Dan Goodley is a professor in the School of Education at the University of Sheffield, UK. His research interests lie in the area of theorising and challenging the conditions of disablism (the social, political, cultural and psycho-emotional exclusion of people with physical, sensory and/or cognitive impairments) and ableism (the contemporary ideals on which the able, autonomous, productive citizen is based). He is also a professorial visiting fellow, University of New South Wales, Australia. Laura Graham is an independent consultant undertaking research and writing in the addiction recovery, mental health and offending arenas. Previously working in policy and strategy development at the Ministry of Justice, she has a regular column in the journal Addiction Today, is the ambassador at large at the Addiction Recovery Foundation and represents the UK at the European Mutual-aid Network for Alcohol problems (EMNA). Brenda Happell is the engaged research chair in mental health nursing and director of the Institute for Health and Social Science Research and Centre for Mental Health Nursing Innovation at Central Queensland University, Australia. Mark Hardy is a lecturer in social work at the University of York, UK. He previously worked as a social worker and probation officer in criminal justice and forensic settings. His PhD investigated the ways in which concerns about risk have impacted upon theory and practice in social work, criminal justice and forensic mental health. Ben Harper is a principal clinical psychologist and director of a Cognitive Behaviour Therapy (CBT) training programme at Lancaster University, UK. xii

A companion to criminal justice, mental health and risk Contributors

Ben currently works as a clinical psychologist with adults and children who have complex needs within the National Health Service (NHS) and within independent practice. He has previously worked as a trauma therapist in Northern Ireland and as a clinical lead of an adolescent forensic service. Craig Harper is a graduate teaching assistant and PhD candidate in social and forensic psychology at the University of Lincoln, UK. He has previously worked in mental health research and audit with the Lincolnshire Partnership National Health Service (NHS) Foundation Trust, UK. Karen Harrison is a senior lecturer in law at the University of Hull, UK. She is an editorial board member of the Journal of Sexual Aggression, an associate editor of Sexual Offender Treatment and the book review editor of the Prison Service Journal. Katherine Harrison is a senior lecturer in sociology at the University of Chester, UK. Her research and teaching focuses on visual culture, most recently, media representations of marginalised social groups. Katherine is series editor of Issues in the Social Sciences, a themed book series published by University of Chester Press, which aims to present current academic research in accessible language for scholars at all levels. Stephanie Headon is a specialist teacher working with students who have specific learning differences (SpLD) at the University of Chester, UK. She has previously worked as a lecturer in teacher education in higher education, specialising in basic skills and numeracy, and has also worked in the further education sector as a basic skills lecturer. Jill Hemmington is a senior lecturer in the School of Social Work at the University of Central Lancashire, UK. She is also course leader for the approved mental health professional (AMHP) programme and continues to practice as an AMHP. Jill’s background is in mental health social work and community mental health team management. Robert Hesketh is visiting lecturer in criminology at the University of Chester, UK, and an associate tutor in forensic psychology at Edgehill University in West Lancashire, UK. He has previously worked for Liverpool Hope University, UK, and the National Health Service (NHS) evaluating a risk management policy aimed at sex and violent offenders returning to the community. Presently, his research centres on deviancy abstention and street ‘gang’ culture in Merseyside, UK. Lucy Holmes is research manager at the UK charity Missing People. She previously worked at the University of Edinburgh, UK, on the Edinburgh


A companion to criminal justice, mental health and risk

Study of Youth Transitions and Crime, and has also conducted research into the regulation of prostitution and homelessness. Graham Jones is a registered mental health nurse and is manager of a Crisis Resolution Home Treatment team in Chester, UK. Timothy W. Jones is ARC (Australian Research Council) DECRA (Discovery Early Career Researcher Awards) research fellow in history at the Australian Research Centre in Sex, Health and Society at La Trobe University, Australia, and lecturer in history at the University of South Wales, Australia. Melanie Jordan is a research fellow based at the Institute of Mental Health at the University of Nottingham, UK, and lectures in the sociology of prisons and incarceration for the School of Sociology and Social Policy. She also undertakes mental health research, often in forensic settings and with a medical sociology focus. Hendrien Kaal is professor of applied sciences at the Department of Social Work of Leiden University of Applied Sciences, The Netherlands. She specialises in intellectual disability and youth crime, in cooperation with the William Schrikker Group, a national organisation for youth protection, youth probation and foster care for parents and/or children with a disability. Anne Keeler is a senior lecturer at the University of Chester, UK, and programme leader for the BA Social Work degree. Anne qualified as a social worker in 1981, working with different service user groups and, 10 years on, a community mental health team. She became an approved social worker in 1991 and worked in this role for nine years before moving to higher education. She is also a non-executive hospital manager panel member for an independent hospital. Stuart Kinner is a principal research fellow in the Centre for Health Policy, Programs and Economics (CHPPE), Melbourne School of Population and Global Health, University of Melbourne, Australia. He also holds honorary positions at The University of Queensland, Monash University, Australia, and the Murdoch Children’s Research Institute. Amy Klassen is a PhD candidate in the Department of Sociology at the University of Toronto, Canada. Her research work looks at the role of mental health in how correctional systems manage challenging and resistant prisoners. She has also done some work on the use of psychiatric medication and involuntary hospitalisation of resistant individuals within the community mental health system. Her work looks at the ways in which persons with mental health issues are managed within civil and criminal contexts in Canada.


A companion to criminal justice, mental health and risk Contributors

Judy Laing is a senior lecturer in law at the University of Bristol, UK. She has previously worked at Cardiff, Liverpool and Leeds Universities, UK, and has written extensively on aspects of medical law, mental health law and criminal justice. Notably, her PhD thesis was published by Oxford University Press (1999) as a monograph (entitled Care or custody? Mentally disordered offenders in the criminal justice system) and she also co-edited (with N. Gray and L. Noaks) a collection of essays on Criminal justice, mental health and the politics of risk (Cavendish, 2001). Angela Lloyd works for the National Health Service (NHS) in the UK as an advanced specialist occupational therapist in a forensic mental health outreach service. She has previously worked within a psychiatric intensive care unit (PICU) and within inpatient mental health and physical health units. Jonathon Louth is programme leader for politics and international relations at the University of Chester, UK. He has previously lectured in international politics at the University of Adelaide, Australia, and has also spent time working as a ministerial advisor. Jonathon’s research interests include the intersections and links between emerging markets, contested concepts of security and critical international political economy. Andrew Lovell is professor of learning disabilities at the University of Chester, UK. He was formerly a learning disability nurse specialising in caring for people with a learning disability with additional issues around mental health and challenging behaviour. He has research interests in the areas of self-injury, autism spectrum disorder and clinical violence, and recently published Understanding and working with people with learning disabilities who self-injure (edited with Pauline Heslop, 2013). Christopher Lube is a registered nurse with extensive experience of working within the clinical environment in direct patient care and in managerial positions and at a corporate level as an associate director with a portfolio for governance and risk management. He has a background in developing and implementing governance and risk management strategies in secondary and primary care settings to ensure regulatory and National Health Service (NHS) Operating Framework requirements are achieved. Stephen MacDonald is a senior lecturer in criminology and programme leader for the BSc(Hons) Criminology programme at the University of Sunderland, UK. He has previously worked in social care in the UK and has also served in the military, where he has worked for the United Nations (UN) in Africa. Karen Machin works freelance in mental health, using personal experience as a service user and carer, for organisations including Time to Change and the Institute of Mental Health in Nottingham, UK. xv

A companion to criminal justice, mental health and risk

Douglas MacInnes is a reader in mental health at Canterbury Christ Church University, UK. He is a registered mental health nurse with over 20 years’ clinical experience of working in forensic settings. Doug has been involved in numerous studies and projects that have examined forensic mental health care and has continued to examine users’ and carers’ experiences in this area. He has also actively encouraged user and carer involvement in forensic mental health care research as members of the research team. Other recent work has centred on the themes of peer support working, the use of new technology in mental health settings and stigma. Margaret Malloch is a reader with the Scottish Centre for Crime and Justice Research at the University of Stirling, UK. Her research interests include: justice and diversity; crime, critique and utopia; criminalisation and justice in transition; women, punishment and social justice; human trafficking; and supporting victims. Elizabeth Mason-Whitehead is a professor of health and social care, University of Chester, UK. Her research and publications are in the areas of stigma, social exclusion, teenage pregnancy and research methods. Elizabeth is currently researching the stigma of teenage abortion. Liam McCann is principal lecturer in criminology at the University of Lincoln, UK and the programme leader for their undergraduate degrees in criminology, both single and joint honours, and their postgraduate degree, the MA Globalising Justice. Rowan McClean is a consultant general adult psychiatrist working in Recovery Mental Health Services in Belfast, Northern Ireland. His academic interests include the treatment of severe and enduring mental illness and risk assessment and management. Polly McConnell works for the Rethink Mental Illness Advice and Information Service, UK, providing information and advice to people affected by mental illness and the criminal justice system. She also writes information resources on this topic for people in the system, their carers, friends and relatives, and professionals. Polly studied MSc Forensic Psychology at the University of Portsmouth, UK, and has previous experience of working in resettlement teams in adult prisons, and providing information and advice on a range of issues to young offenders. Ross McGarry is a lecturer in sociology and criminology at the University of Liverpool, UK. His research is broadly focused on applying sociology, criminology and victimology to war and military service, including issues of victimisation, resilience and military repatriations.


A companion to criminal justice, mental health and risk Contributors

Iain McGowan is a lecturer in mental health nursing at the University of Ulster, UK. He is also academic lead for quality assurance and enhancement in the School of Nursing at Ulster, UK. His research interests include the assessment of suicide risk and Iain has written extensively in the field of suicide. He is on the peer review panel of a number of international journals and is editor in chief of the International Journal of Clinical Psychiatry. Mick McKeown is a principal lecturer, School of Health, University of Central Lancashire, UK. He is a mental health nurse with experience of research and practice in secure mental health settings. Leon McRae is a lecturer in law at the University of Birmingham, UK. He researches in the area of mental health law in the criminal context, and certain aspects of medical law. He is particularly interested in the legal, relational and therapeutic consequences of treating offenders who face legal coercive pressures in prisons and psychiatric hospitals. Caroline Miles is a lecturer in criminology at the University of Manchester, UK. Caroline has previously worked at the University of Oxford, UK, on an Economic and Social Research Council research project on adolescent-to-parent abuse. Recently, Caroline has published in the British Journal of Criminology and Criminology and Criminal Justice. Furthermore, she is co-authoring a book with R. Condry for Palgrave entitled Uncovering adolescent to parent violence (2014). Linda Moore is a senior lecturer in criminology in the School of Criminology, Politics and Social Policy at the University of Ulster. Her research interests are prisoners’ rights, the imprisonment of women and young people, and youth justice. Linda previously was investigations worker with the Northern Ireland Human Rights Commission. Catherine Anne Morgan is a senior lecturer in sociology at Bath Spa University, UK. She is a qualified probation officer who has previously worked in offender management in the UK. Sharon Morley is a senior lecturer in criminology and deputy head of the Department of Social Studies and Counselling at the University of Chester, UK. Most recently, her research and publications span the areas of violence in society and the victimisation of health and social care professionals. Richard Mottershead is a senior lecturer in mental health nursing at the University of Chester, UK. He has worked as a practitioner in a variety of mental health care settings and been involved with practice development and health and social care education within the UK, East Africa, the Middle East and Eastern Europe. xvii

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Emma Murray is PhD candidate in criminology and international relations in the Research Institute of Social Science at Keele University, UK. Bronwyn Naylor is an associate professor in the Law Faculty, Monash University, Australia. She co-authored (with Bernadette McSherry) the law text, Australian criminal laws: critical perspectives (Melbourne: Oxford University Press, 2004), has acted as a consultant to law reform bodies and government, and published widely on: homicide law and defences; gender, crime and media; prisons and human rights; and legal responses to sexual assault. Bronwyn is currently leading two major national research projects on human rights in closed environments and on the use of criminal records in employment decision-making. Karen Newbigging is a senior lecturer in health-care policy and management at the University of Birmingham, UK. Her research interests include advocacy, the implementation of health and social care policy, and action to tackle inequalities. Cassandra A. Ogden is programme leader and a senior lecturer in sociology in the Department of Social Studies and Counselling at the University of Chester, UK. Her current work utilises a critical disability studies perspective and she has also published and co-published on disability hate crime, childhood illness experiences and the narrative inquiry technique. Brendan O’Mahony is a forensic psychologist in independent practice and a registered intermediary at the Ministry of Justice, London, UK. Pat O’Malley is honorary professor of law at the University of Sydney, Australia, and adjunct research professor at Carleton University, Ottawa, Canada. He was previously professorial research fellow at the University of Sydney, Australia. Jane Padmore is a consultant nurse working in the National Forensic Adolescent Service, UK. Jane has worked in CAMHS (Child and Adolescent Mental Health Services) community and inpatient settings, including youth offending services, looked after children, families unit, Generic CAMHS, NDT (Neurodevelopmental Treatment), child protection and paediatric liaison. She has worked in both community and inpatient children, adolescent and adult mental health services. Jane authored four chapters in Norman, I. and Ryrie, I. (eds) (2013) The art and science of mental health nursing (Maidenhead: Open University Press). Nicholas Pamment is a senior lecturer and course leader at the Institute of Criminal Justice Studies (ICJS), University of Portsmouth, UK, having previously worked in various roles for a Youth Offending Team (YOT). His main area of interest lies within youth justice and he has published studies within the fields of policing, multi-agency working, research methodology and community sentences. xviii

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Andrew Papanikitas is a qualified General Practitioner (MRCGP [Member of the Royal College of General Practitioners]). He also holds degrees in the history of medicine, and medical law and ethics, and postgraduate diplomas in history, philosophy and child health. He teaches and facilitates medical ethics and law, as well as inter-professional and clinical communication skills at King’s College London, UK. He is the co-author of four books, and is currently joint ethics and philosophy editor for the London Journal of Primary Care. Tony Parnell is a lecturer in counselling psychology at the University of Manchester, UK, and a chartered practitioner counselling psychologist in private practice. He has been a practitioner for 20 years and, for the past 10 years, has specialised in the treatment of post-traumatic stress disorder (PTSD) and traumarelated issues. Tina G. Patel is a lecturer in criminology at the University of Salford, UK. Tina’s research expertise is in the area of race, racism and criminal justice. She is the co-author with David Tyrer of Race, crime and resistance (Sage, 2011), and is currently writing in the field of post-race, identity and criminalisation. Erika Penner is a registered psychologist employed at BC Children’s Hospital in Vancouver, Canada. She is also a clinical investigator with the Child and Family Research Institute and a clinical associate and instructor at Simon Fraser University, Canada. Her areas of specialty include developmental and forensic psychology. William Penson was in mental health practice for 12 years before becoming a senior lecturer in mental health at Leeds Metropolitan University, UK. Presently, he is a part-time lecturer at the University of Bradford, UK, and associate lecturer at Sheffield Hallam, UK, and teaches at Bradford College, UK, as well as being an independent trainer and consultant. David Pilgrim is professor of health and social policy, Department of Sociology, Social Policy and Criminology, University of Liverpool, UK. Alessandro Pratesi is a lecturer in sociology in the Department of Social Studies and Counselling at the University of Chester, UK. He has previously studied and worked as a researcher and lecturer at the University of Florence, Italy, the École des Hautes Études en Sciences Sociales in Paris, France, the University of Pennsylvania, USA, and Manchester Metropolitan University, UK. His research interests include: care, the ethics of care and care-related technologies; the sociology of emotions; relationships, intimacies and families; and happiness and well-being. Emma Price is a PhD candidate researching recently developed legislation in relation to mentally ill offenders at the University of Chester, UK. She holds a xix

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bachelor’s degree in criminology and psychology and also a master’s degree with distinction in crime and justice. Ben Revi is a visiting research fellow at the University of Adelaide, Australia, publishing in the areas of citizenship and social policy. He has also worked in policy and government services in the governments of South Australia and New South Wales. Lisa Reynolds is divisional lead for health services research and management at City University London, UK. She is a mental health nurse and has previously worked in low, medium secure and community forensic mental health services in the UK. Julie Ridley is a reader in social policy and practice, School of Social Work, University of Central Lancashire, UK. She is an experienced researcher and recent projects have focused on the operation of Scottish mental health legislation and the experiences of relatives of people detained in secure units. Brian Roberts is deputy director of intelligence at Cheshire Police and holds a foundation degree in policing and an honours degree in criminology. Additionally, Brian works as a tactical firearms commander. In 2014, he took up a position to embed evidence-led policing with front-line staff and took responsibility to use those principles to drive a culture of preventing crime and reducing revictimisation. To this end, Brian has been part of a developing relationship between Cheshire Police and the University of Chester, UK. Jeannette Roddy is a PhD student at York St John University, UK, where she holds a studentship for her research entitled A client view of domestic violence counselling. She is a registered member and accredited counsellor/psychotherapist with the British Association of Counselling and Psychotherapy and has previously worked as a counsellor with victims of domestic and sexual abuse. Karen D. Roscoe is a senior lecturer in social work at the University of Chester, UK. Karen is particularly interested in narrative and discourse-analytic approaches to social work in a variety of contexts. She has published in a number of academic journals such as the British Journal of Social Work, Journal of Social Work Practice and Children Families Social Work. Her work primarily focuses on working across interdisciplinary boundaries. Federica Rossi is associate researcher at the Institut des Sciences Sociales du Politique (ISP/CNRS), France. Her PhD thesis analyses the public uses of history of the 1970s in contemporary Italy, with a particular focus on political violence, counterterrorism laws and criminalisation of radical activism.


A companion to criminal justice, mental health and risk Contributors

Katherine Runswick-Cole is a senior research fellow in disability studies and psychology in the Research Institute for Health and Social Change at Manchester Metropolitan University, UK. She writes from a critical disability studies perspective and has published extensively in the area. Recent publications include (with Tillie Curran) Disabled children’s childhood studies: critical approaches in a global context (Palgrave MacMillan, 2013). Mandy Schofield is deputy head of social work at the University of Chester, UK. She has previously worked as an approved social worker and mental health trainer in health and social care. David Scott is a senior lecturer in criminology at Liverpool John Moores University, UK. He has published widely on prisons, punishment and penal abolitionism. Recent book titles include Controversial issues in prisons (Open University Press, 2010), Why prison? (Cambridge University Press, 2013), Prisons and punishment (Sage, 2014) and The caretakers of punishment: power, legitimacy and the prison officer (Palgrave, forthcoming). Jane Senior is a research fellow at the University of Manchester, UK. She previously worked as a mental health nurse in a variety of secure and prison settings. Coral Sirdifield is a research assistant at the University of Lincoln, UK. Anushta Sivananthan is a consultant old age psychiatrist and medical director for safe services at Cheshire and Wirral Partnership National Health Service (NHS) Trust, UK. She is the executive lead for risk management, medicines management and the Mental Health Act. Joakim Sturup is a forensic social investigator and research coordinator at the Department of Forensic Psychiatry in Stockholm and the Swedish National Board of Forensic Medicine, and a researcher at the Division of Forensic Psychiatry at the Karolinska Institutet, Sweden. His research focuses on risk assessments, mental disorders, psychopathy and major violent crimes. Michael Swinswood is a forensic practitioner employed by Cheshire and Wirral National Health Service (NHS) Foundation Trust, UK. A Registered Nurse Learning Disability (RNLD) with 36 years’ experience, he holds a Postgraduate Certificate (Assessment and Treatment of Sexual Offenders) and an MA in Crime and Justice. Mick is a guest lecturer in forensic nursing practice at the University of Chester, UK. Paul Taylor is a senior lecturer in criminology and deputy head of the Department of Social Studies and Counselling at the University of Chester, UK. xxi

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Paul’s core research area is in the field of mental health and risk; however, he also has research interests in military veterans and domestic violence and processes of ‘blaming’ and ‘shaming’ of health and social care professionals following coronial processes. Michael Teague is a criminologist at Teesside University, UK, where he is also a member of the Social Futures Institute. He has published work on US probation and imprisonment, the masculine cultural perceptions of rapists, and the privatisation and marketisation of the criminal and community justice systems in the US and UK. He is currently completing a study of probation culture in England. Prior to his academic career, he was a probation officer working directly with Probation Service users. Terry Thomas is visiting professor of criminal justice studies at Leeds Metropolitan University, UK. David Thompson is a PhD student in the School of Law at the University of Leeds, UK. Philippa Tomczak is a PhD candidate in criminology at the University of Manchester, UK. Philippa is particularly interested in penal reform, activism and abolitionism. Her research is situated within the sociology of punishment and examines the relationship between punishment and charity, focusing on the penal voluntary sector in England and Wales. Clair Tourish is a senior lecturer in the Health Professions Department at Manchester Metropolitan University, UK. She originally graduated as a mental health nurse and worked in both managerial and training roles within the National Health Service (NHS) before moving to higher education in 2002. Clair holds a Master of Laws (LLM) and has a passion for the legal aspects of health-care provision. Her particular interest centres on the practical implications of the legal framework around capacity and consent to treatment. James Treadwell is a lecturer in criminology at Birmingham Law School, University of Birmingham, UK. Julie Trebilcock is a senior lecturer in criminology at Middlesex University, UK, and research consultant for the Howard League for Penal Reform. Her main research interests relate to imprisonment, forensic mental health and legal decision-making. Gordon Turnbull is a consultant psychiatrist in trauma at Capio Nightingale Hospital in London and the Ridgeway Hospital in Wiltshire, UK, adviser in psychiatry to the Civil Aviation Authority (CAA), and visiting professor to the xxii

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University of Chester, UK. His book TRAUMA: from Lockerbie to 7/7: how trauma affects our minds and how we fight back was published in 2011. Jo Turner is programme leader and a lecturer in criminology in the Department of Social Studies and Counselling, University of Chester, UK. Jo’s core research interests lie in the history of crime and punishment, with a developing interest in female offending. Tim Turner is course director for criminology at Coventry University, UK. He was previously employed as a forensic community mental health nurse in north London, and is the joint editor of Critical Issues in Mental Health (Palgrave). His current research focuses on cultural criminology, specifically in relation to drug tourism in Ibiza. Rebecca Twinley (nee Bergan-Gander) is a lecturer in occupational therapy and PhD candidate at Plymouth University, UK. She has previously worked as an occupational therapist in a range of clinical practice settings. Kate van Dooren is a lecturer at the Queensland Centre for Intellectual and Developmental Disability, Australia. Her doctoral research focused on the experiences of young people as they transition out of adult prisons. Kate’s current research interests focus on working with people with intellectual disability across prisoner health, technology and health promotion. Paul Wagg is programme leader and lecturer in counselling skills in the Department of Social Studies and Counselling at the University of Chester, UK. He has previously trained and worked as a police officer and mental health nurse. Stephen Wakeman is a PhD candidate in the Centre for Criminology and Criminal Justice, the University of Manchester, UK. His research interests include drug use and drug policy, cultural studies, and philosophies of penal moderation. He has taught criminology and sociology at a number of UK universities. Tammi Walker is a chartered psychologist at the University of Manchester, UK, and University of Bradford, UK. Her clinical practice has been undertaken in Her Majesty’s Prison Service and the secure forensic psychiatric services and she maintains her long-standing research in self-harm and suicide in prisons, meeting the needs of complex women in the secure estate and gender issues in offending. Sandra Walklate is Eleanor Rathbone chair of sociology and head of the Department of Sociology, Social Policy and Criminology at the University of Liverpool, UK.


A companion to criminal justice, mental health and risk

Jo Warner is a senior lecturer in social work in the School of Social Policy, Sociology and Social Research at the University of Kent, UK. Her main research interest is in risk and, specifically, the way risk work has shaped professional practice in health and social care, including the impact of cultures of inquiry on social workers and others in mental health and, more recently, in children’s services. Richard Whittington is a professor of mental health at the University of Liverpool, UK, and visiting professor at the Norwegian University of Science & Technology (NTNU), Trondheim, Norway. He is a forensic psychologist with an extensive record of published research on violence in mental health services. Siân Williams is a registered mental health nurse and specialist practitioner within a crisis resolution home treatment team in Chester, UK. As well as being a full-time practitioner, Siân has an emerging publication record and has previously published in the area of sentencing reform and prisoner mental health. David Wilson is professor of criminology and director of the Centre for Applied Criminology at Birmingham City University, UK. On completing his PhD, he pursued a successful career as a prison governor at several prisons, including HMPs (Her Majesty’s Prisons) Woodhill and Wormwood Scrubs, UK. David is also the vice chair of the Howard League for Penal Reform, the vice president of New Bridge and the chair of the Friends of Grendon. His most recent book is a biography of the Victorian serial killer Mary Ann Cotton (Winchester: Waterside Press, 2013), and he is currently writing A history of British prisons. David Wood is a team manager in the Merseyside Probation Trust and a sessional lecturer at Liverpool John Moores University, UK. Over the past 12 years, he has worked in the resettlement, community rehabilitation and court settings within the trust. He is currently also completing his PhD in theology and criminology and is chair of the Merseyside branch of the trade union and probation professional association NAPO (National Association of Probation Officers).


A companion to criminal justice, mental health and risk

Acknowledgements The editors would like to sincerely thank Victoria Pittman, Alison Shaw and all the staff at Policy Press for their generous support and enthusiasm for this project. Thanks also go to the reviewers, commissioned by Policy Press, who provided encouraging reviews of the original proposal. Many thanks are also extended to the contributing authors, who have produced over 180 entries between them. It was a pleasure to work with colleagues from a range of backgrounds – including academics, psychiatrists, specialists from charitable organisations, criminal justice practitioners, and social workers, both national and international – all of whom, despite various other commitments, remained generous with their time and knowledge throughout the production of this project.


A companion to criminal justice, mental health and risk

Preface Companions have found their way within a range of subject and disciplinary areas over recent years. They have proved to be a valuable resource for students, educators, researchers and practitioners alike; providing a source of succinct explanation and discussion on key areas of their respective disciplines. However, unlike many companions already available, this Companion to criminal justice, mental health and risk is appreciative of the ideological, legislative, practical and procedural convergence between mental health care and criminal justice. This companion has been developed and presented on the principle that this convergence has taken place (and continues to do so), and is complex to observe, sophisticated in form and influenced by a range of imperatives, agendas and discourses. Our aim here is to present key themes with precision in the overlapping areas of criminal justice, mental health care and risk, and, in doing so, present the critical debates and discussions pertinent to a balanced understanding of the topic. Multi-agency approaches and cross-discipline developments in the area of mental health care, risk management and criminal justice are becoming increasingly normalised in the organising principles of those subject to sanctions and interventions. Throughout this companion, authors not only present a detailed technical or theoretical account, but also point towards opportunities for critical debate and discussion to unfold. It is our intention that readers of this text will become aware of competing issues and discussions relevant to each topic and that this will foster and promote a critical questioning by the reader that this subject so rightly deserves. By virtue of the broad latitude of interconnecting areas of study and practice, this Companion to criminal justice, mental health and risk has a broad scope.That said, the editors have selected entries carefully based on their expertise in the area and have sought to inform users of this text of the key and overarching themes and benchmarks. Experts who have contributed to this book are drawn from several fields, including criminology, sociology, medicine, nursing, social work, policing, psychology and offender management. Their backgrounds are eclectic, and some of them have advised at a government level, researched and published from within campaigning groups, and published widely in their respective areas. Importantly, the authors are not merely a collection of theorists and intellectual thinkers; rather, many have an abundance of policy and/or practical experience in delivering the services that they have written about. Entries in this companion provide readers with key definitions and expert critical evaluation. This is not only an accessible source of reference, but also a rigorous piece of scholarship. Thus, while this resource appreciates and details relevant xxvii

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practices, it is also conceptual. It incorporates key concepts relevant to the fields of criminal justice, mental health and risk, for example, actuarialism, medicalisation and social control, human rights, and zemiology. Theory and practice have been balanced and users of this text are presented with recommended additional sources so that they take their knowledge and understanding beyond the concise entry that is presented.To this end, the national and international perspectives contained within the covers of this book seek to equip students, practitioners and academics alike with fundamental definitions and evaluations within the field of criminal justice, mental health-care interventions and considerations over risk and how to understand it, engage in it and manage it. Paul Taylor, Karen Corteen and Sharon Morley (2014).


A ACTUARIALISM Actuarialism, broadly, is the use of calculation in the prediction and estimation of behaviours in relation to risk. The categorisation of ‘risky’ populations facilitates the management of these groups. Actuarial practices have been observed to pervade numerous aspects of the management of offender populations. With its links to the ‘new penology’ (Feeley and Simon, 1992), actuarialism seeks to find resolution of the management of deviant populations and, importantly, the ‘risks’ that they pose. The principles of actuarialism are observable within a variety of criminal justice agencies operating with common interests in offender management. Risk assessments and clinical risk assessments produce categories and diagnoses. Once applied, these aggregated labels prove valuable to the criminal justice process as particular systems, facilities and approaches are delivered in response to risk thresholds. Actuarial practices are increasingly prevalent in line with the economic imperatives placed on criminal justice agencies.The systematic placement of individuals into groups judged on their perceived risk to self or others fulfils the requirements of schemes that are ‘value for money’ and maintain adequate levels of public protection. In such circumstances, individualised rehabilitative imperatives are at risk of coming secondary to such priorities. The deployment of an actuarial language has been seen to be the most progressive in areas of offender management. Probation services and those involved in the 1

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monitoring and assessment of offenders on community sentences and leaving custody are examples of those directly involved in the application of actuarial practices. However, actuarial practices can also be observed across other professions involved in the maintenance of public protection. Psychiatry has a long history of categorising the social deviant through the application of diagnosis. Since the 18th century, diagnosis has been seen as an effective tool to determine the warranted level of surveillance and control of individuals and identifiable groups. More recently, psychiatry has developed an active role in the regulation of meaning associated with ‘dangerousness’. Security discourses pervaded political and professional spheres in response to the perceived concerns that too many dangerous people were left to remain in society. The former Labour government’s Dangerous Severe Personality Disorder policies of the late 1990s were illustrative of psychiatry’s contribution to a new politics of risk and risk management (Seddon, 2008). For some commentators, such a move is seen to herald disastrous consequences for the identity of the profession and those who find themselves subject to its restrictions. Developments such as this provide strong evidence of the pervading nature of actuarial practices, through the categorisation and management of individuals and groups using labels of risk (eg diagnosis). In light of this, both psychiatry and offender management have somewhat similar agendas – public protection. The medicalisation of deviance is nothing new, yet the commanding and coercive character of it appears to be ever-more coercive, developing in line with the political and social problematising of certain societal individuals and groups. PAUL TAYLOR See also: Actuarial Risk Assessment; Medicalisation and Social Control; New Penology Readings Feeley, M.M. and Simon, J. (1992) ‘The new penology: notes on the emerging strategies of corrections and its implications’, Criminology, 30(4): 449–74. O’Malley, P. (2004) Risk, uncertainty and government. London: Glasshouse Press. Rutherford, A. (2006) ‘Dangerous people: beginnings of a New Labour proposal’, in T. Newburn and P. Rock (eds) The politics of crime control: essays in honour of David Downes. Oxford: Oxford University Press, pp 51–89. Seddon, T. (2008) ‘Dangerous liaisons: Personality disorder and the politics of risk’, Punishment and Society, 10(3): 301–17.


A companion to criminal justice, mental health and risk

ACTUARIAL RISK ASSESSMENT Actuarial risk assessment is a process that allocates individuals into risk categories that each differ in their predicted likelihood (probability) of future harmful outcomes. Allocation is determined after the individual is scored on a set of operationally defined items, comprising an actuarial risk assessment ‘instrument’ or ‘guide’. Item scores are combined using a mathematical formula (algorithm), yielding a final numerical score, which translates into a categorical risk rating. Over the past two decades, actuarial instruments have been used to guide opinions about the probability of both violent (Quinsey et al, 1998) and sexual (Hanson and Thornton, 2000) reoffending. Thus, actuarial assessments allocate individuals into categories that each differ in their base rate for the risk outcome of concern. For example, if an individual scores 14–20 on the ‘Violence Risk Appraisal Guide’ (Quinsey et al, 1998), this indicates membership of the category of whom 64% are predicted to reoffend within 10 years (ie the base rate for the category as a whole is 64%, a figure based on prior research with groups of offenders). The instrument cannot indicate, however, whether the individual case will fall into the 64% who reoffend or the 36% who do not. Such categorisation data are based on longitudinal research that demonstrates how scores correlate with outcomes. With this in mind, they must therefore be applied with caution in populations that differ on key characteristics (such as age, gender or ethnicity) from the research sample. The specific items that the instruments comprise are derived from research showing that they statistically correlate with the outcome of concern, with no assumption of causality or clinical utility. Such items are usually (but not always) ‘static’ (unchangeable), and so actuarial instruments do not greatly assist with risk management, or with monitoring of change in risk states over time. Despite the established value of actuarial approaches to prediction of behavioural phenomena (Grove and Meehl, 1996), clinicians have often been reluctant to embrace actuarial approaches to risk assessment (Dawes et al, 1989). Drawbacks for the clinician include the neglect of what might be highly relevant case-specific factors (eg a patient allocated as low risk may utter a homicidal threat) and limited utility for risk management. In recent years, its application to individuals has also been criticised on statistical grounds, with some (Hart and Cooke, 2013) arguing that the margins of error involved in individual cases are unacceptably high. Although the underlying problem is formally equivalent to the universal clinical epistemological challenge of applying group data to individual cases, one difference with questions of risk is that allocation into high-risk categories may be used to justify interventions that can only disadvantage the individual (such as preventive detention).Where the challenge is about allocating a large number of individuals 3

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into different risk categories, for example, the allocation of scarce resources so as to maximise utility for the population as a whole, actuarial assessments may be especially useful, although, even here, ethical issues regarding, for example, the prejudicial role of static risk factors may be raised (Mullen, 2007). ANDREW CARROLL See also: Actuarialism; Clinical Risk Assessment; Violence Risk Appraisal Guide Readings Dawes, R.M., Faust, D. and Meehl, P.E. (1989) ‘Clinical versus actuarial judgment’, Science, 243(4899): 1668–74. Grove, W. and Meehl, P.E. (1996) ‘Comparative efficiency of informal (subjective, impressionistic) and formal (mechanical, algorithmic) prediction procedures: the clinical-statistical controversy’, Psychology, Public Policy and Law, 12: 293–323. Hanson, R.K. and Thornton, D.M. (2000) ‘Improving risk assessments for sex offenders: a comparison of three actuarial scales’, Law and Human Behavior, February: 119–36. Hart, S.D. and Cooke, D.J. (2013) ‘Another look at the (im)precision of individual risk estimates made using actuarial risk assessment instruments’, Behavioral Sciences & the Law, 31: 81–102. Mullen, P.E. (2007) ‘Dangerous and severe personality disorder and in need of treatment’, British Journal of Psychiatry, 190(May): 3–7. Quinsey, V.L., Harris, G.T., Rice, M.E. and Cormier, C.A. (1998) Violent offenders: appraising and managing risk. Washington, DC: American Psychological Association.


‘Actus reus’ is the Latin term for ‘wrongful act’. Integral in the legal system of England and Wales, and elsewhere, the adjudication of guilt and innocence cannot take place without a crime being committed. Actus reus must therefore be established either as a voluntary wrongful act or through the omission of actions (eg neglect). Actus reus coincides with mens rea. ‘Mens rea’ is the term used to represent the necessity for the legal process to establish whether there was intent for the criminal action.Therefore, actus reus and mens rea are necessary to determine in order to consider the nature and character of criminal responsibility. 4

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In addition to voluntary wrongful acts, actus reus is also applicable where there has been an omission of an intervention where there was a legal obligation to have prevented the event. Frequently evident in cases of breaches in health and safety legislation and increasingly in cases of corporate manslaughter (under the Corporate Manslaughter and Homicide Act 2007), this dimension of actus reus is becoming somewhat more prolific as legislation develops in such areas. While actus reus and mens rea can be observed as the bedrock of judicial proceedings, the simplicity of both concepts is challenged by defendants where mental disorder may be present. In this situation, a number of issues are brought to light. At the first opportunity, the court must assess whether the defendant is fit to stand trial. Further, the court is required to establish whether there was intent to commit the criminal act (mens rea).These requirements involve specialist consultancy drawn from reports provided by psychiatrists and psychologists. Where intent to commit the criminal act is questionable (on the basis of mental disorder), further reports from both the defence and prosecution will be presented. It is likely that, in such cases, the defence will seek mitigation and a reduced sentence or verdict. SHARON MORLEY See also: Insanity and Defect of Reason; M’Naghten Rules Readings McMurran, M., Khalifa, N. and Gibbon, S. (2009) Forensic mental health. Cullompton: Willan Publishing. Soothill, K., Rogers, P. and Dolan, M. (eds) (2008) Handbook of forensic mental health. Cullompton: Willan Publishing.


Adversarial justice is rooted in the practices and procedures of the courtroom. Adversarial justice can be used to describe the process of a contest between the defence and prosecution in the quest to establish proof of guilt or innocence beyond reasonable doubt.The role of the judge is to referee this contest, and the jury to deliberate over the evidence provided. The concept of ‘justice’ is far-reaching and open to a variety of interpretations and applications (eg natural justice, social justice, criminal justice).The intentions 5

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of the criminal courts are to provide a state response to individual or collective wrongdoing.The reality of the criminal courts is a situation where many victims of crime fail to receive what they consider as adequate redress for the harm that they have experienced, and the burdensome and grave scenario of miscarriages of justice. The centrality of ‘theatre’ in the courtroom is where many critics cite the main faults of this approach. Subjectivity, influence and bias are evident in this stage of the criminal justice process and elsewhere. Yet, the adversarial system attempts to remain objective through the presentation of ‘facts’; however, it provides little attention to the role of subjectivity in determining certainty of guilt or innocence. Adversarial justice models can be found in England and Wales, Australia, Canada and the US. Elsewhere, inquisitorial systems are utilised, where the judge plays a more active role in the criminal inquiry, for example, establishing which witnesses are called (Sanders et al, 2010). Inquisitorial systems are often described as comprising of the search for ‘truth’ as opposed to the theatrical contest of adversarial justice. The inquisitorial system is not immune from the prospect of bias (eg the active role of the judge); however, supporters suggest that such an approach reduces some of the problems associated with a trial by jury process (for example, are jurors necessarily a fair representative of society? Are jurors the best people to adjudicate over guilt or innocence?). The current practices of adversarialism have not only raised questions within academic circles. Lord Justice Auld’s (2001) review of the criminal courts raised caution that the ‘game’ of adversarial justice should not lead to a loss of natural justice. While adversarial systems of justice may offer the opportunity for an individual to assert their innocence and have their day in court, there are equally opposing debates which suggest that this historically embedded tradition is highly flawed. KAREN CORTEEN See also: Criminal Justice; Due Process; Justice Readings Auld, R. (2001) A review of the Criminal Courts in England and Wales. London, United Kingdom: Royal Courts of Justice. http://webarchive.nationalarchives. gov.uk/+/http://www.criminal-courts-review.org.uk/index.htm Joyce, P. (2006) Criminal justice: an introduction to crime and the criminal justice system. Cullompton: Willan Publishing.


A companion to criminal justice, mental health and risk

Sanders, A., Young, R. and Burton, M. (2010) Criminal justice. Oxford: Oxford University Press.


Simply put, advocacy provides a means for ensuring that the wishes of service users are given a voice.There is a history of people advocating for detained persons dating to the first legislation permitting forced treatment or deprivation of liberty for those designated ‘mentally abnormal’. As psychiatry has grown, there has been a concomitant international growth in advocacy services. People can speak for themselves (self-advocacy) or through the intercession of an advocate. This can be someone who comes to the advocacy role as a volunteer (volunteer or citizen advocacy), with a shared experience of relevant services (peer advocacy) or who is paid (professional advocacy). Simple information giving does not constitute advocacy, yet would be an important element of a mental health advocate’s role if, for instance, there were concerns over an individual’s awareness of their rights. In a general sense, advocacy functions to: • safeguard individual rights; • empower service users to make informed decisions about care and treatment or take greater control over their lives; • represent the views of service users if the service user wishes it; and • feedback issues raised by service users to those providing and commissioning services to ensure improvement. In England and Wales, the 2007 reforms of the Mental Health Act 1983 ushered in a statutory right to advocacy for those subject to compulsion, resulting in the newly defined, specialised Independent Mental Health Advocacy (IMHA) role, supplementing generic advocacy. These developments complemented the already-established Independent Mental Capacity Advocates (IMCAs) for persons deemed to lack capacity. In Scotland, those treated under the Mental Health (Care and Treatment) (Scotland) Act 2003 have a right to access independent advocacy services. Independence and freedom from any conflicts of interest are a crucial characteristic of good-quality advocacy. Advocates have to negotiate their relationship with care teams and service providers so as to avoid incorporation. Staff such as nurses or social workers can perform a limited advocacy role, speaking up for patients within the immediate care context, but this can never truly be independent.Yet, the use of independent advocacy is not without its problems or challenges. Studies 7

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of independent advocacy in practice have noted the potential for professional care staff to feel threatened by the presence of an independent advocate, resulting in the levels of support for advocates being variable (Newbigging et al, 2012). Mental health advocates are fundamentally concerned with empowerment. Individual choice is paramount; an individual may be otherwise articulate, but may feel intimidated in a health-care setting and prefer to be represented by an independent advocate. Similarly, people’s capacity to make decisions for themselves can change daily. Advocacy undoubtedly plays an important role within contemporary mental health services, with high levels of compulsion and coercion, but it has not been without critique. Arguably, the commissioning and funding of advocacy services has not always been directly related to assessed needs. Certain minority ethnic communities have raised concerns over equality of access or whether the dominant model of independence might clash with preferences for interdependent social relations.The efficacy of advocacy to impact on treatment options and conditions has also been questioned (Townsley et al, 2009; Newbigging et al, 2012). In practice, the process of advocacy – being listened to respectfully for example – may be appreciated over and above securing specific changes in treatment. MICK MCKEOWN, JULIE RIDLEY, KAREN MACHIN and KAREN NEWBIGGING See also: Ethnicity; Mental Health Act 2007; Safeguarding Readings Newbigging, K., Ridley, J., McKeown, M., Machin, K., Poursanidou, D., Able, L., Cruse, K., Grey, P., De la Haye, S., Habte-Mariam, Z., Joseph, D., Kiansumba, M. and Sadd, J. (2012) ‘The right to be heard: review of the quality of Independent Mental Health Advocate (IMHA) services in England’, research report, University of Central Lancashire, 21 June. Townsley, R., Marriott, A. and Ward, L. (2009) Access to independent advocacy: an evidence review: report for the Office for Disability Issues. London: HM Government/ Office for Disability Issues.


Despite being a psychoactive drug that affects judgement and behaviour, the relationship between alcohol and risk is comparatively unexplored, especially in adult populations. Empirical work had focused upon risk, alcohol and general 8

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consumption levels (Rehm et al, 2003), and risk, alcohol and specific disease conditions (Corrao et al, 2004). Foster (forthcoming) explored some of the attitudes of adults to alcohol and risk and found a tendency to discount longterm health risks.The risks that were acknowledged included getting into physical altercations, becoming sick or injuring oneself when intoxicated. If long-term health risks were acknowledged, these were seen as a problem for ‘other people’. One of the biggest changes in the culture surrounding alcohol over the past 30 years has been the shift to increased levels of drinking at home (Foster and Fergusson, 2012) – over 80% of all wine consumption in the UK is at home. Home consumption is seen as unremarkable and Holloway et al (2008) found that home was regarded as safe space. In contrast, the interviewees in Foster (forthcoming) were aware that they were running a calculated risk. The importance of the shift towards drinking at home is that individuals have to become self-limiting, rather than in bars or clubs, where there are external sanctions placed upon risky and intoxicated behaviour.Thus, there is a difficulty for public health professionals in postulating drinking as risky when it is experienced as being risk-free or having minimal risk. Drinking in adults and drinking in young people have to be considered separately. In young people, greater alcohol consumption is associated with more at-risk behaviours such as getting into physical altercations or unsafe sexual practices (Bellis et al, 2007). However, for young people, issues such as risk-taking behaviour being part of healthy development, and the need to ‘fit in’ with their peer group, are more important than drinking ‘sensibly’ (Sorhaindo, 2007). While the peer group is clearly important, there is now good evidence that parental surveillance is associated with less consumption and at-risk behaviour (Bremner et al, 2011). Foster (forthcoming) indicates that adults minimise alcohol and risk, especially when drinking at home. They introduce rituals that minimise the amount of alcohol consumed, such as not drinking before a certain time (eg 8–9 pm) or before young children have gone to bed; drinking alone is seen as risky and indicative of mental distress. Furthermore, Foster’s (forthcoming) analysis also indicated some levels of distrust of sensible drinking guidelines and public health messages. Often, this type of information is presented in epidemiological terms, but individuals do not see risk in these terms, tending to rely instead on their own personal experience. Thus, the importance of more research to understand how individuals perceive risk, particularly when drinking in their own homes, is warranted. JOHN FOSTER See also: Dual Diagnosis; Substance-Related Violence 9

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Readings Bellis, M., Hughes, K., Morleo, M., Tocque, K., Hughes, S., Allen, T., Harrison, D. and Fe-Rodriguez, E. (2007) ‘Predictors of risky alcohol consumption in school children and their implications for preventing alcohol-related harm’, Substance Abuse Treatment Prevention and Policy, 2(1): 15. Bremner, P., Burnett, J., Nunney, F., Ravat, M. and Mistral, W. (2011) Young people, alcohol and influences. York: Joseph Rowntree Foundation. Corrao, G., Bagnardi, V. and Zambon, A. (2004) ‘A meta-analysis of alcohol consumption and the risk of 15 diseases’, Preventive Medicine, 38: 613–19. Foster, J.H. (forthcoming) ‘Alcohol consumption at home: the link between risk and time?’, Health, Risk and Society. Foster, J.H. and Ferguson, C. (2012) ‘Home drinking: a key challenge for public health’, Alcohol and Alcoholism, 47: 355–8. Holloway, S., Jayne, M. and Valentine, G. (2008) ‘Sainsbury’s is my local: English alcohol policy, domestic drinking practices and the meaning of home’, Transactions of the Institute of British Geographers, 33: 532–47. Rehm, J., Room, R., Graham, K. and Monteiro, M. (2003) ‘The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: an overview’, Addiction, 98: 1209–28. Sorhaindo, A. (2007) Young people health risk taking: a brief review of evidence on attitudes, at-risk populations and successful interventions. London: Institute of Education, University of London.


Altruism is derived from the French altruisme, the Italian altrui (someone else) and the Latin alter (other) and is defined as unselfish concern for the welfare of others – selflessness. Analyses and application of altruism in the life-course are broad and far-reaching. Indeed, it has been a topic both debated and challenged on the basis of its philosophical roots. Altruism was deliberated in the writings of 19th-century French philosopher Auguste Comte, who believed that individuals should live for the sake of others. Comte (1852, pp 255–6) stated that: We are born under a load of obligations of every kind, to our predecessors, to our successors, to our contemporaries. After our birth these obligations increase or accumulate, for it is some time before we can return any service…. To live for others gives a direct sanction exclusively to our instincts of benevolence…. Man must serve humanity. 10

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A challenge to Comte’s thesis was tabled by German philosopher Friedrich Nietzsche, who disagreed, considering that to treat others as more important than oneself is demeaning to the self and hinders development and creativity. Nietzsche did uphold the ‘duty’ to help weaker individuals (see Leiter, 2004). Altruism remains a major research theme for psychologists interested in evolution. Some physiological mechanisms, for example, emotions, have evolved to promote altruism and enhance survival and reproductive success. Research has found more altruism between: kin than non-kin; friends than strangers; attractive individuals than those considered unattractive; non-competitors than competitors; and members of ‘in-groups’ than with members of ‘out-groups’. The debate continues regarding the validity of altruism. Egoism suggests that sharing, helping or sacrificing cannot be altruistic because of the possibility of personal gratification. The validity of this argument depends upon whether intrinsic rewards qualify as benefits. Batson, Ahmad and Stocks (2011) identified four motives for altruism: 1. ultimately self-benefiting (egoism); 2. ultimately benefiting others (true altruism); 3. benefiting a group (collectivism); and 4. upholding moral principles (principlism). Empathy-based altruism considers the core drive to be helping to alleviate suffering (physical, psychological and emotional) in others through empathy-generated self-awareness, which compels actions to reduce their own unpleasant emotions. Empathetic individuals help others in distress even when exposure to the situation could be easily avoided, whereas those lacking empathy avoid helping unless it is impossible to avoid such exposure. Research also suggests that greater numbers of bystanders witnessing distress decreases individual feelings of responsibility (the Bystander Effect) but that a witness with a high level of empathetic concern is likely to assume responsibility and assist regardless of the number of bystanders. Mirror neurons ‘mirror’ the behaviour of others, exist in humans and are likely to represent the neural basis of human empathy (Rizzolati and Craighero, 2004). Medical and judicial system applications of these principles include the enduring governing principle of medical practice, the Hippocratic Oath and Therapeutic Jurisprudence, both based on the concept of ‘First, do no harm’. In the context of forensic psychiatry, the subject of altruism presents a number of interesting considerations. Mentally disordered offenders are subject to a tripartite arrangement of medicojuridical-welfare interventions (see Webb and Harris, 1999). In this context, the welfare of the patient is not the only concern, but also the welfare (and safety) 11

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of the public. In such cases, a dualism exists, and welfare can arguably come to mean an overriding of autonomy and restriction of liberties (eg detention and coercion under the Mental Health Act) ‘in the name of public safety’ (Adshead and Sarkar, 2005, p 1013).The ideals of the Hippocratic Oath are central to a long history of a constantly advancing medical profession. However, the very notion that psychiatrists – with an extensive repertoire of legal sanctions at their disposal – are able to meet the demands of the central ethical tenets of the discipline have been called into question, not least by critical and anti-psychiatry perspectives. Issues of paternalism, welfare and ethical behaviours in psychiatry are abundant and authors have called for greater attention to be paid to protecting the altruistic identity of psychiatric professionals (Sarkar and Adshead, 2003) – not an easy task when operating in what may be an incongruous duality of care and control. GORDON TURNBULL See also: Anti-Psychiatry Movement; Deprivation of Liberty Safeguards Readings Adshead, G. and Sarkar, S.P. (2005) ‘Justice and welfare: two ethical paradigms in forensic psychiatry’, Australian and New Zealand Journal of Psychiatry, 39(11/12): 1011–17. Batson, C., Ahmad, N. and Stocks, E.L. (2011) ‘Four forms of prosocial motivation: egoism, altruism, collectivism and principalism’, in D. Dunning and D. Dunning (eds) Social motivation. New York, NY: Psychology Press, pp 103–26. Comte, A. (1852) Catéchisme positiviste: Ou, Sommaire exposition de la religion universelle. Avec une introduction et des notes explicatives par P.-F. Pécaut. Paris: Garnier. Leiter, B. (2004) ‘Nietzsche’s moral and political philosophy’, in E.N. Zalta (ed) The Stanford encyclopedia of philosophy. Available at: http://plato.stanford.edu/ archives/fall2004/entries/nietzsche-moral-political/ Rizolatti, G. and Craighero, L. (2004) ‘The mirror-neuron system’, Annual Review Neuroscience, 27: 169–92. Sarkar, S.P. and Adshead, G. (2003) ‘Protecting altruism: a call for a code of ethics in British psychiatry’, The British Journal of Psychiatry, 183: 95–7. Webb, D. and Harris, R. (eds) (1999) Mentally disordered offenders: managing people nobody owns. London: Routledge.


A companion to criminal justice, mental health and risk

ANTI-PSYCHIATRY MOVEMENT The anti-psychiatry movement represents a group of authors emerging generally in the mid-20th century. Their work is highly critical of the coercive aspects of psychiatric care and the growing power invested in a profession that has the ability to regulate the meaning of normal and abnormal behaviour and apply sanctions to those deemed ‘treatable’. The central thesis of the anti-psychiatry movement is that it opposes the increasing governance of those who are diagnosed. Psychiatry has long been an active agent of social control (eg expansion in diagnosis and the growth of the county asylum system). More recently, the coercive dimension to psychiatry has seen a resurgence (eg Dangerous Severe Personality Disorder programme, gay conversion therapies, anti-gay cures), together with amendments in legislation that have the capability to widen their net of control through a broader definition of mental disorder (Prins, 2008). Concerns have been raised that progressive psychiatric power has become more aligned with the judiciary rather than the benevolent doctrines of health care. Institutional mental health care has come under particular scrutiny. Goffman’s (1961) seminal text Asylums explored the plight of the psychiatric patient. He put forward an in-depth analysis of what he coined the ‘total institution’: a social system of institutionalisation that strips the patient of their social role and inflicts obedience through coercive regimes. The impact of Goffman’s text has been far-reaching. Scull (1984) posits that the mass movement towards deinstitutionalisation in the US and England was founded on Goffman’s findings and a growing psychotropic pharmaceutical market. Laing (1999) asserts that hospitalisation is no better than imprisonment, with both institutions providing little in terms of any therapeutic aims. While authors such as Szasz (1972) have described psychiatric diagnosis as a social construct based on the opinions of powerful individuals with vested interests, the perceived liberal attitudes of this movement have been critiqued. While there is consensus among the anti-psychiatry movement that the medical profession should not ignore human suffering, the condemnation of the involuntary management of the patient has attracted criticism. Catastrophic failures in public protection have been utilised as debating tools against the anti-psychiatry perspective, not least in homicides committed by individuals discharged from institutional care. PAUL TAYLOR


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See also: Altruism; Medicalisation and Social Control; Surveillance Readings Goffman, E. (1961) Asylums: essays on the social situation of mental patients and other inmates. New York, NY: Doubleday Anchor Books. Laing, J.M. (1999) Care or custody? Mentally disordered offenders in the criminal justice system. Oxford: Oxford University Press. Prins, H. (2008) ‘Counterblast: the Mental Health Act 2007 (a hard act to follow)’, The Howard Journal of Criminal Justice, 47(1): 81-5. Scull, A.T. (1984) Decarceration: community treatment and the deviant – a radical view. Cambridge: Polity Press. Szasz, T.S. (1972) The myth of mental illness. London: Paladin.


An appropriate adult is an individual (eg a family member, friend, social/healthcare professional or volunteer) who is present at the police interviewing and charging of a suspect who is under the age of 17 or an individual of any age who is deemed to be mentally vulnerable (eg through learning difficulties, disabilities or mental health conditions). The role of the appropriate adult was formalised under the Police and Criminal Evidence Act 1984 and puts the responsibility of the provision of an appropriate adult on the duty custody officer (usually the custody sergeant). The role of the appropriate adult is to ensure that the suspect or police detainee is aware of what is happening to them and the reasons why. While the use of an appropriate adult seeks to maintain the rights of the suspect or police detainee (the [i] right to have somebody informed of their arrest, [ii] right to free legal advice and [iii] right to consult the codes of practice), research has unveiled that there are inconsistencies in the use of an appropriate adult (Nemitz and Bean, 2001). More recently, it has been recommended that more work needs to be done in recognising the mentally vulnerable in police custody and the use of an appropriate adult (NAAN, 2011). The Bradley Report (Bradley, 2009) undertook a broad-reaching exploration of the experiences of individuals with mental health conditions and learning disabilities in the criminal justice system. Of the 82 recommendations in this report, Lord Bradley made a general note that there should be improved identification and support for those considered mentally vulnerable at the earliest possible opportunity in the criminal justice process, and that this should continue throughout their criminal justice journey. 14

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Recommendations are made in the Bradley Report (Bradley, 2009) to improve the appropriate adult system and the use of it. In the report, Lord Bradley envisages a system whereby identification of the need for the use of an appropriate adult is embedded in daily practice across all police services, that appropriate adults receive relevant training where possible and that health-care professionals with mental health/learning disability expertise are present in the custody environment to allow for early assessment. Following the publication of the Bradley Report (Bradley, 2009), HM Government and Department of Health (2009) published Improving health, supporting justice, a delivery plan for improvements for mentally vulnerable individuals in the criminal justice system. Reviews of current practice are ongoing and it is anticipated that the political and policy attention to this area will improve the structuring and delivery of services in this area. PAUL WAGG See also: Bradley Report; Police and Criminal Evidence Act 1984; Policing and Duty of Care Readings Bradley, K. (2009) The Bradley Report: Lord Bradley’s review of people with mental health problems or learning disabilities in the criminal justice system. London: Department of Health. HM Government and Department of Health (2009) Improving health, supporting justice: the national delivery plan of the Health and Criminal Justice Programme Board. Available from http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/ en/Publicationsandstatistics/Publications/PublicationsPolicyandGuidance/ DH_108606 NAAN (National Appropriate Adult Network) (2011) Appropriate adult report 2010. Available at: www.gov.uk/government/uploads/system/uploads/ attachment_data/file/117683/appropriate-adult-report.pdf Nemitz, T. and Bean, P. (2001) ‘Protecting the rights of the mentally disordered in police stations: the use of the appropriate adult in England and Wales’, International Journal of Law and Psychiatry, 24: 595–605.


The approved mental health professional (AMHP) role was first introduced within the Mental Health Act 1983 (as amended 2007).This role replaces that of 15

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the approved social worker (ASW). The AMHP can be a registered nurse, social worker, occupational therapist or chartered psychologist who has undertaken approved training.Their role is pivotal in the process of assessing and deciding upon compulsory hospitalisation under the Mental Health Act 1983 (as amended 2007). Implemented under the Mental Health Act 1983 (as amended 2007) and guided by the Mental Health (Approved Mental Health Professionals) (Approval) (England) Regulations 2008, the AMHP provides an assessment of an individual where the possibility of compulsory detention is indicated. The assessment undertaken by the AMHP is required to provide a holistic social assessment of the individual, serving to complement or contrast with that of the assessing medical doctor. Like the medical doctor, the AMHP undertakes an evaluation of the risk posed to the individual and others. Central to the AMHP role is to consider whether the deprivation of liberty through compulsory hospitalisation is justified in relation to the risk posed. The AMHP is able to make a number of recommendations following an assessment of the individual.They may recommend compulsory admission to hospital or they may recommend that the individual is not detainable under the Mental Health Act 1983 (as amended 2007) and that less restrictive alternatives should be sought. The implementation of AMHPs has raised significant debate over their ability to remain objective in the assessment process. An AMHP will be certified and authorised to work by the Local Social Services Authority (LSSA). The AMHP may be employed by another organisation, for example, the National Health Service (NHS). It is this relationship that those critiquing the area are concerned may obscure the impartiality of the assessment process. Particularly through the consultation and numerous Mental Health Bills, the Mental Health Alliance and British Association of Social Workers have voiced their concerns over the neutrality of the AMHP. They assert that the role of the AMHP should be independent and it should not be the case that an individual can be detained following a recommendation of an AMHP who is employed by the same organisation that the individual may be detained within (eg NHS Mental Health Trust). An additional function of the AMHP that the ASW was not involved in is the assessment for a recommendation of a Community Treatment Order (CTO). Like the AMHP, the CTO is a new addition in the Mental Health Act 1983 (as amended 2007). The purpose of the CTO is to provide swift hospital recall of an individual discharged to the community. The introduction of the CTO has sparked controversy as its effectiveness is not yet known; however, some of the


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critical problems associated with them are coming to light (see Care Quality Commission, 2010). The role of the AMHP is one of great influence and power.They are required to provide a balance between risk and personal liberties. In such a situation, these practitioners are placed in a position where they must negotiate the tenuous relationship between care and coercion. SIÂN WILLIAMS See also: Community Treatment Orders; Mental Health Act 2007 Readings Care Quality Commission (2010) Monitoring the use of the Mental Health Act in 2009/10. London: Care Quality Commission. Kisely, S.R., Campbell, L.A. and Preston, N.J. (2011) ‘Compulsory community and involuntary outpatient treatment for people with severe mental disorders’, Cochrane Database of Systematic Reviews, 2: CD004408.


The Assessment, Care in Custody and Teamwork (ACCT) approach is a framework of training and reference developed and used by HM Prison Service.The ACCT approach seeks to provide staff with appropriate and relevant training in the identification and management of risk of suicide and self-harm in prison custody. The ACCT approach places emphasis on the ability to prevent incidences of selfharm or suicide through the provision of support for remanded and sentenced prisoners. The ACCT framework provides staff with practical advice on how to recognise prisoners at risk and how to manage potential triggers of self-harm or suicide. It details the individual responsibilities of a variety of professionals, how to implement procedures based on observations of triggers and how staff can be supported in situations where they face critical incidents. Safer Custody Teams (SCTs) are now an integral component in the management of the prison and forensic health-care estate. Despite this, management of selfinjurious behaviour is complex and persistent, as many individuals, especially housed in custodial environments, suffer with undiagnosed or untreated mental illnesses and distress. In 2010/11, there were a total of 59 self-inflicted deaths in England and Wales’ secure estate (Prison and Probation Ombudsman, 2011). 17

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Specialist training, improved facilities and the commissioning of SCTs are all contributory to the ACCT framework, in a bid to learn from events of the past and reduce current figures further. Mental illness and distress can either be imported into the custody environment or the custody environment may bring on, or exacerbate, a condition. Further, Edgar and Rickford (2009) caution that the courts were too often using prisons as ‘a default option’ for people who should have been diverted into the mental health system. Failings of the past include the self-inflicted deaths of six women at Her Majesty’s Prison [HMP] Styal in a 12-month period between August 2002 and August 2003. At an inquest into the death of one of the women who died at HMP Styal, Sarah Campbell, major failings in the safe custody of the young women were raised. Failures to respond to Inspectorate recommendations and a lack of suitable accommodation for at-risk prisoners were just some of the issues brought to light. Deborah Coles, co-director of the INQUEST campaign group, claimed that ‘this inquest has heard shocking evidence that HMP Styal utterly failed in their duty to protect the life of Sarah, a woman who had been clearly identified by several sources as being at risk of suicide and self-harm’ (INQUEST, 2005). In the light of tragedies such as those at HMP Styal and elsewhere, the galvanising of an approach that seeks to support and effectively risk-manage those housed in the secure estate is essential. The ACCT approach is a framework that hopes to provide such a response to a critical problem. Responding to at-risk detainees is not just a responsibility for those in direct face-to-face contact, but rather a collective responsibility to manage both organisationally and interpersonally. KAREN CORTEEN See also: Mental Health In-Reach Services; Self-Harm; Solitary Confinement and Mental Illness Readings Edgar, K. and Rickford, D. (2009) Too little, too late: an independent review of unmet mental health need in prison. London: Prison Reform Trust. HM Prison Service Safer Custody Group (2007) ‘The ACCT approach: caring for people at risk in prison’. Available from www.medicaljustice.org.uk/images/ stories/reports/acctstaffguide.pdf INQUEST (2005) ‘Verdict in the Sarah Campbell inquest – the 18 year old women who died in HMP Styal’. Available at: http://inquest.gn.apc.org/ pdf/2005/Sarah%20Campbell%20Inquest%20verdict%202005.pdf


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Prisons and Probation Ombudsman (2011) Annual report 2010–11. London: Her Majesty’s Stationery Office.


Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder categorised by high and persistent levels of inattention, hyperactivity and impulsivity. Children can exhibit behaviours before age seven and may continue into adulthood. It commonly co-occurs with other specific learning difficulties (SpLDs), psychiatric disorders, substance abuse and increased risk of suicide. According to DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders) criteria, it is primarily manifested in: difficulty sustaining attention; disorganisation; aggression; and occupational, relationship and educational difficulties. However, some question the medical construct of such definitions, affirming that their foundation is value-laden concerning the appropriacy of human behaviour, thus individualising failure. It is estimated to lie between 2% and 16% in the general population and 20% and 80% in prison populations, and males are more likely to be diagnosed than females, who are generally under-diagnosed. The National Institute for Clinical Excellence recommends a holistic programme of pharmacological, psychological and educational support; however, some question its effectiveness as many go undiagnosed. In the criminal justice context, Young et al (2011) report that, ultimately, it cannot afford to ignore ADHD, due to the high proportion of imprisoned offenders with the condition. It is not included in the Grubin Screen, although it could be incorporated; however, high prisoner turnover makes this difficult. Ongoing debate questions whether ADHD alone is a sole determinant of criminal behaviour; it is still unclear whether the link to crime is causal, unfounded or the result of co-occurring conditions or deterministic social factors. A greater number of additional developmental and social risk factors makes it increasingly probable that individuals will engage in criminality (Bartol and Bartol, 2008); nevertheless, strong family and peer support can reduce its detrimental impact. Hence, ADHD alone does not guarantee criminality. Many studies have documented the co-occurrence between depression and ADHD, often appearing after ADHD diagnosis, noting that half of those admitted to psychiatric settings had ADHD.The nature of this link is not fully understood, as diagnosis is challenging due to its complexity and its similarity to other psychiatric conditions; thus, under-diagnosis occurs. Ostrander and Hertman (2006) assert that chaotic and ineffective parenting with ADHD provides fertile ground for depression. Collishaw et al (2004) found that, in recent decades, adolescent mental 19

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health problems have increased due to family change, pressures (education, drugs) and socio-economic inequalities. It has been acknowledged by health, judicial and education professionals that to reduce the impact on individuals and services, further research is required to ascertain effective diagnosis and interventions, thus enabling successful rehabilitation and improved social outcomes. STEPHANIE HEADON See also: Youth Custody and Mental Disorder Readings Bartol, A. and Bartol, C.R. (2008) Criminal behaviour: a psychosocial approach. Upper Saddle River, NJ: Pearson Prentice Hall. Collishaw, S., Maughan, B., Goodman, R. and Pickles, A. (2004) ‘Time trends in adolescent mental health’, Journal of Child Psychology and Psychiatry, 45(8): 1350–62. Ostrander, R. and Herman, K.C. (2006) ‘Potential cognitive, parenting, and developmental mediators of the relationship between ADHD and depression’, Journal of Consulting and Clinical Psychology, 74(1): 89–98. Young, S.J., Adamou, M., Bolea, B., Gudjonsson, G., Müller, U., Pitts, M., Thome, J. and Asherson, P. (2011) ‘The identification and management of ADHD offenders within the criminal justice system: a consensus statement from the UK ADHD network and criminal justice agencies’, BMC Psychiatry, 11(32): 1–14.


Autism Spectrum Disorder (ASD) is a neuro-developmental disability that involves a triad of impairments relating to social interaction, social imagination and communication. Furthermore, individuals have problems adjusting to change and engage in narrowly focused, repetitive behaviours. ASD affects approximately one in every 100 individuals and is manifested more frequently in males (4:1) (National Autistic Society, 2008), with this population as much as four times more likely to be in prison (Fazio et al, 2012). Intelligence quotient (IQ) may be limited or within normal parameters, but, as in the case of Asperger Syndrome, is sometimes well above average.


A companion to criminal justice, mental health and risk

Some of the most pressing concerns surrounding the relationship between ASD and the criminal justice system (CJS) revolve around competence to stand trial, mental capacity, mitigating circumstances and accuracy in the presentation of evidence (Mayes and Koegel, 2003). The identification and treatment of people with ASD within the CJS can present problems, particularly in relation to Asperger Syndrome, because of (rather than despite) the higher level of functioning (Browning and Caulfield, 2011).There are also diagnostic complexities associated with certain criteria being similarly manifested in other mental health conditions, particularly schizoid, schizotypal and personality disorders (Haskins and Silva, 2006). People with ASD may have contact with the CJS as victims, witnesses or offenders, so communication channels should be clear and consistent, with professionals verifying facts, making pertinent accommodations and ensuring equity in relation to justice.There is considerable variation in the communication, intent and ability of those with ASD, which challenges CJS professionals to avoid misinterpretation of words and behaviours as evidence of indifference, guilt or a lack of remorse. Little guidance exists with regard to how service design should be developed to more effectively accommodate people with ASD, particularly when a prison sentence has been imposed (Cashin and Newman, 2009). People with ASD engage in crime for the same reasons as anyone else, although Theory of Mind (or mentalisation), whereby individuals fail to consider the cognitive, perceptual and affective life of others (Hare et al, 1999), is influential. This ‘mindblindness’ (Baron-Cohen, 1995), particularly when coupled with the tendency towards repetitive self-interest, means that individuals with ASD encounter difficulties reading social cues, failing to detect another person’s different emotional experience of the same situation. The effect of such inability to read a situation may result in a failure to withdraw from a social encounter, and a subsequent crime committed as circumstances deteriorate. ANDREW LOVELL See also: Learning Disabilities and Criminal Justice Readings Baron-Cohen, S. (1995) Mindblindness: an essay on autism and theory of mind. Cambridge, MA: MIT Press. Browning, A. and Caulfield, L. (2011) ‘The prevalence and treatment of people with Asperger’s Syndrome in the criminal justice system’, Criminology and Criminal Justice, 11(2): 165–80 Cashin, A. and Newman, C. (2009) ‘Autism in the criminal justice detention system: a review of the literature’, Journal of Forensic Nursing, 5(2): 70–5. 21

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Fazio, R.L., Pietz, C.A. and Denney, R.L. (2012) ‘An estimate of the prevalence of autism-spectrum disorders in an incarcerated population’, Open Access Journal of Forensic Psychology, 4: 69–80. Hare, D., Gould, J., Mills, R. and Wing, L. (1999) A preliminary study of individuals with autistic spectrum disorders in three special hospitals in England. London: National Autistic Society. Haskins, B.G. and Silva, J.A. (2006) ‘Asperger’s disorder and criminal behavior: forensic-psychiatric considerations’, Journal of American Academy Psychiatry Law, 34(3): 374–84. Mayes, T. A. and Koegel, R.L. (2003) ‘Persons with autism and criminal justice: core concepts and leading cases’, Journal of Positive Behavioral Interventions, 5(2): 92–100. National Autistic Society (2008) Autism: a guide for criminal justice professionals. London: National Autistic Society.


Automatism is a legal defence in England and Wales.There are two legally defined automatism defences: insane and non-insane automatism. A plea of automatism would be based on the assertion that the defendant had no control over their actions by their conscious mind. This plea locates the physical actions of the individual as being involuntary. A successful defence of non-insane automatism would result in complete criminal acquittal (unqualified acquittal) as mens rea is not applicable in this situation – all actions are classified as involuntary – whereas insane automatism is a defence whereby the behaviour was resultant from a disease of the mind (McMurran et al, 2009). If this plea were accepted, the verdict would be not guilty by reason of insanity (qualified acquittal). If the charge were murder, then an indefinite hospital order would be applied; for other charges, the Mental Health Act will be utilised (or absolute discharge) under the direction of Section 3 of the Criminal Procedure (Insanity and Unfitness to Plead) Act 1991. Establishing the difference between insane and non-insane automatism is problematic. Several legal cases have highlighted the inconsistencies in the outcomes of automatism pleas. One of the key issues of debate is whether the criminal act was a result of a disease of the mind and there was therefore a defect of reason at the time of the offence. Diseases of the mind move beyond the characteristics of traditional forms of mental illness. Diseases of the mind have come to include conditions such as 22

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epilepsy and even sleepwalking. Behaviour as a consequence of these enduring, transient or intermittent conditions is seen to warrant control. It is here where it may be apparent that public protection becomes paramount. A verdict of insane automatism would allow for controls to be put in place (eg hospitalisation), whereas non-insane automatism would be an unqualified acquittal. In such circumstances, the acceptance of a plea of non-insane automatism may not be accepted based upon the risk that the individual may pose in the future. It is perhaps here where the court’s preference to err on the side of caution becomes apparent. SHARON MORLEY See also: Actus Reus; Insanity and Defect of Reason Readings McMurran, M., Khalifa, N. and Gibbon, S. (2009) Forensic mental health. Cullompton: Willan Publishing. Soothill, K., Rogers, P. and Dolan, M. (eds) (2008) Handbook of forensic mental health. Cullompton: Willan Publishing.


Aversion therapy is a form a behavioural conditioning designed to reduce or eliminate unwanted behaviour. Controversially, it was widely deployed in the mid-20th century to treat sexual and social ‘deviants’, including homosexuals, transsexuals and paedophiles. Aversive techniques were derived from Pavlovian conditioning. In aversion therapy, undesirable feelings or behaviours were repeatedly associated with negative stimuli in the hope of inducing an aversion to the undesired feeling or behaviour. The most common form of aversion used were electric shocks. Gay men, for example, would be shown erotic images of men and women, with shocks being administered only in conjunction with the images of men. In some cases, the administration of electric shocks was linked to homosexual arousal, measured by blood flow to the penis using a plethysmograph. Chemical aversion therapy was also deployed.This involved the administration of emetics to induce vomiting as a negative stimulus. In other cases, a negative emotional stimulus was produced. In the treatment of transvestism, for example, shame could be induced by forcing the transvestite to dress in women’s clothes under the disapproving gaze of the clinician. Those receiving treatment were often treated as patients in psychiatric wards, in addition


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to management of their ‘condition’ as an outpatient. Treatments varied in length from several weeks to over a year. The vast majority of clients were male. Aversion therapy was primarily deployed in contexts where homosexual sex was illegal and considered pathological (eg an illness that could be treated using interventions). Homosexuality and transvestism were classified as mental disorders by the World Health Organization in 1949 and sex between men was a criminal offence in the UK until 1967.Aversion therapies were sometimes offered to those convicted of sexual offences as a more clement alternative to a custodial sentence. The possibility of treatment of sexual deviation was also used as a reformist argument for the decriminalisation of homosexual sex. Aversion therapy declined in use from the 1970s following the gradual decriminalisation of homosexuality in the English-speaking world from 1967, and the removal of homosexuality as a mental disorder from diagnostic and classification manuals from 1973. It was a particular target of the anti-psychiatry movement. Like other psychotherapeutic paradigms of sexual ‘conversion therapy’ such as hormone therapy, psychoanalysis or religious counselling, there is little evidence that aversion therapy changed individuals’ sexual orientation (Bancroft, 1974). At most, it functioned to suppress sexual arousal generally. Aversion therapy is, by its nature, traumatic and poses ethical challenges to the patient–therapist relationship. Aversive techniques are still used in the treatment of some sexual offenders. Most groups attempting to alter sexual orientation (such as the ex-gay movement) now deploy non-aversive cognitive and behavioural therapies, psychoanalytic counselling, or self-help models. TIMOTHY W. JONES See also: Medicalisation and Social Control; Sex Offender Treatment Programmes Readings Bancroft, J. (1974) Deviant sexual behaviour: modification and assessment. Oxford: Clarendon Press. Dickinson, T., Cook, M. and Hallett, C. (2012) ‘“Queer” treatments: giving a voice to former patients who received treatments for their “sexual deviations”’, Journal of Clinical Nursing, 21(9/10): 1345–54. Smith, G., Bartlett, A. and King, M. (2004) ‘Treatments of homosexuality in Britain since the 1950s – an oral history: the experience of professionals’, British Medical Journal, 328(7437): 429.


B BATTERED WOMAN SYNDROME Battered Woman Syndrome (BWS) was first conceptualised in 1977 by Lenore Walker when submitting a research grant application to the United States National Institute of Mental Health (Walker, 1979).The resultant BWS research supported two key concepts – learned helplessness and the cycle theory of violence (Walker, 1979) – which are still used in domestic violence work today. Learned helplessness theory suggested that human beings who consistently fail to control their environment eventually stop trying to do so (Seligman, 1975). Walker (1979) developed this concept by linking the continual abuse inflicted by a male partner to an unconscious acceptance in the female partner that the situation could not be changed, thus producing feelings of helplessness. She also noted that a previous history of abuse could facilitate this process.The cycle theory of violence indicated that tension built within the relationship, violence erupted at some point and then a period of reconciliation followed, before the tension built again. As the woman never knew when the violence would erupt, she lived in a constant state of anxiety, resulting in a number of psychological symptoms, later defined as a subset of post-traumatic stress disorder (Walker, 2009). Walker (1979) argued that the presence of these factors could trigger a violent act from a woman towards her male partner due to her expectation of further physical abuse and heightened emotional state.Where this resulted in her partner’s serious injury or death, the courts were asked to consider it an act of self-defence resulting from BWS, even though this was not a recognised psychological condition. From 25

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the mid-1980s, this meant that a woman in an abusive relationship charged with murder in the US could have verdicts of manslaughter or self-defence also considered (Schuller et al, 2004). Although this helped to increase recognition of the significant trauma resulting from battering, it unintentionally presented women as weak, helpless and mentally unstable, leading to calls to broaden the interpretation of BWS to include the social context of the abuse (Dutton, 1993). As a concept, BWS has provoked significant debate for many years, both in support and against. While it is still not recognised as a formal defence, expert witnesses in BWS today testify in courts around the world to support pleas of mitigating circumstances in cases involving domestic violence. JEANNETTE RODDY See also: Gender, Mental Health and Offending; Loss of Control Readings Dutton, M.A. (1993) ‘Understanding women’s responses to domestic violence: a redefinition of battered woman syndrome’, HOFSTRA Law Review, 21: 1191–242. Schuller, R.A., Wells, E., Rzepa, S. and Klippenstine, M.A. (2004) ‘Rethinking battered woman syndrome evidence: the impact of alternative forms of expert testimony on mock jurors’ decisions’, Canadian Journal of Behavioral Science, 36(2): 127–36. Seligman, M.E.P. (1975) Helplessness: on depression, development, and death. New York, NY: WH Freeman/Times Books/ Henry Holt & Co. Walker, L.E. (1979) The battered woman. New York, NY: Harper & Row. Walker, L.E.A. (2009) The battered woman syndrome (3rd edn). New York, NY: Springer Publishing Co.


Originally founded in 1247 as St. Mary of Bethlehem, Bethlem Royal Hospital (herein Bethlem) is Britain’s oldest hospital for the treatment of mental illness and a contemporary National Health Service (NHS) psychiatric facility. Bethlem was immortalised in Hogarth’s 1735 engraving The Madhouse in his series A Rake’s Progress, and subsequently became known as Bedlam. Thus, Bethlem became synonymous with madness itself.


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Early hospitals such as Bethlem were essentially religious, not medical, establishments and they served as places of rest for pilgrims and places of respite for the poor. During its early years, Bethlem gradually came to specialise in the care of the insane. As intellectual and medical interest in the problems and meaning of insanity developed over the 17th and 18th centuries, so too did public curiosity. Bethlem was a place where the public could view the people confined there. This viewing was stopped in 1770, which Scull (2011, p 43) argues represented ‘a shutting off as well as a shutting up of the patients that ironically would end up exposing them in time to yet greater abuse’. In the absence of any centralised state provision for the insane, the alternatives were the private madhouses that flourished during the 18th and 19th centuries (see Bartlett, 1998). These institutions often relied on paupers sent by parish authorities. Insanity, however, continued to be viewed very much as a domestic problem and wealthy people usually preferred their insane relatives to be cared for at home, as was Bertha Rochester in Charlotte Bronte’s (1847) Jane Eyre for example. Contrary to the image of people being held in manacles in filthy conditions (akin to animals), as depicted by Hogarth, throughout its history, Bethlem has been an acute hospital for short-stay patients, with work and care provided for people according to need. If people could not be helped within 12 months, they were discharged back to their families. For the few that could not be discharged, an extra wing was added in the 1730s where they could remain indefinitely; however, this option was removed in 1919. In 1816, the Home Office agreed with the governors of Bethlem for a criminal lunatic asylum to be built at the site of the hospital but this later became unpopular with the governors of Bethlem because of increasing numbers and a lack of control over admissions and discharges. This facility for the criminally insane was replaced in 1864 by a new institution at Broadmoor in Berkshire. In 1857, Bethlem ceased to admit pauper patients as provision was now made in county public lunatic asylums, as required by the County Asylums Act 1845. This Act, together with the simultaneous Crown assent of the Lunacy Act 1845, changed the face of provision for, and status of, those with mental illness in Britain. Bethlem remained a charitable hospital, but in 1882, began accepting fee-paying patients.These fees were, however, means-tested and free admission remained an option.With the creation of the National Health Service (NHS) in 1948, Bethlem joined Maudsley Hospital to form a postgraduate psychiatric teaching unit. In 1999, they were incorporated into the South London and Maudsley NHS (now Foundation) Trust.Today, Bethlem Royal Hospital continues to provide specialist psychiatric care and treatment. JO TURNER


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See also: High-Security Hospitals; Report of the Select Committee of the House of Commons on Madhouses 1815 Readings Bartlett, P. (1998) ‘The asylum, the workhouse, and the voice of the insane poor in 19th-century England’, International Journal of Law and Psychiatry, 21(4): 421–32. Bronte, C. (1847) Jane Eyre. London: Smith, Elder & Co. Scull, A. (1999) ‘The history of Bethlem’, Medical History, 43(2): 248–55. Scull, A. (2011) Madness: a very short introduction. Oxford: Oxford University Press.


Bifurcation is the practice of separating ‘ordinary’ offenders from those deemed serious or dangerous and is a sentencing policy based upon the principle of ‘just deserts’. It aims to use prison for serious offenders and community-based sentences for those committing less serious offences. It is an example of penal pragmatism and is often interpreted as a reaction to the ‘Penal Crisis’ (ie concerns and debate in relation to the overuse of punishments, in particular, imprisonment) (Cavadino and Dignan, 2013).The theoretical basis of the principle of just deserts was both a return to classicism, in that it argued that punishments should be appropriate to the crime, and a recognition that prisons often stigmatise offenders. Bifurcation is seen to be a pragmatic response to two different forces within criminal justice: first, a reaction to the expansion (and therefore increasing cost) of the penal estate; and, second, the theoretical concept of ‘just deserts’. The interrelationship between these two forces results in pressure on politicians to reduce costs and to appear ‘tough on crime’ at the same time. Adopting a bifurcatory approach allows government to reserve prison for those who pose a realistic ‘risk’ to the public and to utilise alternative punishments for non-violent offenders, thus allowing politicians to appear ‘tough’ and simultaneously find alternatives to a criminal justice approach. In 1984, the then Home Secretary Leon Brittan introduced a range of measures with a strong bifurcatory theme, which increased the eligibility for parole for short-term prisoners and reduced opportunities for parole for certain, more serious categories of offences, such as murder, violent offences and drug trafficking (Cavadino and Dignan, 2013). However, it was the Criminal Justice Act 1991 (CJA) that had the clearest bifurcatory theme. The Act grouped offences under three headings – ‘minor’, ‘more serious’ and ‘serious’ – with only serious acts requiring a custodial sentence. The CJA required imprisonment to be justified in terms of public protection and retribution, and introduced the concept of a 28

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threshold between custody and other penalties, as well as emphasising that the goal of community sentences was punishment. For the first time, when sentencing an individual to imprisonment, a court had to state explicitly that the offence was so serious that no other penalty would suffice.This did result in a drop in the overall prison population: from 45,835 in October 1992 to 41,561 in January 1993. However, sentencers were given little guidance on how to calculate seriousness or dangerousness. In reaction to James Bulger’s tragic, but very much atypical, murder in 1993, the government led a (some might suggest, politically expedient) siren call to ‘common-sense’ values, which pledged to increase the number of people in prison and punish more harshly. This was epitomised by Michael Howard’s infamous ‘Prison Works’ speech, which led to a more punitive agenda that undermined the bifurcatory policy of the CJA. One of the key changes was the introduction of the concept of judicial discretion, whereby sentencers were allowed to take previous convictions into account. This was in contrast to the CJA, where the focus was on the offence committed rather than the history of the offender. LINDA ASQUITH See also: Criminal Justice Act 2003; Just Deserts; Punishment Readings Cavadino, M. and Dignan, J. (2013) The penal system: an introduction (5th edn). London: Sage.


Bipolar disorder, also known as bipolar affective disorder, was previously referred to as manic-depression. It is characterised by episodes of altered mood and behaviour. Individual episodes may be depressive, hypomanic (less severe without psychotic symptoms), manic (this may include symptoms such as delusions and hallucinations) or mixed. In mixed episodes, features of both mania and depression may be present or alternate rapidly (this is less common).The two main classification systems for mental illness define the condition slightly differently. The International Classification of Diseases (ICD-10) (Europe) defines bipolar affective disorder as at least two episodes that include a manic or hypomanic episode.The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (US) classifies the condition as comprising: bipolar I disorder (one or more manic/ 29

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mixed episodes and one or more major depressive episodes), bipolar II disorder (recurrent depressive and hypomanic episodes) and cyclothymic disorder (mood fluctuations over at least two years with episodes of depression and hypomania of less severity). There is some evidence of a genetic component to the illness (giving rise to debates about genetic screening) and people with a history of sexual and physical abuse appear to be more at risk. The illness is more prevalent in higher social classes, possibly reflecting differences in rates of diagnosis rather than rates of illness.The symptoms may be similar to those of medical illnesses, schizophrenia, personality disorders and substance misuse. Relevance to the law and criminal justice lies in the features of the illness. For example, these may include decreased social inhibition with disregard for the potential harm that might arise from dangerous driving, sexual promiscuity, reckless spending or involvement in business, political and religious initiatives. There is an association with violence that is particularly associated with people with the bipolar disorder who also have a substance misuse problem. (Volavka, 2013). Manic episodes may be characterised by an absence of insight. While this may remove criminal responsibility for actions, it may also hinder treatment. In the UK, this means that detention under the Mental Health Act 1983 (as amended 2007) is required. Hospitalisation may be needed if an episode of the illness is severe enough that a person risks harm to him/herself or to others.There has been discussion of the use of advance directives to allow sufferers while well to specify their treatment preferences when unwell (see Widdershoven and Berghmans, 2001). Prognosis is poor, up to 56% of people with the illness attempt suicide at least once and approximately 15% to 19% of sufferers die from suicide (Abreu et al, 2009). ANDREW PAPANIKITAS See also: Diagnostic and Statistical Manual of Mental Disorders Readings Abreu, L.N.D., Lafer, B., Baca-Garcia, E. and Oquendo, M.A. (2009) ‘Suicidal ideation and suicide attempts in bipolar disorder type I: an update for the clinician’, Revista brasileira de psiquiatria, 31(3): 271–80. American Psychiatric Association (2013) Diagnostic statistical manual of mental disorders (5th edn). Washington, DC: APA. Gillett, G. (2005) ‘The unwitting sacrifice problem’, Journal of Medical Ethics, 31(6): 327–32.


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Kastrup, M. (1988) ‘Psychiatry and the death penalty’, Journal of Medical Ethics, 14(4): 179–83. Üstün, T.B., Ayuso-Mateos, J.L., Chatterji, S., Mathers, C. and Murray, C.J. (2004) ‘Global burden of depressive disorders in the year 2000’, The British Journal of Psychiatry, 184(5): 386–92. Volavka, J. (2013) ‘Violence in schizophrenia and bipolar disorder’, Psychiatria Danubina, 25(1): 24–33. Widdershoven, G. and Berghmans, R. (2001) ‘Advance directives in psychiatric care: a narrative approach’, Journal of Medical Ethics, 27(2): 92–7. World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva, Switzerland: WHO.


The Report of the Working Group on Inequalities and Health (Department of Health and Social Security, 1980), commonly referred to as the Black Report after the chair Sir Douglas Black, is frequently cited as a defining statement on the relationship between socio-economic factors and differences in health, illness and mortality across society.The report was commissioned in 1977 by the Secretary of State for Health and Social Security David Ennals. Brian Abel-Smith, influential professor of social administration at the London School of Economics and advisor to successive Labour health ministers, played an important part behind the scenes in encouraging Ennals to commission an investigation into health inequalities – partly as a way of marking the 30th anniversary of the National Health Service (NHS) (Berridge, 2002). The committee was small, comprising two doctors (Black and Jerry Morris) and two sociologists (Peter Townsend and Cyril Smith), assisted by scientific secretary Stuart Blume. Although the brief given to the committee was not negotiable, significant discussions took place regarding methodology. The committee developed important analyses of mortality data (decennial supplements) and newly emerging longitudinal data to demonstrate very clear and consistent associations between occupational class and mortality and morbidity. Following a period where many believed that poverty and its influence in Britain was a thing of the past, the publication of these findings in a government-commissioned report was momentous (Berridge, 2002), though some critics suggested that methodological debates distracted from the development of clear policy recommendations about what should be done (Berridge and Blume, 2003). Disagreements delayed the report’s publication until 1980, in that Black and Morris could not agree with Townsend’s suggestion to fund some recommendations through cuts to acute hospital care. 31

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The then recently elected Thatcher-led Conservative administration was keen to divert attention away from class-based inequalities, publishing only 260 copies of the report on a bank holiday. It was not until the late 1990s that health inequalities were seriously considered again by UK policymakers, though a tendency still lingered towards focusing on individual behaviours, belying the greater explanatory weight of underlying structural factors.This relative blindness towards class at administrative levels is reflective of, and has helped legitimise, a similar overlooking of social inequalities within many sections of broader society (Blaxter, 1997). Despite attempts to ‘bury’ it, the Black Report has had international influence, informing studies into health inequalities by the Organisation of Economic Cooperation and Development and World Health Organization.The Black Report did not itself address inequalities in mental illness; however, there is a growing interest in ‘social factors’ and their explanatory role (Lofors and Sundquist, 2007). PATRICK BROWN See also: Social Exclusion; Social Justice Readings Berridge, V. (2002) ‘The Black Report and the health divide’, Contemporary British History, 16(3): 131–72. Berridge, V. and Blume, S. (2003) Poor health: social inequality before and after the Black Report. London: Frank Cass. Blaxter, M. (1997) ‘Whose fault is it? People’s own conceptions of the reasons for health inequalities’, Social Science and Medicine, 44(6): 747–56. Department of Health and Social Security (1980) Inequalities in health: report of a research working group, London: DHSS. Lofors, J. and Sundquist, K. (2007) ‘Low-linking social capital as a predictor of mental disorders: a cohort study of 4.5 million Swedes’, Social Science and Medicine, 64(1): 21–34.


The Bradley Report was commissioned by the UK government in December 2007 as an independent review into the organisation and effectiveness of court liaison and diversion schemes, which aim to divert offenders with mental health problems or learning disabilities from prison to other services. It was set in the context of a rising UK prison population and a view that the prison environment 32

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may impact negatively on mental health and the risk of self-harm and suicide. The report was published in February 2009 after its focus was widened to include liaison and diversion throughout the criminal justice pathway rather than solely at the court stage. The report’s findings were elicited from a number of sources, namely: literature reviews; individual meetings with key stakeholders; focus groups with service users and carers; site visits; calls for evidence to third-sector agencies, professional groups, the public and members of both Houses of Parliament; and a preliminary cost–benefit analysis. The report provides an insight into policy, research and examples of practice in each stage of the criminal justice pathway and makes 82 recommendations. These focus on the themes of early assessment and identification of mental illness, continuity of care, improving partnership working, and improving communication. Many of the recommendations cross-cut areas of the criminal justice pathway. For example the provision of mental health and learning disability training was recommended for school and primary care staff and those working in police, court, prison and probation settings. Likewise, findings pointed to a need to improve: information on the prevalence of mental illness and learning disability; screening for mental illness and learning disabilities; services for those with a dual diagnosis; and communication between services at several stages of the offender pathway. The government responded to the recommendations in the report and set out a delivery plan in Improving health, supporting justice (Department of Health, 2009). This focuses on: ensuring that services are needs-based, high-quality and costeffective; improving partnership working (including information sharing) between criminal justice and health and social care agencies; improving workers’ knowledge of mental health and learning disabilities; ensuring equity of access to services for offenders; promoting early identification of mental illness; and improving continuity of care. A National Programme Board and Advisory Group have since been established to oversee a strategy for implementing the recommendations. The central assumption underpinning the Bradley Report, as with the Reed Report (Reed, 1992) previously, is that the mentally ill who offend should receive mental health services in an equivalent manner to the rest of the population. In an era of financial austerity, however, little new funding has been made available to implement the findings of the Bradley Report. So, in a similar fashion to the Reed Report before it, the Bradley Report, one or two exceptions notwithstanding (such as court diversion teams and some local-level initiatives), is in danger of


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being constrained in its early years and remaining little more than a statement of good intentions. CHARLIE BROOKER and CORAL SIRDIFIELD See also: Community Forensic Mental Health Teams; Dual Diagnosis; Learning Disabilities and Criminal Justice Readings Bradley, K. (2009) The Bradley Report: Lord Bradley’s review of people with mental health problems or learning disabilities in the criminal justice system. London: Department of Health. Department of Health (2009) Improving health, supporting justice: the national delivery plan of the Health and Criminal Justice Programme Board. London: Department of Health. Reed, J. (1992) Review of health and social care services for mentally disordered offenders and others requiring similar services: final summary report. London: Her Majesty’s Stationery Office.


The Butler Report (Home Office and Department of Health and Social Security, 1975), also known as the Report of the Committee on Mentally Abnormal Offenders, was published in the UK in 1975 and had a profound effect on the development of forensic psychiatric services, through the establishment of the medium secure unit. It followed on from the Glancy Report (Department of Health and Social Security, 1974), which identified the lack of proper facilities to deal with dangerous or difficult patients within general psychiatric hospitals, who were often then sent to prison or treated in special hospitals for excessive periods of time. The Glancy Report recommended that each regional health authority should develop secure mental health facilities for these individuals. The Butler Report expanded on this and recommended that this new tier of regional medium secure units should function as the hub for a comprehensive regional forensic psychiatric service, including specialist community teams, with links to the special hospitals, the general psychiatric facilities and the criminal justice system. Three interim secure units opened in the late 1970s, and by the late 1980s, all regions of England and Wales had some form of medium secure provision.There is now a network of roughly 70 medium secure units throughout the UK, with beds provided by both National Health Service (NHS) and 34

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independent-sector organisations. The size of individual units varies from 30 to over 100 beds. Patients often have complex needs, and length of stay can exceed five years. Medium secure units were originally designed to manage three types of patients: those discharged from special hospitals; those transferred from prisons and courts; and those general psychiatric patients who were too disturbed for local open wards. Patients in medium secure units generally represent a serious, but not immediate, danger to others, often with the potential to abscond. All medium secure units aim to provide a range of therapeutic and recreational activities within a perimeter fence. Since the mid-1990s, there has also been an increased focus on the development of low secure units in order to provide longer-term rehabilitation for chronically disturbed patients. It has been recognised that there is significant variation in the purpose and characteristics of medium secure units throughout the UK.This has arisen through the development of regional services based on individual local factors rather than according to a national programme, and a general lack of clear, succinct definitions of the levels of secure psychiatric care, particularly for medium security.The Royal College of Psychiatrists now manage a quality peer-review network to facilitate quality improvement and change within forensic mental health settings. An additional concern is that a lack of low secure provision has led to delayed discharges from medium secure units. Several published needs assessments have illustrated the inappropriate placement of individuals within the overall system of secure mental health care, and there have been concerns that some patients may be detained in excessive security due to a lack of availability of the right treatment in lower secure provision. ROWAN McCLEAN See also: High-Security Hospitals; Women’s Enhanced Medium Secure Services Readings Department of Health and Social Security (1974) Revised report of the working party on security in NHS psychiatric hospitals (Glancy Report). London: Her Majesty’s Stationery Office. Home Office and Department of Health and Social Security (1975) Report of the committee on mentally abnormal offenders, Cmnd 6244 (Butler Report). London: Her Majesty’s Stationery Office.


C CARE IN THE COMMUNITY Care in the community is the policy of relocating people with severe mental health problems, formerly styled ‘mental patients’, from mental hospitals to sites in the community. Although it has pre-war antecedents, and the closure of the Victorian lunatic asylum was heralded in 1960 by Health Minister Enoch Powell, the policy was formally adopted by the government only in the 1980s. The promotion of alternatives to authoritarian mental hospitals found widespread support among a disaffected post-war generation. In his seminal work Asylums (Goffman, 1961), US sociologist Erving Goffman captured the public mood with his portrayals of the degradations of asylum regimes. However, community care was soon being derided as a cover for cost-cutting measures. Amid headlines in tabloids (eg the Daily Mail and the Daily Mirror) such as ‘Freed mental patients kill two a month’ (Norris, 1997), a succession of cases involving former mental patients were flagged by the media, notably, the killing by Christopher Clunis of a stranger, Jonathan Zito, on the platform of a tube station. The ‘tube murder case’ was deployed as a symbol of the failings of community care policies (Hallam, 2002).The association between mental illness and violence was widely assumed and a person with mental illness who committed a violent act came to embody a fearful stereotype, even more so where black mentally disordered offenders were concerned. In a climate increasingly governed by the politics of fear, the incoming Labour government announced sterner and more restrictive measures. ‘Community care has failed’, declared Health Minister Frank Dobson in 1998. Hereafter, concerns over risk took precedence, leading to the introduction of Community 37

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Treatment Orders (CTOs). Although the ‘failings’ of community care have been much aired, the policy has arguably never been properly applied. From the outset, government commitment was, at best, half-hearted. Historically, the tendency has been for policy to debate rival schemes for dealing with the ‘mentally ill’ as second-class citizens. Over this issue, as with others, the terms of public debate have been unduly narrow, prioritising economic and administrative over ethical considerations (Judt, 2011). Arguably, care in the community requires a profound revaluation of what it means to be the bearer of a psychiatric diagnosis (Barham, 1997). Debates about the role, status and well-being of former mental patients in society have been energised by the emerging user/survivor movement and received added urgency from revelations about the adverse effects of psychiatric drug treatments and about the inefficacy of CTOs. In a climate of austerity, amid cuts to welfare benefits and to services, recipients of care in the community face an uncertain future. PETER BARHAM See also: Community Treatment Orders; Dangerousness and Mental Disorder; Zito Trust Readings Barham, P. (1997) Closing the asylum: the mental patient in modern society. London: Penguin. Goffman, E. (1961) Asylums: essays on the social situation of mental patients and other inmates. New York, NY: Doubleday Anchor Books. Hallam, A. (2002) ‘Media influences on mental health policy: long-term effects of the Clunis and Silcock cases’, International Review of Psychiatry, 14: 26–33. Judt, T. (2011) Ill fares the land: a treatise on our present discontents. London: Penguin. Norris, D. (1997) ‘Freed mental patients kill two a month’, Daily Mail, 13 October, p 25. Rogers, A. and Pilgrim, D. (2010) A sociology of mental health and illness. Maidenhead: Open University Press.


The Care Programme Approach (CPA) was introduced in England by the Department of Health in April 1991.The aim was to provide a policy framework for the coordination and delivery of specialist mental health services for adults following discharge from hospital or release from prison.The core elements of the CPA process involve the systematic assessment of the person’s needs, the drawing 38

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up of a care plan, the allocation of a key worker (or care coordinator) to monitor and coordinate care, and the regular review of progress. Since its introduction, the CPA has attracted considerable criticism, and has been described as ‘a flawed policy introduced insensitively into an inhospitable environment’ (Simpson et al, 2003, p 489). It has undergone reform involving ‘modernisation’ (Department of Health, 1999) and ‘refocusing’ (Department of Health, 2008). The socio-political context for the introduction of CPA is important and this largely relates to the shift from ‘institutional’ to ‘community care’ in mental health policy. The emerging focus in both the media and policy during the 1980s and 1990s was overwhelmingly on the perceived risk of violence by mental health service users. The risk agenda in mental health has largely been characterised by a conflation of serious mental illness with dangerousness. The CPA can thereby be understood as part of ‘a set of interweaving social policies’ that reconstitute the three functions of the asylum to provide accommodation, care and control, specifically, by enabling surveillance to take place outside the institution (Rogers and Pilgrim, 2001, p 177). An important ideological shift in the ‘modernisation’ of the CPA by the Department of Health in 1999 was away from a focus on diagnostic categorisation and towards a focus on risk, vulnerability and need (Rogers and Pilgrim, 2001). The main change was the introduction of a two-tier system of an ‘enhanced CPA’ for those with complex and multiple needs (generally intended for people who had been compulsorily detained in hospital) and a ‘standard CPA’ for people with lower levels of risk and/or need. However, criticism of the CPA, both in terms of the process itself and failures in its implementation, continued after this reform, with the focus continuing to fall on the CPA’s function in relation to managing risk. In a large study of the use of the CPA for perpetrators of homicide in recent contact with mental health services, for example, Swinson et al (2010) found that of 380 such individuals, 69% were not receiving care under an enhanced CPA. In 2008, the two-tier system was dismantled in favour of ‘refocusing’ the CPA on those who were seen as being ‘high-risk’ and as having complex needs, effectively withdrawing CPA from those who would have been subject to standard provisions. JO WARNER See also: Care in the Community; Dangerousness and Mental Disorder


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Readings Department of Health (1999) Effective care co-ordination in mental health services: modernising the care programme approach: a policy booklet. London: Her Majesty’s Stationery Office. Department of Health (2008) Refocusing the care programme approach: policy and positive practice guidance. London: Department of Health. Rogers, A. and Pilgrim, D. (2001) Mental health policy in Britain (2nd edn). Hampshire: Palgrave Macmillan. Simpson, A., Miller, C. and Bowers, L. (2003) ‘The history of the care programme approach in England: where did it go wrong?’, Journal of Mental Health, 12(5): 489–504. Swinson, N., Flynn, S., Kapur, N., Appleby, L. and Shaw, J. (2010) ‘The use of the care programme approach in perpetrators of homicide’, Journal of Forensic Psychiatry and Psychology, 21(5): 649–59.


The Care Quality Commission (CQC) is responsible for protecting the interests of people who are subject to the Mental Health Act 1983 (as amended 2007) (MHA) by monitoring how mental health services in England, in both the National Health Service (NHS) and private sector, are using their powers and fulfilling their duties for patients who are detained in hospital (including under Part III of the MHA in forensic/secure settings) or subject to Community Treatment Orders or Guardianship. Previously, the Mental Health Act Commission (MHAC) performed this role, but since April 2009, the CQC now carries out the functions. The MHAC was commended for its strong commitment and ‘systematic approach’ to human rights (Parliamentary Joint Committee on Human Rights, 2006–07, para 188), but it was not always ‘sufficiently heavyweight’ to exert pressure on health-care providers to improve standards of care and compliance (Boyes and Gunn, 2007, p 11). The government’s rationale for the change, therefore, was to enhance professional regulation, create an integrated regulator, strengthen patient safeguards and harmonise standards across health and adult social care. The CQC is also responsible for the system of registration for health and adult social care that was introduced by the Health and Social Care Act 2008. The CQC seeks to ensure that the care provided by all hospitals in the NHS, the independent sector, specialist care services, community services, care homes, people’s own homes and some aspects of the criminal justice system, for example, prison ‘in-reach’ services, meets government standards of quality and safety. The CQC adopts a compliance approach to regulation: before it will grant a licence to operate, the providers must show that their services meet the essential standards. 40

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The government set 28 standards that demand a certain level of service from all care providers.The CQC focus is primarily on the 16 standards that most directly relate to the quality and safety of patient care. The CQC aims to carry out assessments of care providers at least biannually.They are carried out by compliance inspectors, who check all relevant information about the provider and visit the service to talk to the people who use it (and the staff), observe how the care is provided and check the provider’s records. MHA Commissioners continue to visit, inspect and interview patients detained under mental health legislation and the intention is that the joint arms of the CQC (compliance and mental health inspection) should be able to bolster each other to provide a more effective safeguard for patients subject to compulsion. Successive CQC monitoring reports (and, previously, MHAC reports) have criticised the treatment of some patients detained in forensic settings under Part III of the MHA, in particular, the excessive restrictions and inappropriate use of coercive practices. For example, the 2011/12 report expressed concerns about the practices of night-time confinement, the withholding of mail and the telephone monitoring of patients detained in high secure settings (CQC, 2013, pp 38–41). The report also documented the inappropriate use of mechanical restraints on forensic MHA detainees, particularly when they are being transported between hospitals or conveyed to hospital by the police (CQC, 2013, p 50). The plight of some individuals with mental health problems who are arrested and detained by the police for excessively long periods due to delays in securing mental health assessments and appropriate transport (CQC, 2013, p 56), which is a long-standing difficulty, has also been mentioned in annual reports. JUDY LAING See also: Deprivation of Liberty Safeguards; Second Opinion Appointed Doctor Readings Boyes, S. and Gunn, M.J. (2007) ‘Law, regulation and the Mental Health Act Commission’, in I. Shaw, H. Middleton and J. Cohen (eds) Understanding treatment without consent: an analysis of the work of the Mental Health Act Commission. Aldershot: Ashgate, pp 105–12. Care Quality Commission (2013) Monitoring the Mental Health Act in 2011/12. London: CQC. Parliamentary Joint Committee on Human Rights (2006–07) ‘The human rights of older people in healthcare’, Session 2006–07, HL 156, HC 378.


A companion to criminal justice, mental health and risk

CARERS AND CARERS’ RIGHTS OF MENTALLY DISORDERED OFFENDERS A carer of a person with mental health problems is an individual who assumes an unpaid and unanticipated responsibility for another, the patient, who has mental health problems that are disabling and of a long-term nature with no curative treatment available.The majority of carers are relatives and female, with two thirds being mothers of patients. Carers are often the primary source of long-term support for mentally disordered offenders in hospital and the community. These carers have higher levels of stress and have less contact with services compared with carers of non-offending patients with mental health problems (MacInnes, 2000). In England and Wales, local authorities have a legal duty to inform carers of their right to a carer’s assessment. Eligibility for carers’ services is based on the risk to the sustainability of the caring role. This examines how much of an impact a lack of support has on the carer’s ability to continue caring. The risks are graded as critical, substantial, moderate and low. Local authorities are asked to consider whether they will meet the needs of carers in the different risk bands. These findings should be recorded in a carer’s plan. The ‘Code of practice for the Mental Health Act 1983’ (Department of Health, 2008) states that carers do not have an automatic right to receive information about the patient from the clinical team.The clinical team’s duty of confidentiality to the patient means that it depends upon whether the patient consents to information being shared.The only exception to this is if a carer needs to be given information, as to withhold it might put themselves or others at risk of serious harm. The Code also states that the patient’s progress should be discussed with carers and they should also be involved as far as is possible in the care-planning process.The carer has no power to intervene in a patient’s treatment while admitted under a section of the Mental Health Act 1983 (as amended 2007). The Act uses the legally defined term ‘Nearest Relative’ (NR). The NR has certain legal rights in relation to someone who is detained.The NR may also be different from the identified carer. A carer has no legal powers under the terms of this Act.The NR is normally identified by starting at the top of the following list and working down: 1. Spouse or civil partner 2. Children 3. Parent 4. Sibling 5. Grandparent 6. Grandchild 42

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7. Uncle or aunt 8. Niece or nephew However, where a patient is living with, or being cared for by, any person on the list, or has relatives on the list who live outside of the UK, this can effect who is identified as the NR. The NR can apply for a Mental Health Review Tribunal only if the patient’s discharge has been blocked by the responsible clinician. Unless the patient objects, the NR must also be given the opportunity to become involved in any planning of the patient’s care and services after leaving hospital. DOUGLAS MACINNES See also: Bradley Report Readings Department of Health (1983) Mental Health Act 1983. Available at: www. legislation.gov.uk/ukpga/1983/20/contents Department of Health (2008) Code of practice: Mental Health Act 1983. Available at: www.lbhf.gov.uk/Images/Code%20of%20practice%201983%20rev%20 2008%20dh_087073%5B1%5D_tcm21-145032.pdf MacInnes, D. (2000) ‘The relatives and informal carers of mentally disordered offenders’, in C. Chaloner and M. Coffey (eds) Forensic psychiatric nursing: current concepts. Oxford: Blackwell, pp 208–31.


The concept of the carceral society emerges in Michel Foucault’s (1977) work Discipline and punish and is later developed in his courses at the Collège de France (Foucault, 2003). Studying the history of the modern penal system, the author develops the idea of a continuum existing between the disciplinary power exercised inside the prisons and in the whole society. As the panopticon for prisons – Jeremy Bentham’s rational and scientific design allowing warders to have complete and constant control on inmates’ lives – modern societies are characterised by enhanced systems of surveillance and disciplinary mechanisms to govern individual behaviours. In his book, Foucault highlights the change that occurs with the emergence of the modern state relative to the forms of punishment and confinement. Differently from the pre-modern period, where the public display of punishment was used as a deterrent to lawbreaking and a tool to reassert the authority and power of the 43

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sovereign, modern societies enact a multitude of disciplinary mechanisms aimed at controlling the society through the individual internalisation of norms. From schools to hospitals and factories, innumerable micro-technologies of coercion act upon individuals as an impersonal and efficient system of normalisation, turning them into what Foucault calls ‘docile bodies’.The prison represents the ultimate degree and extreme form of the disciplinary and punishing power, which is essentially the same as that of educating, administrating, curing and so on. Thus, modern societies are structured as ‘carceral archipelagos’: apparatuses of discipline and techniques of control are imposed in different ways on everyday life, a closed system of control is applied to various and disseminated areas of social life, and permeates all organisations that supervise, educate and correct. Control and surveillance become a pervasive and dominant feature of modern societies, whose rational and scientific governance appeal to mechanisms that lead the individuals to internalise social norms. In this perspective, the logic of total institutions (Goffman, 1961) expands from the penal institution to the whole society through the capillary nature of power, leaving little possibility to escape from the prevailing values and rules.This approach pertains to a renewed notion of power elaborated by Foucault. It is conceived as shared and diffused, not only functioning in a vertical mode, but also acting through all forms of social relations, as a constraining network, through laws, apparatuses and technologies, also due to the fragmentation of the punishing power. This concept has proved to be a powerful theoretical tool to apply to the study of Western societies, where increasing spheres of social life are being structured, controlled, categorised and subjected to surveillance. Foucault’s legacy has shaped critical contributions of social scientists working on criminology, prisons and deviance, and more recent critical works on anti-terrorism, risk management and security, and the government of immigrants and asylum seekers.   FEDERICA ROSSI See also: Due Process; Medicalisation and Social Control; Punishment Readings Foucault, M. (1977 [1975]) Discipline and punish: the birth of the prison (trans Alan Sheridan). New York, NY: Pantheon. Foucault, M. (2003) “Society must be defended”: lectures at the Collège de France 1975–1976 (trans David Macey). New York, NY: Picador. Goffman, E. (1961) Asylums: essays on the social situation of mental patients and other inmates. New York, NY: Doubleday Anchor.


A companion to criminal justice, mental health and risk

CHILDREN AND ADOLESCENT MENTAL HEALTH SERVICES Child and Adolescent Mental Health Services (CAMHS) provide assessment, treatment and consultation relating to mental health, emotional and behavioural problems. Public policy in the UK in relation to young people extensively refers to their emotional and social well-being, emphasising that mental health is everyone’s business. CAMHS is an umbrella term for all such services, differentiated from specialist CAMHS, which deliver services to young people with defined mental disorders. In 2012, the Coalition government published No health without mental health (Her Majesty’s Government, 2012), which discusses young people and offenders in separate sections. It sets the strategic vision for the mental health of people of all ages, giving limited attention to the mental health needs of young offenders specifically. The main reference explains that multi-systemic interventions involving young people, parents, schools and the community reduce conduct disorder and improve family relationships, reducing the costs across services. In relation to offenders, it stipulates that they should have equal access to mental health services as the general population and be offered early intervention for issues that are highlighted while in the criminal justice system. There is much debate about what specialist CAMHS treat but young people are usually assessed and treated for disorders that meet the criteria for a mental disorder, as defined under axis one of the International Classification of Diseases (ICD-10) (WHO, 1992) or the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V) (American Psychiatric Association, 2013).These disorders are a clinically recognisable set of symptoms or behaviours associated, in most cases, with considerable distress and substantial interference with personal functions (Meltzer et al, 2000; WHO, 1992). CAMHS usually, but not exclusively, work with families and offer a range of individual, family and group treatments, as well as consultation with other professionals. A minority of young people require inpatient care; most are seen in clinics, schools or other community settings. CAMHS can help with issues such as depression, anxiety, hyperkinetic disorders (such as attention deficit hyperactivity disorder), bipolar disorders, psychoses, eating difficulties, obsessions or compulsions, self-harming behaviour, and the effects of abuse or trauma. The current UK youth justice system was established by the Crime and Disorder Act 1998, with the aim of preventing offending by young people. It placed a statutory responsibility on various agencies, including health, to form boroughbased multi-agency teams named Youth Offending Teams (YOTs). It stipulated that YOTs should include a person nominated by a health authority. The model 45

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for meeting this varies across boroughs but this is frequently a mental health professional, although not one trained in forensic mental health. As a result of this approach, the mental health of young offenders has a higher profile but it is unclear if outcomes in relation to mental health have changed (the key performance indicators relate to access and waiting times for CAMHS, rather than improved mental health). Challenges relating to this way of working include confidentiality, consent and use of language but improved levels of multidisciplinary working (such as working in the immediate environment as others involved in the management/ delivery of services) offers opportunities to address misunderstandings and build partnerships. JANE PADMORE See also: Youth Justice Board; Youth Offending Team Readings American Psychiatric Association (2013) Diagnostic statistical manual of mental disorders (5th edn). Washington, DC: APA. Her Majesty’s Government (2012) No health without mental health: a cross-government mental health outcomes strategy for people of all ages. London: Her Majesty’s Stationery Office. Meltzer, H., Gatward, R., Goodman, R. and Ford, T. (2000) The mental health of children and adolescents in Great Britain. London: The Stationery Office. World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva, Switzerland: WHO.


Circles of Support and Accountability (CoSA) are voluntary arrangements to help sex offenders, or ‘core members’ as they are referred to in CoSA terminology, as they reintegrate into society after their convictions. Offenders are invited to join a circle of volunteers who support and advise them in their efforts to reintegrate back into the community. The idea started in Canada, where religious groups sought to counter the widespread hostility and even vigilantism that serious sex offenders were often experiencing when they came out of prison. In 2000, discussions began in the UK about the use of CoSA and three pilot projects were established in 2002. At the time of writing, there are 13 regional projects in England and Wales who operate with the affiliation of Circles UK (see: www. circles-uk.org.uk/) and there are 78 core members currently participating in CoSA (Circles UK, personal correspondence, 2013). 46

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CoSA are based on restorative justice principles. Each ‘circle’ involves four to six trained volunteers from the community, forming the circle around an exoffender (the ‘core member’). The circle aims to provide pro-social capital to an ex-offender who would otherwise be isolated in the community. That circle, in turn, receives support and training from a professional coordinator. The ‘core member’ receives support in the form of advice on practical matters such as accommodation, finances, health matters and employment, and also receives emotional support where possible. Accountability through CoSA comes by the volunteers initially discussing the core member’s offence(s), and later observing, challenging and reporting risky behaviours where appropriate. CoSA projects also tend to be either closer to, or more distant from, the agencies of the criminal justice system. In the UK, they need the cooperation of agencies such as the Probation Service or the police in order to make contact with potential core members; this brings them closer into the criminal justice system. The idea that they will also report behaviour patterns causing concern also brings them closer. This poses a dilemma for CoSA as to whether they are drawn so far in that they are seen as just another arm of the criminal justice system or whether they can retain sufficient distance to enable them to be innovative and creative in their work; a dilemma between being either mechanistic and conformist or organic and creative. CoSA experiences the generic problems that all voluntary organisations have in selecting suitable volunteers, training them and supervising them, as well as retaining them and making the overall voluntary arrangements sustainable. TERRY THOMAS and DAVID THOMPSON See also: Multi-Agency Public Protection Arrangements; Sexual Offending Readings Bates, A., McCrae, R., Williams, D. and Webb, C. (2012) ‘Ever-increasing circles: a descriptive study of Hampshire and Thames Valley Circles of Support and Accountability 2002–09’, Journal of Sexual Aggression, 18(3): 355–73. Hanvey, S., Philpot, T. and Wilson, A. (2011) Community based approach to the reduction of sexual reoffending: Circles of Support and Accountability. London: Jessica Kingsley Publishers. Wilson, R.J., McWhinnie, A., Picheca, J.E., Prinzo, M. and Cortoni, F. (2007) ‘Circles of Support and Accountability: engaging community volunteers in the management of high risk sex offenders’, Howard Journal of Criminal Justice, 46(1): 1–15.


A companion to criminal justice, mental health and risk

CLINICAL GOVERNANCE AND RISK MANAGEMENT Risk management is a structured approach by which risks can be recognised and assessed, and action identified to accept, reduce or mitigate the risk. Risk management is about being aware of actual or potential problems, thinking through the effect that they could have and planning ahead to reduce the impact. Identifying risks at the same time as determining individual or organisational priorities, aims and objectives will allow a consideration of whether the desired outcomes are achievable from the outset. Effective risk management structures, procedures and processes that are implemented consistently across an organisation are part of a robust safety culture (National Patient Safety Agency, 2004). The current concept of risk management is essentially a post-1970s’ framework (Field, 2003), in which procedures are used worldwide by differing organisations (eg financial, industry and airlines, with one of the largest organisations being the National Health Service [NHS]). To be able to employ risk-management procedures, it is first necessary to identify what is a risk. Risks are inherent in daily activities, whether during personal or work time, as an employee or on behalf of the employing organisation.The Health and Safety Executive (2011, p 2) defines risk as, ‘the chance, high or low, that somebody could be harmed by these and other hazards’. Once a risk is identified, it needs to be assessed using a risk index or matrix to examine the impact and the likelihood of occurrence, allowing for the calculation of a potential severity numeric indicator. It is essential that the risk-identification process is both wide-ranging and comprehensive. Both reactive and proactive sources of information should be used to identify risk. Once risks are identified, something needs to be done to reduce them. These decisions may be taken locally, but they sometimes need to be considered at a more senior level. There will still be risk even after action is taken and this needs to be highlighted and confirmed as acceptable. An effective risk-management and assurance framework will: allow increased confidence in achieving desired outcomes; effectively constrain threats to acceptable levels; and take informed decisions about maximising opportunities (O’Donovan, 1997). One of the issues with risk-management procedures and processes is that although there are internationally recognised frameworks, the outcome of a risk assessment can differ from individual to individual.There will always be a degree of subjective interpretation relating to the potential impact and likelihood when using a risk-scoring matrix. This subjectivity is linked to the level of knowledge, 48

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skill and experience an individual has, but also relates to the area of risk that they are examining. For example, when risk-assessing the likelihood of a patient absconding, there would need to be not only an understanding of the patient, their past admissions and/or their current mental and physical health, but also an ability to interpret and apply the information collected. Therefore, there would not be the expectation for a healthcare assistant to have the same level of understanding and ability to complete a risk assessment as a registered mental health practitioner. CHRISTOPHER LUBE See also: National Service Framework Readings Field, P. (2003) Modern risk management: a history. London: Incisive RWG Ltd. Health and Safety Executive (2011) Five steps to risk assessment. London: Health and Safety Executive. National Patient Safety Agency (2004) Seven steps to patient safety: the full reference guide. London: National Patient Safety Agency. O’Donovan, M. (1997) ‘Risk management and the medical profession’, Journal of Management Development, 16(2): 125–33.


Clinical risk assessment involves identifying the presence or absence of risk factors for various types of harmful or unwanted behaviour by people with mental health problems and personality disorder who are in contact with the mental health and/or criminal justice systems. Most attention has been focused on assessing the risk of violence (including sexual violence) and, to a lesser extent, self-harm, but other risks such as self-neglect and absconding from hospital can be assessed systematically as well. Research in this area has grown exponentially over the past 20 years, driven by a goal of developing efficient and valid structured instruments to support clinical decisions about the need for prison or hospital detention and suitable interventions. Risk assessment is the first stage in a process that includes risk formulation and risk management. Structured risk assessment based on validated tools is widely accepted to be preferable to unstructured approaches based on clinical intuition alone. Examples of well-validated instruments for assessing violence risk are the Historical-Clinical-Risk 20 (HCR20) and the Violence Risk Appraisal Guide (VRAG). Assessments on a range of factors specified in each instrument can be 49

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made through interviewing the person directly or by extracting information from case files. Static factors, such as a history of child abuse, are unchangeable and can be distinguished from dynamic factors, such as misuse of alcohol, which can be the focus of treatment. Actuarial instruments (eg the VRAG) are based on noting the presence or absence of risk factors that are known to be linked to the unwanted behaviour in specified populations. They are formulaic and relatively objective, yielding a score indicating the likelihood of, for example, violence if the assessed person is a member of that population. Structured professional judgement (SPJ) instruments (eg the HCR20) aim to help with planning risk-management approaches rather than just estimating the level of risk.They combine assessment of clearly defined risk factors with clinical experience and knowledge and they often attempt to involve the assessed person more in the process. Criticisms of the structured approach to clinical risk assessment include an overemphasis on negative features while ignoring the presence of more positive, protective factors, and too much focus on the individual rather than the environment, which may play an important part in triggering violence or selfharm.The person being assessed often has very little input into the assessment and may not even be aware that they are being assessed.This approach can also foster a ‘tick-box’ culture in which completing paperwork becomes more important than autonomous decision-making. An overemphasis on risk can itself lead to risk aversion in decision-making and disregard for the importance of care and compassion in mental health services. Also, a comprehensive risk assessment involves extensive data collection, which is not feasible in services with fast turnaround and situations where decisions have to be made rapidly. RICHARD WHITTINGTON See also: Actuarial Risk Assessment; Structured Professional Judgement Risk Assessment Readings Hanson, R.K. (2009) ‘The psychological assessment of risk for crime and violence’, Canadian Psychology, 50(3): 172–82. Otto, R. and Douglas, K. (2009) Handbook of violence risk assessment. London: Routledge. Skeem, J.L. and Monahan, J. (2011) ‘Current directions in violence risk assessment’, Current Directions in Psychological Science, 20: 38–42. Whittington, R. and Logan, C. (eds) (2011) Self-harm and violence: towards best practice in managing risk in mental health services. London: Wiley.


A companion to criminal justice, mental health and risk

COGNITIVE BEHAVIOUR THERAPY Cognitive Behaviour Therapy (CBT) is a talking therapy that is based on the principles of behavioural and cognitive therapy. The behavioural element of CBT has various origins but it has been predominantly linked to the seminal work completed by Watson (1913), which conceptualised human behaviour and associated difficulties as a ‘product’ of learning. Behaviourism arrived in psychotherapy at a time when therapy was focused on the analysis of childhood trauma (eg a Freudian approach), and the approaches developed in this period continue to be used in modern CBT (eg exposure treatment for phobias). Behaviour therapy has been heavily criticised for failing to address the internal thoughts and images that appeared central to many individuals’ distress. Professor Aaron Beck, a forefather of cognitive methods for individuals with low mood, placed significant emphasis on linking an individual’s thinking styles to their behaviour. Cognitive therapy focused on the importance of introspection to explore an individual’s thoughts, feelings and experiences. CBT makes the assumption that cognition influences behaviour and that cognition can be modified. For example, if an individual who had a phobia of busy or congested spaces had the thought ‘I am having a heart attack’, they may experience physiological symptoms of anxiety and manage this through behavioural avoidance (eg avoiding busy areas).The therapist may work with the client to collect evidence for this thought and develop a more balanced thought, for example, ‘I feel really anxious but I am not going to die from these anxious feelings’. The therapist would also explore the resulting behaviour from this anxious thought (eg avoidance). The model advocates the importance of developing a ‘formulation’, which is a ‘map’ or story of the problem and may include ideas on how the problem developed (predisposing factors), what keeps it going (maintenance factors), what triggers the problem (precipitating factors) and what protective factors may help the individual to manage their difficulties. In a criminal justice setting, CBT aims to address individuals’ attitudes and behaviours that are deemed to be unhelpful or anti-social (eg violent or sexual thoughts/behaviours).This approach has been consistently used in adult probation services and Youth Offending Services (YOS). In particular, CBT has been used as an intervention for adults who commit sexual crimes within the Prison Service. A number of meta-analyses have found significant evidence to indicate that a CBT approach can reduce recidivism depending on the definition of sexually risky behaviours (see Craissati et al, 2011).


A companion to criminal justice, mental health and risk

In England, the number of individuals practising and receiving CBT has significantly increased following the introduction of the Increasing Access to Psychological Therapies (IAPT) agenda in 2006. While IAPT may have increased access to mental health services, it could be criticised for being overly reliant on one model of therapy (eg CBT) and for promoting the use of ‘medical labels’ within psychotherapy (such as depression) to the potential detriment of the service user. BEN HARPER See also: Dialectical Behaviour Therapy; Post-Traumatic Stress Disorder; Solution-Focused Therapy Readings Craissati, J., Bierer, K. and South, R. (2011) ‘Risk, reconviction and “sexually risky behaviour” in sex offenders’, Journal of Sexual Aggression, 17(2): 153–65.      Department of Health (2010) ‘Realising the benefits, IAPT at full roll out’. Available at: www.iapt.nhs.uk/silo/files/realising-the-benefits-iapt-at-full-rollout.pdf Watson, J.B. (1913) ‘Psychology as the behaviorist views it’, Psychological Review, 20(2): 158–77.


The Bradley Report (Bradley, 2009) highlighted the need for consideration of alternative provision for mentally disordered offenders (MDOs) than the prison route.The report followed a number of high-profile cases in the UK, which had resulted in serious or fatal harm to individuals perpetrated by MDOs, and served to address the public and political angst raised by these cases. It proposed a more specific offender care pathway to allow for specialist assessment and management of risk via a more robust model, with diversion from prison to alternative specialist facilities (JCPMH, 2013). The recommendations from the Bradley Report highlighted the need for early intervention and integrated partnership working between all relevant parties to ensure appropriate monitoring, sharing of information and management during transition phases of the pathway via specialist forensic services (see Soothill et al, 2008). The forensic care pathway model focuses on placing clients within the least restrictive environment to manage risks, which requires specialist assessment


A companion to criminal justice, mental health and risk

to determine the appropriate security level needed for each individual case (JCPMH, 2013). Forensic mental health services had remained predominantly institutionally based prior to the Bradley Report (Bartlett and McGauley, 2010). The introduction of a ‘Community Care Model’ is now slowly being adopted and developed by individual commissioning groups (JCPMH, 2013). There are two proposed models for community forensic mental health services that operate within the UK. Some services adopt an integrated model of care with specialist practitioners sitting within Community Mental Health Teams (CMHTs), while others operate within a model of a separate specialist forensic community or outreach mental health teams (see Soothill et al, 2008). Community forensic mental health services can work with clients within a wide spectrum of need: from those who are at risk of offending or coming to the attention of the criminal justice system due to their behaviours, using a preventive approach to risk escalation; to those who have been within secure mental health services or prison, but no longer require this level of management (JCPMH, 2013). In this latter case, community forensic mental health services will act in a gatekeeping capacity to identify a timely step-down from these services and support the service user, and any services involved in their care, during the transition back into the community (JCPMH, 2013). Community forensic mental health services offer assessment and consultation to highlight risk potential and identify risk-management strategies with service users and care partners (JCPMH, 2013). This may be on a shared basis with generic mental health teams or may be with the service taking full responsibility for care coordination, depending on local service-level agreements for that particular area (JCPMH, 2013). Service users are often noted to have co-morbid substance and non-compliance problems, and complex mental health needs linked to a history of violent or serious offending (see Appleby et al, 2010). Strong links with other services and processes – such as Multi-Agency Public Protection Arrangements (MAPPAs), substance use services, probation, police, inpatient acute and secure services (both National Health Service [NHS] and independent), prisons, courts, and CMHTs – are therefore an important component of community forensic mental health services to allow adequate coordination of care and appropriate sharing of information to highlight risks and ensure a consistent and robust management (Bartlett and McGauley, 2010; JCPMH, 2013). ANGELA LLOYD


A companion to criminal justice, mental health and risk

See also: Care in the Community; Care Programme Approach; MultiAgency Public Protection Arrangements Readings Appleby, L., Kapur, N., Shaw, J. and Swinson, N. (2010) ‘National confidential inquiry into suicides and homicides by people with mental illness’. Available at: http://iapdeathsincustody.independent.gov.uk/wp-content/uploads/2011/07/ NCI-into-Suicide-and-Homicide-by-People-with-Mental-Illness-AnnualReport-July-2010.pdf Bartlett, A. and McGauley, G. (2010) Forensic mental health: concepts, systems and practice. New York, NY: Oxford University Press. Bradley, K. (2009) The Bradley Report: Lord Bradley’s review of people with mental health problems or learning disabilities in the criminal justice system. London: Department of Health. JCPMH (Joint Commissioning Panel for Mental Health) (2013) ‘Guidance for commissioners of forensic mental health services’. Available at: www.jcpmh. info/wp-content/uploads/jcpmh-forensic-guide.pdf Soothill, K., Rogers, P. and Dolan, M. (eds) (2008) Handbook of forensic mental health. Cullompton: Willan.


Community Treatment Orders (CTOs) are legal orders used in a number of countries, such as the UK under the Mental Health Act 1983 (as amended 2007). CTOs are initiated by psychiatrists in order to minimise treatment noncompliance and revolving hospitalisation. When individuals leave inpatient care, eligible patients are placed onto conditional release, whereby they must continue to take their medication and visit mental health professions in order to remain out of the hospital (Snow and Austin, 2009). The CTO provides psychiatrists with a clear way to monitor patients in the community, while having a system in place for early non-compliance intervention. Non-compliance is the primary justification for using formal mechanisms such as hospitalisation until the patient once again becomes stabilised on their medication. The development of CTOs has been a controversial topic in psychiatric research. Some researchers argue that CTOs are beneficial for ‘revolving-door’ patients because these people have fewer and shorter stays as inpatients (Swartz and Swanson, 2004), use community mental health services more (O’Brien and Farrell, 2005), have access to early intervention strategies, have faster access to hospitalisation as a result of non-compliance, have reduced incidences of medication non-compliance, and have an overall reduction in the amount of 54

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contact they have with the criminal justice system (Swartz and Swanson, 2004). CTOs have been promoted as a less restrictive option for dealing with people who have serious mental disorders than confining them in institutions. On the other hand, studies focused on the ethical implications of CTOs tend to frame the use of CTOs in terms of: human rights violations; concerns over the negative effect of psychiatric coercion to ensure compliance; and a concern over the rising power of psychiatrists to use surveillance to promote compliance. Some researchers argue that coercion-induced compliance is a violation of the right of people to refuse medical treatment (Monahan et al, 2001). Moreover, researchers note that the use of coercion and surveillance to achieve compliance makes the community no less restrictive than the hospital. In fact, the personal circumstances related to prolonged mental illness, such as homelessness, lack of social support or family abandonment, are implications of CTOs that may actually increase the burden placed upon the psychiatric patient (Trueman, 2003). AMY KLASSEN See also: Care in the Community; Mental Health Act 2007; Surveillance Readings Monahan, J., Bonnie, R.J., Appelbaum, P.S., Hyde, P.S., Steadman, H.J. and Swartz, M.S. (2001) ‘Mandated community treatment: beyond outpatient commitment’, Psychiatric Services, 52(9): 1198–205. O’Brien, A.M. and Farrell, S.J. (2005) ‘Community Treatment Orders: profile of a Canadian experience’, Canadian Journal of Psychiatry, 50(1): 27–30. Snow, N. and Austin, W.J. (2009) ‘Community Treatment Orders: the ethical balancing act in community mental health’, Journal of Psychiatric and Mental Health Nursing, 16: 177–86. Swartz, M.S. and Swanson, J.W. (2004) ‘Involuntary outpatient commitment, Community Treatment Orders, and assisted outpatient treatment: what’s in the data?’, Canadian Journal of Psychiatry, 49(9): 585–91. Trueman, S. (2003) ‘Community Treatment Orders and Nova Scotia: the least restrictive alternative’, Health Law Journal, 11: 1–24.


In England and Wales, individuals may be admitted to hospital without their consent under a section of the Mental Health Act 1983 (as amended 2007).This 55

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Act applies only to individuals who are deemed to have a mental disorder – broadly defined in section 1(2) as ‘any disorder or disability of the mind’. This does not include a person who uses drugs or alcohol unless it leads to a mental disorder. Different sections of the Act may be used depending on the individual’s assessed needs, but all detentions under the Mental Health Act must be underpinned by clearly defined principles clarifying the purpose of the admission and ensuring that all outcomes are the least restrictive ones, that there is respect for others and that the service user participates in the assessment and decision where possible. It is the approved mental health professional (AMHP) who makes the application for compulsory admission, but this is founded on two signed ‘medical recommendations’ (only one in an emergency section 4 scenario). These are completed by doctors and are based on their personal examinations. One doctor must have had experience and training in relation to the diagnosis and treatment of mental disorder (section 12); one should also have ‘previous acquaintance’ with the individual. The AMHP has several defined statutory functions and these are largely found in sections 11 and 13 of the Act. For example, they must: inform or consult with the Nearest Relative (identified through a clearly defined hierarchy in section 26); have overall responsibility for coordinating the assessment; and organise the conveying of the community patient to hospital (section 6). An AMHP’s assessment and decision must be made independently and the intention is that this is made from a social, non-medical perspective. Section 2 of the Mental Health Act 1983 (as amended 2007) allows for a person to be compulsorily admitted to hospital and detained for up to 28 days for assessment (although there is the provision to administer treatment). Section 3 allows for an individual to be compulsorily detained for up to six months, and this section is renewable. Documentation must demonstrate that the individual is ‘suffering from a mental disorder of a nature or degree which makes it appropriate for him to receive medical treatment in a hospital’, thereby resting on the principle that there is no less restrictive alternative. Here, ‘nature’ refers to the type of mental disorder, and ‘degree’ relates to the intensity of the disorder and its effects. It must also be ‘necessary for the health or safety of the patient or for the protection of other persons that he should receive such treatment’. For section 3, ‘appropriate medical treatment’ must also be available. Similar to section 3, section 37 lasts for six months initially and can then be renewed. Section 37 is a Hospital Order made by the courts, whereby a person found guilty of a criminal offence and who requires treatment for a mental disorder is detained in hospital as an alternative to a custodial sentence. All detained patients have the right to appeal to the Mental Health Tribunal, an independent legal panel that exists to consider the justification and legality of continued compulsory detention.


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Wales shares the same Mental Health Act with England, but there is a different code of practice. In Scotland, mental health officers have a role that is broadly similar to the AMHPs’. In Northern Ireland, approved social workers have retained this role. JILL HEMMINGTON See also: Approved Mental Health Professional; Mental Health Act 2007 Readings Department of Health (2008) Code of practice: Mental Health Act 1983. Available at: www.lbhf.gov.uk/Images/Code%20of%20practice%201983%20rev%20 2008%20dh_087073%5B1%5D_tcm21-145032.pdf


The term ‘conduct disorder’ (CD) is a psychiatric diagnosis that has been recently updated in the Diagnostic and Statistical Manual of Mental Disorder (DSM-5). The DSM-5 indicates that children who receive a diagnosis of CD must display aggression to people and ‘deceitfulness’, undertake the destruction of property, and exhibit serious violations of social norms (eg truanting from school before the age of 13 years old). This diagnosis has variations for ‘childhood onset’, which is where the child must meet at least one criterion prior to age 10, and an adolescent criteria, which is where there is an absence of any criteria for CD prior to age 10. CD has been heavily criticised within the wider psychological community and the validity of the diagnosis is dubious due to the difficulties in separating the ‘disorder’ from the typical behaviour of many children within this age group. Furthermore, the term fails to consider the impact of social, emotional and environmental factors on the developing child’s behaviour. In addition, diagnostic categories do not actually predict a response to medication or other interventions in comparison to the use of idiosyncratic formulations or ‘symptom clusters’ (see Moncrieff, 2008). The term CD has limited scientific validity and may be conceptualised as a ‘normal’ individual variation in behaviour rather than a medical illness. Defiant and challenging behaviour is not a symptom of an illness, but may be a sign of a child communicating their distress. It is concerning that the most vulnerable populations (eg children who are parented in local authority social service placements) are much more likely to attract this diagnosis (see, eg, Ford et al, 2007). Therefore, 57

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there is a concern that vulnerable populations will receive medical labels that further mark their ‘difference’ from other children in society. Children who present with challenges that may be diagnosed as CD may be behaviourally externalising their emotional distress as this may be a more acceptable and immediate way to have their needs met. Many leading authors understand these challenges within an attachment framework (Golding, 2008). Children who receive diagnoses of CD in childhood typically receive other psychiatric diagnoses, most commonly, attention deficit hyperactivity disorder (ADHD). A diagnosis of CD is often associated with poor educational attainment, social isolation and increased contact with the criminal justice system (NICE, 2013). In the UK, the treatment of children who receive a CD diagnosis is informed by the National Institute for Health and Clinical Excellence (NICE) guidelines. The guidelines recommend that children receive group social and cognitive problem-solving and that this treatment is provided to ‘high-risk’ children within the criminal justice system because of anti-social behaviour.There is also evidence for the effectiveness of parent-training models to address problematic parent–child interactions. This evidence highlights the importance of providing intervention to a child within their context of parenting and a wider relational framework between parent and child interactions. BEN HARPER See also: Attention Deficit Hyperactivity Disorder; Children and Adolescent Mental Health Services Readings Ford, T., Vostanis, P., Meltzer, H. and Goodman, R. (2007) ‘Psychiatric disorder among British children looked after by local authorities: comparison with children living in private households’, The British Journal of Psychiatry, 190(4): 319–25. Golding, K. (2008) Nurturing attachments: supporting children who are fostered or adopted. London: Jessica Kingsley Publishers. Moncrieff, J. (2008) The myth of the chemical cure. Basingstoke: Palgrave Macmillan. NICE (National Institute for Health and Clinical Excellence) (2013) ‘Antisocial behaviour and conduct disorders in children and young people: recognition, intervention and management’. Available at: www.nice.org.uk/nicemedia/ live/14116/63310/63310.pdf


A companion to criminal justice, mental health and risk

CONSENT TO TREATMENT Consent to treatment is the principle that a person must give their permission before any form of medical treatment is administered. For consent to be valid, it must be voluntary and informed, and the person must have the capacity to make the decision. In law, all adults aged 18 or over have the right to give, or withhold, their consent to treatment. An exception to this rule is the Mental Health Act 1983 (as amended 2007), whereby patients detained under certain sections can be compelled to take treatment for their mental disorder. The concept of consent in psychiatry presents a number of ethical challenges. While patient autonomy and choice has been growing steadily in recent years, an emphasis on risk and protection prevails within mental health settings. Unlike the principles governing physical health care, current mental health law allows psychiatrists to override a refusal of certain treatments even when the person has the capacity to make that decision.This lack of respect for autonomy is based on a presumption that psychiatric patients are unable to make rational decisions and is justified on the grounds of beneficence (Adshead and Sarkar, 2005). Coercive detention and treatment in forensic psychiatric settings, with its focus on public safety and protection, is arguably less problematic and more easily legitimised. However, Giordano (2000) argues that while an individual’s physical freedom should be restricted for the protection of others, it does not necessarily follow that detained patients with the capacity to make decisions about their care should be forced to take treatment against their will. She suggests that once an individual is detained, the protection of others has been guaranteed, and therefore questions the necessity of coercive treatment, particularly as there is no ‘cure’ for dangerousness. This concern is echoed by Adshead (2000, p 303) when she suggests that ‘the pharmacological management of violence’ may even be harmful to patients, with certain types of sedative treatment increasing the health risks to patients. Giordano (2000) strongly advocates for the right of all competent patients who are compulsorily hospitalised to participate in their own therapeutic decisions, arguing that a balance should be found between the protection of others and the safeguarding of individual autonomy, even for those deemed ‘dangerous’. However, the extent to which patients in coercive settings can meaningfully consent to treatment is open to debate when decisions about greater freedom and even discharge or release from hospital are often dependent on compliance with treatment (Adshead, 2000). MANDY SCHOFIELD 59

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See also: Anti-Psychiatry Movement; Compulsory Hospitalisation; Dangerousness and Mental Disorder Readings Adshead, G. (2000) ‘Care or custody? Ethical dilemmas in forensic psychiatry’, Journal of Medical Ethics, 26: 302–4. Adshead, G. and Sarkar, S.P. (2005) ‘Justice and welfare: two ethical paradigms in forensic psychiatry’, Australian and New Zealand Journal of Psychiatry, 39: 1011–17. Giordano, S. (2000) ‘For the protection of others’, Health Care Analysis, 8: 309–19.


Psychiatry’s history and contemporary uses of treatments and interventions have attracted both support and criticism from those within and outside of the profession itself.Those that have received the most critical attention are perhaps the ones that reflect the level of invasiveness of those treatments. Here, two particular approaches adopted in the anticipation of the alleviation of psychiatric symptoms are discussed, namely, psychosurgery and electro-convulsive therapy (ECT). Prefrontal lobotomy, initially termed prefrontal leucotomy, is a procedure in which nerve pathways in a lobe or lobes of the brain, usually between the prefrontal cortex and thalamus, are surgically severed.The procedure was formerly used as a radical therapeutic measure to help severely disturbed patients with schizophrenia, manic depression (bipolar disorder), anorexia nervosa and other conditions of mental illnesses.The first operation on a human was performed by Moniz in 1935. A controversial procedure in the US, it nevertheless achieved popularity through the successful work of Freeman and Watts (1945), achieving the status of a miracle cure. Freeman developed and refined the procedure, giving it the name of transorbital lobotomy; the time for the procedure being reduced to some 10 minutes and including the use of an electric shock, which rendered the patient unconscious, removing the need for anaesthesia. Freeman performed lobotomies on over 3,000 patients, including children, with varying results. While the effect of the operation could result in reduced tension, the adverse effects included a diminishing of energy, engagement in life and concentration, and indifference. In the worst case, it caused death, so the operation had unpredictable and inconclusive results. The 1950s witnessed the eventual demise of the prefrontal lobotomy, which was largely the result of the development in the antipsychotic genre of pharmacology, which offered a more presentable (and arguably less barbaric) means of alleviating 60

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the symptoms of mental illness. Initially welcomed and marvelled at as a means of easing suffering, prefrontal lobotomy has been increasingly superseded with more sophisticated antipsychotic medications as a result of a more holistic understanding of mental illness. However, other treatments for psychiatric symptoms have not been without criticism, in particular, the historical and contemporary use of ECT. ECT is a therapeutic treatment for severe depression that involves the passing of an electric current through the brain to produce a convulsion. ECT was introduced as a treatment in the 1930s, was used for a range of mental illnesses and was originally administered without anaesthetic. Developed by Italian psychiatrist Lucio Bini and neurologist Ugo Cerletti, it was considered to be an effective, although brutal, treatment at a time when there were few other means of alleviating a patient’s symptoms.The potential for misuse of ECT was illustrated in the 1975 film One flew over the cuckoo’s nest. The treatment has since been developed and refined; although not universally used, it now involves the use of full anaesthesia and is generally administered in cases of severe depression and when accompanied by severe suicidal ideation, malnourishment and catatonic states. Despite forceful arguments for the positive benefits that ECT can bring, controversy still remains.A tension exists both within and outside of the profession between the benefits of ECT (in those cases when modern antidepressants are deemed not effective) and the iatrogenic effects, such as memory loss, among some who are subject to this intervention. Current treatment using ECT involves procedures of informed consent and choice (except for cases of compulsion under the Mental Health Act). However, there is still little consensus on exactly how ECT works, thus leading to an insecurity of the appropriateness of its use in contemporary health care. PAUL WAGG See also: Aversion Therapy and Homosexuality; Insanity Readings Abrams, R. (1998) Electroconvulsive therapy (4th edn). Oxford: Oxford University Press. Collaizi, J. (1996) ‘Transorbital lobotomy at Eastern State hospital (1951–1954)’, Journal of Psychosocial Nursing and Mental Health Services, 34(12): 16–19. Freeman, W. and Watts, J.W. (1945) ‘Prefrontal lobotomy: the problem of schizophrenia’, American Journal of Psychiatry, 101(6): 739–48. Gostin, L.O. (1980) ‘Ethical considerations of psychosurgery: the unhappy legacy of pre-frontal lobotomy’, Journal of Medical Ethics, 6(3): 149–54.


A companion to criminal justice, mental health and risk

CRIMINAL JUSTICE Criminal justice is the state’s response to acts defined as criminal. Its character is historically and geographically specific, with differing versions practised across time, place and offence. A cursory longitudinal study of criminal justice illuminates the fundamental criminological question ‘What is crime?’, as its focus has been, and is, both broad and strange at times. Fashioned by a plethora of moral panics and resulting increased perceptions of risk, criminal justice can appear to be in perpetual revolution. Ongoing reforms, ‘emergency’ legislation and increased powers are purportedly required to deal with various ‘new’ threats and risks (Blair, 2006). Inconsistently, some intermittent liberal reforms have resulted in intensely contested ‘understandings’ of the need to exclude ‘some’ previously ‘risky or dangerous’ transgressors from ‘full’ criminal responsibility or to offer diversionary non-criminal justice disposals to some, such as ‘young’ children and some mentally disordered offenders. Criminal justice agencies repeatedly react to varying concerns about diverse risks, recidivism rates, miscarriages of justice, corruption and incompetency. At its core, criminal justice attempts to deal with crime, criminals and ‘their’ victims in what is claimed to be a principally fair, rational and proportionate manner. However, as all those ‘principles’ are subjective and contested, and despite the rhetoric of professionalism, criminal justice is often influenced by the broader ideological and political prejudices of society. The resulting fluctuations can facilitate versions of criminal justice that can seem more akin to crime control or due process policies and practices. Criminal justice tries to manage the risks to society posed by those individuals who it is believed freely choose to offend, and that society therefore has a duty to apprehend and punish (Beccaria, 2013 [1764]). It claims that the due process of law safeguards fairness and justice, as guilt must always be proven ‘beyond all reasonable doubt’. Despite this, divergent criticisms of criminal justice agencies and practices, with differing levels of evidential credibility, are pervasive. Allegations that guilty and dangerous offenders are being acquitted, law-abiding citizens are being discriminatorily harassed and sentences and custodial regimes are too lenient and/or too harsh are commonplace. Such claims have influenced the ongoing ‘war on crime’ and the configurations of various criminal justice ‘industries’. Increasingly, parts of criminal justice are being privatised as the state withdraws from some problematic and costly areas of crime control. Propelled by its failures, criminal justice’s focus widens and contracts, and constant change appears to be


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its most consistent international manifestation, which delimits the applicability of its definitions (Carlen and Tombs, 2006). LIAM McCANN See also: Bifurcation; Punishment; Third Way Politics and Crime Control Readings Beccaria, C. (2013 [1764]) ‘On crimes and punishments’, in E. McLaughlin and J. Muncie (eds) Criminological perspectives: essential readings (3rd edn). London: Sage, pp 5–15. Blair, T. (2006) A global alliance for global values. London: The Foreign Policy Centre. Carlen, P. and Tombs, J. (2006) ‘Reconfigurations of penality: the ongoing case of the women’s imprisonment and re-integration industries’, Theoretical Criminology, 10(3): 337–60.


The Criminal Justice Act 2003 (CJA) emerged out of the Halliday review of sentencing procedures, which identified an inconsistent approach to sentencing persistent offenders and suggested a new framework that should support the aims of crime reduction and reparation while meeting the needs of punishment. It is an important piece of legislation comprising of 339 sections, and embodies many of the proposals in the White Paper that the Halliday review inspired. The Act introduced significant sentencing reforms and had public protection at its core. For the first time, the Act laid out the principles and purposes of sentencing (section 142(1)), highlighting the requirements of punishment, crime prevention, deterrence, rehabilitation, public protection and reparation. However, there are potential tensions that can arise from these aims, for example, meeting the needs of both deterrence and rehabilitation. One of the key aims of the Act was to ensure that only serious or dangerous offenders and violent offenders warranted imprisonment, with the hope that the majority of non-violent offenders would receive a non-custodial sentence. Moreover, section 167 of the Act established the Sentencing Guidelines Council, which further emphasised the need to limit the use of custodial sentences. With regards to mental health, two provisions of the Act are particularly important. Section 166(5) empowers the court to ignore provisions that would otherwise 63

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mandate the passing of a particular sentence where the offender is mentally disordered. Section 157(1) mandates the court to obtain a medical report before passing a custodial sentence on an offender who is, or appears to be, mentally disordered. The Act introduced a new ‘all in one’ Community Order, which replaced the variety of community sentences that had preceded it. The new order provided a list of 12 ‘requirements’ from which sentencers could select and produce a sentence tailored to each offender lasting up to three years. It was hoped that sentencers would be innovative and utilise the newer aspects of the order, which included, for example, a Mental Health Treatment Requirement option. There was also concern that sentencers would overload individuals by placing a large number of requirements upon them, effectively setting offenders up to fail (Easton and Piper, 2012). Neither of these concerns materialised and sentencers still preferred to use the traditional sentencing options of unpaid work and probation supervision, with very few of them going beyond two or three requirements (Mair et al, 2008). One of the more controversial aspects of this Act was the introduction of the Indeterminate Sentence for Public Protection (IPP), which was a sentence used for those convicted of a serious offence warranting a sentence of 10 years or more who were assessed as dangerous by the court. This sentencing option was met by much criticism by campaign groups such as the Howard League for Penal Reform, who argued that the IPP was ill-conceived and flawed, mainly due to individuals being held long after their initial tariff has expired.The IPP sentence was abolished by the Legal Aid, Sentencing and Punishment of Offenders Act 2012. LINDA ASQUITH See also: Indeterminate Sentences for Public Protection; Multi-Agency Public Protection Arrangements Readings Easton, S. and Piper, C. (2012) Sentencing and punishment: the quest for justice (3rd edn). Oxford: Oxford University Press. Mair, G., Cross, N. and Taylor, S. (2008) The Community Order and Suspended Sentence Order three years on: the views and experiences of probation officers and offenders. London: Centre for Crime and Justice Studies.


A companion to criminal justice, mental health and risk

CRISIS INTERVENTION Crisis intervention in mental health care evolved from Caplan’s (1964) model of preventive psychiatry. Caplan (1964) developed his model on the premise that mental illness is derived from maladaptive adjustment to negative, harmful socio-economic and environmental influences. Caplan (1964) posited a threestage model consisting of a whole-system approach of primary, secondary and tertiary prevention. Primary prevention identified active intervention by health, social, educational, welfare and religious institutions providing and organising fundamental physical, psychosocial and socio-cultural supports to counteract the negative socio-economic and environmental influences that maintain the incidence of mental disorder. The aim is to restore the balance between ‘equilibrium’ and ‘disequilibrium’ (Caplan, 1964, p 43) within an individual’s social milieu. Caplan (1964) emphasised the significance of the dynamic interplay between the individual, their significant others and their community. Secondary prevention focused on providing early intensive interventions during an acute phase of a mental disorder by a combination of early detection, diagnosis and treatment. Caplan (1964) suggested that reducing the duration and prevalence of existing disorders would improve long-term outcomes (such as lowering the overall prevalence of mental disorders in the community). The third principle of Caplan’s (1964) model is tertiary prevention, which aimed to reduce the rate of disability associated with long-term mental disorder by adopting an ethos akin to the current philosophy of recovery. Here, stigma and social exclusion are mitigated by personal empowerment and improved communication within existing social networks and the reduction in frequency and duration of inpatient care. The current model of crisis intervention has its roots in Caplan’s (1964) model. Crisis Resolution Home Treatment (CRHT) teams have the expressed aim of breaking the cycle of crisis hospitalisation by the provision of a rapid, mobile response that can provide crisis intervention through intensive home treatment for 24 hours a day, seven days per week (Department of Health, 1999, 2000, 2001). CRHT teams operate as a facet of the broader whole-system approach to mental health care and comprise of specialist multidisciplinary professionals who deliver time-limited intensive treatment in a community setting. In addition, CRHT teams facilitate early discharge from hospital for those people who initially could not be safely cared for in a community setting (Department of Health, 2006; McGlynn, 2006). When compared with inpatient treatment, CRHT has been shown to reduce repeat admissions to hospital and improve clinical benefits in the way of ‘superior 65

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mental state outcomes’ (Murphy et al, 2012, p 2). Service users and their families and carers report an increased satisfaction with care, along with a reduction in stigma and social exclusion associated with hospitalisation. In addition, disruption to social life and daily routine was reduced, along with susceptibility to physical illness.The evidence on relapse prevention and cost-effectiveness when compared to inpatient treatment remains equivocal (Murphy et al, 2012). GRAHAM JONES See also: Care in the Community; Care Programme Approach Readings Caplan, G. (1964) Principles of preventative psychiatry. London: Tavistock Publications. Department of Health (1999) The National Service Framework for Mental Health: modern standards and service models. London: Department of Health. Department of Health (2000) The NHS plan, a plan for investment, a plan for reform. London: Department of Health. Department of Health (2001) Policy implementation guide: crisis resolution/home treatment teams. London: Department of Health. Department of Health (2006) Care services improvement partnership guidance statement on fidelity and best practice for crisis services. London: Department of Health. McGlynn, P. (2006) ‘Setting the scene’, in P. McGlynn (ed) Crisis resolution home treatment a practical guide. London: The Sainsbury Centre for Mental Health, pp 15–21. Murphy, S., Irving, C.B., Adams, C.E. and Driver, R. (2012) ‘Crisis intervention for people with severe mental illnesses’, Cochrane Database of Systematic Reviews, CD001087.


Emerging in the late 1960s and early 1970s, the origins of critical criminology can be traced to the former radical criminology and Marxist criminology of the late 1960s. A shared characteristic of critical criminology is its continued recognition of the significance of capitalism and unequal class relations to the socio-economic and political ordering of society, agents and mechanisms of social control, law and order, and the criminal justice system.The exposure of unequal class relations had been extended to include unequal race/ethnic relations, gender/sexual relations and socially marginalised and excluded identifiable groups (eg on the grounds of processes of medicalisation). 66

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Regarding a definition of critical criminology, DeKeseredy (2011, p 7) comments that ‘[a]lthough various definitions have been proposed there is no widely accepted formulation’. Indeed, currently, there is no single critical criminology; rather, there coexists a diversity of critical criminologies (DeKeseredy, 2011). Major schools of thought within critical criminology include: feminism, masculinity theories, Left realism, peacemaking criminology, cultural criminology, and convict criminology (DeKeseredy, 2011). Yar’s (2012, p 52) discussion of the variants of critical criminology also includes feminism, cultural and peacemaking perspectives; in addition, he incorporates radical, abolitionist, conflict, postmodern, green, constitutive and integrative perspectives. Critical criminologies ‘have different origins, use different methods, and have diverse political beliefs’ (DeKeseredy, 2011, p 7). Yet, in common, critical criminologies have shared influences in their development, which can be traced to the origins of critical criminology: these include progressive social movements and critical theory. Hudson (2011) outlines the shared interests of critical theory and critical criminology, which include: a rejection of positivism and the notion of value-free or objective knowledge; information interpretation; and an emancipatory agenda. Indeed, a key characteristic of critical criminologists is their unashamedly political stances and their struggle for human freedom, civil liberties and human rights. Sykes (1974, cited in Yar, 2012) pulled together the shared facets of critical criminology in the 1960s and 1970s. These comprise: a rejection of individualistic accounts of crime; a reinterpretation of the motives of the criminal justice apparatus as implicated in the reproduction of structural inequalities; a replacement of the conceptualisation of the law as the embodiment of moral consensus to that which is ‘imposed by the powerful few upon the (relatively) powerless many’ (Yar, 2012, p 53); and, finally, a reading of official accounts of crime as ‘constructs manufactured by the system’ rather than measures (Yar, 2012, p 53). Contemporarily, ‘all strains’ of critical criminologies are unified by their concern with the ‘unequal distribution of power or of material resources’ (Friedrichs, 2009, cited in DeKeseredy, 2011, p 7) and their shared rejection of punitive, authoritarian and populist ‘solutions’ to the state-defined ‘problem of crime’. They advocate social justice and looking at the frequencies, forms and locations of crime through a zemiological framework, thereby stressing the importance of social harm and harms beyond that of a criminal justice remit.The work of critical criminologists is not (and has not been) a detached academic endeavour in that they want ‘their work to reduce pain and suffering’ (DeKeseredy, 2011, p 9) through radical and emancipatory changes with regard to, and beyond, criminal justice. Critical criminologies want to look beyond the state-defined acts of crime towards the state as complicit in harmful crimes, acts and omissions. This means a shift 67

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in the emphasis from conventional crimes to the crimes and harms committed by powerful actors, including agents of the state and corporate actors. Finally, they share years of in-depth research using an array of research methods that have produced path-breaking theoretical and empirical works and political contributions (see DeKeseredy, 2011). However, there are still healthy disagreements among critical criminologists (and zemiologists), including whether or not criminology ‘can rid itself of the cast iron State defined frame of selected behaviours and responses’ (Hillyard, 2013, p 231), or whether or not the notion of harm can be refined within critical criminology by drawing on new ideas in critical theory, such as identity and respect (Yar, 2012). Whether the diversification of critical criminology into critical criminologies is a limitation or a strength remains a point of contestation. KAREN CORTEEN See also: Cultural Criminology; Social Justice; Zemiology Readings DeKeseredy, W. (2011) Contemporary critical criminology. Oxon: Routledge. Hillyard, P. (2013) ‘Zemiology revisited: fifteen years on’, in J. Gilmore, J.M. Moore and D. Scott (eds) Critique and dissent. Ottawa, Canada: Quill Books, pp 219–33. Hudson, B. (2011) ‘Critical reflection as research methodology’, in P. Davies, P. Francis and V. Jupp (eds) Doing criminological research (2nd edn). London: Sage, pp 328–44. Yar, M. (2012) ‘Critical criminology, critical theory and social harm’, in S. Hall and S. Winlow (eds) New directions in criminological theory. London: Routledge.


Cultural criminology is a rich, dynamic, fluid and occasionally elusive orientation and perspective that has developed over the last two decades. It probes the convergence of cultural and criminal processes in contemporary social life and seeks to comprehend how crime, transgression and control are constructed, enforced, imagined, resisted and understood. Drawing inspiration from the work of the Birmingham Centre for Contemporary Cultural Studies in the 1970s on subcultural symbolism and mediated social control, cultural criminology provides a bridge between subcultural theories of deviance and explorations of postmodern ironies and contradictions. As a mode of analysis sensitive to image, 68

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meaning, power, representation and style in the study of crime, deviance and social control, cultural criminology investigates how various cultural forms and cultural expressions (such as art and music) become criminalised and the ways in which perceptions and understandings of crime and crime control are constructed. Although cultural criminologists conceptualise crime as a subcultural phenomenon and concentrate on the content, dynamics, meanings, rhythms and values of subcultural style as defining both the internal characteristics and external, mediated constructions of subcultures, cultural criminologists do not simply suggest greater criminological attention to media dynamics and the cultural practices of those labelled ‘criminals’.They also question the very possibility and merits of objective, value-free social science, exemplified by large data sets, and argue that statistical models and tests miss the excitement, sensuality and ‘sneaky thrill’ of criminality (Katz, 1988). As such, many cultural criminologists, following Becker’s (1963, p 183, emphasis added) interactionist directive that ‘we look at all the people involved in any episode of alleged deviance’, undertake ethnographic research in order to develop, as Ferrell (2001, p 75) explains,‘a form of criminological verstehen, whereby the researcher approaches an empathic, appreciative understanding of the meanings and emotions associated with crime and crime control’. Increasingly, cultural criminology has come to analyse ‘urban space and its underlife’ (Ferrell et al, 2008, p 80), with particular attention to the impact that late-modern consumer culture has had on the natural and built environment(s) of cities. Cultural criminologists consider the increasing privatisation of public space, the effect of this privatisation on the movements and interactions of urban populations, and the ways in which graffiti writers, ‘hobos’, skateboarders and other subcultures ‘violate conventional legal definitions and legal controls of public and private property’ (Ferrell, 1998, p 246) and challenge ‘the taken-for-granted aesthetics of cultural space’ (Ferrell, 1999, p 605). AVI BRISMAN See also: Deviance; Folk Devil; Social Control Theory Readings Becker, H.S. (1963) Outsiders: studies in the sociology of deviance. New York, NY: The Free Press. Ferrell, J. (1998) ‘Freight train graffiti: subculture, crime, dislocation’, Justice Quarterly, 15(4): 537–608. Ferrell, J. (1999) ‘Freight train graffiti: subculture, media, dislocation’, in J. Ferrell and N. Websdale (eds) Making trouble: cultural constructions of crime, deviance, and control. Hawthorne, NY: Aldine de Gruyter, pp 231–52.


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Ferrell, J. (2001) ‘Cultural criminology’, in E. McLaughlin and J. Muncie (eds) The Sage dictionary of criminology. London: Sage, pp75–7. Ferrell, J., Hayward, K.J. and Young, J. (2008) Cultural criminology: an invitation. London: Sage. Katz, J. (1988) Seductions of crime: moral and sensual attractions of doing evil. New York, NY: Basic Books.


D DANGEROUS AND SEVERE PERSONALITY DISORDER PROGRAMME The Dangerous and Severe Personality Disorder (DSPD) programme was conceived in 1999 with the publication of Managing dangerous people with severe personality disorder (Home Office and Department of Health, 1999). The context for the document was the high-profile trial of Michael Stone in 1998 for the murders of Lin and Josie Russell, which had enflamed the debate about: the rights of the individual to freedom; the need for public protection; and the status of personality disorder within the Mental Health Act 1983. The government’s response was twofold: an attempt to introduce a new Mental Health Act, which led to amending the Mental Health Act in 2007; and the introduction of the DSPD programme. Commissioning of services began in 2001. This included the establishment of four DSPD units to provide assessment and treatment to men identified as having a dangerous and severe personality disorder, and research into the assessment of treatment of this group. Two of the units were established in high-security hospitals (Broadmoor and Rampton) and two in prisons (Whitemoor and Falkland). The term ‘dangerous and severe personality disorder’ is an administrative rather than a medical term; however, it was criticised for being a quasi-medical term that had been born in the Home Office (Gunn, 2000).This convergence between the Home Office and the psychiatric profession echoes some similarities to that described by Foucault (1978) in his account of psychiatry, in the 19th


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century, stepping in to resolve a paradox of: managing dangerousness; personal responsibility; and public protection. The administrative process of the DSPD programme also came under criticism. To gain admittance to a DSPD unit, an individual had to meet three criteria: • they had a high risk of reoffending, with serious impact on others; • they had a severe personality disorder; and • their personality disorder was functionally linked to their offending. Critics commented that: existing technologies of risk assessment can only identify groups at risk rather than accurately predict individual risk; the construct and measurement of the severity of personality disorder is unstable; and a reliable way of assessing the functional link between an individual’s personality disorder and their offending has remained elusive (Tyrer et al, 2010). Evaluation of the programme in 2010 identified that the prison-based units had proven more successful than the units based in high-security hospitals, particularly Broadmoor, with: higher occupancy numbers; lower costs; better staff retention; better staff satisfaction; and better service user satisfaction (Ministry of Justice, 2011).The DSPD programme has been superseded, the unit at Broadmoor being decommissioned in 2012, and, at the time of writing, the other three units operate within ‘The Offender Personality Disorder Pathway Strategy’ (Department of Health and National Offender Management Service, 2012). MATT BOWEN See also: Dangerousness and Mental Disorder; High-Security Hospitals; Personality Disorder Pathway Readings Department of Health and National Offender Management Service (2012) The Offender Personality Disorder Pathway Strategy, London: Her Majesty’s Stationery Office. Foucault, M. (1978) ‘About the concept of the “dangerous individual” in 19thcentury legal psychiatry’, International Journal of Law and Psychiatry, 1: 1–18. Gunn, J. (2000) ‘A millennium monster is born’, Criminal Behaviour and Mental Health, 10: 73–6. Home Office and Department of Health (1999) Managing dangerous people with severe personality disorder. London: Crown Copyright. Joseph, N. and Benefield, N. (2012) ‘A joint Offender Personality Disorder Pathway Strategy: an outline summary’, Criminal Behaviour and Mental Health, 22: 210–17. 72

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Ministry of Justice (2011) The early years of the DSPD (Dangerous and Severe Personality Disorder) programme: results of two process studies. London: Her Majesty’s Stationery Office. Tyrer, P., Duggan, C., Cooper, S., Crawford, M., Seivewright, H., Rutter, D., Maden, A., Byford, S. and Barrett, B. (2010) ‘The successes and failures of the DSPD experiment: the assessment and management of severe personality disorder’, Medicine, Science and the Law, 50(2): 95–9.


The public perception of people who suffer from mental illness is often that they are dangerous, including being violent and committing lewd and sexually depraved acts. This reasoning can be attributed to the idea that the concept of dangerousness is often linked to what we fear most, rather than what is actually dangerous.The link between dangerousness and mental disorder is therefore often made because people suffering from such disorders are a group of individuals who we do not understand and, arguably, it is this discomfort that generates the fear of them being dangerous. The media has also played a significant role in making us believe that mentally disordered offenders (MDOs) are more dangerous than they actually are. Highprofile cases are often reported at the time of the incident, when the court case is taking place and also during the public inquiry; often exaggerating the number of cases in the public’s mind. Furthermore, as with other high-profile cases, newspapers are saturated with information, again making it appear as if all MDOs are dangerous. In one study, homicide and crime were the most frequent reports covered in relation to mental health, with people who have experience of mental health problems rarely interviewed or quoted (Mind, 2013). As one journalist explained, there is no sexiness in mental health unless someone has committed a terrible crime (Cockburn, 2012). Despite such negative perceptions, the reality concerning MDOs is totally different. MDOs commit far fewer homicides than mentally ordered offenders and they are more likely to kill themselves than other people (Peay, 2007). Evidence from the US suggests that only 3% of all violent crime is committed by those who have major mental disorders, with alcohol, drugs and poverty being much more likely contributors (Peay, 2007). This has also been seen in England and Wales. Between January 1997 and December 2005, of the 5,189 people convicted of a form of homicide, only 510 (10%) were found to have mental health problems at the time of the offence (Large et al, 2008). When this information is put into the context of mental disorder prevalence in the general population – one in six 73

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of the adult population will have a significant mental health problem, amounting to more than 7 million people – the 50–70 cases of homicide per year (Mind, 2013) clearly suggests that the vast majority of those who have mental health problems are not dangerous and do not present significant risks to the community. Moreover, those who have been released from hospital following a restriction order are actually less likely to reoffend when compared to those offenders who were held in prison. Between 1999 and 2006, 1,500 patients were discharged from hospital detention in England and Wales. Of these offenders, 1,331 were located on the Police National Computer, with it being established that only 7% had reoffended within two years of discharge (Ministry of Justice, 2010). This would therefore suggest that there is actually a tenuous link between the two concepts. KAREN HARRISON See also: Deviancy Amplification; Media Representations and Mental Disorder; Violence and Mental Disorder Readings Cockburn, P. (2012) ‘The stigma of the hidden schizophrenia epidemic’, The Independent, 27 November. Available at: www.independent.co.uk Jorm, A., Reavley, N. and Ross, A. (2012) ‘Belief in the dangerousness of people with mental disorders: a review’, Australian and New Zealand Journal of Psychiatry, 46(11): 1029–45. Large, M., Smith, G., Swinson, N. and Nielseen, O. (2008) ‘Homicide due to mental disorder in England in Wales over 50 years’, The British Journal of Psychiatry, 193: 130–3. Mind (2013) ‘Mental health facts and statistics’. Available at: www.mind.org.uk/ mental_health_a-z/8105_mental_health_facts_and_statistics Ministry of Justice (2010) Statistics of mentally disordered offenders 2008, England and Wales: Ministry Of Justice statistics bulletin. London: Ministry of Justice. Peay, J. (2007) ‘Mentally disordered offenders, mental health, and crime’, in M. Maguire, R. Morgan and R. Reiner (eds) The Oxford handbook of criminology (4th edn). Oxford: Oxford University Press, pp 496–527. Silton, N., Flannelly, K., Milstein, G. and Vaaler, M. (2011) ‘Stigma in America: has anything changed? Impact of perceptions of mental illness and dangerousness on the desire for social distance: 1996 and 2006’, Journal of Nervous and Mental Disease, 199(6): 361–6.


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DEFENCE OF INSANITY In England and Wales, the defence of insanity is a rarely used defence, partly due to the stigma associated with being labelled as ‘insane’ (Law Commission, 2012; Mackay, 2012). It is available to plead, by a defendant, in relation to all criminal offences. If proven, the defence exempts the defendant from any legal responsibility for their actions, as they lack the ability to reason. Insanity was established as a legal defence after M’Naghten’s case (1843) (10 C and F 200, 8 Eng. Rep. 718), where a defendant accused of murder who suffered from an obsession with morbid delusions was found not guilty by reason of insanity. The courts then established the M’Naghten Rules due to a public outcry in relation to this verdict, which must be proven in order for a defence of insanity to succeed. The M’Naghten Rules state that at the time of committing the act: (i) the defendant must be suffering from a ‘disease of the mind’; (ii) the ‘disease of the mind’ must have induced a ‘defect of reason’; and (iii) the defendant must not have known the nature and quality of his acts, nor have knowledge that they were wrong. If a defendant is found ‘not guilty by reason of insanity’, then the court can order: (i) a hospital order, with or without a restriction order; (ii) a supervision order; or (iii) an absolute discharge, which means that the defendant is not thought to need any medical treatment. The defence of insanity, and its use of the M’Naghten Rules, has been widely criticised as outdated, mainly due to the lack of any reference to, or inclusion of, recognised medical definitions in the defence (see, eg, Norrie, 2001; Law Commission, 2012; Mackay 2012; Peay, 2012). The defence relies on a cognitive model of the mind, which presumes that all individuals are capable of rational, autonomous thought. It assumes that if the individual is aware of the nature or quality of the act and that the individual knows that it is morally wrong, then the individual cannot be classed as legally insane. Psychiatric models of insanity, however, argue that the cognitive, reasoning aspects of the mind can operate while volitional and emotional aspects may not, resulting in criminal acts. Thus, those who are classed as medically insane are often not classed as legally insane (Norrie, 2001). Significantly, the insanity defence locates the cause of mental illness within the individual, rather than viewing its causes outside, within wider social, economic and cultural contexts. This decontextualisation of the causes of mental illness is evidence of social relations of power, ones that the law reinforces when deciding who is classed as legally, but not necessarily medically, insane (Norrie, 2001). 75

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Recently, the M’Naghten Rules, which are partly defined as actions occurring due to ‘a disease of the mind’, have caused controversy as the courts have decided that ‘automatic’ responses such as sleepwalking, diabetes and epilepsy are evidence of insanity rather than automatism (Norrie, 2001). HELEN BAKER See also: Insanity and Defect of Reason; M’Naghten Rules Readings Law Commission (2012) Insanity and automatism: a scoping paper. London: Her Majesty’s Stationery Office. Mackay, R. (2012) ‘Ten more years of the insanity defence’, Criminal Law Review, 12: 946–54. Norrie, A. (2001) Crime, reason and history: a critical introduction to criminal law (2nd edn). Cambridge: Cambridge University Press. Peay, J. (2012) ‘Insanity and automatism: questions from and about the Law Commission’s scoping paper’, Criminal Law Review, 12: 927–45.


The Secretary of State for Health (from September 2012, Jeremy Hunt, a Conservative Member of Parliament) is responsible for health policy (Alaszewski, 2013) in England, drawing on the advice of civil servants and other expert advisers in the Department of Health (Alaszewski and Brown, 2012). Although there are separate health ministers, ministries and policies in Scotland, Wales and Northern Ireland, the Secretary of State for Health has traditionally played a lead role in UK policy relating to the National Health Service (NHS), public health and adult social care. The Department of Health provides health ministers with access to civil servants and advisers and is managed by a departmental board chaired by the secretary of state and including the health ministers and lead civil servants. Like all ministries, the Department of Health is hierarchical and its head, the permanent secretary, is the principal accounting officer who is responsible to Parliament for ensuring that the public monies allocated to the health and social care programme in England are properly spent. In 2010, Una O’Brien, a career civil servant with 20 years of experience in making and implementing health policy, was appointed permanent secretary (Department of Health, no date[a]). She chairs an executive board responsible for the implementation of policy, and the members include the 76

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chief executive of the NHS in England (since 2006, Sir David Nicolson) and the chief medical officer (since 2010, Professor Dame Sally Davies). Civil servants advise ministers on the development of specific policies, such as those for people with mental health needs. In the mid-1970s, scandals and inquiries into long-stay hospitals convinced ministers (Alaszewski and Brown, 2012) that they needed to take a more active role in policymaking. A restructuring of the department in the early 1970s created policy groups, which focused on the needs of specific groups of service users. These policy groups brought together career civil servants and professional civil servants, doctors, nurses and social workers who were recruited into the department. In 1975, the Labour Secretary of State Barbara Castle published the first comprehensive policy for people with mental health needs based on a radical shift of services from long-stay hospitals to acute services within the community (Department of Health and Social Services, 1975). The contribution of career civil servants and professional experts still underpins policymaking. However, with the appointment of high-profile professionals as national clinical directors or tsars, there is increased emphasis on expert – and evidence-based – policymaking, especially national service frameworks, which provide guidelines for service providers.The mental health tsar Dr Hugh Griffiths (Department of Health, no date[b]) was appointed in 2010; he was an NHS consultant and NHS Trust Medical Director and retains a part-time role in clinical practice. Dr Griffiths is responsible for leading the government’s mental health strategy and implementing the National Service Framework for Mental Health. ANDY ALASZEWSKI See also: National Service Framework; Race Equality and Mental Health Policy Readings Alaszewski, A. (2013) ‘Health policy’, in W.C. Cockerham, R. Dingwall and S. Quah (eds) The Wiley-Blackwell encyclopaedia of health, illness, behavior and society. Oxford: Blackwell. Alaszewski, A. and Brown, P. (2012) Making health policy: an introductory text. Cambridge: Polity Press. Department of Health (no date[a]) ‘Permanent Secretary’. Available at: www. dh.gov.uk/health/about-us/people/perm-sec/ Department of Health (no date[b]) ‘National Clinical Director for Mental Health’. R Available at: http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/ en/Healthcare/Mentalhealth/NationalClinicalDirectors/index.htm Department of Health and Social Services (1975) Better services for the mentally ill: Cmnd 6233. London: Her Majesty’s Stationery Office. 77

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DEPRIVATION OF LIBERTY SAFEGUARDS Article 5(1)(e) of the European Convention on Human Rights (ECHR) permits detention on the basis of ‘unsound mind’, provided that it is not arbitrary; adequate safeguards against the risk of arbitrariness are necessary. This may cover people without capacity to make decisions as to where to live, even if they are compliant with their placements. The European Court of Human Rights decided in HL v UK (2004) that the informal admission of such patients breached the ECHR. HL had been placed at Bournewood Hospital, and the lack of procedural safeguards when compared to making use of the Mental Health Act 1983 became known as the ‘Bournewood gap’. With a view to filling this gap, the Mental Health Act 1983 (as amended 2007) added detailed provisions to the Mental Capacity Act 2005, the Deprivation of Liberty Safeguards (DoLS), rather than simply extending the 1983 Act to cover compliant patients without capacity.The body responsible for running the relevant care home or hospital, known as the managing authority, must seek an authorisation to detain from a supervisory authority: this will be a local authority in relation to nursing homes or the National Health Service (NHS) commissioning body in relation to hospitals. The managing authority can grant itself an urgent authority for up to seven days. The process involves assessing the presence of six prerequisites: (i) the person must be 18 or over (the Children Act 1989 applying to those under 18); (ii) there must be mental disorder; (iii) the person must lack capacity in relation to where to live, this incapacity can arise from an inability to understand information relevant to the decision, to retain or weigh it as part of the decision-making process, or to communicate the decision, but only after appropriate efforts have been made; (iv) it must be in the best interests of the person, taking into account various relevant matters, including that it is necessary and proportionate to detain to prevent harm; (v) the circumstances must not be such that the Mental Health Act 1983 (as amended 2007) should be used; and (vi) there must be no conflicting advance directive or direction made under the 2005 Act.These assessments are carried out by best interests assessors; at least two are required, since the mental health and best interests assessments must be made by different people. Gaps and difficulties remain. For example, supported living accommodation is not covered (only care homes and hospitals), and the courts are still seeking to clarify what amounts to a deprivation of liberty. Significantly, statistics on the use of DoLS indicate that there have been fewer applications than were predicted, and the Care Quality Commission has raised concerns about the lack of training


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of care home staff.These may mean that a number of people who should benefit from the protections of DoLS are without adequate protection. KRIS GLEDHILL See also: Consent to Treatment; Mental Capacity Act 2005; Mental Health Act 2007 Readings Care Quality Commission (2012) ‘The operation of the Deprivation of Liberty Safeguards in England: 2010/11’. Available at: www.cqc.org.uk/sites/default/ files/documents/dols.pdf HM Government Information Centre (2011) ‘Mental Capacity Act 2005, Deprivation of Liberty Safeguards assessments (England) – second report on annual data: 2010/11’. Available at: http://data.gov.uk/dataset/mentalcapacityact-2005-deprivation-of-liberty-safeguards-assessments-englandsecond-report-on Jones, R.M. (2012) Mental Capacity Act manual (5th edn). London: Sweet and Maxwell.


Desistance is a criminological concept that refers to the cessation of criminal activities and/or the termination of a criminal lifestyle. It refers to an individual desisting from their offending behaviour. It is frequently understood as the action of crime cessation on the part of the agent; although linked, desistance is not necessarily the same thing as rehabilitation. The latter involves some form of treatment or intervention, while desistance designates an individual’s journey (assisted or otherwise) out of criminality. Conceptually, desistance has somewhat ambiguous parameters. For example, Maruna (2001) notes that as an individual commits an offence, s/he becomes an offender; yet, as soon as the act is complete, the offender has, by definition, desisted.As such, the point of onset (and termination) of desistance remains far from established in any definitive manner. Therefore, desistance is frequently understood as a process – or, more precisely, a set of interrelated processes – before it is an event. Moreover, for Farrall and Calverley (2006), it is usual to distinguish between ‘primary desistance’ (a hiatus in offending behaviour) and ‘secondary desistance’ (the complete termination of offending behaviour).


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As a distinct field of study, desistance theory is still relatively new, but, following Maruna, McNeill (2006) identifies three broad themes discernible from within it: the ‘maturational’, ‘social bonds’ and ‘narrative’ models. The first of these has the longest history and is linked to the early criminal career theories of Glueck and Glueck (1943). Here, offending typically peaks in adolescence and tapers off into adulthood – desistance occurs as offenders ‘grow out’ of their criminal ways. Second, and relatedly, the social bonds model builds upon life-course theories of crime to argue that the new responsibilities and relationships (and, as such, social bonds) of age are central to the processes of crime cessation (eg Sampson and Laub, 1995). Finally, the narrative model is predominantly built upon qualitative research involving offenders’‘identity scripts’ (Maruna, 2001) and how subjective identity shifts play a key role in desistance (eg Vaughan, 2007). Collectively, these models have been adopted and built upon by McNeill in his efforts to develop a desistance paradigm of offender management. Here, his rationale is that such a paradigm is ideally placed to stand in opposition to the dominant actuarial and/or disciplinary practices of the contemporary criminal justice system by prioritising an institutional ethos of encouraging and supporting desistance over and above the simple ‘management’ of offenders (see McNeill, 2006). STEPHEN WAKEMAN See also: Probation; Resettlement Readings Farrall, S. and Calverley, A. (2006) Understanding desistance from crime: theoretical directions in resettlement and rehabilitation. Maidenhead: Open University Press. Glueck, S. and Glueck, E. (1943) Criminal careers in retrospect. New York, NY: The Commonwealth Fund. Maruna, S. (2001) Making good: how ex-offenders change their lives. Washington, DC: American Psychological Association. McNeill, F. (2006) ‘A desistance paradigm for offender management’, Criminology and Criminal Justice, 6(1): 39–62. Sampson, R.J. and Laub, J.H. (1995) Crime in the making: pathways and turning points through life. Cambridge, MA: Harvard University Press. Vaughan, B. (2007) ‘The internal narrative of desistance’, British Journal of Criminology, 47(3): 390–404.


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DEVIANCE The label ‘deviance’ is a socio-political judgement that seeks to differentiate unacceptable and abnormal behaviours and practices. The colloquial expression and successful UK and US television series ‘queer as folk’ alludes to the extensiveness of perceived deviancies in society. That implied inevitability and acceptance is contrasted by more ferocious condemnatory rhetoric about specific deviancies that offend the norms and values of society, personified as ‘ordinary decent hard-working people’, the purported moral ‘silent majority’. Nonetheless, only certain deviancies are liable to be proscribed, penalised or regulated by different agencies at different times and circumstances. Explaining the changing attitudes to specific ‘deviancies’ is a complex and challenging task and analysis of the acceptance of previously marginalised ‘deviants’ into mainstream society often chronicles active resistance to the caricatured label. Authorities who previously labelled homosexuality, for instance, as abnormal and/or a ‘mental disorder’ have been forced to amend their views and practices by such resistance (Janes, 2012). Changing attitudes to formerly accepted notions of deviance have resulted in traditionalist adherents of such illiberal views being increasingly perceived as deviant themselves for their lack of understanding and empathy. It is claimed that globalisation has increased tolerance and that this inescapable process of development will enhance shared norms and values.The decline of the power of religious organisations and the exposure of their crimes and hypocrisies has seen the decrease in the demarcation of allegedly sinful deviances and an increase in concerns about ‘vices’ that purportedly threaten ‘our’ social fabric. The condemnation of others and their deviancies has unifying ideological functions that many are willing to exploit for political and socio-economic interests. The historical examples of the shocking extremes of such are well known in genocide and pogroms. Nevertheless, the resilience of labelling of more everyday deviance is considered in Pearson’s (1983) exemplar study of ‘hooligans’ and Jones’ (2011) study of ‘chavs’. Successful caricatures of deviants and their deviances ascribe the most shocking acts of some to all, and thus the misrepresentation of reality of these ‘others’ is central to the marginalisation of deviants. Such ideological portrayals transform all who loosely fit such broad categories into an allegedly threatening and dangerous subculture. Those caricatures have facilitated many problematic practices in relation to groups such as the mentally ill. Even under allegedly liberal governments, some well-intentioned but ill-considered authoritarian controls have been proposed and implemented that have seriously impaired civil liberties and rights and greatly expanded the powers of the state and its agencies (Fenwick,


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2007). A core problem with deviance is that the claimed norms and values of society are often parodies of reality. LIAM McCANN See also: Deviancy Amplification; Medicalisation and Social Control; Social Control Theory Readings Fenwick, H. (2007) Civil liberties and human rights. Abingdon: RoutledgeCavendish. Janes, D. (2012) ‘“One of us”: the queer afterlife of Margaret Thatcher as a gay icon’, International Journal of Media and Cultural Politics, 8(2/3): 211–27. Jones, O. (2011) Chavs: the demonization of the working class. London: Verso. Pearson, G. (1983) Hooligan: a history of respectable fears. London: Macmillan.


‘Deviancy amplification’ is a term used to capture the phenomena, in sociological terms, that surround deviant behaviour and its relationship with levels of tolerance towards the act.The term was first coined by Wilkins (1964) and later adopted in analyses of social groups by Young (1971) and also Cohen (1972). Central to this concept, and its most common application, is an examination of the processes that take place that may explain escalations in deviant behaviour among certain individuals or social groups. Using deviancy amplification as a framework of analysis, reactions by agencies such as law enforcement and the media are a key concern. Social reactions by official agencies and the general public have the potential to amplify the initial act of deviancy and therefore go some way to legitimise enhanced scrutiny or control of individuals or groups. Deviancy amplification as a concept can be linked to other perspectives, namely, Becker’s labelling perspective and Cohen’s moral panic. Cohen studied the reporting of skirmishes between two rival subcultures, the Mods and Rockers, in 1964, and developed from this what he called the ‘deviancy amplification spiral’. This sets out an escalatory process, which begins with the deviant act itself, then sensationalist news reporting, a distorting of the facts and a gradual build-up of concern that creates a climate of fear or fullblown moral panic among the general public. With such public condemnation and outcry, both the police and government are compelled to act, resulting in


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targeted strategies that invariably set new public identities for those subject to the representations and controls. As a concept, deviancy amplification has been applied in the study of mental health care and policy formation. Indeed, the assumed causal relationship between mental illness/disorder and violent/offending behaviour has been challenged using such a framework (see Ritter, 2011) and the safety concerns underpinning mental health policy writing (Wolff, 2002). The application of this concept is broad and has also been the subject of interest by authors exploring practice within clinical professions. In an examination of general practitioners’ (GPs’) responses to those with a psychiatric diagnosis, Shaw (2004) asserts that deviancy amplification may have the potential to alter treatment outcomes for service users and influence informal labels of ‘good’ or ‘bad’ patients that are loaded with moral judgements. When examining the field of mental health care and the experience of those in contact with services, the potency of labels is an important consideration. So, too, are the reasons that lay behind the amplification of these negative labels. Legislative changes that reflect greater powers (eg Community Treatment Orders), policy that recommends higher levels of surveillance and a more general converging of criminal justice and mental health-care agendas have real potential to exacerbate and worsen the situation for some service users.While the amplification of deviancy and risk may be false among this group, the amplification of marginalisation is all too real. Given the difficulty of controlling public opinion, the responsibility then falls on those within professions, those involved in writing policy and those representing this group (ie the media) to consider with forethought the potential for unintended consequences of their decision-making and actions. ROBERT HESKETH See also: Folk Devil; Social Control Theory Readings Cohen, S. (1972) Folk devils and moral panics. London: Macgibbon and Key. Ritter, D. (2011) ‘“Psychogeddon” in the UK: the manipulation of “mental health” discourse’. Available at: www.cchrint.org/2011/05/13/psychogeddonin-the-uk-the-manipulation-of-mental-health-discourse/ Shaw, I. (2004) ‘Doctors, “dirty work” patients, and “revolving doors”’, Qualitative Health Research, 14(8): 1032–45. Wilkins, L. (1964) Social deviance. London: Tavistock. Wolff, N. (2002) ‘Risk, response, and mental health policy: learning from the experience of the United Kingdom’, Journal of Health Politics, Policy and Law, 27(5): 801–32. Young, J. (1971) The drug takers: the social meaning of drug use. London: Paladin. 83

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DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS First published in 1952, the Diagnostic and statistical manual of mental disorders (DSM) is currently in its fifth edition (DSM-5) (APA, 2013). It is a classification system for mental health conditions designed to help clinicians make accurate diagnoses. It is published by the American Psychiatric Association (APA). The DSM sets out structured information about a range of mental health conditions, including disorders of affect, thought and personality. Each diagnosis belongs to a classification grouping (examples include ‘eating disorders’ and ‘personality disorders’), and has a clearly defined set of related clinical criteria (listing common symptoms and the frequency and duration that these symptoms need to be experienced before an accurate diagnosis can be made) and descriptions providing information about subtypes, cultural considerations and prevalence rates. The DSM is divided into five distinct axes: • Axis I: Clinical disorders, such as schizophrenia, depression and anxiety. • Axis II: Personality disorders, subdivided into clusters based on clinical presentations. • Axis III: Physical health complaints that can impact on mental well-being. • Axis IV: Psychosocial and environmental factors associated with mental illhealth. • Axis V: Global assessment of functioning. The DSM is often held in higher esteem by psychiatrists than merely a classification and diagnostic aide. For this reason, it is commonly referred to as the ‘psychiatric bible’ – the assertion being that clinicians are relying heavily on formal diagnostic criteria rather than professional judgement about the needs of their individual patients (Widiger and Clark, 2000). Despite its status within psychiatry, the DSM has not been without controversy since its inception. Whenever revisions are due, the APA appoints a task force to oversee the new developments, and invites experts to conduct research and provide recommendations about the content that should be included within the updated manual. The DSM is criticised as being skewed in favour of a select number of professionals, with other more critical clinicians’ views being excluded and ignored.This has led to claims that the DSM merely reflects the prevailing consensus within psychiatric thought at that specific point in time.Additionally, the scientific nature of the DSM and the way in which classifications mirror social norms has drawn considerable comment. Perhaps the most high-profile examples of this include the removal of 84

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homosexuality as a mental health diagnosis from DSM-3 (Drescher, 2012) and the addition of the seemingly normal grief reaction to bereavement as a criterion for clinical depression in the current version (Frances, 2010). Despite its drawbacks, the DSM provides a clear framework within which clinicians and researchers can work and investigate mental health conditions, providing clear, if not always widely validated, definitions of disorders. CRAIG HARPER See also: Essentialism; Medicalisation and Social Control; Mental Disorder Readings APA (American Psychiatric Association) (2013) Diagnostic and statistical manual of mental disorders (5th edn). Washington, DC: APA. Drescher, J. (2012) ‘The removal of homosexuality from the DSM: its impact on today’s equal marriage debate’, Journal of Gay and Lesbian Mental Health, 16(2): 124–35. Frances, A. (2010) ‘Opening Pandora’s box: the 19 worst ideas for DSM-5’, Psychiatric Times. Available at: www.janusonline.it/sites/default/files/allegati_ news/FrancesA_PsychiatricTimes110210.pdf Widiger, T.A. and Clark, L.A. (2000) ‘Toward DSM-V and the classification of psychopathology’, Psychological Bulletin, 126: 946–63.


Dialectical Behaviour Therapy (DBT) is a form of cognitive behaviour therapy that is used in the treatment of women with a diagnosis of borderline personality disorder (BPD) who have made repeated suicide attempts (Linehan et al, 1991). DBT was developed by Marsha Linehan and colleagues in response to the poor efficacy of existing treatment approaches for BPD and the subsequent high levels of stress for service providers working with this client group (Dimeff and Linehan, 2001). DBT has been used primarily for female clients in a wide variety of settings, including eating disorder, forensic mental health and substance misuse services. DBT is underpinned by biosocial theory and dialectical philosophy, as well as cognitive behavioural therapy. Biosocial theory was developed by Linehan (1993a). It explains the behaviour of a person with BPD as a biological dysfunction of emotion, which when placed in an invalidating environment, results in the 85

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development of pervasive emotion dysregulation. Dialectical philosophy is used in DBT as an organising theory to help the therapist understand and address tensions and paradoxes that exist within relationships and treatment. DBT seeks to validate and accept clients’ capabilities through individual therapy, group work and coaching. Individual therapy is structured around primary and secondary behavioural targets, each of which has a hierarchy of target behaviours. The reduction of suicidal behaviours is the first target, followed by diminishing behaviours that interfere with therapy and quality of life. Group work is delivered in modules of mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance. Coaching is provided out of hours by the therapist when the client needs help to use or apply a new skill (Linehan, 1993b). Out-of-hours contact is often a concern for service providers. However, in practice, coaching is used infrequently. Randomised controlled trials have been undertaken to ascertain the efficacy of DBT. These studies have indicated that, following DBT, people with BPD have shown a reduction in self-harming behaviours, length of hospital stays and adherence to treatment regimes. However, these studies have not explored the impact of gender differences or application in black and minority ethnic (BME) populations (Rizvi et al, 2013). Therefore, it is unclear how they might be generalised to wider populations. Recently, there has been some success with adapting DBT to be offered as a brief therapy that is undertaken over one day and has been successfully used for non-treatment-seeking people with suicidal ideation (Erin and Ward-Ciesielski, 2013). LISA REYNOLDS See also: Cognitive Behaviour Therapy; Solution-Focused Therapy Readings Dimeff, L. and Linehan, M. (2001) ‘Dialectical behaviour therapy in a nutshell’, The California Psychologist, 34: 10–13. Erin, F. and Ward-Ciesielski, M.S. (2013) ‘An open pilot feasibility study of a brief dialectical behavior therapy skills-based intervention for suicidal individuals’, Suicide and Life Threatening Behavior, 43(3): 324–35. Linehan, M.M. (1993a) Cognitive behavioural treatment of borderline personality disorder. New York, NY: The Guilford Press. Linehan, M.M. (1993b) Skills training manual for treating borderline personality disorder. New York, NY: Guilford Press. Linehan, M.M., Armstrong, H.E., Suarez, A., Allmon, D. and Heard, H.L. (1991) ‘Cognitive-behavioral treatment of chronically parasuicidal borderline patients’, Archives of General Psychiatry, 48(12): 1060. 86

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Rizvi, S.L., Steffel, L.M. and Carson-Wong, A. (2013) ‘An overview of dialectical behavior therapy for professional psychologists’, Professional Psychology: Research and Practice, 44(2): 73–80.


Diminished responsibility is a mental condition defence in England and Wales. It provides a partial defence to a murder charge and a successful plea will reduce the conviction from murder to manslaughter, thereby giving the judge discretion in sentencing. A range of sentencing options are available, including penal sanctions or therapeutic disposals, such as a hospital order (with/without restrictions) under Part III of the Mental Health Act 1983. Many successful pleas will result in therapeutic disposals, thereby enabling a ‘mentally abnormal’ defendant to be contained in a secure environment, while, at the same time, receiving appropriate treatment for his/her mental condition. Under section 2(1) of the Homicide Act 1957, the partial defence was created and applied to a defendant suffering from an abnormality of mind, which substantially impaired his/her mental responsibility. This formulation of diminished responsibility was problematic, as there were concerns about the lack of clarity surrounding the concept of ‘abnormality of mind’ (Mackay, 1999, p 118), the breadth of the defence and the fact that it was out of step with medical understanding and diagnostic practice (Law Commission, 2006, paras 149, 5.107). Despite these criticisms, the defence has received surprisingly ‘little judicial scrutiny’ (Mackay, 1999, pp 118, 125). However, following the recommendations of the Law Commission (2006) and a government consultation (Ministry of Justice and the Home Office, 2008), it was amended by the Coroners and Justice Act 2009. Section 52 of the 2009 Act replaces section 2(1) of the 1957 Act with a reformulated defence.The burden of proof remains on the defendant to establish the defence on the balance of probabilities, although this is procedurally out of step with other partial defences to murder, such as provocation (Quick and Wells, 2006, p 521). The defendant must prove: 1. Abnormality of mental functioning: S/he is suffering from an abnormality of mental functioning, which is a flexible concept and more in line with accepted diagnostic practice. 2. Recognised medical condition: The abnormality of mental functioning must arise from a recognised medical condition, which is linked to the accepted international classificatory systems, and is therefore more explicit than the


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previous test. It encompasses recognised physical as well as psychiatric and psychological conditions, and so embraces a broader range of conditions. 3. Substantially impaired ability: The defendant’s ability to do any or a combination of the things listed below must be substantially impaired by the abnormality. The impairment need not be total, but must be more than trivial. It is likely that medical evidence will be a crucial factor in establishing this limb, which means that expert witnesses retain a significant role in diminished responsibility cases (Quick and Wells, 2006, p 521). Nevertheless, this requirement contrasts with the previous law, which required the defendant’s mental responsibility to be substantially impaired. The test does not now include any consideration of the defendant’s responsibility and is a question of fact for the jury. • Ability to understand the nature of the defendant’s conduct: This limb applies if the defendant has a mental condition that causes delusions and is unable to understand the nature of his/her conduct. For example, if the defendant constantly plays video games and kills when interrupted. It may be that s/ he is unable to understand the nature of his/her conduct, as s/he cannot separate video games from reality and believes that the victim could be revived. There may be some overlap here with the insanity defence and M’Naghten Rules. • Ability to form a rational judgement: If the defendant’s perception of reality is impaired as a result of his/her medical condition, it will affect his/her ability to form a rational judgement. For example, this limb may apply to a battered wife who kills her husband after years of abuse. She may have developed a depressive illness, consequent upon the abuse, which distorts her perception of reality. • Ability to exercise self-control: Several medical conditions can affect an individual’s ability to exercise self-control/restraint and control their temper. For example, if a mental condition causes the defendant to behave in an impetuous way. 4. An explanation for the defendant’s conduct in killing: The final element is that the abnormality of mental functioning must cause or be a significant contributory factor for the defendant’s conduct in killing (or being a party to the killing). There must be some causal connection between the abnormality and the killing; it need not be the sole cause, but it must be more than trivial. This was introduced in the 2009 Act and was not a requirement under the previous law. JUDY LAING See also: Infanticide; Unfitness to Stand Trial (Criminal Procedure (Insanity and Unfitness to Plead) Act 1991)


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Readings Law Commission (2006) Report on murder, manslaughter and infanticide: Law Com No. 304. London: Law Commission. Mackay, R.D. (1999) ‘The abnormality of mind factor in diminished responsibility’, Criminal Law Review, February: 117–25. Ministry of Justice and the Home Office (2008) Murder, manslaughter and infanticide: proposals for reform of the law – consultation paper CP 19/08. London: Ministry of Justice. Quick, O. and Wells, C. (2006) ‘Getting tough with defences’, Criminal Law Review, June: 514–25.


Hate crime legislation has its roots in the civil rights struggles in the US in the 1960s and 1970s (Chakroborti and Garland, 2012). However, it was not until 2003 that the Criminal Justice Act recognised disability hate crime in the UK. Disability hate crime is defined as any criminal offence (including violence, threat, abuse, damage to property and physical or mental injury) that is perceived by the victim, or any other person, to be motivated by prejudice towards or hatred of disabled people (Criminal Justice Act 2003). Punishment for offenders who commit disability hate crime is usually more severe than if a similar crime had been carried out without prejudice (Piggott, 2011). In the UK, extensive coverage of the case of Fiona Pilkington (Walker, 2009) is credited with having brought disability hate crime into public consciousness (Piggott, 2011). UK government statistics suggest that the incidence of disability hate crime is rising (Home Office, 2012). Links have been made between the rise in disability hate crime and media portrayals of disabled people. It is certainly the case that pernicious images of disabled people, including the scapegoat, the sinner, the freak, the victim and the scrounger, are disseminated in the media (Quarmby, 2011). In order for a crime to be categorised as a disability hate crime, disabled people must define themselves individually as objects of hatred in the eyes of the law (Chakraborti and Garland, 2012). This approach suggests that the ‘problem’ lies within the disabled person. Such an approach is at odds with understandings of disability that have focused on the social barriers to disabled people’s participation (Goodley, 2011). Debates about disability hate crime centre on whether all victims of crime should be treated in the same way or whether people who face unique and/or additional social barriers to accessing the criminal justice system should be treated differently (Piggott, 2011).


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Disability hate crime has been constructed through the lens of identity politics, but this may only serve to reinforce biases and stereotypes within the criminal justice system, while failing to attend to the intersectional nature of identity (Chakraborti and Garland, 2012). Moreover, by focusing on individuals and groups of disabled people, there is a simultaneous failure to pay attention to the ableist cultures in which disability hate crime flourishes (Piggott, 2011). KATHERINE RUNSWICK-COLE See also: Normalcy; Policing and Duty of Care Readings Chakraborti, N. and Garland, J. (2012) ‘Reconceptualising hate crime victimization through the lens of vulnerability’, Theoretical Criminology, 16(4): 499–514. Goodley, D. (2011) Disability studies: an interdisciplinary introduction. London: Sage. Home Office (2012) ‘Hate crimes: England and Wales 2011/12’. Available at: www.homeoffice.gov.uk/publications/science-research-statistics/researchstatistics/crime-research/hate-crimes-1112/ Piggott, L. (2011) ‘Prosecuting disability hate crime: a disabling solution?’, People, Place and Policy Online, 5(1): 25–34. Quarmby, K. (2011) Scapegoat: why we are failing disabled people. London: Portobello Press. Walker, P. (2009) ‘Profile: Fiona Pilkington’, The Guardian, 29 September. Available at: www.theguardian.co.uk


The Domestic Violence, Crime and Victims Act (DVCVA) is an Act of the UK Parliament that received Royal Assent on the 15 November 2004, applying to England, Wales and, in part, Northern Ireland. Part I of the DVCVA represented a major overhaul of law relating to domestic violence, significantly amending the civil law protections for victims in the Family Law Act 1996 (FLA). Breach of a non-molestation order became a criminal offence, punishable with up to five years imprisonment.The protections in Part IV FLA were extended to same-sex couples and couples who had never cohabited or married by changing the definition of ‘associated persons’. Accordingly, section 3 permits same-sex couples to apply for occupation orders, while section 4 enables unmarried couples and couples who have never cohabited to apply for non-molestation orders. Section 5 created the new offence of ‘causing or allowing the death of a child or a vulnerable adult’, later 90

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amended to ‘causing or allowing serious physical harm’ by the DomesticViolence, Crime and Victims (Amendment) Act 2012. This was provided as a remedy in situations where it was clear that one or other of a child’s parents had been responsible for their death but there was not sufficient evidence to demonstrate which. Section 9 establishes the procedure for domestic homicide reviews. Part II made various alterations to criminal procedure, including extended availability of restraining orders (sections 12–13). Particularly significant are sections 22–25, which relate to the determination of defendants’ fitness to plead and the disposals available to the court in these circumstances, and where a defendant is found not guilty by reason of insanity. Section 22 establishes that the question of fitness to plead should be determined by the court, not a jury, as was previously the case (amending section 4(5) of the Criminal Procedure (Insanity) Act 1964 [CP(I)A]). Section 24 of the DVCVA amends section 5 of the CP(I)A, providing the court with three principal disposals where a defendant is found unfit to plead/not guilty by reason of insanity: a hospital order, which may be accompanied by a restriction order (as provided for, and only permitted, where sections 37 and 41 of the Mental Health Act 1983, respectively, are fulfilled); a supervision order; and, finally, absolute discharge. Supervision orders detailed in the DVCVA replaced the supervision and treatment order contained in the Criminal Procedure (Insanity and Unfitness to Plead) Act 1991. These provisions within the DVCVA ensure that defendants cannot be admitted to a psychiatric hospital without relevant evidence. The changes implemented under the legislation also mean that the secretary of state no longer has a role in deciding admissions to hospital. Section 24 amends the Criminal Appeal Act 1968 (sections 16A and 16B), granting rights of appeal to the Court of Appeal in relation to supervision and hospital orders. Part III gave statutory recognition to the ‘Code for Victims’ and established the ‘Commissioner for Victims’ (section 48), who is responsible for promoting the interests of victims and witnesses. Sections 35–46 create rights of victims to receive information about, and make representations relating to, the release or discharge of those found to have committed sexual or violent offences. KATHRYN DUTTON See also: Compulsory Hospitalisation; Hospital Order; Mental Health Act 2007; Victims of Crime Readings Domestic Violence, Crime and Victims Act 2004. Available at: www.legislation. gov.uk/ukpga/2004/28


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Lawson, E., Johnson, M., Adams, L., Lamb, J. and Field, S. (2005) Blackstone’s guide to the Domestic Violence, Crime and Victims Act (2004). Oxford: Oxford University Press.


Dual diagnosis refers to the coexistence of a mental health disorder and substance use in an individual. There is little evidence available about the exact nature of this relationship or how one might aggravate the other. Often, one is the ‘primary’ diagnosis (eg symptoms of a mental health problem), coupled with a ‘secondary’ diagnosis (substance use). Lord Bradley’s review of people with mental health problems in the criminal justice system (Bradley, 2009) recommended that improvements to services for prisoners who have a dual diagnosis of mental health and drug/alcohol problems should be developed urgently. In response, the Department of Health (2009) issued A guide for the management of dual diagnosis in prisons. Four principle definitions of dual diagnosis are suggested: • • • •

a primary mental health problem that provokes the use of substances; substance misuse or withdrawal leading to psychiatric symptoms; a psychiatric problem worsened by substance misuse; and substance misuse and mental health problems that do not appear to be related to one another.

Similar to community settings, prison environments have a tendency to manage dually diagnosed people within a parallel approach.This means that mental health services and substance misuse services provide support separately, but within the same time frame. There are advantages to this approach as both areas of support can focus on their specialisms. However, this can lead to fragmented care when the two teams involved are not communicating well. For example, there may be an improvement in the area of substance use but no change observed in the mental health aspect. Additionally, medication used to manage a mental health problem may conflict with work undertaken with the substance use issue. For example, some mental health medications may blunt an individual’s emotions, which will negatively impact on substance use work on expressing and understanding emotions. There is a paucity of evidence for effective interventions with dual diagnosis and no standardised treatment exists. There are, however, recommendations based on broader principles of good practice. Largely, these support the use of an 92

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integrated approach that allows for professional skills to be shared across the fields of mental health and substance use, stronger communication and observation to enhance care planning, and an increased opportunity for clearer pathways into suitable treatment on release from prison. In recent years, there has been the establishment of specialist dual diagnosis services in some prisons, with staff drawn from psychiatry, psychology, social care and substance misuse. The role of these services is to assess the individual, consult with others involved in their care, casework, educate and train non-specialist staff about dual diagnosis, and forge links with other support services within the prison (eg family link workers) and outside of the prison in preparation for release. With so much still unknown about dual diagnosis, debates are abundant. In particular, what is the most effective way to treat people who have a dual diagnosis and is group work damaging to this population? Furthermore, there are questions surrounding issues of whether dual diagnosis is over- or under-diagnosed in individuals when there is a short episode of mental illness during a period of drug-taking or a diagnosis of schizophrenia is given without consideration of drug or alcohol consumption. LAURA GRAHAM See also: Alcohol and Risk; Substance-Related Violence Readings Bradley, K. (2009) The Bradley Report: Lord Bradley’s review of people with mental health problems or learning disabilities in the criminal justice system. London: Department of Health. Department of Health (2009) A guide for the management of dual diagnosis in prisons. London: Department of Health.


Due process is an idealised model of criminal justice and a theoretical construct. Deeply embedded in law, it is characterised by a complex and lengthy criminal process and a series of obstacles, in which rights, fairness, equality, control of state power and delivery of justice are of paramount importance (Packer, 1968; Wilson, 2004). It focuses on protecting suspects in order to acquit the innocent and convict only the guilty; thus, it comes to exemplify common phrases in law, such as the right to a fair trial and the presumption of innocence (Davies et al, 1998). Further important characteristics of due process include an onus on the 93

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prosecution to prove guilt beyond reasonable doubt, strict rules governing the admissibility of evidence and transparency in court (Ellis and Nash, 2012). Originating from the 18th century, a time when harsh punishments dominated, the concept of due process is evident in many areas of the contemporary criminal justice system. In particular, in England and Wales, the Police and Criminal Evidence Act 1984 controls police powers of investigation surrounding stop and search, detention and the treatment and questioning of suspects while in custody. However, it is important to note that individual rights can be curtailed at any time due to increased political tension, media scrutiny or public anxiety concerning specific crimes. For example, following the London bombings in July 2005, there have been substantial criticisms of the lack of due process with regards to anti-terrorism legislation, whereby a suspect can be held for a number of days without trial (Ellis and Nash, 2012). While considered an ideal model of how the criminal justice system should function and operate, it can be argued that due process is difficult to fully achieve in practice and that increasing procedural complexity could work against achieving justice. In addition, a focus on formal procedures neglects wider, more important issues surrounding human rights and abolitionism or other ways of achieving justice without a criminalising process, such as restorative approaches. Perhaps most importantly, due process is criticised by those who subscribe to crime control, a ‘populist’ model that prioritises the expedient apprehension and conviction of the guilty through increased police powers and a disregard of legal controls, in which mistakes are acceptable (Packer, 1968). NICHOLAS PAMMENT See also: Adversarial Justice; Populist Punitiveness Readings Davies, M., Croall, H. and Tyrer, J. (1998) Criminal justice: an introduction to the criminal justice system in England and Wales (2nd edn). Essex: Pearson Longman. Ellis,T. and Nash, M. (2012) ‘Crime control or due process?’, in T. Ellis and S. Savage (eds) Debates in criminal justice: key themes and issues. Oxford: Routledge, pp 7–32. Packer, H. (1968) ‘Two models of the criminal process’, University of Pennsylvania Law Review, 133: 1–68. Wilson, D. (2004) ‘The politics and processes of criminal justice’, in J. Muncie and D. Wilson (eds) Student handbook of criminal justice and criminology. London: Cavendish Publishing, pp 21–34. 94

E EMOTIONAL CPR Emotional CPR (eCPR) is a public heath educational programme developed by the National Coalition for Mental Health Recovery (NCMHR) based in Washington, DC in the US. eCPR has similar aims to Mental Health First Aid, in that it trains members of the public to provide immediate care and support to those experiencing emotional and mental distress. The NCMHR was formed in 2006 by people with lived experience of mental ill-health and has its roots in the mental health consumer/survivor movement of the 1970s. The core purpose of the NCMHR is to ensure that ‘mental health consumers/survivors play a major role in the development and implementation of mental health care and social policies at a state and national level’ (NCMHR, 2013a). This approach shares its underpinning principles with a number of other support approaches: emotional intelligence; suicide prevention; cultural attunement; the learning and experience of the provision of trauma care; and the provision of counselling following disasters (NCMHR, 2013b). eCPR is designed to teach anyone to assist another person through an emotional crisis and regain a sense of hope and purpose in their lives. The ‘vast and compelling need’ for the general public to learn how to assist anyone experiencing an emotional crisis (NCMHR, 2013b) is underpinned by the belief that the experience of emotional crisis is universal and that sincerely offered, ‘heart-toheart’ resuscitation provides the best assistance to those in crisis. In the same way that physical CPR sustains the heart until it begins to beat again, so emotional CPR 95

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sustains the emotional heart until the distressed individual can cope themselves or receive appropriate professional help. eCPR focuses on developing human connections and communication at the point of distress, the programme teaches participants the application of three simple steps: C – Connecting; P – Empowering; and R – Revitalising (NCMHR, 2013b). These three steps are based on the principles of deep listening and interacting in a respectful manner to support the individual through the crisis. HELEN CORTEEN See also: Solution-Focused Therapy Readings National Coalition for Mental Health Recovery (2013a) ‘Our mission’. Available at: www.ncmhr.org/index.htm National Coalition for Mental Health Recovery (2013b) ‘Emotional CPR’. Available at: www.emotional-cpr.org


A sociological understanding of the term ‘ethnicity’ refers to group membership based on a real or perceived shared background in language, belief and social practices (Moore, 2003). Although everybody has an ethnic identity, the term is often used to mark out notions of difference, which in white-majority Western societies, means that it is commonly used to refer to people of a non-white background. There are a significant number of black and minority ethnic people, especially those of black African and Caribbean background, who are disproportionately represented and experience serious disadvantage in both the criminal justice and mental health systems (Nacro, 2007). For example, recent figures show that this category of black and minority ethnic groups are just over 40% more likely than average to be referred to mental health services through the criminal justice system (Healthcare Commission, 2007). Assumptions about the ‘ethnic deviant other’ have underpinned the higher rates of mental health intervention among black and minority ethnic groups, especially via criminal justice system referrals. This is because criminal justice professionals more readily associate people of black African and Caribbean background with a sense 96

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of danger (Nacro, 2007).This uses a ‘fixed’ definition of culture to problematically construct these ethnic groups as genetically or culturally ‘deficient’ and in need of greater mental health intervention (Ahmad, 1996), or a particular type of intervention (Bhavnani et al, 2005). For instance, consider how these ethnic groups are far less likely to receive psychotherapy and counselling compared to their white counterparts. Instead, they are more likely to experience physical restraints and receive high-dosage medicalisation (Prins, 1993; Nacro, 2007). The higher rate of deaths among this ethnic group is therefore unsurprising (see the cases of Orville Blackwood in 1991 and David Bennett in 2003). Assumptions about ethnic difference and criminal propensity also mean that variables such as gender, age, class and other socio-economic factors, as well as external structural inequalities, fail to be adequately considered in mental health referrals, resulting in mental health policy misdirection and resource misuse (see, eg, the over-medicalisation study of Bolton [1984]). Contemporary consideration of ethnicity, criminal justice and mental health must therefore acknowledge the continued existence of ethnic bias, stereotyping and discrimination. To do so highlights a number of issues in need of attention, namely, those in the areas of misdiagnosis and inadequate service delivery. TINA G. PATEL See also: Race Equality and Mental Health Policy Readings Ahmad, W.I. (1996) ‘Making black people sick: “race”, ideology and health research’, in W.I. Ahmad (ed) ‘Race’ and health in contemporary Britain. Buckingham: Open University Press, pp 11–33. Bhavnani, R., Mirza, H.S. and Meetoo, V. (2005) Tackling the roots of racism. Bristol: The Policy Press. Bolton, P. (1984) ‘Management of compulsory admitted patients’, International Social Psychiatry, 30(1/2): 77–84. Healthcare Commission (2007) Results of the 2006 national census of inpatients in mental health and learning disability services in England and Wales. London: Commission for Healthcare, Audit and Inspection. Moore, R. (2003) ‘Ethnicity’, in G. Bolaffi, R. Bracalenti, P. Braham and S. Gindro (eds) Dictionary of race, ethnicity and culture. London: Sage, pp 94–9. Nacro (National Association for the Care and Resettlement of Offenders) (2007) Black communities, mental health and the criminal justice system. London: Nacro (Mental Health Unit). Prins, H.A. (1993) Report of the Committee of Inquiry into the death in Broadmoor Hospital of Orville Blackwood and a review of the deaths of two other Afro-Caribbean patients: ‘Big, black and dangerous?’. London: Special Hospitals Service Authority. 97

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ESSENTIALISM ‘Essentialism’, as we know it now, is a term arguably arising out of the positivist ventures of the modern period with reference to the physical sciences. Earlier iterations of essentialism arose from Aristotelian metaphysics, spiritual/religious formulations that the ‘laws of nature are immanent in the things that exist in nature’ (Ellis, 2002, p 1), as a function of creationism, or through acts of a deity.This offers the basis of a later belief that there exist irreducible states or characteristics that, once revealed, offer an insight into typology, thus providing a structure to organise subsequent classification. Such essences are hidden but give an object its thingness or causality (what makes a dog is its dog-ness) (Cain, 2012). In the physical sciences, this can be seen in the periodic table of elements, wherein atoms are classified on the basis of their unique number of electrons: a sodium atom cannot have more or fewer atoms and still be sodium, and this is the case wherever sodium is found. As such, the numbers of electrons becomes an essence necessary for that thing (element) to be itself in the world. This level of assessment is thought to be more problematic at the level of organisms, when complexity increases substantially and the possibilities for classification diversify. Alternatively, essences can be viewed as a property of a thing, for instance, to be human is to have certain characteristics, and this is true of other species. Essentialists would hold that such systems of distinction have validity as natural categories or natural kinds, irrespective and outside of human construction, although how this can be verified is contested. Challenges to essentialism arose through the postmodern turn, which broadly questions how humans can claim external knowledge of the world without reference to cultural, social and political influences. Such challenges are notable in a range of activist movements around gender, race, sexuality and disability that question imposed categorical assessment and the often oppressive consequences of this. Objections arise in part because essentialism deals in binary oppositions such as man–woman instead of ‘gradations and empirical continua’ (Fuchs, 2001, p 13). In this sense, essentialism may be more of an epistemological strategy that aims to establish conditions of natural kind than an entirely successful methodology that manages to do so. Two exemplars of this would be: first, discourse around gender, which posits a range of gender positions, including challenges to binary biological categories (consider trans and intersex people who unsettle binary definitions) and the idea of gender as something socially performed (Butler, 2001); and, second, within psychiatry, the controversial identification of disease states in functional mental illnesses through diagnostic procedures intended to arrive at discrete diagnosis – recently, the validity of this has been questioned by a range of critics, including Boyle (1990), Bentall (2010) and the British Psychological


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Society (2013), who argue that mental ill-health and distress are not necessarily referents of an underlying pathological state. WILLIAM PENSON See also: Social Justice; Stigmatisation and Mental Disorder Readings Bentall, R.P. (2010) Doctoring the mind: why psychiatric treatments fail. London: Penguin. Boyle, M. (1990) Schizophrenia: a scientific delusion. London: Routledge. British Psychological Society (2013) DSM-5: the future of psychiatric diagnosis (2012 – final consultation): British Psychological Society response to the American Psychiatric Association. Leicester: British Psychological Society. Available at: www.bps.org.uk Butler, J. (2001) ‘Gender trouble’, in V.B. Leith, W.E. Cain, L. Finke, B. Johnson, J. McGowan and J.J. Williams (eds) The Norton anthology of theory and criticism. London: WW Norton & Company, pp 2488–501. Cain, M.J. (2012) ‘Essentialism, externalism, and human nature’, in C. Sandis and M.J. Cain (eds) Human nature, Royal Institute of Philosophy supplement: Volume 70. Cambridge: Cambridge University Press, pp 29–51. Ellis, B. (2002) The philosophy of nature: a guide to the new essentialism. Chesham: Acumen. Fuchs, S. (2001) Against essentialism: a theory of culture and society. London: Harvard University Press.


A witness, for the purposes of the criminal trial, is a person who, in the opinion of the judge, is properly qualified in the subject requiring expertise.This will usually be decided by reference to written evidence; though, on rare occasions, the judge will speak with the expert in private to determine their competency (voir dire). An expert may acquire their expertise through formal qualifications or experience; thus, a solicitor with 10 years’ study as an amateur graphologist was an expert in handwriting (R v Silverlock [1894] 2 QB 766). A witness who is not properly qualified will only be permitted to express opinion on factual matters. Similarly, expert opinion will be inadmissible if the witness does not practise in a field that is ‘sufficiently well-established to pass the ordinary tests of relevance and reliability’ (Tapper, 2010, p 545).


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An expert witness will usually give evidence based on facts supplied by others; for example, ‘the pathologist might be asked … given certain marks on the body, what might be the likely cause of death’ (Uglow, 2002, p 324).The expert should state in court the assumed facts upon which the opinion is based.These must then be proved, either by calling the person who supplied the primary facts to give direct evidence of them or, subject to the judge’s discretion to require attendance, the ‘hearsay’ statement of the person with knowledge of the facts relied upon (section 127 of the Criminal Justice Act 2003). This means that expert opinion based on primary facts appearing in reputable research publications are generally admissible. What an expert witness should not be permitted to do is express an opinion on the ultimate issue in a trial. An example would be an expert who is asked whether, in their opinion, a doctor accused of negligence had failed to exercise the expected standard of medical care (see Rich v Pierpoint [1862] F. & F. 35). This is because the answer to this question has the potential to unduly influence the jury on the ultimate issue of guilt. However, in reality, the expert witness is routinely permitted to express their opinion provided ‘the diction employed is not noticeably the same as that which will be used when the matter is subsequently considered by the court!’ (Keane et al, 2010, p 542). Once the judge has admitted the expert opinion, the jury, in deciding the ultimate issue, must decide how much weight to attach to it. A judge should not attempt to direct jury members as to the preferred outcome. An exception exists if uncontradicted medical opinion on the mental state of the accused at the time of the offence indicates that he was not guilty (R v Sanders [1991] 93 Cr App 4 245). By comparison, if the expert evidence is contradictory, the jury must decide which account it prefers. In reaching a decision, the jury may take into account the experience and qualifications of the expert, as well as the relationship between the assumed facts relied upon and the primary facts established. LEON MCRAE See also: Adversarial Justice; Intermediary Readings Keane, A., Griffiths, J. and McKeown, P. (2010) The modern law of evidence (8th edn). Oxford: Oxford University Press. Tapper, C. (2010) Cross and Tapper on evidence (12th edn). Oxford: Oxford University Press. Uglow, S. (2002) Criminal justice (2nd edn). London: Sweet and Maxwell.


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EXTENDED SENTENCES FOR PUBLIC PROTECTION Extended sentences imposed for the purposes of public protection incorporate a range of measures primarily intended to incapacitate individuals and prevent further offending that poses risk of harm. These sentences mostly target three potentially ‘dangerous’ groups: violent offenders, sex offenders and mentally disordered offenders. Measures include life imprisonment without prospect of release (Whole Life Tariff, Life Without Parole), indeterminate prison sentences (Imprisonment for Public Protection in England and Wales), extended postcustodial licences (Scotland’s Order for Lifelong Restriction, New Zealand’s Extended Supervision Orders), licences with additional requirements (electronic monitoring; notification and registration requirements) and post-sentence civil commitment (Sexually Violent Predator legislation in the US). Although incapacitating sentences such as preventive detention and mandatory life terms were available for much of the 20th century (see Forrestor, 2002), public protection has moved to the centre of contemporary penality since the 1990s (Nash, 2006). It is part of a shift in penal climate in developed countries, variously described by criminologists as the ‘new punitiveness’ (Pratt et al, 2013), a ‘culture of control’ (Garland, 2001) or the ‘new penology’ (Feeley and Simon, 1992).This ‘punitive turn’ incorporates more severe sanctions and prioritises risk management. An exemplar is the controversial provision for dangerous offenders introduced in England and Wales in 2003. Imprisonment for Public Protection (IPP) sentences replaced automatic life sentences for repeated serious offending and could be imposed where the court was of the view that further offending posed a significant risk of serious harm to the public. Release was contingent on satisfying the parole board that risk of harm and reoffending was reduced. The formula for presuming dangerousness in IPP sentences was criticised for being too prescriptive and infringing judicial discretion (see Rose, 2012). Government inspection identified a range of systemic problems, noting that IPP prisoners placed pressure on parole and ‘lifer’ management procedures and fuelled a sharp rise in the prison population.A key issue was insufficient provision of appropriate interventions to address risk factors in a timely fashion (tariffs were customarily short); this was the basis of legal challenges mounted in 2007 by prisoners who were detained after their tariff expired. The European Court of Human Rights found that post-tariff detention was arbitrary, unlawful and a breach of convention rights. Following amendment in 2008 and review in 2010, which questioned the sustainability of IPP sentencing, provisions were abolished in 2012 and automatic life sentences for repeated serious offending were restored (Rose, 2012). Critics of public protection sentences argue that such measures are insuperably complex in so far as they deal with anticipated risk, which is difficult to measure 101

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and predict, and designate some offenders as being ‘dangerous’, which is difficult to define (see Nash, 2006).There are concerns that such categorisation is a form of ‘net-widening’, enmeshing more people into the criminal justice system. A further problem is balancing justice with public safety: it is argued that such riskbased sentencing is unfair, reduces offenders’ human, constitutional and civil rights, and punishes people (via incapacitation) for possible future behaviour rather than past (and proven) conduct. CATHERINE ANNE MORGAN See also: Indeterminate Sentences for Public Protection; New Penology Readings Feeley, M.M. and Simon, J. (1992) ‘The new penology: notes on the emerging strategy of corrections and its implications’, Criminology, 30(4): 449–74. Forrestor, A. (2002) ‘Preventative detention, public protection and mental health’, Journal of Forensic Psychiatry and Psychology, 13(2): 329–44. Garland, D. (2001) The culture of control: crime and social order in contemporary society. Oxford: Oxford University Press. Nash, M. (2006) Public protection and the criminal justice process. Oxford: Oxford University Press. Pratt, J., Brown, D., Brown, M., Hallsworth, S. and Morrison, W. (eds) (2013) The new punitiveness. London: Routledge. Rose, C. (2012) ‘RIP the IPP: a look back at the sentence of Imprisonment for Public Protection’, The Journal of Criminal Law, 76: 303–13.


F FALLON INQUIRY The Fallon Inquiry, chaired by Peter Fallon QC, is the committee of inquiry into the Personality Disorder Unit (PDU), Ashworth Special Hospital in 1999. It was held in response to allegations made by a former patient of the PDU that: paedophile activity was taking place in the unit; there were financial irregularities; and pornography, drugs and alcohol were freely available to patients.The Inquiry found that there was evidence to support many of the allegations, including the grooming of a young child by a patient with a history of child sexual abuse. The Fallon Report is the second Ashworth inquiry, the first being led by Louis Blom-Cooper in 1992. The Blom-Cooper Inquiry criticised Ashworth Hospital for being too security-focused, with institutionalised practices that were reminiscent of Goffman’s asylums (Goffman, 1961). The Fallon committee of inquiry reported that in response to the recommendations of the Blom-Cooper Report, Ashworth Hospital had become too liberal. Improvements made to address institutional practices were not tailored to specific client groups, and users with personality disorders were erroneously managed in the same way as those with a diagnosis of mental illness. The Fallon Report had a significant impact on forensic mental health and penal systems, with new procedures established for child visiting, movement of service users to lower levels of security and the increase of physical and procedural security measures within high security. The Report recommended that the PDU at Ashworth Hospital should be closed. Personality disorder services at 103

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Ashworth Hospital were later closed and patients relocated. Other, widerranging recommendations that affected both health and penal systems were also made in the Report. These included enhanced measures for child protection, in particular, that no child under 16 years should visit wards and that children should only visit a member of their own family and be directly supervised. Social services were also to be consulted in advance of children visiting secure services. Further recommendations were made regarding procedural security measures: the searching of staff and visitors; the increased frequency of room searches; and the placing of restrictions on patient access to computer equipment.The Report also highlighted the need for specialist training for professionals working with people with a diagnosis of personality disorder. The Fallon Inquiry called for an independent review of the physical security at Ashworth Hospital. The remit of the review was later widened to encompass all special hospitals in England (Ashworth, Broadmoor and Rampton). The review was led by Sir Richard Tilt in 2000, who was a previous director of English prison services.This review heightened the focus of forensic services on procedural and physical security (Exworthy and Gunn, 2003). LISA REYNOLDS See also: High-Security Hospitals Readings Exworthy, T. and Gunn, J. (2003) ‘Taking another tilt at high secure hospitals: the Tilt Report and its consequences for secure psychiatric services’, The British Journal of Psychiatry, 182: 469–71. Goffman, E. (1961) Asylums: essays on the social situation of mental patients and other inmates. London: Anchor Books.


Female sex offenders are estimated to account for approximately 5% of all sexual abuse (Cortoni et al, 2010). However, sexual offending by females is thought to be under-reported due to widely held societal assumptions that female sexual abuse is either ‘implausible’ or ‘innocuous’. Nevertheless, recognition of female sexual abuse has improved over the past decade as a result of increased research and high-profile cases such as that of nursery worker Vanessa George.


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Low numbers of detected female sex offenders has meant that assessment and management for this population has lagged significantly behind that of male sex offenders. The key issue faced by professionals involved with the assessment and management of female sex offenders relates to the lack of rigorous research conducted. For example, although the rate of female sexual reoffending has been established (at around 1–3%; see Cortoni et al, 2010), very little is known about the factors related to this risk of sexual reoffending in females. As a result, there are no widely accepted tools for assessing risk in female sex offenders. Research is, however, accumulating to suggest that female sex offenders hold possible risk factors or treatment needs in the areas of: offence-supportive thinking (eg beliefs that support offending), sexual interests (eg inappropriate sexual interest in prepubescent children), intimacy (eg poor relationship management), emotional regulation (eg poor coping), and dependency (eg passive traits and dependence on males; see Gannon and Cortoni, 2010). Many of the areas of need identified in female sex offenders are similar to those identified in male sex offenders (ie offence-supportive thinking, sexual interest, intimacy and emotional regulation). However, the emerging research suggests that for females, these factors manifest themselves in gender-specific ways (see Gannon and Cortoni, 2010). One factor identified that appears to be highly specific to female sex offenders and especially crucial for adequate assessment and management of this population is dependency. Research suggests that issues of dependency may increase the likelihood that a woman will be coerced into sexually offending by a male (Gannon et al, 2008). Thus, it is crucial that issues of coercion (on the part of the male) and dependency (of the female) are assessed thoroughly when a female is identified as having sexually abused in the company of a male. Females who have been coerced into sexual offending and those who offend of their own volition have been identified as requiring quite different treatment responses (Gannon et al, 2008). Due to the paucity of research and limited numbers of detected female sex offenders, treatment efforts with this population have been limited in scope.The majority of treatment efforts appear to have been individual in nature, although notable group treatment programmes currently run in Canada Corrections and some states within the US (Blanchette and Taylor, 2010). In the UK, the Lucy Faithful Foundation (a child protection charity) has established a specialist assessment and treatment service for female sexual offenders that has been operating since 1993. This charity provides specialist advice and training for those working with female sexual offenders, as well as tailored assessment and intervention services. THERESA A. GANNON


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See also: Gender, Mental Health and Offending; Sex Offender Treatment Programmes; Sexual Offending Readings Blanchette, K. and Taylor, K.N. (2010) ‘A review of treatment initiatives for female sexual offenders’, in T.A. Gannon and F. Cortoni (eds) Female sexual offenders: theory, assessment, and practice. Chichester: Wiley-Blackwell, pp 119–42. Cortoni, F., Hanson, R.K. and Coache, M.E. (2010) ‘The recidivism rates of female sexual offenders are low: a meta-analysis’, Sexual Abuse: A Journal of Research and Treatment, 22: 387–401. Gannon, T.A. and Cortoni, F. (eds) (2010) Female sexual offenders: theory, assessment, and practice. Chichester: Wiley-Blackwell. Gannon, T.A., Rose, M.R. and Ward, T. (2008) ‘A descriptive model of the offense process for female sexual offenders’, Sexual Abuse: A Journal of Research and Treatment, 20: 352–74.


The theme of mental illness, disorder and distress has pervaded many a cinematic title. Its flow has often been delineated in archetypes, whether the comedic, such as Disney treatments of the Mad Hatter, or the dangerous, such as Hitchcockean figures like Norman Bates in Psycho. Cinema offers vivid opportunities for stigmatisation and categorisation to reach mass and niche audiences paying to see a carnival of psychiatric deviance. The identities that are portrayed range in character and form, such as rebellious free spirits, homicidal maniacs, seductresses, enlightened members of society, narcissistic parasites and creaturelike representations akin to zoo specimens (Hyler et al, 1991). Examples abound such as – and this is merely selective – Jack Nicholson’s character in One flew over the cuckoo’s nest; Robert De Niro’s Travis Bickle in Taxi driver; Anthony Hopkins’s Hannibal Lecter; or Aileen Wuornos in Monster. Critics note a filmic fetish for conflating one minority group with another – hence the penchant for ‘killer Queens’, for the psychotic lesbian figure (see Rubin, 2012) or for the entwining of disability with mental disorder. Contemporary critical debates feed into the effects (if any), uses and reception of these culturally available, lingering archetypes. This, then, is part of the wider media effects and reception debate: this has seen film scapegoated for criminality in some cases by tabloid media (film supposedly precipitates ‘moments of madness’), or exonerated by academics who feel that a causal link between film watching and deviant behaviour is reductive and wrong (Gauntlett, 2005). 106

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We can divide those asserting an effect into two camps. The more pessimistic commentaries are predicated on the assumption that there is an effect on audiences, and that stigmatisation is essentially harmful, whether to popular perception or the mentally ill themselves. Such suggestions have been heavily debated academically, with authors such as Wahl and Yonatan Lefkowits (1989) concluding that films intensified stigmatisation of the mentally disordered and to such a degree that it was resistant to corrective factual information after the films had been shown. The more optimistic authors produced research which concludes that audiences, in particular, college and university students, can be trained so that the psychopolitics of the film, the way it addresses the viewer, can chisel away at prejudice and tempt empathy. Film is a useful resource as it meets with less brow-furrowing (than journals) from ‘visual learners’; furthermore, it provides the main source of information about minority or vulnerable groups for some. For example, Livingston (2004) found that analysing the physical presentations and nonverbal signals of those deemed mentally ill in cinema stimulated criminological imagination. With converged media, film – once seen just as scale and spectacle – is experienced not just in a multiplex, but also in the palm of the hand. Technology means that films can be found both in big-budget Hollywood or Bollywood studios and produced, directed and distributed on the mobile paraphernalia of the general public (such as mobile telephones and tablets). Therefore, the accessibility of fictional and factual images of the mentally ill proliferates. The mentally ill, whether in florid fiction or the mundane everyday, however represented in hegemonic Hollywood or the global South, still find themselves framed by film (see Rubin, 2012). When it comes to dramatising psychiatric disorder, publics remain intrigued and fascinated about such plots driven by medicalised identities – something that has been firmly embedded in the history of film. Further, with the ‘more intense and ubiquitious’ ‘manipulative force associated with the late modern Mediascape’ (Hayward, 2009, p 12), this shows little sign of subsiding. MARK BENDALL See also: Dangerousness and Mental Disorder; Media Representations and Mental Disorder Readings Gauntlett, D. (2005) Moving experiences: media effects and beyond. London: John Libbey.


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Hayward, K. (2009) ‘Visual criminology: cultural criminology-style’, Criminal Justice Matters, 78(1): 12–14. Hyler, S.E., Gabbard, G.O. and Schneider, I. (1991) ‘Homicidal maniacs and narcissistic parasites: stigmatization of mentally ill persons in the movies’, Hospital & Community Psychiatry, 42(10): 1044–8. Livingston, K. (2004) ‘Viewing films about mental illness through a sociological lens’, Teaching Sociology, 32(1): 119–28. Rosenstock, J. (2003) ‘Beyond A Beautiful Mind: film choices for teaching schizophrenia’, Academic Psychiatry, 27: 117–22. Rubin, L.C. (ed) (2012) Mental illness in popular media: essays on the representation of disorders. Jefferson, NC: McFarland and Co. Wahl, O.F. and Yonatan Lefkowits, J. (1989) ‘Impact of a television film on attitudes toward mental illness’, American Journal of Community Psychology, 17(4): 521–8.


‘Folk devil’ is a term used in sociologies of crime and deviance to describe identifiable individuals or groups who have come to be understood as deviant and/or dangerous, and, as such, a threat to civilised society. The concept’s precise roots are unclear, but it rose to prominence through the work of the sociologist Stanley Cohen (1942–2013): specifically, his 1972 text Folk devils and moral panics. Cohen’s (1972) work was heavily influenced by social constructionism and was central to the development of the new deviancy theories in British criminology. Essentially, through his analysis of identifiable youth movements (the ‘Mods’ and ‘Rockers’), Cohen demonstrated how news media and other social commentators played a pivotal role in the symbolic construction of these groups as deviant and/or dangerous, frequently exaggerating their transgressions and the threat they posed, creating what he termed a ‘moral panic’. The folk devil is inextricably bound up with the moral panic: the two concepts are constitutive of one another. Through the social construction of folk devils, moral panics are born, these then go on to reinforce the symbolic image (and, as such, the threat) of the folk devil in popular imaginations. For Cohen (1972) and his contemporaries (eg Young, 1971), these combined processes result in ‘deviancy amplification’, whereby the construction of the folk devil becomes responsible for its perceived threat to society over and above the actual deviancy of those so labelled. As such, the concept of folk devil was subsequently adopted and developed by the Birmingham School scholars in their influential work on ‘muggings’ and the ways in which the symbolic construction of folk devils


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can be utilised by governments to justify draconian law and order policies that strengthen/maintain hegemonic rule (see Hall et al, 1978). As an analytical concept, the folk devil has maintained a prominent position in sociological/criminological theory from its initial deployment in the 1970s up until the present day. However, it has not evolved without attracting critical attention. For example, McRobbie and Thornton (1995) argue forcefully that the proliferation of divergent media outlets in contemporary times has made the construction of folk devils a far more complex (and less effective) process than it once was. Moreover, recent developments in criminological theory have called for a move away from constructionist theoretical apparatuses such as the folk devil in that they have little (if any) potential to aid in advancing understandings of criminal/deviant motivations and proclivities to cause harm (see Hall, 2012). STEPHEN WAKEMAN See also: Cultural Criminology; Deviance; Social Control Theory Readings Cohen, S. (1972) Folk devils and moral panics. London: MacGibbon and Kee. Hall, S. (2012) Theorizing crime and deviance: a new perspective. London: Sage. Hall, S., Critcher, C., Jefferson, T., Clarke, J. and Roberts, B. (1978) Policing the crisis: mugging, the state, and law and order. London: Macmillan. McRobbie, A. and Thornton, S.L. (1995) ‘Rethinking “moral panic” for multimediated social worlds’, British Journal of Sociology, 46(4): 559–74. Young, J. (1971) The drugtakers: the social meaning of drug use. London: Paladin.


G GENDER, MENTAL HEALTH AND OFFENDING There are important links between mental health, gender and offending. Many people whose actions breach criminal laws have mental illnesses. For example, the World Health Organization (WHO) reports that around one quarter of the 2 million prisoners in Europe suffer from a significant mental disorder, and more suffer from common mental health problems, such as depression and anxiety (WHO, 2013). Women are far less likely than men to commit crimes or to participate in the criminal justice system. Across the world, around 80% of offenders dealt with by the police are male. Men are also more likely than women offenders to be sentenced to imprisonment, comprising 95% of prisoners (Walmsley, 2012). At the same time, women in prison are far more likely than men to be diagnosed with a mental illness, reported to be up to 80% of women in prison in Europe (WHO, 2013). While many prisoners have experienced traumatic abuse, relevant both to offending and to the development of mental illnesses, women prisoners are far more likely to have experienced sexual, mental and physical abuse, and around half have also been victims of domestic violence (WHO, 2013). This picture raises fundamental questions for the management of the criminal justice system. Important issues include: how mental illnesses lead to offending; whether there are better ways of managing mental illness in the community; and the extent to which imprisonment itself produces mental illnesses. 111

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The link between mental illness, gender and crime is also, more symbolically, important in criminal law. Criminal law has historically tended to use mental illness as an explanation for violence by women. This may have provided leniency for some women, but also medicalised women’s responses to objective situations (Chan et al, 2005). Criminal defences to homicide such as self-defence and provocation have developed historically and culturally (with different legal jurisdictions adopting different defences) with reference to male behaviour. For example, in some jurisdictions, a man who experienced sexual jealousy and killed his wife or her lover ‘in the heat of the moment’ can raise the defence of provocation. He can argue self-defence if immediately using violence against an attacker. Such defences may have little application to women’s violence. While women’s violence is rare, it is most commonly directed at family members. Women who act violently towards their male intimate partners often tend to do so without an obvious imminent threat and in response to a history of male partner violence (Heimer and Kruttschnitt, 2006). In the 1980s, women’s experiences in such cases came to be characterised as a mental illness, that of ‘Battered Woman Syndrome’, to fit them into the masculine defences (Chan et al, 2005). Following much feminist criticism, subsequent reforms have focused on creating new, more relevant defences (eg ‘loss of control’). Similarly, women who kill their young baby have been able to raise the defence of infanticide, based on the legal assumption that their ‘mind was disturbed by reason of her not having fully recovered from the effect of giving birth to the child or by reason of the effect of lactation’ (Infanticide Act 1938, section 1(1)). In more recent times, the defence has been recognised as an attempt to reflect women’s experience of postnatal depression and isolation, and in some jurisdictions, has been reformulated to make this explicit. BRONWYN NAYLOR See also: Female Sex Offender Assessment and Management; Violence Risk Appraisal Guide Readings Chan, W., Chunn, D. and Menzies, R. (2005) Women, madness and the law: a feminist reader. London: Glasshouse Press. Heimer, K. and Kruttschnitt, C. (2006) Gender and crime: patterns of victimization and offending. New York, NY: New York University Press. Walmsley, R. (2012) ‘World female imprisonment list’. Available at: www. amnistia-internacional.pt/files/WFIL%202nd%20edition%5B1%5D.pdf


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WHO (World Health Organization) (2013) ‘Prisons and health’. Available at: www.euro.who.int/en/what-we-do/health-topics/health-determinants/ prisons-and-health/facts-and-figures


‘Governmentality’ is a term coined by Michel Foucault to refer to a complex form of government that emerged from the 17th century onwards. It took as its focus the regulated well-being of the population. It was distinguished from discipline, for example, which referred to the technique of governing problems through the correction of individuals who deviated from a norm, characteristic of institutions such as prisons and hospitals. Governmentality is characterised by the idea that distributive phenomena such as populations and economies, or rates of madness and crime, have their own determinants and cannot simply be commanded. In consequence, new relations were established between government and expertise such that criminologists and psychiatrists became indispensable to good government of crime or mental health. This ‘historical’ governmentality was characterised by knowledge of (often statistical) distributions of phenomena, which, in turn, also linked governmentality historically with the development of predictive and preventive (‘risk-based’) techniques of rule. In his analysis of the rise of historical governmentality, Foucault deployed a methodological technique that he also referred to as governmentality. This analytical tool became especially influential in the study of criminal justice, health (including mental health) and related institutions, such as insurances and crime prevention. Its chief characteristics were threefold. First, the identification of how governmental programmes understand the ‘problem’ they are to govern. This ‘problem’ includes explanations, for example, of violent crime or schizophrenia, and ‘subjectifications’, or the types of problem ‘subject’ (eg ‘born criminals’) believed to exist. Second are the outcomes sought. Again, these were likely to include subjectifications (the ideal subjects to be created), as well as desired conditions, such as recovery from paranoia or declining crime rates. Third are the closely linked techniques of government deployed to bring about the desired ends. Thus, if violent offending is believed to arise out of a ‘culture’ of violence, the techniques deployed would differ from those mobilised to deal with a ‘problem’ of individual pathology. An essential feature of governmentality is that the truth or otherwise of governmental visions is not questioned. What matters is that these representations of truth inform government, and thus justify it and give it shape. The analytic is deceptively simple, but takes its form from a methodological refusal to announce 113

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any theoretically driven ‘truth’, partly because this would provide a licence to govern and form a political programme. Likewise, centring governance as emerging from ‘problems’ and inventiveness is intended to deflect visions of history as determined by theoretically identified forces. Governmentality is part of a broader project concerned to minimise domination, and its aim is to produce a ‘strategic knowledge’ for use in such politics. This is not a sociological or theoretical account, but a ‘diagram’ of power. Thus, Foucault’s account of the panoptic prison was based on documents mapping out the ‘ideal’ prison, its aims and techniques, rather than on descriptions of prisons in action – for it is the former that reveals the strategy of governance; the latter only reveals their imperfect realisation. PAT O’MALLEY See also: Carceral Society; Risk Society Readings O’Malley, P. (2010) ‘Governmental criminology’, in E. McLaughlin and T. Newburn (eds) The Sage handbook of criminological theory. London: Sage, pp 319–36. Rose, N., O’Malley, P. and Valverde, M. (2006) ‘Governmentality’, Annual Review of Law and Social Science, 2: 83–104.


H HIGH-SECURITY HOSPITALS In the UK, high-security hospitals are specialist psychiatric services within the National Health Service (NHS), providing care and treatment for individuals who have a mental disorder that is related to the risk of violence towards others. The National Health Service Act 2006 (as amended by the Health and Social Care Act 2012) places a duty on the secretary of state to ensure provision of services for individuals ‘who require treatment under conditions of high security on account of their dangerous, violent or criminal propensities’. Individuals meeting the criteria for admission are transferred for assessment and/or treatment either via the criminal justice system or other NHS services, such as medium-secure units, if they cannot be safely managed in conditions of lesser security. Thus, the purpose of high-security hospitals is to provide high-level, secure psychiatric care and treatment for mentally disordered offenders and those at risk of offending, while ensuring public protection. Risk assessment, individual formulation and management of violence are key challenges for clinicians in any secure setting (see Logan and Johnstone, 2012). Therapeutic interventions aim to increase patients’ mental health awareness, promote recovery, reduce the risk of recidivism and alleviate symptoms of their mental disorder through multidisciplinary working. Ashworth, Broadmoor and Rampton Hospitals are the three high-security psychiatric hospitals in England and Wales, with the state hospital, Carstairs, serving Scotland and Northern Ireland, operating under Scottish mental health 115

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legislation. The history of the provision of high-security psychiatric care in the UK can be traced back to the cases of James Hadfield in 1800 (see Stevens, 2013) and Daniel M’Naghten in 1843. Puri, Brown, McKee and Treasaden (2012) highlight notable changes in mental health care and legislation, including the case of Daniel M’Naghten. M’Naghten believed that he had been poisoned and attempted to shoot the Prime Minister Sir Robert Peel, but killed his secretary in the process. He was considered to be ‘deluded and insane’ and was acquitted. This case led to the ‘M’Naghten (or McNaughton) Rules’, proposed to better inform the decision-making process in court in cases where individuals were purported to be ‘not guilty by reason of insanity’, thus introducing the legal concept of insanity. Although other places of ‘asylum’ existed for such individuals, a lack of suitable facilities at Bethlem Hospital, and the need for appropriate placements, led to the introduction of the Criminal Lunatics Asylum Act 1860, which, in turn, led to the building and opening of Broadmoor Hospital in 1863. Due to overcrowding, other hospitals were built, with Rampton Hospital opening in 1912. Moss Side Hospital opened in the 1920s, followed by Park Lane Hospital in 1974; later, these merged to become Ashworth Hospital in 1990. Following various inquiries into the high-secure hospitals, including two inquiries into practices at Ashworth Hospital in the 1990s, greater emphasis has been placed on integrating therapy and security. It remains an ongoing challenge for staff working in high-security hospitals to achieve a true balance between the dual aims of protecting the public and facilitating patients’ recovery and rehabilitation. SARAH GLADDEN See also: Bethlem Royal Hospital; Fallon Inquiry Readings Logan, C. and Johnstone, L. (eds) (2012) Managing clinical risk: a guide to effective practice. Abingdon: Routledge. Puri, B.K., Brown, R.A., McKee, H.J. and Treasaden, I.H. (2012) Mental health law: a practical guide (2nd edn). London: Hodder Arnold. Stevens, M. (2013) Broadmoor revealed: Victorian crime and the lunatic asylum. Barnsley: Pen and Sword Social History.


In England and Wales, the Mental Health Act 1983 (as amended 2007) contains provision for those people who commit criminal offences while suffering from 116

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some form of mental health condition. Section 37 allows the Crown Court to impose what is known as a Hospital Order on someone who has been convicted of an imprisonable criminal offence, often, but by no means exclusively, entailing violence. They require an individual to reside in hospital and receive treatment that will hopefully alleviate their mental health difficulties and, as a corollary, reduce the likelihood of reoffending. Significantly, however, once such an order is made, the patient is legally completely removed from the criminal justice system (except for those circumstances in which a Hospital Order is also ‘restricted’ under section 41). Certain criteria must be satisfied in order for a Hospital Order to be imposed, namely, that the individual is suffering from a mental illness or impairment, or psychopathy, of a nature or degree that warrants hospital treatment. In this respect, there is little distinction between the criteria for admission in criminal or civil cases. There are, of course, controversies regarding the operation of all aspects of the Mental Health Act, and the Hospital Order is no different. There are practical issues, for example, regarding the availability of beds in medium secure settings, potentially inhibiting the use of the order in appropriate cases. However, it is ethical issues that can be most perplexing, whether for the lay person or the professional At an ethical level, culpability is an important consideration in deciding whether or not a Hospital Order is more appropriate than a custodial disposal. The issue here will be whether or not, even though an offender clearly was or is mentally ill, they nevertheless chose to commit an offence. This paradox cuts both ways, as mental disorder need not have played a role in the offence that the Hospital Order might be made in the context of. Thus, it is possible for a mentally ill offender to receive a custodial sentence inappropriately, or for an offender who was not mentally ill when an offence was committed to receive a Hospital Order where a custodial sentence might appear warranted. There are also concerns about the veracity of professional judgement. Sometimes, particularly in high-profile cases, the decision to impose a Hospital Order attracts criticism as a supposedly ‘soft’ sentence. The suspicion here is that offenders play up mental health conditions in order to escape justice, and that mental health professionals – usually psychiatrists – are taken in by this. Equally, judges may ‘duck’ the decision to impose a Hospital Order, rather than a prison sentence (Peay, 1997), possibly to avoid media opprobrium, ‘safe’ in the knowledge that once within the prison system, ongoing symptoms can be addressed via transfer from prison to hospital under section 47. While meeting pragmatic considerations, such approaches neglect important justice-related considerations regarding the impact that criminal sentence or medical diagnosis can have on an individual’s future life trajectory.


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Although data is difficult to synthesise, the consensus among commentators is that patients subject to a Hospital Order generally spend longer in hospital than the equivalent prison sentence for a similar offence. This is because the focus of the order is treatment of mental disorder rather than proportionality between offence seriousness and sentence length. Discharge will only occur once clinicians are convinced that the patient is no longer suffering from a mental disorder, and this may sometimes take a long time, especially where there are concerns about risk. As Bartlett and Sandland (2003, p 296) state: ‘it can be no easy feat to leave hospital for those sent there by a court’. This highlights that it is in its operation that mental health legislation effectively delineates the borders between madness and badness, thus necessitating careful, considered decision-making by practitioners, whose judgements must always seek to strike an appropriate balance between freedom and constraint, justice and well-being. MARK HARDY See also: Compulsory Hospitalisation; Defence of Insanity; Mental Health Act 2007 Readings Bartlett, P. and Sandland, R. (2003) Mental health law: policy and practice (2nd edn). Oxford: Oxford University Press. Peay, J. (1997) ‘Mentally disordered offenders, mental health and crime’, in M. Maguire, R. Morgan and R. Reiner (eds) The Oxford handbook of criminology. Oxford: Oxford University Press, pp. 496–527. Peay, J. (2011) Mental health and crime. Abingdon: Routledge.


Hostage/Crisis Negotiations (H/CNs) is the discipline of using communication techniques and time to preserve life in situations where: (a) one or more subject(s) (Ss) have barricaded themselves in a fortified/unknown location with or without hostages; and/or (b) one or more hostage taker(s) (HTs) seize one or more unwilling person(s) and hold them through the threat or actual use of violence. Although its validity has been challenged (Lipetsker, 2004), the Federal Bureau of Investigation’s Hostage Barricade Statistics database suggests that police negotiators most frequently attend incidents that fall into one of two broad behavioural categories:


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1. Instrumental, or hostage, incidents occur when an HT seizes one or more hostages (Hs) for the purpose of forcing third parties, such as family, civil or hospital authorities, to fulfil demands for items, such as money, freedom and so on, that serve easily recognisable, often explicitly stated, goals that benefit the HT. Since HTs’ behaviour is typically rational and goal-directed, negotiation techniques include bargaining and problem-solving. Miller (2005) reports that fewer than 20% of incidents involve actual hostage taking. 2. Expressive, or non-hostage, incidents constitute the remainder of police cases (Sherman, 2006). Miller (2012) suggests that, of these, up to 52% involve Ss with diagnosed mental disorders, most commonly, paranoia, depression and antisocial personality disorder. Non-hostage incidents include those where a subject has barricaded themselves without hostages. These are often precipitated by crises such as domestic violence, becoming trapped while committing a crime, mental disorder, substance abuse, suicidality and so on. Ss experience a temporary episode of intense emotional distress, overwhelming their ability to cope and causing a disorganised and/or self-destructive approach to problemsolving. Apart from demands to be left alone, substantive demands are not usually made. Since Ss’ behaviour is typically irrational and not goal-directed, negotiation techniques include active listening, where the negotiator reflects back to the Ss what the negotiator has heard. This can reduce Ss’ emotional distress, increase rationality and engage them in a positive problem-solving mode. Most injuries and deaths to hostages and others are due to rescue attempts (Sherman, 2006). Rescuer-caused fatalities at Attica State Prison and elsewhere in the 1970s highlighted the need for a set of non-lethal tools to safely manage these incidents. New York City Police Department Psychologist/Detective Harvey Schlossberg developed techniques such as ‘dynamic inactivity’, which uses time to negotiators’ advantage. Fully trained hostage negotiation teams are now the norm in law enforcement agencies across the world. Despite being illegal in some countries, and criticism that it promotes kidnapping, the kidnap and ransom (K&R) insurance industry provides those operating in high-risk areas with professional negotiators and financial compensation if the insured is kidnapped. K&R negotiators’ aim is to preserve life. They normally advise clients on how and when to pay ransoms. Focused less on apprehension than police, most will cooperate with them when required (Álvarez, 2007). Sherman (2006) and Miller (2005) report that 87–95% of hostage incidents and 90% of non-hostage incidents are resolved through negotiations with no fatalities. JAMES R. ÁLVAREZ


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See also: Mental Disorder; Dangerousness and Mental Disorder; Personality Disorder and Offending Readings Álvarez, J.R. (2007) ‘The psychological impact of kidnap’, in E. Carll (ed) Trauma psychology. Westport, CT: Greenwood/Praeger, pp 61–96. Lancely, F.J. (2003) On-scene guide for crisis negotiators (2nd edn). Boca Raton, FL: CRC Press. Lipetsker, A. (2004) ‘Evaluating the hostage barricade database system (HOBAS)’, Journal of Police Crisis Negotiations, 4(2): 3–27. Miller, L. (2005) ‘Hostage negotiation: psychological principles and practices’, International Journal of Emergency Mental Health, 7(4): 277–98. Miller, L. (2006) Practical police psychology: stress management and crisis intervention for law enforcement. Springfield: Charles C. Palmer Publisher Ltd. Miller, L. (2012) ‘Practical psychology of hostage and crisis negotiation’. PowerPoint slides presented at the training meeting of the Delaware Valley Negotiators Association, September, Conshohoken, Pennsylvania, USA. Available at: http://delvalnegotiators.org/Miller-HostageCrisis.pptx Sherman, B. (2006) ‘Selection and training of a crisis negotiation team’, The Negotiator Magazine, May. Available at: http://negotiatormagazine.com/ article324_3.html Soskis, D.A. and Van Zandt, C.R. (1986) ‘Hostage negotiation: law enforcement’s most effective nonlethal weapon’, Behavioral Sciences & the Law, 4: 423–35. Strenz, T. (2006) Psychological aspects of crisis negotiation. Boca Raton, FL: CRC Press.


Human rights are a universal set of values legally defined under the European Convention on Human Rights (ECHR) and include: the ‘right not to be tortured or treated in an inhuman or degrading way’ (Article 3); the ‘right to liberty’ (Article 5); and the ‘right to a fair trial’ (Article 6). The Human Rights Act 1998 guarantees that all UK citizens are protected by these rights and that disputed cases may be referred to the European Court of Human Rights. However, protecting the human rights of mentally disordered offenders (MDOs) presents challenges. First, people with mental health problems, and especially those who also break the criminal law, are not easily portrayed in society as victims of human rights violations (Peay, 2011). Economically and politically, mental health matters are afforded low priority relative to other health concerns and there is no unified message from experts about what mental disorder means (Dudley et al, 2012). 120

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As a consequence, those defined as mentally disordered become stigmatised, a ubiquitous and persistent attitude that often results in MDOs experiencing various form of social marginalisation and exclusion (Boardman, 2011). Second, because MDOs are the concern of both mental health and criminal justice agencies, the concept of responsibility is central to a consideration of human rights. The problem is that while mental disorder and crime may co-occur, this does not mean that they are related (Peay, 2011). Therefore, MDOs may be legally understood as either offender-patients (persons who are criminally culpable but with an unconnected mental disorder) or patient-offenders (person who are mentally unwell and who offend as a consequence). Attempts to differentiate these two types of offender/patient have implications for Article 6, as the police, lawyers and psychiatrists try to determine complex jurisprudent/mental health matters such as: whether to divert the accused away from criminal prosecution and into mental health care; the defendant’s fitness to plead; and their competency to stand trial. Third, the co-occurrence of mental disorder and offending behaviour also creates significant problems in terms of Articles 3 and 5. If the offender/patient is to be detained, should this be in a prison (as a punishment for their offence) or a hospital environment (where their mental disorder can be treated)? Detention in prison could result in a violation of Article 5 because it might be deemed inhumane and degrading not to appropriately treat the offender’s mental disorder (European Court of Human Rights, 2012). However, being sectioned to hospital under the Mental Health Act 1983 (as amended 2007) might result in a violation of Article 3, as the offender/patient may be forced to stay in hospital for longer than the prison sentence punishment for their particular criminal offence. The complexity of the situation is exacerbated by the fact that the actions of MDOs violate Article 17 of the ECHR, which recognises that individual rights are limited in order to secure, protect and respect the rights of others in the wider society. Thus, there is often a tension between the rights of the MDO and the rights of the wider community, which, in turn, raises questions about the risk that the offender/patient poses to society and the public’s demand for retribution for the offence. Some progress has been made towards ensuring that mental health legislation protects human rights, including the introduction of the Mental Capacity Act 2005, the Deprivation of Liberty Safeguards (DOLS) and, somewhat controversially, aspects of the Mental Health Act 2007. However, Lewis (2009) argues that achieving better human rights for MDOs will require the adoption of mental health legislation that moves away from a controlling or even a paternalistic response, towards an emancipatory agenda that recognises the lived experiences of


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those with mental distress and tackles the prejudice, discrimination and exclusion that often affects their daily lives. TONY COLOMBO and TIM TURNER See also: Deprivation of Liberty Safeguards Readings Boardman, J. (2011) ‘Social exclusion and mental health: how people with mental health problems are disadvantaged: an overview’, Mental Health and Social Inclusion, 15(3): 112–21. Dudley, M., Silove, D. and Gale, F. (2012) Mental health and human rights: vision, praxis and courage. Oxford: Oxford University Press. European Court of Human Rights (2012) ‘M.S. v. THE UNITED KINGDOM – 24527/08 [2012] ECHR 804’, 3 May. Available at: www.bailii.org/eu/cases/ ECHR/2012/804.html Lewis, L. (2009) ‘Mental health and human rights: social policy and sociological perspectives’, Social Policy and Society, 8(2): 211–14. Peay, J. (2011) Mental health and crime. Oxford: Routledge.


I INDEPENDENT MONITORING BOARDS Independent Monitoring Boards (IMBs) are groups of independent, unpaid, lay people who have a statutory role in monitoring day-to-day life in their local custodial institution (whether public or contracted out), including ensuring the humane and just treatment of those held in custody. All prisons and immigration removal centres, and some short-term holding facilities at airports, have their own designated IMBs. Each board is usually made up of between 12 and 20 members selected from the local area. Originally created by Queen Elizabeth I, the activities, responsibilities and composition of IMBs have evolved over time. Under the Prison Act 1898, Boards of Visitors were created for each of the convict prisons. Visiting Committees continued to operate in local prisons until 1971, when they were replaced by Boards of Visitors. For over 100 years, there was a stipulation that each Board of Visitors had to include at least two magistrates, but that requirement has now been abolished. Although, prior to 1992, Boards of Visitors held adjudicatory/ disciplinary powers and responsibilities, the function of IMBs is now one of oversight and monitoring. Following the recommendations of the Lloyd Review (Home Office, 2001), they were renamed ‘Independent Monitoring Boards’, which reiterated their role in monitoring and oversight and removed confusion with the role and responsibilities of official Prison Visitors. IMBs are required to meet at least once a month and, between meetings, at least one IMB member must carry out an inspection visit. These routine visits are 123

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usually organised on a rota basis. Subject to security issues, IMB members have unrestricted access to all prisoners and to all parts of the prison, at any time, and may interview any prisoner out of the sight and hearing of officers. In addition, they deal with requests made by individual prisoners and must be notified of any serious incident by the governor, without delay, so that they can monitor the situation and its outcomes. At the end of the rota week, a written report of the visit(s) must be submitted to the governor, and it is expected that any urgent matters or those needing immediate attention will be discussed immediately with the governor. Each IMB submits an annual report to the secretary of state, which is then published on the IMB website. The National Council for Independent Monitoring Boards (NCIMBs) also publishes annual reports, which highlight themes and matters of concern, combined with the identification of good practice. IMBs provide a significant mechanism for the visible promotion and protection of prisoners’ rights and standards of care in custody. However, there are sometimes tensions in the recent debates surrounding IMB members’ access to Security Information Reports (SIRs), although throughout the negotiation process, the emphasis on the right of access to all prisoners and parts of prisons at all times has been a key focus (NCIMBs, 2013). Their role has been strengthened and reinforced as they are now recognised as forming one of the 18 bodies that collectively constitute the UK’s National Preventive Mechanism, in line with the Optional Protocol to the United Nations Convention Against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (OPCAT), which came into force in 2006. HELEN CODD See also: Human Rights and Mentally Disordered Offenders; LongTerm Imprisonment and Mental Health Readings Home Office (2001) Review of the Boards of Visitors: A report of the working group chaired by Rt. Hon. Sir Peter Lloyd MP. London: Her Majesty’s Stationery Office. NCIMBs (National Council for Independent Monitoring Boards) (2013) ‘“Behind closed doors”: 2012 annual report’. Available at: https://www.justice. gov.uk/downloads/about/imb/behind-closed-doors-2012.pdf


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INDETERMINATE SENTENCES FOR PUBLIC PROTECTION Coming into force in April 2005, Indeterminate Sentences for Public Protection (IPPs) were introduced by New Labour as a way of proving to the public that the government was proactively managing crime (Nash, 2010). New Labour took a more punitive approach to crime to reassure society that they were being given the best protection against criminal activity (Prins, 1999; Nash, 2010). The development of the IPP was a policy to represent this tough approach to crime, mainly because of the fact that punishment was based upon risk and the probability that an offender would repeat criminal behaviour, and cause further harm to society, at some point in the future (Nash, 2010). Thus, the court could issue an IPP to those convicted of offences classed as dangerous and those who were believed to have the potential of becoming dangerous in the future (Nash, 2010). IPP prisoners would be given a sentence tariff, which outlined the minimum amount of time they must spend in prison; however, there was no right to automatic release (Peay, 2011).Therefore, IPPs enabled dangerous offenders to be imprisoned until they could prove that they were no longer a risk of causing harm to society (Nash, 2010). Despite IPPs being New Labour’s attempt to provide society with protection from dangerous offenders, they quickly came under scrutiny (Prins, 1999). IPPs were criticised for causing severe distress and damage to the mental well-being of IPP prisoners (Asthana, 2010). The fact that offenders had no guarantee of release from prison kept them in a state of limbo regarding release dates. This had a direct impact on the mental well-being of IPP prisoners and resulted in individuals developing psychological issues or exacerbating existing mental health conditions. In addition, IPP prisoners found it extremely difficult to prove that they were no longer a risk to society in order to be released from prison, because the courts were often hesitant to release such offenders due to there being no guarantee that further crimes would not be committed (Asthana, 2010). Research has shown that being imprisoned for longer periods of time, with no set release date, has a negative effect on an individual’s mental health, with a study showing that IPP prisoners had a significantly higher rate of mental health illnesses and suicide compared to the overall prison population. Due to being heavily criticised, IPPs were abolished in 2012 and were widely accepted as being an extremely ill-thought-out piece of legislation, which had detrimental effects on the mental well-being of IPP prisoners, as well as being unsuccessful in managing the risk of crime (Prins, 1999). EMMA PRICE


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See also: Criminal Justice Act 2003; Extended Sentences for Public Protection Readings Asthana, A. (2010) ‘Prisoners on indeterminate sentences “left in limbo” over parole dates’, The Observer, 31 October. Available at: www.guardian.co.uk/ society/2010/oct/31/prisoners-left-in-limbo-parole Nash, M. (2010) ‘The politics of public protection’, in M. Nash and A. Williams (eds) Handbook of public protection. Cullompton: Willan Publishing, pp 60–82. Peay, J. (2011) Mental health and crime. London: Routledge. Prins, H. (1999) Will they do it again? Risk assessment and management in criminal justice and psychiatry. London: Routledge.


Infanticide is the killing of a child under the age of 12 months by one or both parents. Another closely related concept is filicide, which is the killing of a child by one or both of its parents. In research, a distinction is made between infanticide and neonaticide, in which the latter refers to the killing of a newborn during the first 24 hours after its birth. While a majority of neonaticides are committed by mothers, in infanticides, fathers are perpetrators in slightly more than half of the cases overall (West, 2007). In the past, infanticide was considered permissible in many societies, and in some present-day jurisdictions, certain mitigating circumstances differentiate this act from other forms of killings (Marks, 2009). In more than 20 jurisdictions, for example, England, Wales and Sweden, ‘Infanticide Acts’ were introduced based on the idea that child-bearing and delivery may disturb the balance of the mind of the mother; therefore, she should be considered to have diminished criminal responsibility, or be punished less severely. In a comprehensive study from England and Wales, 16% of all filicide offenders between 1996 and 2001 were convicted under the terms outlined by the Infanticide Act 1938 (Flynn et al, 2007). In absolute numbers, infanticides are rare; however, it is important to note that a newborn child is at a considerably higher risk of being killed compared to individuals in other age groups. Moreover, newborn children are four times more likely to be the victim of homicide in their first year of life, compared to during the rest of their lives. In England and Wales, the rate of infanticide, 4.5 per 100,000 live births, is reported to have remained stable over the last 30 years (Flynn et al, 2007). The most important risk factors for infanticide are lack of prenatal care, young maternal age (below age 20), low education (less than 12 years) and being a single parent (Overpeck et al, 1998). There is an established 126

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link between infanticide and various mental health problems, particularly for neonaticide perpetrators. It is not uncommon that the mothers hide or deny their pregnancy until delivery. In another study from the UK, a majority of the mothers (66%) and a considerable proportion of the fathers (27%) who had killed their child had a history of mental illness and displayed psychotic symptoms (53% versus 23%) at the time of the offence (Flynn et al, 2013). It should be noted that as infanticides are rare, prevention is difficult, and preventive measures should target specific risk groups, such as young, single mothers with a history of mental illness. JOAKIM STURUP See also: Diminished Responsibility; Gender, Mental Health and Offending Readings Flynn, S., Shaw, J. and Abel, K. (2007) ‘Homicide of infants: a cross-sectional study’, Journal of Clinical Psychiatry, 68: 1501–9. Flynn, S., Shaw, J. and Abel, K. (2013) ‘Filicide: mental illness in those who kill their children’, PLoS ONE, 8(4): 1–8. Marks, M. (2009) ‘Infanticide’, Psychiatry, 8(1): 10–12. Overpeck, M., Brenner, R., Trumble, A., Trifiletti, L. and Berends, H. (1998) ‘Risk factors for infant homicide in the United States’, New England Journal of Medicine, 339(17): 1211–16. West, S. (2007) ‘An overview of filicide’, Psychiatry, 4(2): 48–57.


Over the last 200 years, public inquiries have played a key role in the development of policies and services for people who experience mental health problems (Alaszewski and Brown, 2012). In 1813, Godfrey Higgins, a York magistrate, investigated the York Asylum and uncovered mistreatment and financial irregularities. Unable to get action to remedy the problems, he informed the press, but to prevent a full investigation, the staff burnt down part of the building, killing four patients and destroying incriminating records.This stimulated a parliamentary inquiry into conditions in asylums, resulting in state action to regulate the care and treatment of people with mental health problems and provide public asylums (Jones, 1972). The 19th-century system of state regulation and public asylums survived the formation of the National Health Service in 1948 and was only undermined 127

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by another public inquiry. In 1954, the then minister of health appointed a Royal Commission (Royal Commission on the Law Relating to Mental Illness and Mental Deficiency, 1957) to examine concerns articulated by the National Council for Civil Liberties and Members of Parliament about the ways in which individuals detained in mental deficiency hospitals were deprived of their civil liberties and exploited. The Royal Commission noted that the existing legalistic framework was hindering the development of more progressive, community-based services and that legal compulsion to treatment should be used as a last resort. Its recommendations underpinned the Mental Health Act 1959 and the subsequent development of community care. The more recent period has been characterised by an increasing number of ‘disasters’ and inquiries. In the 1970s, these related mainly to the inadequacies of isolated and institutionalised hospitals, such as the Inquiry into Rampton Hospital, which found large-scale brutality by staff who were resistant to change (Department of Health and Social Security, 1980). In the 1990s, there was evidence of a new type of disaster, serious harm resulting from the discharge of patients from acute mental health facilities into inadequate community services. Christopher Clunis’s fatal attack on Jonathan Zito became a defining event. The subsequent inquiry identified important service failures, particularly the failure to effectively assess the risk that Clunis posed to others (Ritchie Inquiry, 1994). These events had major repercussions: for the press, they indicated the failure of community care and became an iconic way of framing mental illness as a source of danger. The Department of Health sought to reassure the press and public through the care programme approach, which involved assessing and managing risk. For those providing care and treatment, there was increased pressure to play safe, which underpinned the development of a risk escalator in which it was far easier to increase a patient’s level of assessed risk than to reduce it (Heyman et al, 2002). The Department of Health also moved to routinise inquires, instructing local health agencies to set up an inquiry ‘independent of the providers involved’ (Department of Health, 1994, p 11) whenever a person who had been in receipt of mental health services killed another person. In 2005, the Department of Health reissued the guidance and extended it to all ‘adverse events’ in mental health services, for example, suicides (Department of Health, 2005). Inquiries involve the application of root-cause analysis to identify why an adverse event has occurred, and should focus on openness, learning and creating change (Department of Health, 2005). From 1995 onwards, there were on average over 50 homicides a


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year in which the courts accepted a plea of diminished responsibility (Szmukler, 2000) and 15 published reports a year (Munro, 2005). ANDY ALASZEWSKI See also: Fallon Inquiry; High-Security Hospitals Readings Alaszewski, A. and Brown, P. (2012) Making health policy: an introductory text. Cambridge: Polity Press. Department of Health (1994) Guidance on the discharge of mentally disordered people and their continuing care in the community, London: Department of Health. Department of Health (2005) Independent investigations of adverse events in mental health services. London: Department of Health. Department of Health and Social Security (1980) Report of the review of Rampton Hospital: Cmnd 8073. London: Her Majesty’s Stationery Office. Heyman B., Griffiths C.B. and Taylor, J. (2002) ‘Health risk escalators and the rehabilitation of offenders with learning disabilities’, Social Science and Medicine, 54(9): 1429–40. Jones, K. (1972) A history of the mental health services. London: Routledge. Munro, N. (2005) ‘What can policy makers learn from homicide inquiries?’. Available at: www.lse.ac.uk/collections/CARR/pdf/05StudentConf/Munro.pdf Ritchie Inquiry (1994) Report of the inquiry into the care and treatment of Christopher Clunis: Chairman J. H. Ritchie. London: Her Majesty’s Stationery Office. Royal Commission on the Law Relating to Mental Illness and Mental Deficiency (1957) Report: Cmnd 169. London: Her Majesty’s Stationery Office. Szmukler, G. (2000) ‘Homicide inquiries: what sense do they make?’, Psychiatrist, 24: 6–10.


While a broad historical lens may capture a number of scholarly works accounting for the history of madness, insanity and mental illness, the pre-eminent text is Foucault’s Histoire de la Folie, published in French in 1961 initially, and then as an abridged text in English in 1967 as Madness and civilisation: a history of insanity in the age of reason (Foucault, 1971). This was Foucault’s first major work with a broad readership, and was seen as a major contribution to the field of critical mental health and psychiatry (Miller, 1994), although he had previously published a short text titled Madness: the invention of an idea in 1954 (Foucault, 1976). Madness and civilisation is significant to Foucault’s oeuvre in two other ways: first, in his 129

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treatment of the operations of clinical disciplinary powers and domination (Dreyfus and Rabinow, 1982), expertise and practice; and, second, as an early example of his archaeological strategy. Archaeology, in this case, refers to an account not so much of the truth of the claims of psychiatry and its earlier iterations, but of the conditions and contingencies that allowed psychiatry and psychology to position themselves as disciplines, and be able to make certain statements about madness that can only be made if certain social, legal, practical and political conditions are such. Foucault edits an illustrative case study of such a process in I, Pierre Rivière (Foucault, 1978), a lesser-known text, illuminating a key point in French history wherein psychiatric expertise made its presence known, and negotiated itself into legal proceedings: the expert witness, ideas of fitness to plea, extenuating circumstances and sentencing. Foucault’s early archaeological work becomes the basis of his later genealogical strategies for enquiry. Madness and civilisation was a key text in the anti-psychiatry movement, and David Cooper, a British anti-psychiatrist, wrote the preface to the English edition. The publication of this abridged version raised problems in the translation, often hinging on a nuanced reading of just one word or phrase, which led to this version being treated as controversial, with accusations of poor scholarly work and vagueness. Still and Velody’s (1992) Rewriting the history of madness: studies in Foucault’s Histoire de la folie is dedicated to discussing these flaws, and contestations, prior to the full English translation published in 2006 as History of madness (Foucault, 2006). Khalfa (2006, p xix) explains that the History of madness: was to trace the origins of our conception of human beings as psychological subjects from the moment when a radical separation between madness and reason had taken place … and when the possibility of a science of this new object appears. Despite its age, and its historical subject, History of insanity remains a seminal text in the mental health field, which links to Foucault’s later work on sexuality and penology, and it remains controversial in its treatment of modern psychiatry and psychology. His historical critiques illuminate the present (Veyne, 2010): they ‘develop a general diagnosis of our current cultural situation’ (Dreyfus and Rabinow, 1982, p xxii). WILLIAM PENSON See also: Bethlem Royal Hospital; York Retreat


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Readings Dreyfus, H.L. and Rabinow, P. (1982) Michel Foucault: beyond structuralism and hermeneutics. Brighton: The Harvester Press. Foucault, M. (1971) Madness and civilisation: a history of insanity in the age of reason. London: Tavistock. Foucault, M. (1976) Madness: the invention of an idea. London: Harper Perennial. Foucault, M. (ed) (1978) I, Pierre Rivière, having slaughtered my mother, my sister and my brother: a case of parricide in the 19th century. London: Penguin. Foucault, M. (2006) History of madness. London: Routledge. Kalfa, J. (2006) ‘Introduction’, in M. Foucault, History of madness. London: Routledge, pp xiii–xxvi. Miller, J. (1994) The passion of Michel Foucault. London: Flamingo. Still, A. and Velody, I. (eds) (1992) Rewriting the history of madness: studies in Foucault’s Histoire de la folie. London: Routledge. Veyne, P. (2010) Foucault: his thought, his character. Cambridge: Polity Press.


A separate entry deals with the issue of what happens if a defendant cannot participate in a trial (‘unfitness to stand trial’); mental disorder may also be relevant in assessing whether the defendant was in control of his or her actions at the time of the incident that gives rise to the charge or was acting involuntarily or without the relevant guilty mind so as to be not guilty by reason of insanity.The substantive test for insanity is a matter for the common law; however, there is statutory regulation of the consequences. The M’Naghten Rules, announced by the judges in response to questions from the House of Lords, set the test for insanity: a presumption of sanity must be displaced, which involves showing that the defendant did not know the nature or quality of what he or she was doing or that it was legally wrong. This state must arise from a ‘defect of reason’ caused by a ‘disease of the mind’.This is not limited to psychiatric disorders, and can arise from physical conditions that cause a lack of control (eg arteriosclerosis); while it can be temporary, it will not be made out if due to an external cause (eg hypoglycaemia, anaesthetics). Complexities arise if there is a mixture of internal and external causes (such as a mental disorder made worse by intoxication) or is self-induced (eg failing to take adequate food with an insulin injection). In the Crown Court, if the defendant is found to have committed the act while insane, the verdict is not guilty by reason of insanity (section 2 of the Trial of Lunatics Act 1883). If the defendant did not commit the act, the verdict will simply 131

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be not guilty. The special verdict had since 1800 led to indeterminate detention (‘during Her Majesty’s Pleasure’) in a psychiatric hospital. However, the relevant current provision – section 5 of the Criminal Procedure (Insanity) Act 1964, as amended by the Criminal Procedure (Insanity and Unfitness to Plead) Act 1991 and the Domestic Violence, Crime and Victims Act 2004 – now allows the judge to impose a Hospital Order under section 37 of the Mental Health Act 1983 (as amended 2007), which can be combined with a Restriction Order if the criteria under section 41 are met, or a Supervision Order or absolute discharge. In the Magistrates’ Court, there is no special verdict and so insanity at the time of the offence leads to an acquittal. However, the court can act under section 37(3) of the 1983 Act to impose a hospital or guardianship order without a conviction if the relevant statutory criteria for hospitalisation or guardianship are made out. KRIS GLEDHILL See also: M’Naghten Rules; Unfitness to Stand Trial (Criminal Procedure (Insanity and Unfitness to Plead) Act 1991) Readings Gledhill, K, (2012) Defending mentally disordered offenders. London: Legal Action Group, esp chs 12, 13. Gostin, L., Bartlett, P., Fennell, P., McHale, J. and MacKay, R. (2010) Principles of mental health law and policy. Oxford: Oxford University Press, esp ch 20.


In the 19th century, the idea of a low Intelligence Quotient (IQ) being an important explanatory factor in the occurrence of criminal behaviour was widespread. The research on which this view was based heavily relied on verbal tests and measuring academic achievement. Later, when awareness of the significance of social-structural factors grew within the field of criminology, it became apparent that the influence of a low IQ was more limited than had previously been thought. Prospective research detailing risk factors for delinquent behaviour shows that IQ has a predictive value for criminal behaviour (Farrington, 2000). It appears that a high IQ protects against criminal influence and a lower IQ is associated with longer criminal careers, which also start earlier on (Kandel et al, 1988; McGloin and Pratt, 2003). From research looking into how many of those in the criminal 132

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justice system have a low IQ, the conclusion has been drawn that the average IQ of delinquents is around eight points lower than that of the average population (Day, 1993; Herrnstein and Murray, 1994). The differences are greater on verbal scores than they are on performance and greater differences are found between, for example, ‘non-delinquents’ and ‘chronic delinquents’. Finding a correlation does not necessarily have to indicate a causal relationship. In research in which different variables such as socio-economic status, age, gender and ethnicity were controlled for, the relationship between IQ and delinquency appeared weaker, but was still found (eg Moffitt et al, 1981; Levine, 2011). It is therefore now generally accepted that there is a mild relationship between IQ and criminal behaviour. One of the suggested causes for the difference is the detection effect: people with a low IQ would be more readily apprehended and caught in the criminal justice system.This has not been confirmed by subsequent studies (eg Hirschi and Hindelang, 1977; Moffitt and Silva, 1988). Other causes can be found in an indirect effect (academic performance, access to work and social integration) or in a direct effect of not rightly judging the consequences of one’s behaviour. It is important to note that much research limits itself to an IQ range of one standard deviation above and below the average: more often than not, these studies do not concern those with a (borderline) learning disability. Increasingly, more studies into lower IQ are being conducted and they show that the linear relationship between criminality and IQ does not exist. Among those with lower IQs, the relationship is more ambiguous and seems rather to suggest a curvilinear relationship: when considering individuals with lower IQs (ie below 80), we find that people with lower IQs commit less. After all, acts of crime assume mens rea, which is often assumed to be lacking in people with intellectual disabilities. Also, various selective mechanisms play a role in the decision to make a statement on an individual (eg fear of carers about what might happen to the person, fear about being blamed or fear about the reputation of the care home). Furthermore, among those with a lower IQ, there can be strong protective factors regarding the social environment. Looking at the characteristics of the group, its over-representation in the criminal justice system is perhaps lower than expected (Holland, 2004). Even if IQ is not an (important) criminogenic factor, it is still important to take into account the IQ of those engaged in delinquency. According to the responsivity principle (Andrews and Bonta, 2010), it is always necessary to adapt services and interventions to the characteristics of the individual in order to come to an effective way of dealing with offending behaviour. HENDRIEN KAAL


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See also: Learning Disabilities and Criminal Justice; Rational Choice Theory Readings Andrews, D.A. and Bonta, J. (2010) The psychology of criminal conduct (5th edn). New Jersey, NJ: Matthew Bender and Company. Day, K. (1993) ‘Crime and mental retardation: a review’, in K. Howells and C.R. Hollin (eds) Clinical approaches to the mentally disordered offender. Chichester: John Wiley and Sons, pp 111–44. Farrington, D.P. (2000) ‘Adolescent violence: findings and implications from the Cambridge Study’, in G. Boswell (ed) Violent children and adolescents: asking the question why. Philadelphia, PA: Whurr Publishers, pp 19–35. Freeman, J. (2012) ‘The relationship between lower intelligence, crime and custodial outcomes: a brief literary review of a vulnerable group’, Vulnerable Groups and Inclusion, 3: 1–25. Herrnstein, R.J. and Murray, C. (1994) The bell curve: intelligence and class structure in American life. New York, NY: Free Press. Hirschi, T. and Hindelang, M.J. (1977) ‘Intelligence and delinquency: a revisionist review’, American Sociological Review, 42(4): 571–87. Holland, A.J. (2004) ‘Criminal behaviour and developmental disability: an epidemiological perspective’, in W.R. Lindsay, J.L. Taylor and P. Sturmey (eds) Offenders with developmental disabilities. Chichester: John Wiley and Sons, pp 23–34. Kandel, E., Mednick, S.A., Kirkegaard-Sorensen, L., Hutchings, B., Knop, J., Rosenberg, R. and Schulsinger, F. (1988) ‘IQ as a protective factor for subjects at high risk for antisocial behavior’, Journal of Consulting and Clinical Psychology, 56(2): 224–226. Levine, S.Z. (2011) ‘Elaboration on the association between IQ and parental SES with subsequent crime’, Personality and Individual Differences, 50(8): 1233–7. Lindsay, W.R., Taylor, J.L. and Sturmey, P. (eds) (2004) Offenders with developmental disabilities. Chichester: John Wiley and Sons. McGloin, J.M. and Pratt, T.C. (2003) ‘Cognitive ability and delinquent behavior among inner-city youth: a life-course analysis of main, mediating, and interaction effects’, International Journal of Offender Therapy and Comparative Criminology, 47(3): 253–71. Moffitt, T.E. and Silva, P.A. (1988) ‘IQ and delinquency: a direct test of the differential detection hypothesis’, Journal of Abnormal Psychology, 97(3): 330–3. Moffitt, T.E., Gabrielli, W.F., Mednick, S.A. and Schulsinger, F. (1981) ‘Socioeconomic status, IQ, and delinquency’, Journal of Abnormal Psychology, 90(2): 152–6.


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INTERMEDIARY The Youth Justice and Criminal Evidence Act 1999 (YJCE Act) introduced a number of special measures to support vulnerable witnesses. One of these special measures is the intermediary. Section 16 of the YJCE Act states that eligibility for the range of special measures, including that of the Registered Intermediary (RI), is limited to: witnesses who are under the age of 17 (raised to 18 by the Coroners and Justice Act 2009); someone whose evidence is likely to be diminished in quality by reason of mental disorder or a significant impairment of intelligence and social functioning; or the witness has a physical disability or is suffering from a physical disorder. Quality of evidence means quality in terms of completeness, coherence (ie the ability when giving evidence to give answers that address the questions asked and that can be understood both individually and collectively) and accuracy (Ministry of Justice, 2012). The function of the intermediary is to communicate: • to the witness, any questions put to them; • to any persons asking such questions, the answers given by the witness in reply to them; and • to explain such questions or answers so far as necessary to enable them to be understood by the witness or the questioner. Intermediaries have professional backgrounds in fields such as speech and language therapy, psychology, occupational therapy, nursing, social work, or education. Intermediaries are impartial and work for the court rather than the person that requests their service. In England and Wales, the Ministry of Justice recruits the intermediaries and there is a Witness Matching Service currently managed by the Serious and Organised Crime Agency (SOCA). When a police officer or the Crown Prosecution Service requires an intermediary, they make contact with SOCA so that the most appropriately skilled intermediary can be matched to a particular case. The intermediary will complete a comprehensive assessment of the vulnerable person’s communication needs and write an evidence-based report for the police and the court detailing the individual’s specific communication strengths and limitations and giving advice to the police and the court about how communication needs can be addressed. A ‘Ground Rules’ hearing takes place at court prior to the witness giving evidence, where the written advice about communication is discussed with the RI by counsel and the judge and strategies are agreed, for example, for questioning and breaks. 135

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Legislation has been passed in England and Wales for the use of an intermediary in defendant cases when the vulnerable defendant gives oral evidence at court. While this legislation (section 104 of the Coroners and Justice Act 2009) has yet to be enacted, there have been cases where judges have used their inherent discretion to request an intermediary in the interests of justice (O’Mahony, 2009; O’Mahony et al, 2011). However, April 2013 saw a pilot project introduced in Northern Ireland where vulnerable police suspects also had access to an RI during police questioning (O’Mahony, 2012; Cooper and Wurtzel, 2013). It remains to be seen how the role of the RI and the Appropriate Adult fit together in police suspect interviews and whether vulnerable defendants require communication support throughout their trial and not just while giving oral testimony. BRENDAN O’MAHONY See also: Adversarial Justice; Due Process Readings Cooper, P. and Wurtzel, D. (2013) ‘A day late and a dollar short: in search of an intermediary scheme for vulnerable defendants in England and Wales’, Criminal Law Review, 1: 4–22. Ministry of Justice (2012) The registered intermediary procedural guidance manual. London: Ministry of Justice. O’Mahony, B.M. (2009) ‘The emerging role of the Registered Intermediary with the vulnerable witness and offender: facilitating communication with the police and members of the judiciary’, British Journal of Learning Disabilities, 38: 232–7. O’Mahony, B.M. (2012) ‘Accused of murder: supporting the communication needs of a vulnerable defendant at court and at the police station’, Journal of Learning Disabilities and Offending Behaviour, 3(2): 77–84. O’Mahony, B.M., Smith, K. and Milne, B. (2011) ‘The early identification of vulnerable witnesses prior to an investigative interview’, The British Journal of Forensic Practice, 13(2): 114–23.


J JUST DESERTS ‘Just deserts’ is a moral and practical explanation for why states punish criminals. Rooted in the retributive theory of punishment, just deserts emphasises that people, as responsible agents, deserve to be punished when they break the law. It can be compared with a number of consequentialist theories, which broadly focus on the potential to reduce crime through punishment. The rationale for punishment based on just deserts is generally twofold. First, punishment is ‘a conventional device for the expression of attitudes of resentment and indignation, and of judgment of disapproval and reprobation’ (Feinberg, 1965, p 397). Thus, punishment takes on the form of communication between the state and criminals: adequate and consistent punishment in the event of wrongdoing helps to maintain cohesion among law-abiding citizens by reinforcing legal and social boundaries. This indicates that excessive punishment may have the opposite effect of undermining the expressive function of the law. Second, the criminal gains an unfair advantage over law-abiding citizens when he commits a crime, and this must be eliminated by imposing the burden of punishment upon him. The wider explanation is that citizens are bound by social contract to the reciprocal disadvantage of pursuing their interests without interfering with the freedoms of others. Punishing wrongdoers restores a notional equilibrium between advantages and disadvantages among ‘violators’ and ‘nonviolating fellows’ (Von Hirsch, 1976, p 46). Punishment, therefore, serves a


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utilitarian function: the burden of punishment to those who experience it is outweighed by its societal benefit. A problem with the burden versus benefit analysis is that not all crimes confer a benefit, and not all self-restraint confers a disbenefit. For instance, the criminal law punishes incomplete attempts, and most in society have no interest in committing crime. Even if the line between benefit and disbenefit can be sensibly drawn, punishment justified by the just deserts rationale may leave us with ‘the unappealing assertion that two wrongs somehow make a right’ (Lacey, 1988, p 26). A further problem with just deserts is that the use of punishment to denunciate criminals presupposes that the distinction between moral and immoral behaviour is an objective reality. However, this ‘Don’t play God’ objection is inconsistently applied:‘we use moral desert as a reason not to punish.Why should it be different when we use the presence of desert as a reason to punish?’ (Moore, 2009, p 113). Despite these limitations, legal reform over the past 20 years has been heavily influenced by the principle of just deserts. LEON McRAE See also: Bifurcation; Punishment Readings Feinberg, J. (1965) ‘The expressive function of punishment’, The Monist, 49(3): 397–423. Lacey, N. (1988) State punishment: political principles and community values. London: Routledge. Moore, M. (2009) ‘The moral worth of retribution’, in A. von Hirsch, A. Ashworth and J. Roberts (eds) Principled sentencing: readings on theory and practice (3rd edn). Oxford: Hart Publishing, pp 110–15. Von Hirsch, A. (1976) Doing justice: the choice of punishments (report of the Committee for the Study of Incarceration). New York, NY: Hill and Wang.


Justice can only be properly understood by reference to other pertinent ideas and concepts, such as due process, fairness, criminal justice and social justice.The ethical and moral appropriateness of decisions and practices that are rational, reasonable and fair is said to assure justice. Rules of law and religion, and the enforcement of principles, are attempts to regulate practices in order to achieve justice.


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In criminal justice, following ‘the letter of the law’, abiding by the strict rules of due process and punishing proportionately all duly convicted offenders professedly secures justice. The equality of treatment of all suspected offenders and the constant respect for their rights allegedly ensures that all discriminatory social factors such as class, race, gender, disability and sexuality are inconsequential, and that only the rationally correct verdicts and appropriate sentences will result. Those processes, it is claimed, exemplify justice in its truest form. Nevertheless, the relationship between justice and fairness is a relatively modern advance and its effectiveness is often challenged as being overly technical and working against natural justice. Varieties of justice are influenced by political, social, economic and cultural factors, which affect alternating standpoints, policies and practices. Utilitarian justice claims that it is primarily concerned with the wider social good, a contentious and ambiguous concept. Retributive justice, perhaps the most commonly held notion of justice, affirms that society must punish offenders as it is morally appropriate and deserved. Restorative justice is much less overtly punitive: it attempts to make amends for the harms caused by offenders by trying to get them to restore to the victim the losses that they have experienced and to understand the effects of their offending (Johnstone, 2002). Natural justice encompasses the idea that people get what they deserve, wherein good deeds naturally bring about beneficial rewards and bad deeds will naturally have negative consequences. However, such concepts neglect the determining contexts of individual life choices and the reality that allegedly free and rational choices are often influenced by many external factors and pressures. Likewise, assertions made about the desirability of social justice and public welfare can be inverted by claims that in a democratic meritocracy, giving to the needy encourages fecklessness and the spur of poverty is needed to rebuild their personal responsibility. Justice is inconsistently applied and some offenders who cause the greatest harms in society consistently escape the consequences of their actions (see Tombs and Whyte, 2003). Nonetheless, such crimes of the powerful are increasingly a matter of academic concern and some marginal progressive increases in their prosecutions and the subsequent achievement of justice is becoming gradually more evident. LIAM McCANN See also: Criminal Justice; Social Justice


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Readings Jamieson, R. and McEvoy, K. (2005) ‘State crime by proxy and juridical othering’, The British Journal of Criminology, 45(4): 504–27. Johnstone, G. (2002) Restorative justice: ideas, values, debates. Cullompton: Willan Publishing. Tombs, S. and Whyte, D. (eds) (2003) Unmasking the crimes of the powerful: scrutinizing states and corporations. New York, NY: Peter Lang.


Many commentators have observed that the victim is the ‘forgotten’ party of the criminal justice system. Nonetheless, the first Victims Charter of 1990, extended in 1996, significantly reoriented the work of the Probation Service to the victim rather than the offender, and these developments were given an added impetus in the embrace of the Human Rights Act in 1998, interpreted as giving entitlements to protection for victims as well as suspects. Alongside the greater willingness to listen to women’s experiences of the criminal justice system, and the unfolding legacy of the Lawrence Inquiry, an overall review of policy towards victims was established. In the light of that review the White Paper Justice for all (Home Office, 2002) was published. Clark (2004, p 21) stated that ‘Justice for All is guided by a single clear priority – to rebalance the criminal justice system in favour of the victim and the community so as to reduce crime and to bring offenders to justice’. This preoccupation with rebalancing the justice system has been a key policy platform since then. It reached a high point in the passing of the Domestic Violence, Crime and Victims Act 2004. This introduced surcharges on fines and fixed penalties for motoring offences that contribute to the funding of the Victims Fund, allowed the Criminal Injuries Compensation Authority to recover payments made to victims from their offenders, widened the opportunities for victims to be given information and to provide information in cases where their offender receives a prison sentence, provided for a Commissioner for Victims and Witnesses, and set out a Code of Practice for Victims. The breadth of this legislation in relation to victims was without precedent in England and Wales. Miers (2007, p 337) has observed that this metaphor of ‘rebalancing’ is contentious. It not only puts victims/witnesses (complainants) and offenders (defendants) in an oppositional relationship with one another (which may be more imagined than real), but also begs the question as to the purpose of the criminal justice system itself. Some time ago, McBarnett (1988, p 300, emphasis added) observed that ‘[T]he offence is not just against the victimised person, the offence is against the 140

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state.… If the victim feels that nobody cares about their suffering, it is in part because institutionally nobody does’. Understanding this relationship between the state and the offender is central to understanding the problematic nature of the rebalancing metaphor: what or who is being rebalanced and in what direction? This preoccupation with rebalancing is underpinned by at least two concerns: to ensure the continued legitimacy of criminal justice (ie people as victims/ witnesses continue to participate in it); and to respond to populist pressures in appearing to address the actual and/or perceived victims’ needs for punishing the offender (secure votes). Thus, the Justice for all White Paper has not only failed to address the concerns raised about the operation of the criminal justice system from the victims’ perspective, but also failed to appreciate the central purpose of the criminal justice system itself. SANDRA WALKLATE See also: Victims of Crime Readings Clarke, P. (2004) ‘Redressing the balance: the Criminal Justice Bill 2002’, in E. Capes (ed) Reconciling rights. London: LAG. Home Office (2002) Justice for all, Cm 6287, London: Home Office. McBarnett, D. (1988) ‘Victim in the witness box – confronting victimology’s stereotype’, Contemporary Crises, 7: 279–303. Miers, D. (2007) ‘Looking beyond Great Britain: the development of criminal injuries compensation’, in S. Walklate (ed) Handbook of victims and victimology. Cullompton: Willan Publishing.


K KNOWLEDGE (SOCIOLOGY OF) Sociology is concerned with understanding how social change impacts on individuals, groups, institutions and communities. The sociology of knowledge focuses on the ways in which changes in individual experiences, as well as community and institutional practices, reflect society’s developing understanding of the world and how it works. Knowledge, meanwhile, is difficult to define and conceptualise but is generally taken to refer to what is known, as opposed to what is not known or merely thought of as known, reflecting Plato’s distinction between knowledge, belief and opinion. The main foci for the sociology of knowledge, then, are the ways in which social change – broadly defined – impacts on how knowledge is defined and utilised.Traditionally, post-Enlightenment, and reflecting dominant modernist principles, the assumption was that the application of the scientific method would, cumulatively and progressively, allow individuals to ascertain knowledge – or truth – regarding the world and their place in it with ever-increasing degrees of certainty. Here, knowledge represents the solution to problems stemming from uncertainties associated with ignorance, or lack of knowledge. However, over the last 50 years or so, the rise to prominence of postmodern perspectives has challenged the dominance of these assumptions, such that faith and confidence in the modernist ideal has waned. Key theorists have revealed the inherently subjective nature of supposedly objective knowledge claims and so challenged the authority and legitimacy of foundational truths. Strong claims about the world, and about categories and classifications routinely applied to 143

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groups and individuals, are now recognised as social constructions (Berger and Luckman, 1967), intimately entwined with the operation of power in society (Foucault, 1972), while science itself is recognised as a messy business, often entailing subjective, interpretive judgements, rather than the straightforward specification of objective facts (Lakatos, 1978). As a consequence of more widespread recognition of the subjective nature of supposedly objective knowledge, the uncertain status of knowledge claims routinely made by decision-makers, including politicians, policymakers and practitioners, is now widely recognised. This changed understanding of knowledge and its relationship to uncertainty has impacted on the institutions and practices of criminal justice and mental health over the last 30 years or so. The decline of the rehabilitative ideal, a pervasive lack of trust in the effectiveness and veracity of ‘social’ practices, the shift from welfare to risk, the development of actuarial justice, and the emphasis on evidence-based practice are all developments that relate, to some extent, to shifts in confidence in the knowledge base that underpins the actions of professionals (Garland, 2001). Critical scholars have emphasised the ways in which shifts ‘from art to science’ have eroded transformative potential in favour of a reliance on managerial systems (eg Feeley and Simon, 1992; Fitzgibbon, 2011), and, in some respects, this is true. However, they also overstate the case. It is known that even in a ‘risk society’, professionals in criminal justice and mental health continue to draw upon informal, tacit, clinical knowledge in arriving at judgements regarding complex issues, and that often, though not always, these are ‘correct’. This should not be surprising. It mirrors what science and technology studies – a major branch within the sociology of knowledge – demonstrate to be the case in science more generally (eg Latour and Woolgar, 1986). The sociology of knowledge is a reminder that knowledge is neither precise nor static. In the practice-based disciplines, this means that professional knowledge claims, whether a diagnosis, a case formulation or a risk assessment, and whether based upon formal, informal or ‘hybrid’ knowledge sources, also remain best guesses rather than facts. MARK HARDY See also: Medicalisation and Social Control; New Penology Readings Berger, P. and Luckman, T. (1967) The social construction of reality: a treatise in the sociology of knowledge. New York, NY: Doubleday. Feeley, M. and Simon, J. (1992) ‘The new penology: notes on the emerging strategy for corrections’, Criminology, 30(4): 449–75.


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Fitzgibbon, W. (2011) Probation and social work on trial: violent offenders and child abusers. Basingstoke: Palgrave Macmillan. Foucault, M. (1972) The archaeology of knowledge. London: Tavistock. Garland, D. (2001) The culture of control. Oxford: Oxford University Press. Lakatos, I. (1978) The methodology of scientific research programmes. Cambridge: Cambridge University Press. Latour, B. and Woolgar, S. (1986) Laboratory life: the construction of scientific facts. Princeton, NJ: Princeton University Press.


The concept of ‘power/knowledge’ is central to the work of the philosopher Michel Foucault. He famously suggested that ‘power produces knowledge … power and knowledge directly imply each other’ (Foucault, 1977, p 27). Foucault approaches issues of power and the state from an unconventional perspective. Traditional analyses anchor power within the logic of sovereignty, whereby a central agency or individual ‘holds’ power and utilises it repressively in a topdown fashion. Foucault, by contrast, conceives of power as ubiquitous, pervasive and dispersed throughout society. He therefore rejects the idea that power is necessarily oppressive, as the sovereign model assumes. Instead, he suggests that power can also be productive. Indeed, he rejects the idea that power is ‘possessed’ by some while others lack it. His focus is therefore on the techniques and tactics of disciplinary power at ‘micro-political’ level rather than with the ethics and practices of sovereign power. Foucault’s concern with power is significant in his influential theory of the development and operation of disciplinary power, a whole complex of distinctive techniques that are not dependent upon coercion or force and that are peculiar to modernity. Whereas sovereign power is highly visible and ordinarily corporeal in its focus and application, disciplinary power entails certain characteristic techniques, notably, surveillance, which entails cumulative processes of monitoring, record keeping and report writing. These contribute to normalising judgements. Norms may be behavioural or attitudinal, and represent the standards towards which those who may be at fault, and therefore subject to discipline, are expected to conform. Foucault’s formulations raised the issue of whether the diffusion of disciplinary mechanisms led to the emergence of a distinctive ‘disciplinary society’ in which discipline becomes the primary mode of government. The techniques associated with disciplinary power enable a transformation in the subject of power based upon changed relations of subjectification, whereby the dispersal of power to


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experts enables disciplines such as psychiatry, criminology and social work to become established. The development of Foucault’s ideas around discipline was a theoretical precursor for later work, in which he examined the workings of power in social life in some depth, including the disciplining of both the subject and the self. Both of these entail the involvement of expertise and particular forms of knowledge, not least those upon which the penal-welfare and ‘psy’ complexes are premised. The issue that therefore arises is how discourse – the ways that particular issues, topics or problems are talked about within society – via power/knowledge, constitutes the subject, in particular, through the human sciences and the associated disciplinary mechanisms of professions and institutions. It does so via forms of power that are locally dispersed rather than centrally orchestrated, using small- rather than largescale techniques and tactics, reflecting the stress on the significant constitutive effect of ‘the micro-physics of power’. Various authors have taken forward this project as it applies to criminal justice and mental health (eg Rose, 2000; Garland, 2001); work that is ongoing, particularly under the banner of ‘governmentality’. MARK HARDY See also: Carceral Society; Surveillance Readings Foucault, M. (1977) Discipline and punish. London: Allen Lane Garland, D. (2001) The culture of control. Oxford: Oxford University Press. Rose, N. (2000) ‘Government and control’, British Journal of Criminology, 40(2): 321–39.


L LABELLING PERSPECTIVES Labelling perspectives are closely related to social construction and symbolic interaction analyses, prominent during the emerging sociology of the 1960s in the US. ‘Labelling’ stemmed from the early symbolic interactionism of the Chicagoan sociology of the 1930s, with its heyday in the turbulent period of the 1960s and 1970s.While becoming less popular in ensuing decades, labelling perspectives were highly influential on the embryonic sociological criminology in the UK in the late 1960s, especially at the first National Deviancy Symposium, where it proved influential on those sociological criminologists whose dissatisfaction with the Orthodox Criminology of ‘positivists’ (and criticism of their medico-psychological assumptions) caused a significant rift in the discipline (Sumner, 1994). Theoretically, labelling perspectives are concerned with the social construction of crime and specifically how the self-identity and self-schema of individuals may be determined or influenced by the terms used to describe, classify or categorise them. In common, labelling perspectives (for there is no single labelling position) hold that descriptors or categorisations – including terms related to deviance, criminality, sexuality, disability or diagnosis of a mental disorder – can, of themselves, be problematic. While, on the surface, these labels are merely descriptors, such terms (specifically when linked to formal state mechanisms) can powerfully sculpt or alter a person’s social identity and shape the individual’s and social practices, and social reactions to them.


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In the late 1930s, Tannenbaum’s (1938) Crime and community introduced the concept of ‘tagging’ delinquent behaviour, where a negative tag or label often contributed to further involvement in delinquent activities.This work contrasted with the then dominant biological determinism and internal explanations of crime (including the eugenics movement). The perspective seemed more salient after the Second World War, but became most influential in the 1960s in US sociology and in works such as Becker (1963), Schur (1965) and Scheff (1966). In the UK, labelling works such as these influenced the early works of Stanley Cohen and Jock Young. Relatively short-lived as a distinct theoretical orientation (by the early 1970s, there were already critiques emerging and its influence was in decline), the perspective is now regarded as passé (Sumner, 1994); however, its central tenets continue to inspire. On a broader level, labelling perspectives claim that criminology can give too much prominence to the common-sense view of criminals as particular ‘types of people’, and narrow conceptions and categorisations of ‘crime’. Labelling-inspired critiques recognised how, traditionally, criminology had given insufficient attention to social control and responses to crime. This observation doubtlessly remains significant still. Conceptualised in this way, labelling perspectives’ theoretical legacy is clear. Indeed, its lasting influence on critical and idealist criminology, left realism, and, recently, zemiology and cultural criminology is testimony to that. JAMES TREADWELL See also: Deviance; Social Control Theory Readings Becker, H. (1963) Outsiders: studies in the sociology of deviance. New York, NY: Free Press. Scheff, T.J. (1966) Being mentally ill: a sociological theory. New York, NY: Aldine. Schur, E. (1965) Crimes without victims. New Jersey, NJ: Prentice Hall. Sumner, C. (1994) The sociology of deviance: an obituary. Milton Keynes: Open University Press. Tannenbaum, F. (1938) Crime and community. New York, NY: Columbia University Press.


A high proportion of people with learning disabilities (7% compared to 2.5% of the general population) negotiate the criminal justice system (CJS) as victims or 148

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perpetrators of crime, in police custody, or in courts and prisons (Department of Health, 2010). An individual is considered eligible to receive forensic care from learning disability services according to three criteria: if s/he has been assessed as having a learning disability and is currently in receipt of or entitled to receive a service as a consequence of a learning disability-related need; if s/he has been convicted of committing a criminal offence or is alleged to have committed a criminal offence; and if s/he has engaged in behaviour that is considered to be of concern in relation to the risk presented to her/himself, others or property. One of the key elements of learning disability is the comprehension of the circumstances that the individual finds him/herself in, so an individual’s ability to cope is significantly enhanced by the provision of good-quality, accessible (eg easy-read or pictorial format) information. The relationship between learning disability and criminal justice has a complex history, and whole-scale institutional closure by the end of the last century highlighted the issue of how society should deal with offenders with learning disabilities. Particular concerns in the context of learning disability have revolved around fire-setting behaviour, sex offending and extreme aggression (Lindsay et al, 2004; Riding et al, 2005). The degree of severity of behaviour correlates with the existence of learning disability, so that the more severe the offence, culminating in murder, the less the likelihood of the perpetrator of the crime being learningdisabled (Read, 2008). The Mental Health Act 1983 (as amended 2007) defines learning disability as ‘a state of arrested or incomplete development of mind which includes significant impairment of intelligence and social functioning’, but does not constitute a ‘mental disorder’ (unless the individual is detained under a shortterm section, ie sections 2, 4, 135, 136) except if ‘associated with abnormally aggressive or seriously irresponsible conduct’ (Barber et al, 2012, p 23). Key debates have related to the extent to which individuals should be diverted from the CJS, whether alternative pathways should be created and whether the learning disability is objectively irrelevant and people with learning disabilities should be subjected to exactly the same legal process as those without. Nevertheless, increased concerns about the numbers of people with learning disabilities in prison (eg Talbot, 2007), and the subsequent publication of the Bradley Report (Bradley, 2009), resulted in increased initiatives to divert this population from the CJS. The current situation is witnessing a renegotiation of the boundaries between agencies providing varying levels of security (prison, high, medium, low and community), which means that there is a degree of uncertainty as to how the overall service structure might develop over the coming years. Some secure services catering for offenders with learning disabilities are having to adapt to changing circumstances, with a younger, more able population with complex


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difficulties, including substance misuse and a history of mental health problems, now increasingly requiring care. ANDREW LOVELL See also: Autism Spectrum Disorder and Criminal Justice; Bradley Report; Intelligence Quotient and Delinquency Readings Barber, P., Brown, R. and Martin, D. (2012) Mental health law in England and Wales: a guide for mental health professionals (2nd edn). London: Sage. Bradley, K. (2009) The Bradley Report: Lord Bradley’s review of people with mental health problems or learning disabilities in the criminal justice system. London: Department of Health. Department of Health (2010) Positive practice, positive outcomes: a handbook for professionals working with offenders with a learning disability. London: Department of Health. Lindsay, W.R., Taylor, J.L. and Sturmey, P. (eds) (2004) Offenders with developmental disabilities. Chichester: John Wiley and Sons. Read, S. (2008) ‘Learning disabilities and serious crime: murder’, Mental Health and Learning Disabilities Research and Practice, 5: 63–76. Riding, T., Swann, C. and Swann, B. (eds) (2005) The handbook of forensic learning disabilities. Abingdon: Radcliffe. Talbot, J. (2007) No one knows: identifying and supporting prisoners with learning difficulties and learning disabilities: the views of prison staff. London: Prison Reform Trust.


Long-term imprisonment has the potential to cause and exacerbate mental health problems. Because the vast majority of prisoners will eventually be released into the community, the immediate and longer-term impacts of imprisonment upon mental health are important considerations. However, there is a lack of empirical evidence about the effect that being imprisoned for any length of time has on prisoner health (OHRN, 2010). Mental health is a product of interactions between an individual and their social contact (Schnittker and John, 2007).The impact of long-term imprisonment on mental health, therefore, depends upon the personal characteristics of the individual prisoner, that individual’s experiences of long-term imprisonment and the quality of the penal regime(s) that they are subjected to.


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Some prisoners can withstand the effects of long-term imprisonment. After an initial period of adjustment to prison, many prisoners display evidence of coping with the regime (Schnittker and John, 2007). Furthermore, the standard of prison health care has developed significantly over the last decade in England and Wales through the introduction of the ‘principle of equivalence’ in prison health care and the transfer of health care from the Prison Service to the National Health Service (NHS) (RCN, 2010). As such, prisons may no longer be wholly antitherapeutic environments (OHRN, 2010). However, the rates of mental health problems and substance misuse among prisoners are dramatically higher than those observed in the general population (OHRN, 2010). Prison populations are disproportionately comprised of people from disadvantaged backgrounds with a history of loss, trauma and low resilience to distress (RCN, 2010). Experiencing imprisonment is also a risk factor for mental distress. Factors such as the rules and regimes, overcrowding, lack of meaningful or purposive activity, boredom, loss of autonomy, inadequate mental health services, and separation from social and familial networks can all be detrimental to the mental health of prisoners (Kupers, 2008; OHRN, 2010). These stresses may be more keenly felt by prisoners serving longer terms. Prisoners who have or develop serious mental health problems deal with harsh conditions such as overcrowding and punitive segregation very poorly, which may lead to them incurring further disciplinary sanctions (Kupers, 2008). Being confined in isolation is known to be particularly damaging to prisoner mental health. Involuntary isolation for longer than three months causes lasting emotional damage for almost all prisoners (Kupers, 2008). In addition to the immediate effects of imprisonment, there are also longer-term mental health impacts to consider. The suicide rates of recently released prisoners are exceptionally high, approaching the level found among recently discharged psychiatric patients. This may indicate that psychological coping mechanisms that are beneficial while in prison become problematic in other contexts. Abandoning initiative, accepting externally imposed constraints and blunting emotions can enable prisoners to cope with prison regimes but might cause problems in the home or workplace (Schnittker and John, 2007). PHILIPPA TOMCZAK See also: Mental Health In-Reach Services; Pains of Imprisonment Readings Kupers, T.A. (2008) ‘What to do with the survivors? Coping with the long-term effects of isolated confinement’, Criminal Justice and Behavior, 35(8): 1005–16.


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OHRN (Offender Health Research Network) (2010) ‘The pathway of prisoners with mental health problems through prison health services and the effect of the prison environment on the mental health of prisoners’. Available at: www. ohrn.nhs.uk/OHRNResearch/EnvPath.pdf RCN (Royal College of Nursing) (2010) ‘Prison mental health: vision and reality’. Available at: www.centreformentalhealth.org.uk/pdfs/prison_mental_ health_vision_reality.pdf Schnittker, J. and John, A. (2007) ‘Enduring stigma: the long-term effects of incarceration on health’, Journal of Health and Social Behavior, 48(2): 115–30.


In England and Wales, ‘loss of control’ is a partial defence available only in relation to a charge of murder. Successful pleading of the defence leads to both the avoidance of the mandatory life sentence for murder, and a conviction of the lesser offence of manslaughter (Norrie, 2010). The defence of loss of control replaced the problematic broader historical defence of provocation, created by the judiciary. Provocation was controversial, resulting in many judicial disagreements and legal inconsistencies over both its interpretation and the scope of its application to defendants accused of murder (Law Commission, 2004). Critics of the provocation defence argued that it was biased towards men and therefore discriminatory, particularly against women accused of the murder of their abusive male partners. This is because their actions or inactions, caused by fear and despair, rather than anger, did not typically fit the requirements of the defence to suddenly and temporarily lose self-control. In these circumstances, women argued a ‘slow-burn’, culminative reaction to the provocation of domestic violence that they experienced. The courts, however, frequently rejected such arguments as the time lapse between a killing and the last provocative act of the deceased was perceived as too long for the defence to succeed (Carline, 2009; Edwards, 2010). These issues led to the Law Commission (2004) suggesting legal reform of the provocation defence, and to abolishing the controversial loss of self-control requirement of the defence. Ultimately, however, the government decided upon the abolition of the provocation defence (section 56 of the Coroners and Justice Act 2009) and the introduction of a new defence of loss of control, the central feature of which is a requirement of loss of self-control (Carline, 2009; Norrie, 2010). There are three parts to the defence of loss of control that must be proven: 152

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1. The defendant’s acts or failure to do acts, or being involved in the killing, resulted from their loss of self-control (section 54 of the Coroners and Justice Act 2009). 2. The defendant’s actions or inactions fit one or both of two ‘qualifying triggers’ (section 55(3)–(5) of the Coroners and Justice Act 2009). These are: (a) that the defendant’s loss of self-control was attributable to ‘fear of serious violence’; and/or that (b) ‘things done or said (or both)’, which are of an extremely grave character, caused the accused to have a ‘justifiable sense of being seriously wronged’. This qualifying trigger is thought to apply in exceptional circumstances. The first of these ‘qualifying triggers’ was designed specifically for cases where women have killed their abusive male partners (Carline, 2009; Edwards, 2010). 3. The defendant must prove that a person of their sex and age, with a normal degree of tolerance and self-restraint and in their circumstances, might have reacted in the same or in a similar way to them (section 54(1)(c) of the Coroners and Justice Act 2009). This is an objective test (Norrie, 2010). HELEN BAKER See also: Battered Woman Syndrome Readings Carline, A. (2009) ‘Reforming provocation: perspectives from the Law Commission and the government’, Web Journal of Legal Issues, 2. Available at: www.researchgate.net/publication/237532814_Reforming_Provocation_ Perspectives_from_the_Law_Commission_and_the_Government Edwards, S. (2010) ‘Anger and fear as justifiable preludes for loss of self-control’, Journal of Criminal Law, 74(3): 223–41. Law Commission (2004) Partial defences to murder: No. 290. London: Her Majesty’s Stationery Office. Norrie, A. (2010) ‘Coroners and Justice Act 2009 – partial defences to murder: loss of control’, Criminal Law Review, 4: 275–89.


M M’NAGHTEN RULES The M’Naghten Rules were devised by the House of Lords in 1843 to cater for defendants pleading insanity during criminal trials. For the defence to apply in England and Wales (and other jurisdictions), it must be proved that at the time of the alleged offence, the defendant did not know what he was doing (the ‘cognitive’ limb) or that what he was doing was wrong (the ‘wrongfulness’ limb), due to a ‘defect of reason’ arising from a ‘disease of the mind’. The burden of proving the existence of insanity usually lies with the defendant ‘on the balance of probabilities’. If the burden of proof is met, the defendant is entitled to the verdict of ‘not guilty by reason of insanity’ (the ‘special verdict’). The effect of the special verdict is that he is adjudged not to be responsible for his crime, meaning that he cannot be sentenced. Instead, the judge has the power to order absolute discharge, treatment under supervision in the community or treatment in a psychiatric hospital (Hospital Order). Prior to 1991, the only possible disposal on special verdict was indefinite, mandatory confinement in a psychiatric hospital (under the Criminal Procedure (Insanity and Unfitness to Plead) Act 1991). The unattractiveness of hospital detention resulted in few defendants pleading insanity (MacKay, 1990). While insanity pleas have increased, concerns about the label ‘insane’ and the possibility of lengthy detention in hospital remain (MacKay et al, 2006). A further concern, repeatedly expressed, is that the limbs of the M’Naghten Rules are both underand over-inclusive in scope. 155

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The ‘wrongfulness’ limb is potentially under-inclusive because the test focuses on whether the defendant knew that his actions were legally wrong. In Australia, by comparison, evidence of insanity can be derived from the defendant’s mistaken belief that his act was right according to the ordinary standards of reasonable men. In reality, the courts may, on occasion, approach the issue on a more relaxed basis (Mackay and Kearns, 1999). Whether the defendant has a ‘disease of the mind’ is determined by psychiatric evidence. However, it is not merely psychiatric disorders that qualify under this limb: diabetes (in the absence of insulin), sleepwalking, heart disease and epilepsy are examples of disorders that have qualified under the M’Naghten Rules as insanity. It is argued that ‘the gross unfairness of labelling [such people] as insane’ is to empower the court to take ‘measures of social defense against them’ (Ashworth, 2009, p 143). A further criticism is that medical and legal understandings of insanity (if such a label can be applied to psychiatry) are divergent. In response to many concerns about the application of the M’Naghten Rules, the Law Commission has been commissioned to examine the law on insanity in England and Wales to ensure that it is ‘fit for purpose in the 21st century’ (Law Commission, 2012, p 1). It does concede, however, that the very small number of successful insanity pleas indicates that expressed concerns may be more conceptual and theoretical than practical. LEON McRAE See also: Insanity and Defect of Reason Readings Ashworth, A. (2009) Principles of criminal law. Oxford: Oxford University Press. Law Commission (2012) Insanity and automatism: a scoping paper. London: Law Commission. Mackay, R.D. (1990) ‘Fact and fiction about the insanity defence’, Criminal Law Review, April: 247–55. Mackay, R.D. and Kearns, G. (1999) ‘More fact(s) about the insanity defence’, Criminal Law Review, September: 714–25. Mackay, R.D., Mitchell, B.J. and Howe, L. (2006) ‘Yet more facts about the insanity defence’, Criminal Law Review, May: 399–411.


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MAGDALEN ASYLUMS In 1758, Magdalen Hospital (Magdalen House), St George’s Field, London was established by philanthropic and utilitarian notions of the day and deliberately called a ‘hospital’ because of the conviction that its regime was therapeutic. Magdalen Hospital was opened as a refuge for ‘fallen’ women (ie repentant prostitutes, destitute women and single mothers) to provide a ‘safe retreat’. The emphasis for admission was to be on penitence rather than penury; thereby, inmates were referred to as ‘penitents’. The utilitarian scheme was to include a public laundry staffed by ‘Girls of the Poor’; an important source of income for the Hospital’s funds (Batchelor, 2004). In 1767, a Magdalen Asylum was established in Dublin. A succession of penitentiaries and rescue organisations followed the establishment of these 18thcentury asylums in major cities across England and Ireland (and France and other Catholic countries), providing temporary asylum for women. Magdalen Asylums grew out of the Evangelical Rescue Movement in the UK during the 19th century, whose formal goal was to rehabilitate prostitutes. However, the regime of the Magdalen was about ensuring a woman’s submission; something that prefigured the system of penal incarceration being devised by John Howard in the 1770s. Indeed, the regime and conditions of the Magdalen comprised of a systematic stripping of the penitent’s former identity through an enforced anonymity (Nash, 1984). The reasons for the founding of such institutions are complex, reflecting the philosophy of the times. Critics of the period suggest the following factors: • the persistence with which the discourses of prostitution inflected those surrounding female labour – the rehabilitated prostitute needed to be made to serve rather than threaten the tasks of nation and empire building (Batchelor, 2004); • the Rescue or Penitentiary Movement, which involved the detention and rehabilitation of all classes of ‘fallen’ women, and the Contagious Diseases legislation, which was an attempt to reduce, through the cleansing of prostitutes, the armed forces’ vulnerability to venereal disease (Finnegan, 2004); and • a place of confinement for prostitutes because they were perceived to be a threat to the moral fibre of society (Smith, 2004). As the Magdalen movement became increasingly distant from the original idea of the Rescue Movement, the asylums/laundries became increasingly prisonlike. Finnegan (2004) describes conditions of harsh confinement, forced labour, senseless atonement and separation from their children, with some women remaining in the homes until they died. As the phenomenon became more 157

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widespread, confinement extended beyond prostitution to unmarried mothers, the mentally impaired and abused girls. This paralleled the practice in state-run psychiatric asylums in Britain and Ireland in the same period, where many people with alleged social dysfunction were committed to asylums. For many years, the resolve of the Magdalen movement remained unfettered and continued to operate even when the Women’s Movement was at its height. Ireland’s last Magdalen Asylum closed in 1996, putting an end to a regime of women being held in such places against their will unlawfully, unethically and immorally. BARBARA EDGE See also: Social Justice Readings Batchelor, J. (2004) ‘“Industry in distress”: reconfiguring femininity and labor in the Magdalen House’, Eighteenth-Century Life, 28(1): 1–20. Finnegan, F. (2004) Do penance or perish: Magdalen asylums in Ireland. Oxford: Oxford University Press. Lloyd, S. (1996) ‘“Pleasure’s golden bait”: prostitution, poverty and the Magdalen Hospital in eighteenth-century London’, History Workshop Journal, 41: 51–70. Nash, S. (1984) ‘Prostitution and charity: the Magdalen Hospital, a case study’, Journal of Social History, 17(4): 617–28. Smith, J.M. (2004) ‘The politics of sexual knowledge: the origins of Ireland’s containment culture and the Carrigan Report (1931)’, Journal of the History of Sexuality, 13(2): 208–33.


Representations are crucial to the social construction of mental disorder, from the grotesque, manacled statues of ‘Madness’ designed for London’s Bethlem Hospital (‘Bedlam’) in 1677, to today’s splashy tabloid newspaper headlines, which report salaciously on the violent crimes of ‘psychos’. Mass media representations are of interest to academics and mental health professionals because they have the potential to affect the quality of life and recovery of people experiencing mental disorders, funding for mental health services, and public perceptions of the risks posed by the mentally ill. Contemporary tabloid news media reportage plays a significant role in the stigmatisation of people with mental health disorders (Mind and Rethink Mental Illness, 2012). Through language and images, mental health issues are 158

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predominantly represented negatively as sources of crisis, personal tragedy or public violence. In 2003, The Sun was criticised for its use of emotive language in a front-page story about the admission to a psychiatric hospital of former boxer Frank Bruno, under the headline, ‘Bonkers Bruno Locked Up’ (Gibson, 2003). Although the newspaper responded quickly to condemnation by amending its headline to the more empathetic ‘Sad Bruno in Mental Health Home’, the media’s polarisation of the mentally ill into categories of ‘mad’, ‘bad’ or ‘sad’ has been identified as a potent source of stigmatisation that obfuscates the mundane reality that mental illness is common and experienced routinely by ‘normal’ people (Appignanesi, 2008). In comparison, there are relatively few reports of positive outcomes for those labelled as mentally disordered and news stories are rarely written by people with first-hand experience of mental health problems. The mass media habitually represent people with mental illnesses as dangerous, implying a causal link to violent crimes (Miller, 2007). Although the vast majority of homicides in Britain and elsewhere are committed by individuals who have not been clinically diagnosed with a mental disorder, violent offenders are commonly represented in pseudo-psychiatric terms as ‘nutters’ and ‘maniacs’, regardless of whether or not they are known to be mentally impaired. This contributes to a heightened sense of risk surrounding the mentally ill. Tabloid portrayals of violent criminals also draw parallels to macabre fictional psychopaths. For instance, news coverage of the Aurora cinema shootings in 2012 compared the perpetrator to ‘The Joker’, illustrating the sensationalistic register of much factual reporting (see Daily Mail, 2012). Studies have highlighted the role of gender, particularly femininity, in depictions of madness (Showalter, 1987; Appignanesi, 2008). Women who deviate from socially acceptable feminine behaviour have been labelled as insane by the press. In 1908, for example, The Observer questioned the sanity of female suffragists who heckled the Chancellor of the Exchequer, comparing the scene to ‘Bedlam’ (Purvis, 2007). Showalter’s (1987) argument that the madwoman is an abiding cultural icon is borne out in representations of mentally disordered women today, which still play a significant role in the negotiation of social concerns about proper female conduct. While newspapers undoubtedly carry some responsibility for the continuing stigmatisation of the mentally ill, historical scholarship shows that such evocative representations pre-date the modern news media. KATHERINE HARRISON See also: Dangerousness and Mental Disorder; Film and Mental Illness; Stigmatisation and Mental Disorder


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Readings Appignanesi, L. (2008) Mad, bad and sad: a history of women and the mind doctors from 1800 to the present. New York, NY: W.W. Norton. Daily Mail (2012) ‘Eyes rolling, head swaying and that bright red Joker hair: Colorado killer faces victims’ families in bizarre first appearance in court’, 23 July. Available at: www.dailymail.co.uk/news/article-2177736/James-Holmes-DarkKnight-massacre-gunman-appears-court-prosecutors-seek-death-penalty.html Gibson, O. (2003) ‘Sun on the Ropes over “Bonkers Bruno”’, The Guardian, 23 September. Available at: www.theguardian.com/media/2003/sep/23/ pressandpublishing.mentalhealth Miller, G. (2007) ‘Mental health and the mass media: room for improvement’, Lancet, 370(9592): 1015–16. Mind and Rethink Mental Illness (2012) ‘Leveson Inquiry: culture, practice and ethics of the Press’. Available at: https://www.rethink.org/news-views/2012/11/ challenging-and-improving-press-coverage-of-mental-health Purvis, J. (2007) ‘Unladylike behaviour’, The Guardian, 13 November. Available at: www.guardian.co.uk/education/2007/nov/13/research.highereducation Showalter, E. (1987) The female malady: women, madness and English culture, 1830–1980. London: Virago.


Medicalisation refers to the identification and categorisation of conditions or behaviours as requiring medical intervention.An increasing medical colonisation of hitherto untouched aspects of experience has been criticised as a form of social control. This appropriates ‘normal’ and ‘deviant’ manifestations of human life (childbirth, sexuality, sexual behaviour, drug use, emotions, personality, ageing, death) under the purview of expert medical practitioners and their acolytes. Such trends have historically been linked with the Enlightenment supplantation of religion by science, the ascendancy of capitalistic and patriarchal governance systems, and, latterly, the emergence of societies preoccupied with risk. Foucault (1973) views medicine as a dominant discourse offering an epistemic ‘claim to truth’. These truth claims operate to close down opportunities for framing understandings outside the dominant narrative. Zola’s (1972) seminal work showed how this privileging of medical knowledge is an essential driving force of medicalising imperialism, extending the reach of the medical gaze into the social world. Illich’s (1976) ‘iatrogenesis’ emphasises the negative impacts of misplaced faith in curative medicine. Marxists further suggest that medicalisation serves capitalism, shifting responsibility for wellness (and, hence, capacity for


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productivity) onto individuals, delegitimising concern with the social causes of disease and solidifying the role of doctors in amelioration. Psychiatry is interesting for considering the extent to which medicalisation (psychiatrisation) is inextricably bound up with social control. The focus of the discipline is more obviously, and unashamedly, on the management of deviance. Such arguments can be evidenced in examples such as the massive power wielded by multinational pharmaceutical companies, the expanding levels of prescription of drugs such as antidepressants or offering prescriptions for ‘new’ conditions such as attention deficit hyperactivity disorder or social anxiety disorder. Recent contemporary critique crystallises around the extension of the medicalising reach from diagnostic handbooks such as the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV to DSM-V. Previous criticisms highlighted the lack of validity of many diagnostic categories; arguably, the various ‘personality disorders’ merely describe ordinary human variation and the application of these diagnoses is arbitrary and highly subjective. The history of psychiatry can be viewed in terms of the assumption of authority by psychiatrists and various para-professionals over a system increasingly designed to identify abnormal ‘others’ and segregate them from the wider population. In the course of these developments, psychiatrised knowledge seeps out of the ‘psy-complex’ to infiltrate everyday life, problematising new domains of human behaviour along the way. The public become inducted into the routine usage of psychiatric language, rendering the ‘human soul’ a legitimate target for the application of psychiatric judgements and technologies (Rose, 1990). The incorporation of practitioners as agents of social control has been referred to as a peculiar malaise of modernity. Commentators arguing that late capitalism heralds a postmodern age contend that simplistic accounts of medicalisation are insufficient to explain recent developments. This philosophical turn makes reference to contradictory forces of complicity of ordinary people in their own medicalisation (people themselves wanting a pill for everything), coupled with the sort of resistance embodied in service user social movements and even disquiet within the medical profession itself (see the campaign to end psychiatric diagnosis). Furthermore, society has arguably become increasingly sceptical or even antagonistic to the dominance of rational science, and medicine has experienced numerous profound failings of ethics and practice that serve to undermine any inevitable association with progress or providence. MICK McKEOWN See also: Anti-Psychiatry Movement; Deviance; Social Control Theory


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Readings Foucault, M. (1973) The birth of the clinic (trans A. Sheridan). London: Tavistock. Illich, I. (1976) Medical nemesis. New York, NY: Pantheon. Rose, N. (1990) Governing the soul: the shaping of the private self. London: Routledge. Zola, I. (1972) ‘Medicine as an institution of social control’, Sociological Review, 20: 487–504.


Mental capacity is the ability to understand and make a decision based on relevant information. A person lacks capacity if, at the time, they are unable to make a decision in relation to a specific issue due to impairment or disturbance of the function of the mind or brain. The Mental Capacity Act 2005 is a UK legal framework to support and protect incapacitated adults. It regulates the way that adults (over 18) who lack capacity may have decisions made for them. There are five guiding principles: 1. A person must be assumed to have capacity unless proven otherwise. 2. A person should not be treated as unable to make decisions unless steps are taken to help regain capacity. 3. A person cannot be treated as unable to make a decision just because they make an unwise one. 4. The decision or act made on behalf of an incapacitated adult must be in their best interests. 5. Before the decision/act is done, professionals must ensure that it has the least restrictive impact on the person’s rights and freedoms. The Mental Capacity Act 2005 covers issues to do with an individual’s finance, health and welfare. All professionals must be able to assess capacity. It is not solely the responsibility of a doctor or psychiatrist. To assess capacity, the professional must ensure that the person: • • • •

understands the relevant information; can retain the information for long enough to make a decision; can use or weigh up the information (ie understand the risks and benefits); and can communicate that decision (by whatever means).

If a person cannot fulfil one of these, they will be deemed to lack capacity.


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All staff who make decisions for or act on behalf of an incapacitated adult must act in the person’s best interests. To act in the person’s best interests, staff must consider whether the person will gain capacity, encourage them to take part, find out their past and present wishes, and take into account anyone involved in their care. No adult can make a decision for another adult unless they have a valid Lasting Power of Attorney (or are appointed by a court). If a person lacks capacity, it is the professional who wants the decision made (decision-maker) who must assess capacity and ensure that their best interests are taken into account. For example, a person with dementia, lacking capacity, who requires full nursing care, can have their assessment undertaken by the support worker who needs to wash and dress them, as this will be in their best interests. This will not need to be a formal assessment, but the support worker must use the principles of the Act to care for them. However, if the decision is for a serious medical treatment, for example, a surgical operation, there would need to be a fuller assessment by an appropriate professional (in this case, the surgeon). A full best interests meeting is usually convened to ensure that all views (including the patient’s) are taken into account. ANUSHTA SIVANANTHAN See also: Deprivation of Liberty Safeguards; Mental Capacity Act 2005; Mental Health Act 2007 Readings Mental Capacity Act (2005) Code of practice (2007). London: Her Majesty’s Stationery Office.


In England and Wales, the Mental Capacity Act 2005 (MCA) provides a statutory framework to empower and protect people who are not able to make their own decisions. It makes clear who can take decisions, in which situations and how they should go about this. It enables people to plan ahead for a time when they may lose capacity.The MCA only concerns adults (from the age of 16 in England and Wales) who are legally incapable. Decision-making capacity is not present


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if a person, as a result of an impairment of, or disturbance in, the functioning of the mind or brain, is unable to do any of the following: • • • •

understand relevant information; retain the relevant information; use the information to come to a decision; and communicate the decision (whether by talking, using sign language or any other means). (This test of capacity is based on the so-called ‘Re C’ test in UK case law.)

The MCA is underpinned by five key principles: capacity should be presumed to be present – every competent adult has the right to make his or her own decisions and must be assumed to have capacity to do so unless it is proved otherwise; individuals who have reduced capacity have a right to be supported in making decisions – people must be given appropriate help before being considered to be incapable of making their own decisions; individuals retain the right to make what might be seen as eccentric or unwise decisions; anything done for, or on behalf of, people without capacity must be in their best interests; and anything done for, or on behalf of, people without capacity should be the least restrictive of their basic rights and freedoms. The MCA also makes a number of provisions about decisions taken in advance of the loss of capacity: it allows people to choose a person to whom they give ‘Lasting Power of Attorney’ (LPA). LPA allows decisions to be made about health, wealth and social care; however, the person who is bestowing the LPA decides what kind of decisions the LPA includes. This must be done in advance of a person becoming incapacitated, for example, a patient in the early stages of Alzheimer’s may decide who should be able to make decisions on their behalf when they are no longer capable and specify what decisions the LPA relates to. However, a person with LPA must still consider the incapacitated person’s best interests. In England and Wales, the Court of Protection makes decisions on behalf of those without capacity under the MCA. Decisions regarding financial and social care, as well as medical care, can be made. The Court of Protection delegates to the ‘Office of the Public Guardian’ (OPG) the power to assign a court-appointed deputy to make decisions on the incapacitated person’s behalf; this will usually be a relative or friend. Those who have not appointed someone with LPA and do not have a suitable carer are appointed an Independent Mental Capacity Advocate (IMCA) The MCA also makes valid advance directives (living wills) regarding refusal of medical treatment legally enforceable. The Mental Health Act 2007 amends the MCA by introducing safeguard against the deprivation of liberty in care settings.


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The Adults with Incapacity (Scotland) Act 2000 addresses similar issues for adults over the age of 16 in Scotland. ANDREW PAPANIKITAS See also: Deprivation of Liberty Safeguards; Mental Capacity Readings British Medical Association (2012) ‘Treating adults who lack capacity’, in British Medical Association, Medical ethics today: the BMA’s handbook of ethics and law (3rd edn). Chichester: John Wiley & Sons, pp 93–143. C (Adult: Refusal of Treatment), In re [1994] 1 WLR 290; [1994] 1 All ER 819.


The task of defining ‘mental disorder’ continues to present theoretical, methodological, ethical and practical challenges; all of which are enhanced by the controversy caused by the way mental disorders are perceived. For this reason, the social model of mental disorders (as opposed to the disease, psychodynamic and cognitive-behavioural models) understands mental disorders are constructed differently in different social environments.This upholds the case for any definition to consider ethical issues, such as taking account of societal attitudes to mental disorders. The theoretical implications of defining mental disorder dominate discussions of the workgroups tasked with revising each of the two major established classification systems: 1. The International Classification of Diseases (currently revising ICD-11), produced by the World Health Organization (WHO, 2013) for multidisciplinary users. (In the UK, clinicians predominantly use the diagnostic criteria set out in the chapter relating to mental and behavioural disorders of the ICD.) 2. The Diagnostic and Statistical Manual of Mental Disorders (recently revised DSM-V), produced by the American Psychiatric Association (APA, 2013) primarily for US clinicians and researchers. Much controversy surrounds the proposed new definition of mental disorder for inclusion in the DSM-V, which implies that there is an underlying biological component to all mental disorders. Consequently, challenges are encountered by those in practice, such as psychiatrists, who diagnose mental disorders against such standardised criteria. Additionally, this impacts upon research, particularly in the study of diagnosis and treatment of mental disorders, whereby researchers 165

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experience methodological implications of working with challenging definitions (Keel and Klump, 2003; Todd et al, 2004). Such challenges could be seen to persist because the aetiology (the origins and causes) and pathogenesis (the development) of mental disorders remain ambiguous. Categorically, the term ‘mental disorder’ covers a broad range of illnesses, or health problems, with a diverse range of symptoms that have a significant effect upon an individual. In general, mental disorders are characterised by a combination of abnormal thoughts, emotions, behaviour and relationships (or interaction) with others. In terms of the most common mental disorders, there is consensus that depression and anxiety feature heavily, and among the less common are those that involve psychosis, such as schizophrenia and bipolar mood disorder. In the UK, the Mental Health Act 1983 (as amended 2007) introduced a broad definition of mental disorder as being ‘any disorder or disability of mind’. The UK Crown Prosecution Service uses this definition when referring to ‘mentally disordered offenders’. In order for prosecutors to review cases in accordance with the Code for Crown Prosecutors (Crown Prosecution Service, 2013), they require prompt information and evidence about any reported mental health problems. If confirmed, a defendant’s mental disorder may impact upon: the decision to prosecute; the decision to divert; the offender’s fitness to plead; and/ or their sentencing/disposal. While there is not a universal and convincing definition, there is a healthy and dynamic debate about how mental disorder is defined. Crucially, there is an ongoing demand for those who work with individuals with mental health needs to be able to clearly distinguish what constitutes a mental disorder. REBECCA TWINLEY See also: Diagnostic and Statistical Manual of Mental Disorders; Mental Health Act 2007 Readings APA (American Psychiatric Association) (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edn). Washington, DC: American Psychiatric Association. Crown Prosecution Service (2013) The code for Crown Prosecutors (7th edn). London: Crown Copyright. Keel, P.K. and Klump, K.L. (2003) ‘Eating disorders culture-bound syndromes? Implications for conceptualizing their etiology’, Psychological Bulletin, 129(5): 747–69.


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Todd, J., Green, G., Harrison, M., Ikuesan, B.A., Self, C., Baldacchino, A. and Sherwood, S. (2004) ‘Defining dual diagnosis of mental illness and substance misuse: some methodological issues’. Journal of Psychiatric and Mental Health Nursing, 11: 48–54. World Health Organization (2013) ‘Classifications: International Classification of Diseases (ICD)’. Available at: www.who.int/classifications/icd/en/


Much of the scholarship that examines the multifaceted issues surrounding mental illness and disorder and criminal justice focus on severe mental illness and disordered personalities. Bona fide (in a classification sense) diagnoses such as schizophrenia, bipolar affective disorder and personality disorder have dominated the research and policy domain, whereas what may be viewed as less tangible and transient conditions of mental distress are perhaps less well understood. The threshold between distress and illness or disorder is largely a question of professional opinion through intervention; however, undetected symptoms of excessive worry, stress, anxiety and/or low mood – static or transient – are still a cause of concern for those working within, or in contact with, criminal justice agencies. While episodes of depressive mood, anxiety and/or stress may not be officially diagnosed as an illness or disorder, these symptoms may well mirror in behaviours and adjustments to social situations, causing disruption and uncomfortable feelings. Mental distress may feature in a variety of criminal justice interactions. Indeed, research in the UK has shown a disproportionate number of victims of crime who experience mental distress and find it difficult to achieve ‘justice’ through the courts due to issues such as insufficient support for witnesses during the trial (Mind, 2007). Furthermore, crime and fear of crime have been explored in relation to mental well-being (see Lorenc et al, 2012), as well as gendered issues in the area of victimisation and mental distress (see Jordan et al, 2010). The mental vulnerabilities of suspects, defendants and offenders themselves have been the subject of much policy emphasis recently in the UK, in particular, within the 2009 Bradley Report (Bradley, 2009). Central to much of this report is the recommendation for improved training and awareness among criminal justice practitioners and priorities for diversion. Indeed, this far-reaching report itself – covering the police, courts, punishments and resettlement – reflects upon the fact that there are an abundance of definitions at play in the criminal justice and


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health fields, and settles on a working definition of ‘mental health problems’ so as not to exclude conditions that may exist outside of set diagnoses. Some of the most extensive work regarding the mental distress felt by offenders has been in the prison context. Seminal studies (eg Sykes, 1958; Carlen, 1998) have pointed towards the deleterious effects of imprisonment through several impactful deprivations, whereas other authors have supplemented these indigenous deprivations with considerations over the importation of behaviours and characteristics into the prison environment (see Dye, 2010). In a similar vein, the obstacles apparent in the prison that have the potential to exacerbate preexisting mental distress, or cultivate new forms of distress, have been reviewed, with conclusions being made that by virtue of the function of the prison as an institution of punishment, it therefore has few therapeutic aims (Burki, 2010). Recognising symptoms or indicators of mental distress is not an easy task for criminal justice professionals; however, given the context in which criminal justice operates (eg victimising events and harmful incidents, retelling the circumstances surrounding a victimising event through a court trial, depriving offenders of their liberty), practitioners and policymakers are at the interface of such issues. A concentration on diagnosed illness and disorders is perhaps a myopic enterprise, and therefore symptoms of distress may well go undetected or unresolved due to the reverence attached to formally diagnosed illnesses and disorders. This is not to say that there should be an increased application of diagnoses; rather, on the contrary, opportunities may be available for a broader appreciation and awareness of not just the presence of illness and disorder in the criminal justice context, but also the nature and character of stressors and distressing events that criminal justice may be implicit in exacerbating, or stop short in supporting. PAUL TAYLOR See also: Bradley Report; Mental Disorder Readings Bradley, K. (2009) The Bradley Report: Lord Bradley’s review of people with mental health problems or learning disabilities in the criminal justice system. London: Department of Health. Burki, T. (2010) ‘Grasping the nettle of mental illness in prisons’, The Lancet, 376(9752): 1529–30. Carlen, P. (1998) Sedgehammer: women’s imprisonment at the millennium. London: MacMillan. Dye, M.H. (2010) ‘Deprivation, importation, and prison suicide: combined effects of institutional conditions and inmate composition’, Journal of Criminal Justice, 38(4): 796–806. 168

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Jordan, C.E., Campbell, R. and Follingstad, D. (2010) ‘Violence and women’s mental health: the impact of physical, sexual, and psychological aggression’, Annual Review of Clinical Psychology, 6(1): 607–28. Lorenc, T., Clayton, S., Neary, D., Whitehead, M., Petticrew, M., Thomson, H., Cummins, S., Sowden, A. and Renton, A. (2012) ‘Crime, fear of crime, environment, and mental health and wellbeing: mapping review of theories and causal pathways’, Health & Place, 18(4): 757–65. Mind (2007) ‘Another assault: Mind’s campaign for equal access to justice for people with mental health problems’. Available at: www.mind.org.uk/ media/273466/another-assault.pdf Sykes, G.M. (1958) The society of captives. A study of a maximum security prison. Princeton, NJ: Princeton University Press.


In England and Wales, the Mental Health Act 2007 amends (does not replace) the Mental Health Act 1983 in a number of important ways.The Mental Health Act 1983 had four categories of mental disorder that could be covered by the Act: mental illness, severe mental impairment, mental impairment and psychopathic disorder. These categories were removed from the legislation when the Mental Health Act 2007 came into force. Only those who suffer from a mental disorder are covered by the Act – treatment of people with learning disability and mental impairment (such as from dementia or a stroke) is now covered by the Mental Capacity Act 2005. The Act replaces the term ‘approved physician’ with ‘approved clinician’ – non-medical clinicians with appropriate training may authorise detention and compulsory treatment. The Act also introduces ‘Supervised Community Treatment Orders’, with the result that people may receive compulsory treatment for mental health conditions in the community while being treated under the Act. Should they fail to comply with treatment in the community, then treatment may be continued while detained in hospital. The Act also creates a system for advocacy. Where there is no appropriate next of kin, an Independent Mental Health Advocate may be appointed. The Act introduces additional safeguards for the use of electro-convulsive therapy and reduces the time limit before hospital managers must refer patients for a Mental Health Review Tribunal if the patient does not request it him or herself. The 2007 Act introduces a duty on commissioners and managers of health-care services to provide appropriate facilities where patients under the age of 18 are detained under the Act. 169

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The Mental Health Act 2007 also importantly amends the Mental Capacity Act 2005 by introducing the Deprivation of Liberty Safeguards (DoLS) for people without capacity. Furthermore, the Mental Health Act 2007 amends victims’ rights under the Domestic Violence, Crime and Victims Act 2004. Victims of offenders who are detained, or on supervised community treatment, may in appropriate circumstances receive information about or make representations regarding the relevant patient’s treatment and release. ANDREW PAPANIKITAS See also: Community Treatment Orders; Compulsory Hospitalisation; Consent to Treatment Readings Brindle, N. and Branton, T. (2010) ‘Interface between the Mental Health Act and Mental Capacity Act: Deprivation of Liberty Safeguards’, Advances in Psychiatric Treatment, 16(6): 430–7. Department of Health, Mental Health Act Implementation Team (2008) Mental Health Act 2007 – guidance on extension of victims’ rights to information under the Domestic Violence, Crime and Victims Act 2004. London: Department of Health.


Mental Health First Aid (MHFA) originated in Australia in 2000 and was developed by Betty Kitchener and Tony Jorm at the Centre for Mental Health Research at the Australian National University in Canberra. Kitchener brought the course to the UK in 2003, originally in Scotland, where the training materials were adapted and developed for the UK, and then to England in 2006. MHFA England, a community interest company with the sole aim to ‘increase the mental health literacy of the whole population’ (MHFA, 2013, p 1), was established in 2008 with the seven-day instructor-qualifying programme being accredited by the Royal Society of Public Health and endorsed by the Department of Health. To ensure quality and consistency in the delivery of MHFA, instructors undergo a seven-day training programme with a probationary period prior to full accreditation as an instructor and are required to register with MHFA England annually in order to continue to deliver the MHFA course. In 2010, the Youth MHFA programme was established to address the particular needs of young people aged 11–18. MHFA aims to teach people how to give initial care to someone experiencing mental ill-health in the same way that traditional first aid trains people to respond 170

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to physical injury and illness. The course trains participants to recognise the symptoms of mental health problems, provide initial help and guide a person towards appropriate professional help. Mental health problems are common; according to the Coalition government’s mental health strategy No health without mental health (Department of Health, 2011), mental ill-health represents up to 23% of the total burden of ill-health in the UK and is the largest single cause of disability. This means that in the course of their lives, the majority of people are likely to either experience mental illhealth or to come across someone who does. MHFA was established as a response to the widespread ignorance of mental ill-health in the general population, the myths and stigma that surround those experiencing mental ill-health, and a lack of confidence in how to help in crisis situations. In addition to providing training on how to give initial care until professional help is obtained, MHFA also provides participants with an understanding of mental health/ill-health and looks specifically at anxiety disorders, suicide, depression and psychosis. A key feature of the training is the inclusion of films and presentations by people with lived experience of mental ill-health. HELEN CORTEEN See also: Emotional CPR Readings Department of Health (2011) No health without mental health. London: Department of Health. MHFA (Mental Health First Aid England) (2012) Mental health first aid manual (2nd edn). London: MHFA England CIC. MHFA (2013) Line managers’ resource. A practical guide to managing and supporting people with mental health problems, London: MHFA England CIC. Available from: http://mhfaengland.org/files/5613/9101/5215/MHFA_Line_Managers_ Resource.pdf


The presence of people with mental health problems is a long-standing problem within the prison system. A national prevalence study conducted in England and Wales concluded that nine out of 10 prisoners had at least one psychiatric diagnosis, with rates of neurotic disorder, personality disorder, hazardous drinking and drug use significantly higher than in the general population. Rates of psychotic disorder 171

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were also disproportionately high, with between 7% of sentenced men and 14% of women prisoners suffering from psychosis (Singleton et al, 1998). Despite high rates of mental illness, prison-based mental health services have been historically criticised as ineffective, neither reflective of current best practice nor actual clinical need, delivered by inadequately qualified staff in unsuitable physical environments, and yet costing more than services to the wider community (British Medical Association, 2001; Birmingham, 2003). In 2000, The NHS plan (Department of Health, 2000, p 121) set a target that, by 2004: 5,000 prisoners at any time should be receiving more comprehensive mental health services in prison. All people with severe mental illness will be in receipt of treatment, and no prisoner with serious mental illness will leave prison without a care plan and a care co-ordinator. The following year, the Department of Health and HM Prison Service (2001) published Changing the outlook, outlining a new model whereby National Health Service (NHS) community mental health services would in-reach into prisons, providing the mechanism through which to achieve the target set in The NHS plan. In-reach teams, predominantly comprising mental health nurses, supported by other professionals, for example, psychiatrists and psychologists, are now ubiquitous across the England and Wales prison estate. Their impact has been examined in a national evaluation study (Offender Health Research Network, 2009), which found that while in-reach services have generally been welcomed as a useful initiative, they have experienced difficulties adjusting their working practices to allow the delivery of modern mental health care in the prison environment, and in establishing clear models of care for their stated target group, those with serious mental illness. An examination of their clinical impact found that inreach teams struggled to successfully target all those with serious mental illness: Senior et al (2013) reported that only a quarter (25%) of people with serious mental illness were assessed by in-reach services and only 13% were taken onto the caseload. The reasons for this limited impact are multifaceted, including: continued disparity between the size of the population to be served compared with the front-line resources available; generally inadequate health-screening and assessment procedures upon initial reception into prison; lack of appropriate treatment availability for people with personality disorders; and underdeveloped models of primary mental health-care services for those experiencing common mental health problems. Future developments in prison-based mental health care will need to address all these issues holistically, as well as developing ways of maximising engagement with community-based services upon release, if


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significant positive outcomes for both individuals and society are to be achieved in this vulnerable and socially excluded population. JANE SENIOR See also: Assessment, Care in Custody and Teamwork Approach Readings Birmingham, L. (2003) ‘The mental health of prisoners’, Advances in Psychiatric Treatment, 9: 191–201. British Medical Association (2001) Prison medicine: a crisis waiting to break. London: British Medical Association. Department of Health (2000) The NHS plan. London: Department of Health. Department of Health and HM Prison Service (2001) Changing the outlook: a strategy for modernising mental health services in prisons. London: Department of Health. Offender Health Research Network (2009) ‘A national evaluation of prison mental health in-reach services: a report to the National Institute of Health Research’. Available at: www.ohrn.nhs.uk/resource/research/Inreach.pdf Senior, J., Birmingham, L., Harty, M.A., Hassan, L., Hayes, A.J., Kendall, K., King, C., Lathlean, J., Lowthian, C., Mills, A., Webb, R., Thornicroft, G. and Shaw, J. (2013) ‘Identification and management of prisoners with severe psychiatric illness by specialist mental health services’, Psychological Medicine, 43(7): 1511–21. Singleton, N., Meltzer, H. and Gatward, R. (1998) Psychiatric morbidity among prisoners in England and Wales. London: Her Majesty’s Stationery Office.


In England and Wales, the Mental Health Review Tribunal (MHRT) was first introduced by the Mental Health Act 1959 to review the lawfulness of detention under the Act and to provide a legal safeguard against unjustified detention for those subject to a compulsory order. These ‘quasi-judicial’ bodies consist of a panel of three members: a legal member who is the chair; a medical member who has a duty to examine the patient; and a lay member who may have relevant professional experience or qualifications.The MHRT is now accountable to the Tribunals, Courts and Enforcement Act 2007. Patients detained under Part II of the Mental Health Act 1983 (as amended 2007) (sections 2 and 3) and those subject to Guardianship (section 7) or a Supervised 173

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Community Treatment Order (section 17A) may appeal to the MHRT, as can those detained under section 37 (Hospital Order). Those subject to restrictions (sections 41 and 42) may also apply to the MHRT after the first six months following detention, but discharge is only with the consent of the secretary of state. The power to discharge a patient (section 72) can be immediate or deferred if there is a need to make suitable care arrangements (Fennell, 2007). The main power of the MHRT is to review a patient’s detention, and if the criteria for detention are no longer met, to discharge the patient. A majority vote is sufficient to discharge a patient. The Mental Health Act 1959 placed the burden of proof with the patient, and this was amended with the Mental Health Act 1983 (Remedial) Order 2001 to ensure that evidence for discharge under section 72 is compatible with the European Court of Human Rights (ECHR) (Fennell, 2007). While the MHRT deliberates on evidence from the care team, this often emphasises risks presented by the patient within the hospital setting. Arguments focus on how these risks can be presented in the community and the patient is no longer under 24-hour supervision. Sarkar and Adshead (2005) imply that some risk-averse Responsible Clinicians (RCs) may offer a biased perspective of the patient’s behaviour rather than offering a balanced perspective that also considers their strengths. Public safety is a concern for all involved, and Sarkar and Adshead (2005) suggest that MHRTs are often presented with unsubstantiated evidence of a person’s dangerousness. MHRTs are a forum in which to review the patient’s care plan, and with appropriate feedback from the panel, this can help the patient to acknowledge where progress has been made. While patients often use their rights to access the MHRT, not all fully understand their powers or the procedures. Additionally, unsuccessful applications can lead to difficult relationships with the RC (Dolan et al, 1999). MHRTs may therefore be seen as an end in themselves rather than a constructive part of the patient’s recovery to good mental health. ANNE KEELER See also: Community Treatment Orders; Compulsory Hospitalisation; Restricted Patient Readings Dolan, M., Gibb, R. and Coorey, P. (1999) ‘Mental health review tribunals: a survey of special hospital patients’ opinions’, The Journal of Forensic Psychiatry, 10(2): 264–75. Fennell, P. (2007) Mental health: the new law. Bristol: Jordan Publishing. 174

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Sarkar, S. and Adshead, G. (2005) ‘Black robes and white coats: who will win the new mental health tribunals?’, British Journal of Psychiatry, 186: 96–8.


In an attempt to provide the courts with greater flexibility, community sentences were replaced by a single Community Order under the Criminal Justice Act 2003. Magistrates and judges now have 12 options (‘requirements’) available to them when making a Community Order. One is the Mental Health Treatment Requirement (MHTR), although an order may consist of a number of other requirements, including unpaid work, supervision and drug rehabilitation. An MHTR requires an offender to receive treatment from a registered medical practitioner or psychologist for up to 36 months. If the order is to be made, the court must be satisfied that the offender has a mental health condition, that treatment is available and that the offender is willing to consent. The court must also be satisfied that treatment can be undertaken in the community and that the offender does not require admission to hospital under the Mental Health Act 1983 (as amended 2007). Despite the high levels of mental health problems among people who offend, use of the MHTR has been limited. The highest number issued since their introduction was 809 in 2009, representing only 0.035% of the total number of requirements issued as part of a Community Order (Scott and Moffatt, 2012). Their use has declined since this time, with only 406 issued in the first three quarters of 2012 (Ministry of Justice, 2013). A number of reasons have been put forward for the limited uptake. These include: a lack of clarity about who should receive an MHTR; the need for a psychiatric report before an MHTR can be made; and uncertainty about how breaches of Community Orders should be managed (Scott and Moffatt, 2012). Research has also identified divergent professional views about the MHTR and some considerable regional differences in its use (Pakes and Winstone, 2012). Other concerns have been raised about the availability of resources to support the use of the MHTR (Scott and Moffatt, 2012). Some optimism surrounds the introduction of the Legal Aid, Sentencing and Punishment of Offenders Act 2012, which allows greater discretion to deal with breaches of Community Orders, broadens the range of professionals who can assess mental health for an MHTR and removes the prerequisite of having a psychiatric report before an MHTR can be issued. However, concerns have also been raised that proposals to toughen community sentences under the Crime 175

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and Courts Bill 2012 (enacted 2013) may lead the ‘unfulfilled potential’ of the MHTR to continue (Moffatt, 2012). JULIE TREBILCOCK See also: Probation Readings Khanom, H., Samele, C. and Rutherford, M. (2009) A missed opportunity? Community sentences and the Mental Health Treatment Requirement. London: Sainsbury Centre for Mental Health. Ministry of Justice (2013) Offender management statistics: quarterly bulletin – July to September 2012, England and Wales. London: Ministry of Justice. Moffatt, S. (2012) ‘The Mental Health Treatment Requirement’, Criminal Law and Justice Weekly, 22 December. Available at: www.criminallawandjustice.co.uk/ comment/Mental-Health-Treatment-Requirement Pakes, F. and Winstone, J. (2012) ‘The Mental Health Treatment Requirement: the promise and the practice’, in A. Pycroft and S. Clift (eds) Risk and rehabilitation: management and treatment of substance misuse and mental health problems in the criminal justice system. Bristol: The Policy Press, pp 107–18 Scott, G. and Moffatt, S. (2012) The Mental Health Treatment Requirement: realising a better future. London: Centre for Mental Health.


Mentally disordered offenders may be managed in secure hospital facilities, prisons or the community. Significant attention has been paid by researchers, policy writers and service providers to the challenges of mental illness and disorder in the prison context. The incidence of mental illness among offenders is greatly elevated compared with that of the general population. In developed nations, around one in seven prisoners has a psychotic illness or major depression, which are risk factors for suicide (Fazel and Danesh, 2002). Although the majority of prisoners are male, the prevalence of mental illnesses/disorders among female offenders is even higher. Poor mental health is a predictor of both preventable mortality and recidivism after release from prison (Merrall et al, 2010); therefore, improving mental health outcomes among offenders is important from both health and criminal justice perspectives. In developed countries, the high prevalence of mental illness/disorder among offenders may be partially attributed to processes known as ‘deinstitutionalisation’ 176

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and ‘transinstitutionalisation’. The routine use of psychotropic medications in the 1950s helped to stabilise those who were institutionalised, allowing them to be discharged into the community. This transition from inpatient to outpatient treatment (‘deinstitutionalisation’) led to the closure of many largescale psychiatric facilities. Deinstitutionalisation was intended to occur alongside comprehensive community supports; however, a shortfall in these led to increasing contact between individuals with poorly managed mental illness/disorder and the criminal justice system (‘transinstitutionalisation’). Mental illness/disorder among offenders presents complex management and health-care challenges across all stages of contact with the criminal justice system. Although a link between poorly managed mental illness/disorder and offending exists, the nature of this relationship is unclear. Poorly managed mental illness may cause offending, but experiences of incarceration (prison or hospital) may also precipitate or exacerbate mental illness. Offenders with mental illness are also more likely to be substance-dependent and to experience poor physical health. The prevalence of more common illnesses and disorders (particularly depression and post-traumatic stress disorder), intellectual disability, and attention deficit disorder is also elevated (Abdalla-Filhoa et al, 2010). These conditions significantly impact upon quality of life, but are often under-diagnosed and under-treated in settings such as the prison. Additionally, separate health-care systems in prisons and the community can complicate transitions of care. Evidence suggests the need for integrated, collaborative approaches that move beyond ‘siloed’ healthcare and social service delivery. Despite international declarations such as the European Convention on Human Rights, the World Health Organization Trenčín Statement on Prisons and Mental Health, and the United Nations Basic Rules for the Treatment of Prisoners, most offenders do not receive adequate mental health care either in custody or during the high-risk period of transitioning back to the community. Research in this area is one of growth; however, the evidence base related to offenders with mental illnesses/disorders is heavily skewed towards Western countries, despite the fact that two thirds of the world’s prisoners are incarcerated outside of Western countries. KATE VAN DOOREN and STUART KINNER See also: Care in the Community; Learning Disabilities and Criminal Justice


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Readings Abdalla-Filhoa, E., De Souzac, P.A., Tramontina, J.F. and Tabordae, J.G.V. (2010) ‘Mental disorders in prisons’, Current Opinion in Psychiatry, 23: 463–6. Fazel, S. and Danesh, J. (2002) ‘Serious mental disorder in 23000 prisoners: a systematic review of 62 surveys’, The Lancet, 359: 545–50. Merrall, E.L.C., Kariminia, A., Binswanger, I.A., Hobbs, M.S., Farrell, M., Marsden, J., Hutchinson, S.J. and Bird, S.M. (2010) ‘Meta-analysis of drugrelated deaths soon after release from prison’, Addiction, 105: 1545–54.


Patients who go missing or abscond from inpatient care present a significant challenge to health-care providers and the police. Organisations define absconding differently, making it difficult to compare rates of absconding across research studies, but Stewart and Bowers’ (2010) wide-ranging literature review and metaanalysis well illustrates the complexity of the issue. Reasons behind absconding are varied and include (inter alia): wishing to leave to attend to responsibilities at home; boredom; dislike of treatment or the unit; feeling they did not need to be in hospital; wishing to leave to use alcohol or illicit substances; psychiatric symptoms; administrative confusion; and feeling trapped. (Stewart and Bowers, 2010, pp 15–16) Some patients abscond by not returning from an agreed period of leave, while others actively leave without permission. Research has found that while ‘one of the most common [destinations] was the patient’s home’ (Stewart and Bowers, 2010, p 18), other destinations were found, such as pubs, friends’ and family’s homes, wandering around town and even leaving the country. Patients may face significant risk while away from the ward; one study found that ‘27% of inpatient suicides take place off the ward, often after the person has gone missing’ (Bartholomew et al, 2009, p 4). In Stewart and Bowers’ (2010) wide-ranging literature review, recorded harms to absconding patients included overdosing, attempted suicide, self-harm and completed suicide. The missing patients are not the only ones affected by incidents of missing or absconding: ‘absence also prevents therapeutic input from staff, and is anxiety provoking for those involved.… Research has also shown that missing patient


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incidents can affect carer and relative views, and faith, in mental health services’ (Bartholomew et al, 2009, p 4). Patients going missing also ‘places a burden upon staff who worry about the safety of absconding patients and upon the police who are often involved in returning patients to hospital’ (Stewart and Bowers, 2010, p 2), and it is therefore important that strategies are employed to seek to prevent and reduce missing patient incidents, and to deal effectively with those incidents that do occur. The National Mental Health Development Unit proposed a series of strategies for mental health wards to reduce missing incidents. These are that: unit staff should develop understanding of the problem; the unit should have entry and exit policies; meaningful engagement must be provided; staff should take care to structure each day; and the unit must engage with key stakeholders, for example, by implementing a joint protocol with local police (Bartholomew et al, 2009).      LUCY HOLMES See also: Missing People Readings Bartholomew, D., Duffy, D. and Figgins, N. (2009) Strategies to reduce missing patients: a practical workbook. London: National Mental Health Development Unit. Stewart, D. and Bowers, L. (2010) Absconding from psychiatric hospitals: a literature review. Report from the Conflict and Containment Reduction Research Programme. London: Kings College London, Institute of Psychiatry.


People go missing, and are reported missing, in a variety of circumstances. Many missing people are reported to local police forces, particularly where there are concerns for their welfare or when agencies have internal procedures that require staff to report all absences to police. ‘The police receive an estimated 360,000 reports of missing people every year across the UK … [amounting] to approximately 200,000 people going missing every year’ (Home Office, 2011, p 7). Recent police guidance allows for forces to provide a tiered response to reports of missing people: ‘anyone whose whereabouts cannot be established and where the circumstances are out of character or the context suggests the person may be the subject of crime or at risk of harm to themselves or another’, and for people 179

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who are believed to be absent, who are ‘not at a place where they are expected or required to be’ (Association of Chief Police Officers, 2013, p 5). Not all people who are absent or missing will be reported to the police, either because they return before those people left behind wish to involve the police, or because their absence is not noticed or deemed suitable for police involvement. A large proportion of adults who go missing are believed to have a mental health problem. UK estimates vary between 22% and 80%, but recent research suggests that around 45% of adults reported missing to police have a mental health problem (Woolnough et al, 2014). Estimates of prevalence of mental health problems in the missing population tend to measure both diagnosed conditions and informant reports of mental ill-health (Woolnough et al, 2014). Accurate information about missing people’s mental health is lacking because: the missing person might not have experienced mental health problems prior to the missing incident; the missing person may not have consulted a clinician about their mental health or may not have received a diagnosis; informants may not know the details of any diagnosis; and police records can be variable in quality or difficult to access. Mental health problems can act as a cause or trigger for a missing incident, and may be a sign that someone’s mental health is declining. Missing people may also face circumstances, while away, that contribute to a decline in their mental well-being, such as not having access to treatment or support, or sleeping rough, substance misuse, lack of sleep or victimisation: A missing adult who is unwell and who has no support can rapidly come to harm through neglect and self harm. It is known that over a quarter of suicides recorded for mental health residential units actually take place away from the ward, often after the patient has been reported missing. (Home Office, 2011, p 16) LUCY HOLMES See also: Missing Patients Readings Association of Chief Police Officers (2013) ‘Interim guidance on the management, recording and investigation of missing persons’. Available at: www.acpo.police. uk/documents/crime/2013/201303-cba-int-guid-missing-persons.pdf Home Office (2011) ‘Missing children and adults: a cross-government strategy’. Available at: https://www.gov.uk/government/uploads/system/uploads/ attachment_data/file/117793/missing-persons-strategy.pdf


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Woolnough, P., Alys, L. and Shalev Greene, K. (2014) ‘Mental health issues and missing adults’, in K. Shalev Greene and L. Alys (eds) Missing persons: a handbook of research. Surrey: Ashgate.


Public and political anxieties about the risks posed by violent and sexual offenders during the 1990s led to a number of legislative changes.These include the introduction of Multi-Agency Public Protection Arrangements (MAPPAs) under the Criminal Justice and Court Services Act 2000. Later strengthened by the Criminal Justice Act 2003 (CJA), MAPPAs place a statutory duty on the police, probation and prison services (the ‘Responsible Authority’) to establish procedures to identify and reduce the risk posed by violent and sexual offenders. Under section 325 of the CJA, a number of other agencies, including health and local authority social services, have a statutory duty to cooperate with the Responsible Authority. Together, these agencies are responsible for the following functions: identification of MAPPA offenders; assessment of their risk; management of the risks they pose; and effective information sharing between relevant agencies. Offenders are managed at three levels, with each intended to reflect the level of multi-agency cooperation required. MAPPA-eligible offenders (defined by section 327 of the CJA) include registered sex offenders (under the Sexual Offences Act 2003) and those sentenced to 12 months or more in prison following conviction for a specified sexual or violent offence (under Schedule 15 of the CJA). In addition, some offenders who are subject to provisions of the Mental Health Act 1983 (as amended 2007) may also be managed under MAPPA. Agency cooperation has long been a feature of criminal justice policy (Clift, 2012). However, what is different is the statutory requirement that these agencies work together to manage risk. However, much debate has surrounded the question of what a duty to cooperate should actually entail (Snowden and Ashim, 2008). Mental health professionals have expressed particular concerns about information sharing and patient confidentiality. This demonstrates that MAPPAs are primarily focused on risk and public protection rather than on a medical duty of care to the patient. This has led to some resistance among mental health staff and concerns that MAPPAs may have a negative impact on the quality of therapeutic relationships (Yakeley and Taylor, 2011).


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Other, more practical challenges have also been identified. A pertinent reminder highlighted by Snowden and Ashim (2008) is that despite having a duty to cooperate, health services are not provided with additional funding to help implement MAPPAs. Difficulties with trying to combine different agency-based assessments of risk have also been reported (Yakeley and Taylor, 2011). In all, MAPPAs have no doubt helped to manage the risk posed by some offenders with mental disorder. However, these arrangements have also served to further blur the boundaries between criminal justice and mental health care, and often placed medical professionals in the difficult position of having to prioritise risk over the needs and rights of their patients. More than a decade after MAPPAs first emerged, there are still calls for clearer and more consistent guidelines to help address the challenges surrounding their implementation with mentally disordered offenders (Yakeley et al, 2012).   JULIE TREBILCOCK See also: Criminal Justice Act 2003; Dangerousness and Mental Disorder; Probation Readings Clift, S. (2012) ‘Risk, assessment and the practice of actuarial criminal justice’, in A. Pycroft and S. Clift (eds) Risk and rehabilitation: management and treatment of substance misuse and mental health problems in the criminal justice system. Bristol: The Policy Press, pp 21–64. Snowden, P. and Ashim, B. (2008) ‘Release procedures and forensic mental health’, in K. Soothill, P. Rogers and M. Dolan (eds) Handbook of forensic mental health. Cullompton: Willan Publishing. Yakeley, J. and Taylor, R. (2011) ‘Multi-agency public protection arrangements (MAPPA): can we work with them?’, in A. Rubitel and A. Reiss (eds) Containment in the community: supportive frameworks for thinking about antisocial behaviour and mental health. London: Karnac Books Ltd. Yakeley, J., Taylor, R. and Cameron, A. (2012) ‘MAPPA and mental health – 10 years of controversy’, The Psychiatrist, 36(6): 201–4.


N NATIONAL CONFIDENTIAL INQUIRY INTO SUICIDE AND HOMICIDE BY PEOPLE WITH MENTAL ILLNESS The National Confidential Inquiry into Suicide and Homicide by People with Mental Illness was established at the University of Manchester in 1996, following its initial inception in London in 1992. It is one of three confidential enquiries that investigate adverse outcomes when people are engaged with health-care services; the others being the National Confidential Enquiry into Patient Outcome and Death and the Confidential Inquiry into Maternal Deaths. Essentially a UK-wide audit of suicides of, and homicides by, people engaged with mental health services, the National Confidential Inquiry traces its roots back to government and public concerns about a number of high-profile homicides in the early 1990s, including the murder of Jonathon Zito by Christopher Clunis in 1992 (Robinson and Bickley, 2004). As part of the Health of the nation strategy for England (Department of Health, 1992), suicide was also included as an adverse outcome. Robinson and Bickley (2004) outline three stages of data collection in relation to suicide. First, details on all suicides in the UK are collected, including deaths recorded as ‘open verdicts’. From this, people in contact with mental health services are identified through an established mechanism involving local National Health Service (NHS) Trusts. Having identified individuals in contact with mental health services, detailed information is then collected about them, including


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psychiatric history, antecedents of the suicide and details of the suicide, including methods used. The National Confidential Inquiry was previously criticised for providing only descriptive data that were uncontrolled and did not allow factors that may lead to suicide to be extrapolated. Similarly, the lack of evidence of effective interventions to reduce suicide led to some of the recommendations from the National Confidential Inquiry reports being described as a waste of resources (Geddes, 1999). Methodological criticisms of the National Confidential Inquiry included the retrospective nature of data collection and the subjective judgement of clinicians in completing the reports. In order to address these limitations, the National Confidential Inquiry expanded its remit to include case control studies to further investigate the risk and protective factors for suicide, a study investigating the relationship between service provision and suicide rates, and a psychological autopsy. This involved the collection of qualitative and quantitative data and information on the deceased from a variety of sources, including immediate family members, relatives and friends, and healthcare personnel caring for the deceased. This is collated and added to case files and records, giving a comprehensive overview of the deceased. It is argued that this minimised the risk of subjective bias noted earlier. In addition to annual reports, the National Confidential Inquiry produces a selfassessment ‘toolkit’ that allows organisations, and NHS Trusts in particular, to audit their performance against the recommendations of the National Confidential Inquiry. IAIN McGOWAN See also: National Suicide Prevention Strategy; Qualitative and Quantitative Inquiry in Mental Health Research; Zito Trust Readings Department of Health (1992) Health of the nation strategy for England. London: Department of Health. Geddes, J. (1999) ‘Suicide and homicide by people with mental illness: we still don’t know how to prevent most of these deaths’, British Medical Journal, 318: 1225–6. Robinson, J. and Bickley, H. (2004) ‘The role of the National Confidential Inquiry in relation to suicide prevention’, in D. Duffy and T. Ryan (eds) New approaches to preventing suicide: a manual for practitioners. London: Jessica Kingsley Publishers, pp 194–212.


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Swinson, N., Ashim, B., Windfuhr, K., Kapur, N., Appleby, L. and Shaw, J. (2007) ‘National Confidential Inquiry into Suicide and Homicide by People with Mental Illness: new directions’, Psychiatric Bulletin, 31(May): 161–3.


The National Offender Management Service (NOMS) is the organisation responsible for prison and probation services created in response to the 2003 Carter Review, which was commissioned to review correctional services. Carter (2003) perceived a lack of coordination between custodial and community interventions, sentencing thresholds being passed too easily, and too little focus on effectiveness and affordability. Throughout its short existence, NOMS has experienced a constant state of flux; it could be argued that its initially intended architecture has yet to be fully realised (Burke and Collett, 2010). Certainly, despite the length of time that the organisation has been in existence and the vision of a more coordinated service promoted, there is still a strong element of ‘silo-ism’ at ground level. One example is in partnership arrangements with mental health service providers. For practitioners, while referral pathways have started to become clearer, there are still significant problems experienced with regards to funding and practice responsibilities. A significant contribution of NOMS to the practice agenda was the development of the NOMS Offender Management Model (Home Office, 2006). This model sought to achieve continuity between the management of offenders in custody and in the community through ‘end-to-end offender management’. Part of this new language involved the creation of the terms ‘Offender Manager’ and ‘Offender Supervisor’, with Offender Managers having oversight for the overall management of an offender’s sentence and the Offender Supervisor delegated responsibility for aspects of sentence delivery. It was envisaged that an Offender Manager in the community would prepare a report on an offender pre-sentence and then, should they receive a custodial sentence, retain responsibility for that offender throughout the custodial element of the sentence and through to their subsequent supervision on licence. While incarcerated, the Offender Manager would liaise with the offender’s prison-based Offender Supervisor in planning their prison-based interventions and management. With regards to the offender management concept, one of the most important criticisms is with regards to the language used and its implications. Alongside academic research (eg desistance), prisoner- and ex-offender-led groups have highlighted the importance of offender engagement and ownership of their own progress and future. The language of offender management not only concentrates 185

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on the term ‘offender’, but also places the offender as a passive recipient of services instead of enabling their personal ownership and responsibility for change. A further key concept that has become embedded as part of the NOMS agenda, and perhaps the most significant in terms of long-term change in the criminal justice system, has been that of commissioning and contestability. Carter’s (2003) review highlighted the future importance of effectiveness and affordability and suggested the involvement of private- and third-sector organisations to achieve this end. This has led to questions as to whether the commissioning should be locally or nationally derived and what work should remain public. From an academic perspective, however, perhaps the more interesting question this poses is that of determining who the customer is in a marketised criminal justice system. To date, the road travelled suggests the offender’s experience in this respect is not a primary consideration, and, as with offender management, there is little evidence to date that commissioning of services will better engage offenders in their own journey of change (Stacey, 2012). DAVID WOOD and LOL BURKE See also: Offender Assessment System; Probation Readings Burke, L. and Collett, S. (2010) ‘People are not things: what New Labour has done to probation’, Probation Journal, 57(3): 232–49. Carter, P. (2003) Correctional services review: managing offenders, reducing crime – a new approach. London: Strategy Unit. Home Office (2006) The NOMS offender management model. London: Home Office. Stacey, C. (2012) ‘The marketisation of the criminal justice system: who is the customer?’, Probation Journal, 59(4): 406–14.


In 1997, the new Minister of Health Alan Milburn created a framework for the effective delivery of health. The key elements of the reforms included clinical governance, national service frameworks (NSFs) and the National Institute for Clinical Excellence (NICE), and were designed to create a health-care system based on evidence-based guidelines which ensured that service providers delivered high-quality and safe care (Alaszewski and Brown, 2012).


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The services provided by the National Health Service (NHS) and associated social-care services have been divided into specialist areas, usually based on the needs of specific client groups, and the plan is that in each area, expert groups are formed that codify the best available knowledge or evidence about the best way of delivering care, and incorporate this knowledge into an NSF. These evidencebased NSFs are designed to ‘set clear quality requirements for care’ (NHS, 2013, p 1) for each client group or disease area, and provide the basis for developing and monitoring services, a process overseen by National Clinical Directors or Tsars – lead clinicians. The Tsar’s role is to act as advocate for the NSF ‘within the NHS and other services, and represent the NHS and other services in the Department of Health’ (Department of Health, 2010, p 1). By 2008 there were ten frameworks including one for Mental Health (NHS, 2013). The NSF for Mental Health was one of the first NSFs (Department of Health, 1999) and was based on the advice of an External Reference Group, which brought together key stakeholders in mental health care, including professionals, service managers, service users and carers, and was chaired by Professor Graham Thornicroft of the Institute of Psychiatry, King’s College, London. The role of the External Reference Group had been to create a ‘solid basis of evidence’ for the NSF (Department of Health, 1999, p 1). The NSF focused on the needs of working-age adults up to the age of 65. The mental health needs of children and young people (Department of Health and Department for Education and Skills, 2004, Standard 9) and older people (Department of Health, 2001) were addressed in separate NSFs. While the NSF can be seen as a rational form of policymaking – a systematic and considered review of evidence – it does not ensure that all policymaking is rational. Health ministers in democratic societies are subject to a variety of pressures, including those from the media (Alaszewski and Brown, 2012). In the case of mental health, this pressure has been around the issue of dangerousness and the desire of ministers to protect the public and avoid disasters. This concern is reflected in the appointment of a second mental health tsar, Professor Louis Appelby, as the Tsar for Health and Criminal Justice. This concern about safety underpins ministers’ receptiveness to claims that people with mental illness are dangerous (Brown, 2006). ANDY ALASZEWSKI See also: Department of Health Readings Alaszewski, A. and Brown, P. (2012) Making health policy: an introductory text. Cambridge: Polity Press. 187

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Brown, P. (2006) ‘Risk versus need in revising the 1983 Mental Health Act: conflicting claims, muddled policy’, Health, Risk and Society, 8(4): 343–58. Department of Health (1999) A National Service Framework for Mental Health: Modern standards and service models. London: Department of Health. Department of Health (2001) Older people: a National Service Framework for Mental Health: modern standards and service models. London: Department of Health. Department of Health (2010) ‘The role of National Clinical Directors’. Archived at: http://webarchive.nationalarchives.gov.uk/20130107105354/http://www. dh.gov.uk/en/Aboutus/MinistersandDepartmentLeaders/DH_4105389 Department of Health and Department for Education and Skills (2004) The mental health and psychological well-being of children and young people. London: Department of Health. NHS (National Health Service) (2013) ‘National service frameworks and strategies’. Available at: www.nhs.uk/nhsengland/nsf/pages/nationalserviceframeworks. aspx


Acknowledging approximately 5,000 deaths annually in England from suicide or undetermined cause up to the year 2000, the National Suicide Prevention Strategy for England was published in 2002 with the overall aim of reducing deaths by suicide and undetermined cause by 20% by the year 2010. The strategy set out specific measures designed to support the policy paper Saving lives: our healthier nation (Department of Health, 1999) and was reinforced in the (England) National Service Framework for Mental Health (Department of Health, 2007). Based on the principles of comprehensiveness, being evidencebased, specifity and being subject to evaluation, the strategy set out six goals that included general population interventions to promote mental well-being, in addition to interventions aimed at high-risk group, including young males and prisoners. Responsibility for the implementation of the strategy was devolved to the National Institute for Mental Health in England (NIMHE). Similar strategies were published and adopted in Scotland, Wales and Northern Ireland. Over the eight-year period to 2010, the strategy had some success in reducing suicide-related deaths, although the overall aim of reducing suicide by 20% was not fully achieved. In 2012, the Department of Health for England, supported by the Samaritans, published an updated strategy Preventing suicide in England – a cross-government outcomes strategy to save lives (Department of Health, 2012). While retaining six ‘areas for action’, notable differences between the two strategies include the move 188

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away from general population mental health promotion interventions. Instead, the strategy recommended a focus on the development of mental health services for specific groups, including children and young people, those in state care, prisoners, and armed forces veterans. The strategy encourages and highlights localism in meeting specific needs, arguing that local providers are best placed to understand local need. It is supported by a commitment to provide £1.5 million of research funding to support research into interventions to reduce suicide. It was reported that up to 50 different groups across the voluntary and statutory sectors had agreed to work together on the implementation of the strategy. Nationally, reference is made to the policy document No health without mental health (Her Majesty’s Government, 2011), which addresses issues such as the impact of housing and unemployment on suicide rates. However, the updated strategy can be criticised for lacking a specific measurable outcome in relation to deaths by suicide. Instead, a commitment to reduce deaths and ‘monitor’ progress is given. IAIN McGOWAN See also: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Readings Department of Health (1999) Saving lives: our healthier nation. London: Department of Health. Department of Health (2007) National Service Framework for Mental Health: modern standards and service models. London: Department of Health. Department of Health (2012) Preventing suicide in England – a cross-government outcomes strategy to save lives. London: Department of Health. Her Majesty’s Government (2011) No health without mental health: A crossgovernment mental health outcomes strategy for people of all ages. Available from: www. gov.uk/government/uploads/system/uploads/attachment_data/file/213761/ dh_124058.pdf


Feeley and Simon (1992) provide a theoretical examination of how penality has changed from focusing on the individual towards techniques that identify, classify and manage groups based on their perceived level of dangerousness. Crime control in the New Penology has a managerial focus based on regulating deviance at the 189

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aggregate level, rather than responding to individual deviants (Feeley and Simon, 1992). Feeley and Simon (1992) argue that moral and clinical depictions of individuals gave way to the language of probability and population management, and suggest that the prison has re-emerged as a successful site of control, where incapacitation is geared towards risk management over offender transformation. The New Penology is about bringing the future into the present, while expanding the number of people who are covered by penal sanctions. Some scholars use the rise of risk and the development of the New Penology to explain the decline of rehabilitation and the rise of punitive incapacitation. With the advent of actuarial justice (inspired by the New Penology), Simon (1988) argues that risk-based crime control methods are geared towards mapping out the distribution and arrangement of populations in order to increase the efficiency of the aggregate. Simon (1988) notes that while discipline is about controlling the body through altering the mind, risk-based actuarial practices are about organising bodies in space and creating spaces for dangerous classes. Actuarial justice is about testing, comparing and ranking groups based on their level of risk, rather than managing individual manifestations of crime (Simon, 1988). However, some scholars have been critical of Feeley and Simon’s (1992) suggestion that the New Penology has dramatically changed penology. Despite Feeley and Simon’s (1992) suggestion that actuarial justice has overtaken rehabilitation, Maurutto and Hannah-Moffat (2006) argue that, in reality, rehabilitation still exists, but it has been repackaged and assembled with risk as a means of addressing offender criminogenic needs. Even though they agree that risk has become a powerful force in penal governance in recent times, they argue that the New Penologists’ suggestion of the cohesion of risk governance and the erosion of rehabilitation have been overstated, since the grasp of actuarial justice is actually more fragile and less coherent than originally suggested by Feeley and Simon (1992). Maurutto and Hannah-Moffat (2006) demonstrate that risk is a fluid concept that changes over time and is assembled in a variety of ways to support correctional rehabilitation, rather than replace it. While this movement towards reconstituting the penal subject as transformable does not exactly reinvigorate the classic formulation of rehabilitation, they argue that the association between need and risk promotes targeted interventions that transform risky individuals into less risky subjects, thereby destabilising the risk–rehabilitation binary created by the concept of the New Penology. AMY KLASSEN See also: Actuarialism; Extended Sentences for Public Protection; Parole


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Readings Feeley, M. and Simon, J. (1992) ‘The new penology: notes of the emerging strategy for corrections and its implications’, Criminology, 30(4): 49–74. Maurutto, P. and Hannah-Moffat, K. (2006) ‘Assembling risk and restructuring of penal control’, British Journal of Criminology, 46: 438–454. Simon, J. (1988) ‘The ideological effects of actuarial practices’, Law and Society Review, 22: 801–30.


The theoretical justification for the changes made to provision for the poor and unfortunate in the 1830s was Reverend Thomas Malthus’s (2008 [1798]) influential publication An essay on the principle of population. Malthus, an educated man whose theories were later taken on by Charles Darwin, had proposed that the rate of population growth, especially among the section of society that seemed unable to support themselves, would quickly outstrip the ability of the economy to provide enough food for the whole of society. According to Malthus and his supporters, as the population grew, so would poverty, and mass starvation would eventually become a possibility (indeed, some years, when harvests failed and wage rates fell, some rural communities had seen something akin to famine, and, of course, Ireland experienced famine in the 1840s). Because the provisions of existing poor-relief provision originally introduced in Elizabethan England were thought incapable of addressing this problem, the 1832 Royal Commission into the Operation of the Poor Laws proposed a number of reforms. Eventually enacted by Earl Grey’s government two years later, the 1834 Amendment established a Poor Law Commission to oversee the national operation of a new kind of system. All parishes in England and Wales (Scotland passed its own amendment Act in 1845) formed Poor Law Unions, with Poor Law Guardians to oversee the provision of relief. So, in part, the Act provided a streamlined bureaucracy to localise the alleviation of poverty. The main thrust of the change, however, was to massively reduce outdoor relief, and, instead, to introduce the workhouse for those who could not support themselves. The workhouse system was fully established a decade after the 1834 Act but quickly became associated with the new form of relief, and also with the attempt to semi-criminalise poverty. The workhouses separated family members (by gender) and forced labour to be extracted from their inmates. Although they did, indeed, keep their inmates alive by providing food and shelter, they shared many features with prisons (requiring labour to be completed, restricted visiting, control of movement, etc). They were, then, prisons for the poor. The ‘stain’ of spending time as a workhouse inmate, and the fear of falling into that system, long 191

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coloured people’s perceptions of state provision of poor relief. This was especially true in the industrial North and Midlands, where the cyclical economic booms and busts made the workhouse an ever-present spectre. As the economy grew in the 1870s and 1880s, the workhouse became associated with an underclass. The system seemed to house those at the very bottom of society rather than those who needed temporary support. Nevertheless, temporary unemployment and underemployment swelled the workhouses in desperate times, and this continued well into the 20th century, especially the 1930s. The rise of the post-war welfare state removed the workhouse from the legislative landscape (they were abolished in 1948), but their cultural memory lived on in the minds of working-class people who, sometimes by very little margins, managed to escape the clutches of these hated institutions. BARRY GODFREY See also: Vagrancy Acts Readings Malthus, T. (2008 [1798]) An essay on the principle of population. Oxford: Oxford University Press.


The normal category exists not as a simple fixed position of humanity, but as a register, a subject position, a preferred way of living life and a phenomenon of ableist cultures. Being non-disabled, normal and healthy makes up the preferential ontological state of contemporary societies. Remaining normal is a somatic preoccupation of contemporary life. Normality is a preferred moral category of contemporary life (Goodley, forthcoming). Normal is synonymous with categories of the able-bodied (Wendell, 1989), normalcy (Davis, 1995), the normate (Garland-Thomson, 2005) or ableist normativity (Campbell, 2009). By deploying the concept of ‘the normal’, we are permitted to emphasise the cultural, relational and psychological processes involved in distancing the non-disabled self from the disabled other (Goodley, forthcoming). More often than not, normalcy is tied to the processes of ableism, which accounts for the stifling practices associated with a contemporary society that increasingly seeks to promote a typical individual citizen: a citizen that is ready and able to work and productively contribute; an atomistic phenomenon bounded and cut off from others, capable, malleable and compliant (see Campbell, 2009). Ableism 192

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breeds paranoia, confusion, fear and inadequacy. Ableism is an ideal that no one ever matches up to. Ableism is equally an individual and a global project. DAN GOODLEY See also: Disability Hate Crime Readings Campbell, F.K. (2009) Contours of ableism: territories, objects, disability and desire. London: Palgrave Macmillan. Davis, L.J. (1995) Enforcing normalcy: disability, deafness, and the body. New York, NY: Verso. Garland-Thomson, R. (2005) ‘Feminist disability studies’, Signs: Journal of Women in Culture and Society, 30(2): 1557–87. Goodley, D. (forthcoming) Dis/ability studies. London: Routledge. Wendell, S. (1989) ‘Toward a feminist theory of disability’, Hypatia, Special Issue: Feminist Ethics and Medicine, 4(12): 104–24.


O OFFENDER ASSESSMENT SYSTEM The Offender Assessment System (OASys) is the prison and probation services’ principal tool for risk assessment and sentence planning (NOMS, 2006).Alongside these primary functions, its inception was also designed to complement the effective practice agenda by relating the work planned with offenders to areas which research suggested that targeting would result in a reduction in the likelihood of reoffending (Home Office, 2002). Further, it provided a system that could be used to plot progress of offenders over time; hence, measuring the effectiveness of interventions. OASys comprises actuarial and clinical components, providing practitioners with a percentage risk of reoffending in comparison to other offenders of a similar statistical history (eg age, gender, offending history) based on the combination of static and dynamic factors. The risk of harm element of the assessment is based on the discretion of the user but should be informed by their thorough and considered completion of all the sections that comprise the clinical assessment. These sections require the assessor to consider the offender’s history and contemporary situation in relation to: the offence and offending history; accommodation; employment training and education; finances; relationships; lifestyle and associates; substance use; emotional well-being; thinking and behaviour; and attitudes. Health issues are addressed but not scored. Specifically, the assessor is to consider the relation of each of these areas to both risk of reoffending and risk of harm, and if linked, to then produce a sentence plan that addresses these areas. This leads to an approach to offender management that is strongly focused on the management of risk in 195

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its structure, an element that, in itself, can prove problematic when working in partnership with other agencies with their own assessment tools, such as mental health agencies, where the focus may be more therapeutic. Robinson (2003) has highlighted the tension between addressing comprehensiveness and retaining user-friendliness; the amount of time required to thoroughly complete OASys is well documented (Mair et al, 2006). This leaves two viable solutions: (i) to not complete the document in a thorough and considered manner; or (ii) to spend time completing the document at the expense of time with the offender. Further to this, even a well-designed tool within a well-designed process will still be dependent upon the skills of the assessor for its results to be of a high standard and quality. OASys, like any other tool, requires consistent and highquality interviewing and information-gathering and -processing skills on the part of the officer (Crawford, 2007), and all of these areas are significantly impacted by the time available to assessors. A final critical point of consideration that has been levelled is the concern that the nature and distinct areas of consideration detract from a holistic approach to the offender’s life as a whole. In turn, this may hinder assessors’ ability to consider interrelated issues within an offender’s life and thus limit the effectiveness of their interventions (Fitzgibbon, 2008). DAVID WOOD and LOL BURKE See also: Actuarialism; Probation Readings Crawford, A. (2007) ‘What impacts on quality assessment using OASys?’, Probation Journal, 54(2): 157–69. Fitzgibbon, D.W. (2008) ‘Fit for purpose? OASys assessments and parole decisions’, Probation Journal, 55(1): 55–69. Home Office (2002) OASys manual v.2. London: Crown Copyright Mair, G., Burke, L. and Taylor, S. (2006) ‘“The worst tax form you’ve ever seen?” Probation officers’ views about OASys’, Probation Journal, 53(1): 7–23. NOMS (National Offender Management Service) (2006) The NOMS offender management model. London: Home Office. Robinson, G. (2003) ‘Implementing OASys: lessons from research into LSI-R and ACE’, Probation Journal, 50(1): 30–40.


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ORGANIC DISORDERS ‘Organic disorders’ is a broad term used to describe mental disorder resulting from damage to the brain or due to a medical illness. Organic disorders can be broadly categorised into three separate areas: dementia, delirium and neuropsychiatric disorders. They present with a variety of clinical features, but, in the main, they affect orientation, concentration, memory, perception and judgement.They may also cause personality changes. The most common organic disorder is dementia. Dementia is a syndrome characterised by progressive impairment of memory, concentration, judgement, social skills and functioning – it is not solely a memory problem. It is estimated that 750,000 peoplein the UK suffer with dementia (Dementia UK, 2007). The prevalence of dementia increases with age. The most common form of dementia is Alzheimer’s disease, which accounts for approximately 50% of all dementias. Other common forms of dementia are vascular and Lewy Body type. The diagnosis of dementia is made by taking a full history, mental state examination and memory test. In some cases, blood tests and a brain scan may be undertaken. Assessment should also include corroborative information from family or friends. Alzheimer’s disease usually starts insidiously and gets progressively worse over a number of years. There are frequently word-finding and constructional deficits. Patients with vascular dementia have cardiovascular risk factors and a fluctuating presentation, and are said to have stepwise deterioration. Lewy Body dementia is characterised by fluctuating confusion, visual hallucinations, falls and Parkinson’s disease-type features (eg slowed movement, shuffling gait and tremor). Other symptoms frequently associated with dementia, known as behavioural and psychological symptoms (BPSD), are depression, anxiety, psychosis and agitation. The treatment for dementia is mainly supportive, ensuring that sufferers have activity and structure to maintain functioning. However, there are four medicines licensed for use in Alzheimer’s disease that improve memory and functioning, and slow down deterioration. The National Dementia Strategy (Department of Health, 2009) focuses on living well with dementia, including the need to provide an early diagnosis, information and support to the sufferer and carer so that they can plan for the future. It also emphasises the need for good-quality hospital care, carer support, public awareness-raising and research. Delirium (or acute confusion) is characterised by altered levels of consciousness, fluctuating confusion, poor concentration and memory impairment. Patients may also have visual hallucinations, agitation or withdrawal. Delirium is usually caused by medical illnesses, examples of which are infections, metabolic disorders 197

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such as unstable diabetes or side effects of medication. Treatment involves treating the underlying medical condition. Nursing care needs to include assisting patient orientation, using well-lit rooms, reducing ward moves and communicating clearly (written as well as verbal). Unless treated robustly, the prognosis can be poor. Approximately 60% of older people in acute hospitals suffer with either delirium or dementia or a combination of both (Royal College of Psychiatrists, 2005). Neuropsychiatric conditions such as head injury, stroke or Parkinson’s disease can cause a range of psychiatric symptoms, such as disorientation, confusion and personality change. Patients with organic conditions may have impaired capacity. Therefore, it is vital for staff to assess capacity at every intervention. ANUSHTA SIVANANTHAN See also: Mental Capacity Act 2005; Mental Health Act 2007 Readings Alzheimer’s Society (2010) National Dementia Strategy for England. London: Alzheimer’s Society. Dementia UK (2007) A report into the prevalence and cost of dementia. London: Alzheimer’s Society and Dementia UK. Department of Health (2009) Living well with dementia: a national strategy. London: Department of Health. Royal College of Psychiatrists (2005) Who cares wins: improving the outcome for older people admitted to the general hospital. London: RCPsych.


P PAINS OF IMPRISONMENT The structured pains of imprisonment have long been identified in the penological literature, though the analysis by Gresham Sykes (1958, pp 63–83) in his book Society of captives is perhaps most well-known. For Sykes, the ‘pains of imprisonment’ are the deprivations of liberty, goods and services, heterosexual relationships, autonomy, and security.Thomas Mathiesen (1986) explains that the deprivations of liberty and autonomy are the most significant pains of confinement as they are impossible to overcome in the prison place. These structured pains cannot be removed through improving prison conditions – the environment could be very pleasant but the deprivations of liberty and freedom remain unaltered. The structured ‘pains of imprisonment’ are, then, not to be found in the given quality of living conditions, relationships with staff or levels of crowding. At times, prisons are places of frantic activities; yet, paradoxically, at others, they are empty, dull and motionless (Cope, 2003). It is the dreadful emptiness of prison life that is the real terror (Medlicott, 2001). This conscious wasting of life, the enforced passivity and the emptiness of time are sources of ‘acute suffering’ (Medlicott, 2001). The negation of the ability to control time and space is something that affects the well-being of everyone. Prisons hurt, therefore, because of the denial of personal autonomy, feelings of time consciousness and the lack of an effective vocabulary to express the hardship of watching life slip away. For penal abolitionists, the prison place should be conceived as a highly toxic environment, undermining constructions of the self for all prisoners. While there 199

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are moments of hope and (isolated) acts of human kindness within prisons, most prisoners only just cope with its mundane realities. The prison place fosters an existential crisis, ultimately leaving some prisoners shattered (Cohen and Taylor, 1972). Yet, there is no linear adaptation to the pains of the prison environment – coping in the prison place is always a tenuous, relative and fluid concept that ebbs and flows over the prison sentence. The structured pains of imprisonment also have serious ‘collateral consequences’ – prison life is a humiliating and unsafe existence, perpetuating fear and loathing on a daily basis. Overwhelming evidence indicates that prisoners commonly experience serious physical and mental health problems due to their confinement while rates of self-inflicted deaths across the penal estate in the UK and many other countries remain disturbingly high (Scott and Codd, 2010). DAVID SCOTT See also: Long-Term Imprisonment and Mental Health; Penal Abolitionism; Solitary Confinement and Mental Illness Readings Cohen, S. and Taylor, L. (1972) Psychological survival. Harmondsworth: Penguin. Cope, N. (2003) ‘“It’s no time or high time”: young offenders’ experiences of time and drug use in prison’, The Howard Journal, 42(2): 158–75. Mathiesen, T. (1986) ‘The politics of abolition’, Contemporary Crises, 10: 81–94. Medlicott, D. (2001) Surviving the prison place. Aldershot: Ashgate. Scott, D. and Codd, H. (2010) Controversial issues in prisons. Buckingham: Open University Press. Sykes, G. (1958) Society of captives. New Jersey, NJ: Princeton University Press.


Parole in the form recognisable today was introduced to the criminal justice system of England and Wales through the Criminal Justice Act 1967. The parole system provides the state, through a parole panel, the opportunity to consider a prisoner’s progress on the custodial element of their punishment and decide whether they are at a stage where they can be released to the community, or re-categorised for a move to a less secure prison establishment, such as an open prison. The Parole Board may also suggest further work that the prisoner should take to enable their progression, and in the event of recommending release, can impose conditions to be attached to the offender’s condition for release on licence. 200

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The Parole Board’s role has changed markedly since it was first established. It is no longer merely an advisory body, but instead a decision-making one, and thus more court-like in the way it operates. Although as an independent body it is free from direct government control, it is sponsored by the government and so has to be attached to a government department. Up until 2007, the Parole Board was attached to National Offender Management Service but the Court of Appeal judgement in the case of Brooke brought into question the independence of the sponsorship arrangements. Since then, it has been attached to the Access to Justice Group within the Ministry of Justice. The majority of prisoners are not subject to the parole process, having standard determinate sentences and automatic dates for release. However, life-sentence prisoners and those with indeterminate sentences will be considered by the Parole Board as to their suitability for release. Additionally, under certain conditions, some prisoners will enter the parole system following recall to prison subsequent to an unsuccessful release on licence in the community. A Parole Board will consider a variety of reports and assessments. These will include submissions from their Offender Manager and Offender Supervisor and prison security reports, and may also include information submitted from victims, psychological and psychiatric services, and other service providers/people involved with the prisoner. Given the different organisational contexts of the individuals who are providing reports, this can often mean that a Parole Board is faced with assessments of an offender that conflict, for example, the strong focus of risk management in the reports of the Probation Service and the more therapeutic reports that are often characteristic of mental health service providers. This can lead to the Parole Board being provided with differing assessments of risk and differing views on how to move a case forward; which should take priority, care and treatment or punishment and control (Peay, 1997)? Decisions made to release prisoners by the Parole Board are potentially subject to a great deal of scrutiny, especially if the prisoner is of a high profile or goes on to commit further serious offences. As such, parole decisions have the potential to be impacted not only by professional assessments, but also by the potential for media and political judgement and influence within the context of a risk society (Harding, 2006). Further, this context not only applies to Parole Board members, but also to the practitioners contributing their assessments to the Parole Board within the organisational priorities and systems that frame their submissions (Fitzgibbon, 2008). This poses an important question with regards to due process, justice and parole, as at parole, the question of proportional punishment becomes


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focused on the perceived progress of the prisoner as opposed to a response to the commission of the crime. DAVID WOOD and LOL BURKE See also: Desistance; Probation Readings Fitzgibbon, D.W. (2008) ‘Fit for purpose? OASys assessments and parole decisions’, Probation Journal, 55(1): 55–69. Harding, J. (2006) ‘Some reflections on risk assessment, parole and recall’, Probation Journal, 53(4): 389–96. Peay, J. (1997) ‘Mentally disordered offenders’, in M. Maguire, R. Morgan and R. Reiner (eds) The Oxford handbook of criminology. Oxford: Clarendon Press, pp 661–702.


The Psychopathy Checklist-Revised (PCL-R) (Hare, 2003) is a widely researched rating scale designed to assess psychopathic traits, which has achieved considerable acceptance in the forensic mental health field in North America and Europe. The instrument is also used to guide risk assessments for violence and recidivism. Clinicians who use the PCL-R should possess an advanced degree in a social, medical or behavioural science and should receive special training in how to use the instrument. The PCL-R uses a semi-structured interview, file review and collateral information, and uses these to measure and diagnose an individual with regards to psychopathy and psychopathic traits. The instrument includes 20 items, rated 0–2, and the final score is set from 0 to 40 (Hare, 2003). In the diagnostic practice, the threshold score to fulfil the criteria for psychopathy is set to 30 in the US. However, it has been argued that the lower threshold score of 25 should be used in Europe (Cooke and Mitchie, 1999).The PCL-R is most often structured into a two-factor model in which ‘Factor 1’ measures the interpersonal and affective aspects and ‘Factor 2’ measures an antisocial lifestyle. The widespread use of PCL-R in settings where risk for future criminal conduct is of concern (eg parole release decision-making, sexually violent predator civil commitment trials) is perhaps based largely on the moderate relationship between scores on this instrument and subsequent criminal and sexual recidivism. The predictive validity of the PCL-R and violent and non-violent recidivism is comparable to that of other risk-assessment instruments (Singh et al, 2011). 202

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Although typically described as ‘reliable and valid’, the use of the PCL-R in applied settings, especially ‘Factor 1’, has received some criticism by researchers in the last half-decade (see Sturup et al, 2013). JOAKIM STURUP See also: Actuarial Risk Assessment; Clinical Risk Assessment; Structured Professional Judgement Risk Assessment Readings Cooke, D. and Mitchie, C. (1999) ‘Psychopathy across cultures: North America and Scotland compared’, Journal of Abnormal Psychology, 108: 56–68. Hare, R. (2003) Hare Psychopathy Checklist-Revised technical manual (2nd edn). Toronto, Canada: Multi-Health Systems. Singh, J., Grann, M. and Fazel, S. (2011) ‘A comparative study of violence risk assessment tools: a systematic review and metaregression analysis of 68 studies involving 25,980 participants’, Clinical Psychology Review, 31(3): 499–513. Sturup, J., Edens, J., Sörman, K., Karlberg, D., Fredriksson, B. and Kristiansson, M. (2013) ‘Field reliability of the Psychopathy Checklist-Revised among life sentenced prisoners in Sweden’, Law and Human Behavior, PMID: 24127896. Available at: www.ncbi.nlm.nih.gov/pubmed/?term=24127896.


Penal abolitionism provides an anti-positivist interpretive framework that acknowledges the social construction of problematic behaviours, troubles and conflicts and looks to find pragmatic solutions to such difficulties without adopting the punitive rationale (logic of punishment). Rather than providing a solution, the penal law is understood as creating new, rather than dealing with existing, social problems (Van Swaaningen, 1997). There are a number of different ‘abolitionist perspectives’ and the core assumptions of the approach are influenced by, among others, anarchist, libertarian, Christian and Marxist philosophies (Ruggiero, 2010). Penal abolitionists maintain that there are no radical differences between criminals and non-criminals, and that divisions between such categories are largely achieved because similar behaviours are treated differently. Connecting individual biographies with broader structural relations of a given historic period, abolitionists examine how penalisation operates within a society that is deeply divided around the structural fault lines of ‘race’, class, gender, sexuality and age (Sim, 2009). The penal law is seen as being disproportionately applied to the poor, underprivileged, 203

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unskilled and ‘unrespectable’. At the heart of this process is the use of separating or ‘dividing practices’ (Foucault, 1977). Through the act of dividing the manipulative from the genuine, the deserving from the undeserving, and the ‘us’ from the ‘them’, a false dichotomy is established facilitating the differential treatment of people. This means of ‘othering’ is also linked to the construction of social and psychic distance of the offender – the greater the distance between offender and victim, the more likely the criminal law will be used, particularly if they are deemed to be ‘unrespectable’ and low status. For penal abolitionists, prisons are understood as counterproductive and as institutions that create ‘crime’ rather than resolve social and moral conflicts (Foucault, 1977). The prison place is conceived as a toxic environment and all humans placed in such a degrading and damaging place are considered vulnerable to its structured pains and harms (Scott and Codd, 2010). For abolitionists, one way to draw attention to the inherent immoral practices of the prison place is through highlighting the everyday problems, troubles and conflicts of prison life and their detrimental impact upon the health of prison populations. These troubles are a private matter that occur within the lived experiences of individual prisoners and affect their immediate relationships and social world. They become, however, a controversial issue when they are transformed into a public matter and linked to the political and economic structures of a given society (Scott and Codd, 2010). Individual troubles in prison can be used to make connections between the micro-realities of prison life and a new and plausible ‘bigger picture’ of the social world – that is, the prison can come to resemble a reflection of the inequalities inherent in wider society. DAVID SCOTT See also: Penal Crisis Readings Foucault, M. (1977) Discipline and punish. Harmondsworth: Penguin. Ruggiero, V. (2010) Penal abolitionism. Oxford: Clarendon Press. Scott, D. and Codd, H. (2010) Controversial issues in prisons. Buckingham: Open University Press. Sim, J. (2009) Punishment and prisons. London: Sage. Van Swaaningen, R. (1997) Critical criminology. London: Sage.


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PENAL CRISIS ‘Penal crisis’ is a term with far-reaching structural, political and social implications – all of which indicate the extent of the problem(s) and, to some degree, support the need for change.Yet, in the penal system, crises are not new, but, rather, have been commonly represented in both media and academic accounts for over 30 years. Headlines reading ‘crisis of imprisonment’, ‘crisis of offending’ and ‘crisis of penal resources’ all present the extent of the crisis across the penal system. Arguably, the crisis that beset penal systems operating in England and Wales and elsewhere during the last quarter of the 20th century was precipitated, in part, by the collapse of faith in the rehabilitative ideal during the 1970s. This was in the wake of research evidence that rehabilitative programmes were ineffective and excessively interventionist (Martinson, 1974). These developments are summed up by Garland (1990) as constituting a ‘crisis of penal modernism’. Within the prison system in particular, the ‘orthodox account’ provides an ongoing explanation of the penal crisis in terms of: overcrowding; violence and riots; the incidents of self-harm and suicide; the toxic mix of long-term and life-sentence prisoners and mental illness; and drug addiction and health problems (see Cavadino et al, 2013). What is interesting about these factors is the interrelatedness of issues that are identified, all of which need not be present simultaneously for a crisis to develop or worsen. Nor are they all a product of the prison institution per se. Overcrowding and increasing prison populations, for example, are primarily products of penal policy and sentencing. In the UK, the 2001 Halliday Report made it clear that sentencing has become more severe. Both judges and magistrates are awarding more custody than they used to, with the average length of a custodial sentence awarded in the Crown Court approximately 50% longer than it was 10 or 15 years ago. This is despite a 42% decline in the amount of crime reported by the British Crime Survey since 1995 (including the fall in crimes reported to the police). Crime is not necessarily increasing but the use of prisons is; this is what Cavadino, Dignan and Mair (2013) refers to as the ‘crux’ of the penal crisis – the crisis of sentencing. Scholars reflect that penal systems, such as that of the UK, have ‘reached a critical juncture’ (Cavadino and Dignan, 2002, p 11), wherein they punish excessively, and with little attention paid to the relationship between policy and prison numbers (Commission on English Prisons Today, 2007). Such practices resonate and, arguably, prison has become the defining tool of the punishment process. The penal crisis can be viewed as being composed of several interlocking crises: a crisis of purpose (ideology); a crisis of prisons and resources (material); and, therefore, a crisis of legitimacy for the penal system (moral). Collectively, all of


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these factors present an opportunity to challenge the very foundations of the way that the state and societies respond to and deal with crime. GARETH ADDIDLE See also: Carceral Society; Penal Abolitionism Readings Cavadino, M. and Dignan, J. (2002) The penal system: an introduction (3rd edn). London: Sage. Cavadino, M., Dignan, J. and Mair, G. (2013) The penal system: an introduction (5th edn). London: Sage. Commission on English Prisons Today (2007) Do better do less. London: The Howard League for Penal Reform. Garland, D. (1990) Punishment and modern society: a study in social theory. Oxford: Clarendon Press. Martinson, R.L. (1974) ‘What works? Questions and answers about prison reform’, The Public Interest, 53(Spring): 22–54.


Although there are uncertainties in its definition, classification, treatment efficacy and outcome, personality disorder is currently an indispensable concept for the mental health professional. A simple definition of the disorder is that it comprises the three Ps, with behaviour that is Pathological, Persistent and Pervasive. This definition sets the bar at a high level, which is reflected in reduced general population prevalence rates in recent studies of about 4% (Coid et al, 2006). Research findings suggest that personality disorder – more than other mental disorders – is associated with offending, and with violent offending in particular. For instance, a recent systematic review showed a significantly increased risk of violence (Odds Ratio [OR] = 3.0) for all personality disorders that rose to or = 12.8 for those with Antisocial Personality Disorder (ASPD) (Yu et al, 2012). Furthermore, the Prisoner Cohort Study – a prospective two-year follow-up of over 1,600 male and female offenders after their release from prison – found that the severity of the personality disorder was associated with an increased risk of acquisitive and violent offending (Coid et al, 2007). While a mechanism linking personality disorder to offending remains to be established, longitudinal studies have identified a number of psychological 206

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characteristics that render the individual at increased risk of persistent offending (Moffitt, 1993; Moffitt et al, 1996). Some of these temperamental factors (such as callous and unemotional traits that can be heritable; see Viding, 2005) interact with harsh parenting, leading to poor school performance and occupational history so that the individual is prone to react to environmental challenges in a negative manner. These individuals (who have been medically defined as ‘psychopaths’, ‘sociopaths’, ASPD, etc) tend to have high levels of callousness, have diverse offence profiles, rapidly fail when in the community and are persistently noncompliant. The natural history of ASPD attests to its widespread negative impact (Black et al, 1995). Until recently, there was a nihilistic view regarding treatment for this group, resulting in many being excluded from services altogether. This exclusion, together with the issue that those identified with conditions such as these may have a tendency to reject rather than to seek help, has resulted in there being a dearth of evidence either in favour of or against intervening in this disorder. Despite this, government policy continues to target the needs of this group. Its most recent strategy, which is to be co-commissioned by both health and criminal justice, has a stronger criminological emphasis, with a focus on early identification and management in prison and the community (rather than in secure hospitals), and with ongoing support throughout the lifespan rather than relying on single interventions to effect change (Joseph and Benefield, 2012). The cost of personality disturbance is substantial – not only for the individual, but also for their families and the wider society, because its effects are transgenerational. Consequently, any effective intervention to alter the natural trajectory of the disorder for the better is likely to yield considerable benefits. CONOR DUGGAN See also: Dangerous and Severe Personality Disorder Programme; Personality Disorder Pathway Readings Black, D.W., Baumgard, C.H. and Bell, S.E. (1995) ‘The long-term outcome of antisocial personality disorder compared with depression, schizophrenia, and surgical conditions’, Journal of the American Academy of Psychiatry and the Law Online, 23(1): 43–52. Coid, J., Yang, M., Tyrer, P., Roberts, A. and Ullrich, S. (2006) ‘Prevalence and correlates of personality disorder in Great Britain’, British Journal of Psychiatry, 188: 423–31.


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Coid, J., Yang, M., Ullrich, S., Zhang, T., Roberts, A., Roberts, C., Rogers, R. and Farrington, D. (2007) Predicting and understanding risk of re-offending: the prisoner cohort study. London: Ministry of Justice. Joseph, N. and Benefield, N. (2012) ‘A joint offender personality disorder pathway strategy: an outline summary’, Criminal Behaviour and Mental Health, 22(3): 210–17. Moffitt, T.E. (1993) ‘Adolescence-limited and life-course-persistent antisocial behavior: a developmental taxonomy’, Psychological Review, 100(4): 674–701. Moffitt, T.E., Caspi, A., Dickson, N., Silva, P. and Stanton, W. (1996) ‘Childhoodonset versus adolescent-onset antisocial conduct problems in males: natural history from ages 3 to 18 years’, Development and Psychopathology, 8(2): 399–424. Viding, E., Blair, R.J., Moffitt, T.E. and Plomin, R. (2005) ‘Evidence for substantial genetic risk for psychopathy in 7-year-olds’, Journal of Child Psychology and Psychiatry and Allied Disciplines, 46: 592–7. Yu, R., Geddes, J.R. and Fazel, S. (2012) ‘Personality disorders, violence, and antisocial behaviour: a systematic review and meta-regression analysis’, Journal of Personality Disorders, 26(5): 775–92.


The personality disorder pathway (PDP) is a relatively recent policy initiative in England and Wales developed by the Department of Health and Ministry of Justice (2011a, 2011b), which seeks to specify an integrated, workable, systemwide strategy for working with and managing offenders with a diagnosis of personality disorder (PD). It superseded the Dangerous and Severe Personality Disorder (DSPD) initiative (Home Office and Department of Health, 1999), which had been the focus for PD investment for the previous decade. Whereas this previous – controversial – initiative focused on a small number of seemingly high-risk individuals, the new strategy is concerned with the much wider array of offenders with a PD diagnosis. There are real and enduring controversies regarding the nature and status of PD as a clinical entity, but the Ministry of Justice has nevertheless estimated – speculatively – that approximately 50% of convicted offenders have a PD of some sort, mainly antisocial and borderline variants, often co-morbid with other forms of mental disorder. This represents a sizable proportion of the convicted population. If this is the case, concentrating resources on the small number of individuals who meet the criteria for DSPD (generally acknowledged as a political rather than a clinical construct) seems inappropriate, especially as research and evaluation question the benefits of the programme overall (Ministry of Justice, 2008).


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The PDP, then, addresses the need for service provision to this group that addresses both health/well-being and public protection, coordinated and delivered by staff with enhanced knowledge and skills in working effectively with personalitydisordered offenders, over and above what has traditionally been the norm. There is a strong emphasis on early intervention, improved assessment and wider provision throughout the sentence-management process, with a new emphasis on follow-up support after successful completion of treatment. Although assessment and treatment utilise psychological models to a large extent, their foci are relationships and social contexts, rather than pathological dangerousness, and so arguably represent a shift in emphasis that reflects the sorts of experiences that contribute to the development of PD in the first place. For individuals in both prison and the community, there is a greater emphasis on the use of therapeutic communities, as well as support provided within ‘psychologically informed planned environments’ at different stages of a sentence. Whereas under DSPD, service provision was to all intents and purposes restricted to high-security institutions, under PDP, there is an equal emphasis on utilising lower-security and community-based resources as part of a ‘step-down’ approach. Although these shifts represent welcome moves towards forms of constructive, therapeutic jurisprudence, there are evident limitations to such a strategy. Concern has been expressed about the widening out of the screening and assessment role to include non-medically-trained practitioners in what some insist remains a process of diagnosis (Witherana and Ho, 2011). Additionally, the ‘working assumption’ is that a large proportion (maybe half) of those who meet the criteria will not engage with services that they might be offered. Based on unvalidated estimates, this still leaves estimated target populations of approximately 21,000 in custody and 58,500 in the community who it is assumed would engage and benefit from treatment (Joseph and Benefield, 2012). The sheer numbers of individuals involved are such that without extra resources – unlikely under ‘austerity’ – inevitably, there will need to be either a dilution of expectations regarding service provision, availability and effectiveness, and/or the development of new thresholds for access that effectively exclude large proportions of this population. Either of these eventualities suggest that, like its predecessor, questions must be asked about the likely efficacy of a strategy that is unsure exactly who or what it is dealing with and, to some extent, why. MARK HARDY See also: Dangerous and Severe Personality Disorder Programme; Personality Disorder and Offending


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Readings Department of Health and Ministry of Justice (2011a) ‘Consultation on the offender personality disorder pathway implementation plan’. Available at: www. womeninprison.org.uk/userfiles/file/dh_124489%20consultation%20doc.pdf Department of Health and Ministry of Justice (2011b) ‘Response to the offender personality disorder consultation’. Available at: www.pn.counselling.co.uk/ offender_personality_disorder_oct_11.pdf Home Office and Department of Health (1999) Managing dangerous offenders with severe personality disorder. London: Her Majesty’s Stationery Office. Joseph, N. and Benefield, N. (2012) ‘A joint offender personality disorder pathway strategy: an outline summary’, Criminal Behaviour and Mental Health, 22: 210–17. Ministry of Justice (2008) The review of the DSPD programme. London: Ministry of Justice. Witharana, D. and Ho, D.K. (2011) ‘Personality disordered offenders – complex patients requiring more expertise’, The Psychiatrist, 85: 855–6.


The Police and Criminal Evidence Act 1984 (PACE) was introduced to unify police powers under one code of practice and to balance the rights of the individual against the powers of the police.The Codes of Practice that accompany PACE further explain to officers the extent of their powers, for example, stop and search, arrest, and detention in police custody areas. The Serious Organised Crime and Police Act 2005 underpins the rights of the public and the taking of an individual’s liberty by introducing changes to PACE requiring the police to ensure that there is a real necessity to arrest as opposed to dealing with the matter in a less intrusive way. In essence, British police operate with the consent of the public, which can be a fine balancing act. A core policing principle is to prevent and detect crime, that is, those activities that infringe the civil liberties of victims. Simultaneously, the investigative powers needed, such as stop and search, arrest, and detention, will interfere with a suspect’s civil liberties. To achieve balance, laws are needed that provide the police with the powers necessary to work efficiently and, at the same time, keep the infringements of civil liberties to a minimum. PACE was passed to deal with this basic dilemma (Ozin et al, 2006). Taking the power to stop and search as an example, this must be used fairly and responsibly, and the intrusion on the person stopped must be brief, with the process carried out in the proper manner and the stop being recorded in the correct way.


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Before 1984, laws governing police powers were fragmented and insufficient, leading to misconduct of the police and miscarriages of justice, for example, the ‘Birmingham Six’, where manipulation of evidence led to the false conviction and imprisonment of the suspects (Zander, 2005). After high-profile miscarriages of justice, there is a sense of accountability by the police in the eyes of the public, and a need to be transparent in the methods they use. While many welcomed PACE, it was also criticised by some, including human rights activists who considered the powers granted to the police to be unnecessarily excessive (see Zander, 2005). In their opinion, PACE did not prevent the infringement of civil liberties, but legitimised it (see Baxter and Koffman, 1985). However, a major part of the European Convention on Human Rights is dedicated to defining circumstances in which it is acceptable to infringe civil liberties within the needs of the criminal justice system. The fact that PACE aims to provide definitions of situations where interference with civil liberties must be possible also implies that regulation of these situations is vital for a functioning legal system (Zander, 2005). BRIAN ROBERTS See also: Appropriate Adult; Bradley Report; Policing and Duty of Care Readings Baxter, B. and Koffman, L. (eds) (1985) Police, the constitutional and the community: a collection of original essays on issues raised by PACE. Abingdon: Professional Books. Ozin, P., Norton, H. and Spivey, P. (2006) PACE 1984: a practical guide to the Act. Oxford: Oxford University Press. Zander, M. (2005) PACE 1984 (5th edn). London: Sweet and Maxwell.


A duty of care can be seen as a legal obligation for all individuals and organisations to ensure they do not, either by their actions or through their lack of action, cause injury to another person. The current requirements for establishing a duty of care came from Caparo Industries Plc v Dickman (1990), which laid out three requirements that need to be satisfied for a duty of care to be owed: the harm must have been reasonably foreseeable; there must have been sufficient proximity; and it must be fair, just and reasonable to impose a duty of care.


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One might assume that a police officer, like anyone else, may be liable in tort to a person who is injured as a direct result of their acts or failures to act, and may therefore be liable in damages for assault, unlawful arrest, wrongful imprisonment, malicious prosecution, negligence and so on. Here, we are interested in the duty of care imposed by the tort of negligence. Different criteria would apply to an action based on unlawful arrest, wrongful imprisonment or malicious prosecution. Police officers owe to the general public a duty to enforce the criminal law. However, Regina v Commissioner of Police of the Metropolis, Ex parte Blackburn (1968) held that a chief officer has a wide discretion as to the manner in which that duty is discharged and while laying upon chief officers an obligation to enforce the law, it makes no specific requirements as to the manner in which the obligation is to be discharged. In the case of Hill v Chief Constable of West Yorkshire (1988), the judges held that imposing a duty of care on the police may encourage defensive practice in the exercise of their duties and that this would distract them from their primary functions of preventing crime and enforcing criminal law. The conclusion of the court was based around the second strand of Caparo that there was insufficient proximity between the police and the general public when police officers’ conduct their normal duties. It also came to this conclusion on the grounds of public policy, the third strand of Caparo. Since the Hill case in 1988, the courts have been reluctant to impose a duty on the police, even where proximity has been established, as in the case of Osman v Ferguson (1993) (also Osman v UK (1997)), because it would not be in the public interest to impose a duty of care. However, with the enactment of the Human Rights Act 1998 there has been an additional cause of action in English law, in particular, in relation to Article 2, the right to life. The case of Chief Constable of The Hertfordshire Police v Van Colle in 2007 concerning the failure by the police to protect a witness did establish that there is a positive obligation that can be actionable at the suit of an individual, although it is one that is interpreted so as not to impose an impossible or disproportionate burden on the police. GEOFF ELVEY See also: Police and Criminal Evidence Act 1984; Section 136 of the Mental Health Act 1983 (as amended 2007) Readings Caparo Industries PIc v Dickman and Ors [1990] UKHL 2 (08 February 1990). Chief Constable of The Hertfordshire Police (Original Appellant and Cross-Respondent) v Van Colle on appeal from: [2007] EWCA Civ 325 and [2008] EWCA Civ 39. 212

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Hill v Chief Constable of West Yorkshire [1988] 2 WLR 1049 (House of Lords). Osman v Ferguson [1993] 4 All ER 344 (Court of Appeal). Osman v United Kingdom Case No 87/1997/871/1083 (European Court of Human Rights). Regina v Commissioner of Police of the Metropolis, Ex parte Blackburn (No. 2) [1968] 2 QB 150, 154 (Court of Appeal). Smith v Chief Constable of Sussex [2008] EWCA Civ 39.


Political participation, particularly in relation to casting a vote at a national election, is viewed as a central measure of legitimacy for modern democracies. The importance placed on participation in Western democracies has a long lineage; inferred are Aristotelian notions of citizens and virtue, Lockean concepts of popular consent, and a Millian perspective on the importance of a skilled and active citizenry (Hill and Louth, 2004). Yet, within most modern democracies, there exists a capacity for the state to actively disenfranchise certain sections of the community. Although there is a degree of variation between countries, the two groups most commonly impacted are prisoners and those detained or institutionalised because of mental illness. In the case of the latter, this can be interpreted as contravening recent international agreements. Article 29 of the United Nations Convention on the Rights of Persons with Disabilities states that voting should be accessible, easily understood and a guaranteed and free expression of a person with disabilities’ political rights. In accordance with Article 17 of the Convention, this includes the right that a person with disabilities’‘mental integrity’ is treated ‘on an equal basis with others’. In the case of England and Wales, there exists debate and tension over the voting rights of those detained by the state. Psychiatric patients who are detained under Part II of the Mental Health Act 1983 (as amended 2007) are eligible to vote in elections. Those detained under the Act have the same rights of voting as anybody else (including those remanded to hospital), providing that they have not been: • hospitalised following an order of a court for a criminal conviction (sections 37, 38, 44 or 51(5) of the Mental Health Act 1983 [as amended 2007]); • subject to a hospital direction under section 45A, 46, 47 of the Mental Health Act 1983 (as amended 2007); • subject to an order under section 5(2)(a) of the Criminal Procedure (Insanity) Act 1964; and • subject to an order under section 6(2)(a) or section 14(2)(a) of the Criminal Appeal Act 1968. 213

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Those psychiatric patients subject to restrictions under Part II of the Mental Health Act 1983 (as amended 2007) who were eligible to vote, traditionally had to do so by post or proxy. This changed with the Electoral Administration Act 2006, which stipulated that those patients must be able to access the same rights to vote in person at a polling station. To allow this, detained patients must be authorised to leave the hospital premises by the Responsible Clinician using section 17 of the Mental Health Act 1983 (as amended 2007). While an eligibility to vote exists for some who are subject to state-endorsed sanctions, others are disenfranchised. As outlined earlier, in England and Wales, psychiatric patients who have been hospitalised following a criminal conviction are not entitled to participate politically and neither are conventionally sentenced prisoners. In the UK context, the current situation of blanket bans on all prisoner voting has provoked substantial disquiet and opposition. Indeed, in 2005, a European Court of Human Rights ruling, in Hirst v UK, outlined that the blanket deprivation of voting rights for convicted prisoners was incompatible with Convention rights (see Easton, 2006). However, successive governments have maintained a position that individuals convicted of crimes that are sufficiently serious to warrant a custodial sentence should forfeit their right to a vote. At the time of writing, and despite pressure from the European Court, the UK government maintains a position of disenfranchisement for convicted prisoners. The international picture of prisoner voting rights is mixed. Legal and de facto bans are fewer in number than countries opting for partial or total allowance, with many jurisdictions opting for judicial discretion and/or disenfranchisement based on offence type (see Dhami and Cruise, 2013; White and Parliamentary Constitution Centre, 2013). Within the US, prisoner disenfranchisement is a state issue, with considerable variation. In two US states, prisoners have full voting rights, while in most, there will be some level of disenfranchisement across the whole of the sentence, not just for the period of incarceration. In some states, suffrage is lost for serious crimes, while in a high proportion of other states, there is an indefinite disenfranchisement that can only be overturned by petition, a process that is not simple. In all, some three quarters of voters disqualified due to criminal convictions are no longer incarcerated (Ewald, 2002). The Australian context is one of partial allowance. Prisoners serving less than a three-year sentence are entitled to vote in federal elections. Voting is either completed via post or the Australian Electoral Commission may visit prisons (AEC, 2007). The arguments for the UK ban (and elsewhere) to be lifted are persuasive and challenge the availability and quality of evidence that informs current practice. For example, questions have been forwarded as to the availability of evidence that shows how disenfranchisement assists in reducing crime. Moreover, the 214

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function of imprisonment has been called into question, whereby the extent of liberty denial has been scrutinised and whether being barred from voting falls into, or outside of, liberty removal. Central to much concern of the continuing governmental imperatives (and rejections of appeals by the Supreme Court) to restrict voting rights of prisoners is how such approaches may be at odds with investment in rehabilitative strategies, and further reinforce a separation between the offender and society. The disenfranchisement of prisoners is often connected to contractarian theory, which asserts that individuals who have been convicted and imprisoned have broken the social contract. As a consequence of breaching this implicit contract, the removal of prisoners’ political rights is deemed to be justifiable. There is a similar claim from republican thought, where the communal common good is underpinned by the ‘civic virtue’ of the citizen; felons represent a threat to the body politic, again, justifying the removal of political rights. However, in both cases, this ‘civil death’ can be understood in ideological and historical terms, with those most impacted coming from groups (based on race, class, etc) who have experienced discrimination (Ewald, 2002). The damage caused by a denial of full suffrage and the ‘civil death’ for sentenced prisoners is acute (Singh, 2008), not just for the prisoners themselves, but also, as some have argued, for the pursuit of democratic ideals (Dhami, 2005). JONATHON LOUTH and PAUL TAYLOR See also: Social Justice Readings Australian Electoral Commission (2007) ‘Prisoner voting’. Available at: www. aec.gov.au/about_aec/Publications/Fact_Sheets/fact_sheets/prisoner-voting.pdf Dhami, M.K. (2005) ‘Prisoner disenfranchisement policy: a threat to democracy?’, Analyses of social issues and public policy, 5(1): 235–47. Dhami, M.K. and Cruise, P.A. (2013) ‘Prisoner disenfranchisement: prisoner and public views of an invisible punishment’, Analyses of Social Issues and Public Policy, 13(1): 211–27. Easton, S. (2006) ‘Electing the electorate: the problem of pr isoner disenfranchisement’, The Modern Law Review, 69(3): 443–52. Ewald. A. (2002) ‘“Civil death”: the ideological paradox of criminal disenfranchisement law in the United States’, Wisconsin Law Review, March: 1045–132. Hill, L. and Louth, J. (2004) ‘Non-compliance, institutional support and compulsory voting: a comparative approach’. Refereed paper presented to the Australasian Political Studies Association Conference, University of Adelaide, Australia, 29 September to 1 October. 215

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Singh, K. (2008) ‘Civil death of prisoners: disenfranchising the prisoner in reality causes his civil death’, NUJS Law Review, 1(2): 239–54. United Nations General Assembly (2006) ‘Final report of the Ad Hoc Committee on a Comprehensive and Integral International Convention on the Protection and Promotion of the Rights and Dignity of Persons with Disabilities’, A/61/611. Available at: www.un.org/esa/socdev/enable/rights/ahcfinalrepe. htm White, I. and Parliamentary Constitution Centre, House of Commons Library (2013) ‘Prisoners’ voting rights’. Available at: www.parliament.uk/briefingpapers/sn01764.pdf


Populist punitiveness refers to a particular style of civil engagement with the state in the sphere of law and order. The term was introduced by Bottoms (1995, p 40) as ‘politicians tapping into, and using for their own purposes, what they believe to be the public’s generally punitive stance’. ‘Penal populism’ is an alternative – broadly interchangeable – conceptualisation of this trend. It is characterised by an enhanced role for public opinion in the formulation of criminal justice policies. Public perceptions (shaped by and filtered through the media’s often distorting and selective coverage of crime) that governments have ineffectively punished offenders and prioritised their needs over protecting a law-abiding silent majority of ‘ordinary people’ leads to a demand for more ‘common-sense’ policies (Pratt, 2007). The political rhetoric to be ‘tough’ on crime epitomises this tendency, which can thus be viewed as a driver of the ‘punitive turn’ in a number of developed countries in the last three decades, whereby rehabilitation and ‘improvement’ in rationalised modern penal systems has been displaced by a shift towards containment and more severe punishment. Signs of populist punitiveness include harsher punishment for children and young offenders, the criminalisation of nuisance behaviour, more humiliating and stigmatising punishment, a political preference for imprisonment over community sentences, reduced concern for offenders’ rights, and the foregrounding of victimisation in penal discourse.The imprint of populism can be seen in policies such as ‘three strikes’ legislation, ‘zero tolerance’ policing, calls for the reestablishment of the death penalty, mandatory prison sentences, visible punishment (eg community service uniforms), indeterminate sentences and more restrictive monitoring of offenders in the community (such as notification and registration for sexual offences). These measures are designed to regain confidence in the penal system and respond to public concerns about crime. However, it is argued that although governments should be responsive to the public, populist punitive 216

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policies exploit anxieties and are implemented for electoral gains rather than because of proven effectiveness in tackling crime (see Roberts et al, 2003). Research on attitudes towards criminal justice has also raised questions about the nature and extent of populist punitiveness, with some criminologists arguing that punitive attitudes have been exaggerated and their influence has been overstated (see Matthews, 2005).The assumption that the public are homogeneously disposed towards a punitive stance is not borne out by some research, which suggests that it may fluctuate according to the type of offence or situation of an offender. Attitudes to criminal justice may vary between jurisdictions (eg Scandinavia, Canada and Germany are suggested as sites of resistance to this trend), as well as within them, according to factors such as gender, age, ethnicity, life experience and information provided about crime. Moreover, it is suggested that attitudes to criminal justice are not one-dimensional: in addition to punitiveness, there is also evidence of empathic, lenient and merciful stances towards punishment in empirical studies of attitudes to criminal justice. CATHERINE ANNE MORGAN See also: Extended Sentences for Public Protection Readings Bottoms, A. (1995) ‘The philosophy and politics of punishment and sentencing’, in C. Clarkson and R. Morgan (eds) The politics of sentencing reform. Oxford: Oxford University Press, pp 17–49. Matthews, R. (2005) ‘The myth of punitiveness’, Theoretical Criminology, 9(2): 175–201. Pratt, J. (2007) Penal populism. London: Routledge. Roberts, J.V., Stalans, L.J., Indermaur, D. and Hough, M. (2003) Penal populism and public opinion: lessons from five countries. Oxford: Oxford University Press.


Post-Traumatic Stress Disorder (PTSD) has been identified as a debilitating disorder since its official classification in the third edition of the American Psychiatric Association’s (APA’s) Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980. The key feature of this diagnostic classification was that it recognised the central importance of ‘external factors’, this has subsequently been a source of much debate.


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With the establishment of the International Society for Traumatic Stress Studies and the publication of the Journal of Traumatic Stress in 1985, followed by recognition of the PTSD definition by the military in 1986, the trauma field was established. These developments prompted a growth in research undertaken to establish understanding of a range of issues relating to the expression, definition and biological, neurological and psychological aspects of PTSD. DSM-IV (in 1994) and the subsequently revised DSM-IV TR (in 2000) were refined as a result of research and clinical experience. The revisions have been extended and incorporated within DSM-5 (in 2013), the key shifts in this latest version are that PTSD has moved from its previously classified ‘Anxiety Disorder’ to the reclassified ‘Trauma and Stress Related Disorders’, this is in response to clinical recognition of variable expressions of distress as a result of traumatic experiences. DSM-5 proposes, and updates, four separate diagnostic clusters: (1) Re-experiencing; (2) Avoidance; (3) Negative Cognitions and Mood; and (4) Arousal. There are also criteria for the diagnosis of PTSD within the International Classification of Diseases (ICD-10) published in 1992 by the World Health Organization. A central factor in the development of PTSD is the clients’ experiential process, specifically, the degree of importance that perception held over the manner in which a traumatic event was experienced. A key element within a diagnosis of PTSD is the requirement that the individual has had exposure to actual or threatened death, serious injury, or sexual violation (APA, 2013). This places perception at the heart of a diagnosis of PTSD and has generated a wide range of research and debate. Treatments for PTSD in the UK have been influenced by the production of clinical guidelines by the National Institute for Health and Care Excellence (NICE) in March 2005. The recommendations for the psychological treatment of PTSD from the clinical guidelines were based on ‘an independent, systematic, rigorous and sophisticated multi-stage process for identifying, reviewing and appraising evidence for the effective treatment of PTSD’ (Dorahy, 2006, p 314). The recommendations from this analysis were that all individuals with PTSD should receive either trauma-focused cognitive behavioural therapy or eye movement desensitisation and reprocessing. Medication is also recommended as an additional treatment or if psychological treatment is not desired by the patient. PTSD has been at the centre of a range of controversies since its classification. Some of these include: the process and impact of diagnosis; social, legal and political implications of diagnosis and issues of power; the construction of the criteria for the classification of PTSD; and misdiagnosis. Despite the disputes that form the basis of the debates around PTSD, recognition of this debilitating


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condition has informed a greater understanding of its formation, maintenance and potential treatment. TONY PARNELL See also: Diagnostic and Statistical Manual of Mental Disorders; Veterans, Mental Disorder and Criminal Justice Readings American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edn). Washington, DC: APA. Dorahy, M.J. (2006) ‘Cautions on the overgeneralized application of the NICE and CREST recommendations for the treatment of PTSD in the UK: a reflection from practice in Belfast, Northern Ireland’, Clinical Psychology and Psychotherapy, 13: 313–23. National Institute for Health and Care Excellence (2005) Post-traumatic stress disorder: the management of PTSD in adults and children. London: Gaskell and BPS. World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva, Switzerland: WHO.


The privatisation of prisons is the process through which the state ‘hands over’ the delivery of new or existing penal services to private-sector organisations. Changing political ideologies since the 1980s have led to an increase in privatisation across the Western world.The rise of the new political Right has enabled privatisation not just of penal services, but also of schools and hospitals. In the UK, the outsourcing of traditionally state-run facilities is associated with the rise of the Conservative government led by Margaret Thatcher, and now under the Conservative and Liberal Democrat Coalition. However, the Labour governments (1997–2010) allowed the privatisation of penal services to continue, contrary to previous political opposition. The fundamental political idea underpinning privatisation is that the government is able to reduce the ‘overall burden of taxation’. Privatisation may also lead to increased competition between public and private service providers, driving down costs and securing high-quality services. Forms of privatisation vary but only slightly. Private operators can bid to take on the whole process of managing new prisons, including the financial burden, the actual construction and development of the prison itself, and, once opened, the delivery of the regime. 219

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Where private operators take over the full project, an agreement is entered into with the state where costs are drawn back over time through a negotiated cost of housing each offender. The state and the private operator work under contract to allow for close monitoring by the state to ensure satisfactory service delivery and complete accountability. The privatisation of penal services is diverse. In the UK, prisoner escort services, the provision of prison food, education, the electronic monitoring of offenders released from prison and community supervisions provided through the National Offender Management Service (NOMS) have all been outsourced (to varying degrees) to private organisations and, in some instances, charitable organisations. There have been a number of criticisms about prison privatisation – most notably, the central presumption that privatisation will result in the more effective management of institutions and thereafter reductions in recidivism rates (see Bottomley et al, 1996). Furthermore, critics argue that the increasing privatisation of penal services has become too heavily hinged on profit for the private operators, leading to a need to drive down running costs, which has resulted in the reduction of staff, who have less job security and a lower income (Sachdev, 2004). Finally, there are fears that private operators will seek to increase the use of imprisonment so as to be able to continue to build, facilitate and manage service delivery for profit. However, in the wider context of penal theory, this anxiety is in direct opposition to the reduction of the number of offenders ‘serving time’ (see Liebling, 2004). More generally, as with the privatisation of duties associated with policing functions, the use of private operators continues to be viewed as objectionable in principle and requiring ‘robust scrutiny’ (see Ryan, 2003). DAVID WILSON See also: Penal Crisis Readings Bottomley, A.K., James, A., Clare, E. and Liebling, A. (1996) Wolds remand prison – an evaluation: research findings No 32. London: Home Office. Liebling, A. (2004) Prisons and their moral performance: a study of values, quality and prison life. Oxford: Oxford University Press. Ryan, M. (2003) Penal policy and political culture in England and Wales. Winchester: Waterside Press. Sachdev, S. (2004) Paying the cost? Public private partnerships and the public service workforce. London: Catalyst.


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PROBATION ‘Probation’ is the term that is popularly used to refer to supervision of offenders by Offender Managers (previously known as Probation Officers) as a result of either a court order or a prison licence effective subsequent to being released from incarceration.The historical development of probation as a recognisable entity in England and Wales is commonly traced back to the invention of the Police Court Mission at the end of the 19th century. The Church of England Temperance Society was given a donation by Fredric Rainer, who was said to be ‘appalled by the cycle of offence after offence and sentence after sentence’ (Whitfield, 2001, p 11). However, perhaps a more accurate picture would include the work of pioneering sentencers such as Recorder Edward Cox and the probation movement in the US, alongside other justice reform movements such as the Howard League, as also being influential and providing the necessary groundwork for probation to become rooted in the legal system. During its century-long history, probation has always had at its heart working with offenders with a view to their personal transformation, although the methodologies that have been adopted to achieve this have varied. At the outset, Christian mission and temperance were high on the agenda, but with the growing influence of the welfare state came a growing treatment ideal. By the 1970s came an increasing politicisation of criminal justice and the forceful arguments that supported a scepticism of the rehabilitation ideal, captured by Martinson and encapsulated in the sentiments that ‘nothing works’. By the 1990s, this apparent pessimism (practitioners would argue that positive optimistic work had always continued) was replaced by the optimism of the ‘what works’ movement, which saw an increase in cognitive behavioural approaches to practice and group work, and appeal to evidence-based practice. To a certain degree, this collage of treatment, enablement and control has continued as a practice trichotomy. Probation works closely in association with partner agencies, who all bring different organisational priorities and perspectives to practice. For the practitioner, there is a need to balance the care and treatment paradigms of mental health and substance use services with the enablement that some voluntary agencies bring, while maintaining an organisational imperative to manage the risk posed by the offender. In effect, this can lead to compromise and the offender may not always receive the best of what can be offered in this sense due to the plurality of organisational needs. Contemporary debates in practice have promoted a return to a focus on the importance of the practitioner–probationer relationship. This has been enabled through a loosening of the National Standards practice guidelines, and the burgeoning ‘desistance’ research focusing on the importance of the offender’s 221

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experience of their journey from crime. For some, desistance approaches to practice are reminiscent of the ‘advise, assist and befriend’ of the Police Court Missionary; however, contemporary practice has a much stronger focus on risk management. This provides the context for what is at the heart of the most challenging aspect of probation: attempting to achieve public protection and enforcing orders through returning offenders to court or custody, while, at the same time, attempting to build trusting relationships with offenders that will promote, support and enable rehabilitation (Robinson and Raynor, 2006). Attempting to balance this illusive dialectic could provide the elixir of probation practice and is surely more complex than the rather simple-sounding phrase of ‘doing the right thing with the right individual in the right way at the right time to reduce re-offending and protect the public’ (Ministry of Justice, 2011, p 3). DAVID WOOD and LOL BURKE See also: Desistance; National Offender Management Service; Recidivism Readings Ministry of Justice (2011) Practice framework – national standards for the management of offenders. London: Ministry of Justice. Robinson, G. and Raynor, P. (2006) ‘The future of rehabilitation: what role for the Probation Service?’, Probation Journal, 53(4): 334–46. Whitfield, D (2001) Introduction to the Probation Service. Winchester: Waterside Press.


In its simplest sense, surveillance is the act of observing others or of being observed. The concept of surveillance implies that an individual under surveillance needs to be observed or watched because they are behaving suspiciously or are known to engage in criminal activity. Psychiatric discourse has relied upon a number of routine surveillance strategies of patients within mental health wards. Some of these include: special observations, whereby dedicated nursing staff continuously watch a patient and follow them around the ward; observation and monitoring of patient involvement in therapeutic activity and their general participation on the ward; and through the maintenance of patient records. The double-edged nature of surveillance within mental health ward environments simultaneously promotes the idea of safety for patients and staff on wards and is equally construed


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as curtailing patient privacy, dignity and human rights. In this respect, surveillance and surveillance practices will always be open to challenge. The nature of observation of patients and surveillance within mental health wards has undergone significant changes in the recent past. The introduction of new surveillance technologies, for example, the use of Closed Circuit Television (CCTV) monitoring of patients, has raised other concerns around surveillance strategies within mental health ward environments. New surveillance technologies have been criticised for intensifying the nature of surveillance; also, within mental health ward environments, the mechanistic aspect of watching patients through the lens of a CCTV camera is perceived as dehumanising patient observations, with the gaze of the camera being seen as replacing the softer, more human form of surveillance undertaken by nursing staff. New surveillance technologies have also introduced the idea of panoptic power in the monitoring and management of patients within mental health wards. Foucault (1979) draws on Bentham’s original idea for a panoptic prison, whereby the design of the building is such that prisoners have no awareness of when, how and by whom they are being observed. The aim of the panoptic prison is to create an environment where prisoners discipline their own behaviour themselves. This process of monitoring one’s own behaviour is described by Foucault as disciplinary power. The potential for surveillance technologies, such as CCTV, to evoke self-discipline and the regulation of one’s own behaviour forms a central theme of surveillance studies and discourse. However, this view assumes that patients within mental health wards have the cognition to discipline their own behaviour. Questions are raised about whether some patients, who are subject to a wide range of cognitive distortions, can, indeed, discipline their own behaviour. In addition, the same surveillance technologies deployed to observe patients also have the potential to watch staff, bringing with it the potential for changing therapeutic practices (Desai, 2009, 2010). SUKI DESAI See also: Surveillance Readings Desai, S. (2009) ‘The new stars of CCTV: what is the purpose of monitoring patients in communal areas of psychiatric hospital wards, bedrooms and seclusion rooms?’, Diversity in Health and Care, 6: 45–53. Desai, S. (2010) ‘Violence and surveillance: some unintended consequences of CCTV monitoring within mental health hospital wards’, Surveillance and Society, 8(1): 85–92. Foucault, M. (1979) Discipline and punish. Harmondsworth: Penguin. 223

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PUNISHMENT Punishment is a sanction imposed for a criminal offence. It involves the deliberate infliction of ‘pain’ by state officials who have been given the power and authority to punish. These sanctions can include restrictions on people’s freedom, and they can cause physical and/or financial, as well as emotional, hardships. Due to this, there need to be justifications for the infliction of pain or the restriction of liberties. These justifications are based on moral and philosophical reasoning, including the reduction of crime, protection of the public, reparation to victims, retribution and denunciation. Punishment is a major form of legal sanction, and as Von Hirsch (1998) has highlighted, this function makes punishment a necessary part of any legal system. Moreover, what makes punishment distinctive is its expressive function, which Feinberg (1994, p 73, emphasis in original) states ‘is a conventional device for the expression of attitudes of resentment and indignation, Punishment, in short, has a symbolic significance largely missing from other kinds of penalties’. Indeed, the deliberate infliction of suffering is ordinarily considered to be morally wrong and thus requires explicit justification. The morality of punishment rests upon a number of theories, including: deterrence; retribution; just deserts; rehabilitation; incapacitation; and, more recently, restorative justice. These explicit justifications reside in two traditional models of punishment: the consequentialist or utilitarian tradition; and the retributive tradition. The utilitarian tradition of punishment is forward-looking, that is, it looks to future criminal behaviour. The focus is on the maximisation of human happiness and the reduction of pain. This is based on the work of Bentham (1748–1832) and his ‘greatest happiness principle’. For Bentham, punishment is itself an evil that can only be justified if it brings about the greatest good, namely, the reduction of crime and the protection of the public, that is, achieving a net social benefit. Thus, punishment is a means to an end, not an end in itself, and it needs to work in order to justify its continued use. As such, utilitarian justifications are premised upon the notions of deterrence, rehabilitation and incapacitation. The retributive tradition, on the other hand, is a backward-looking approach that focuses on the wrong already done. Retributivists argue that an offender takes an unfair advantage over law-abiding citizens in breaking the law; thus, the annulment of this unfair advantage is achieved through punishment. Under this tradition, punishment is also inflicted in order to hold the offender accountable for their offending behaviour. As such, retributivism regards punishment as a moral imperative to reflect the wrong done by the offender by inflicting upon them the appropriate censure and sanction. Thus, there is no attempt to reduce the rates of offending, or to rehabilitate the offender. Rather, this is an ancient concept based on the belief that the offender deserves punishment, that they should ‘pay their debts to society’. As Easton and Piper (2012, p 164) highlight, ‘retribution, as a justification for punishment, has become increasingly important since the 224

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1970s with the emergence and prominence given to the idea of “desert”…. In the late 1970s the penalogical vacuum was filled with a resurgence of punitive ideologies’. The deleterious effects of punishment are compounded even further when accounting for the convergence of criminal justice and mental health policy, legislation and practice. SHARON MORLEY See also: Bifurcation; Just Deserts; Penal Abolitionism Readings Easton, S. and Piper, C. (2012) Sentencing and punishment (3rd edn). Oxford: Oxford University Press. Feinberg, J. (1994) ‘The expressive function of punishment’, in A. Duff and D. Garland (eds) A reader on punishment. Oxford: Oxford University Press, pp 71–91. Von Hirsch, A. (1998) ‘Penal theories’, in M. Tonry (ed) The handbook of crime & punishment. New York, NY: Oxford University Press, pp 659–82.


Q QUALITATIVE AND QUANTITATIVE INQUIRY IN MENTAL HEALTH RESEARCH Those identified as experiencing ‘mental impairment’ have long been the subject of inquiry, and, broadly speaking, the data produced on this population can be classified as quantitative and/or qualitative in nature. Research has contributed to the ever-increasing body of knowledge about mental health and has often created competing and contested theories about those deemed mentally ill. Quantitative inquiry typically involves the measurement of mental health/illness or its perceived impact and results in the construction of statistics that describe the incidence of mental illness and its effects (eg the National Confidential Inquiry into Suicide and Homicide by People with Mental Illness) or measure or assess the population’s limitations or ‘capacity to perform’ (Fujiura and RutkowskiKmitta, 2001). Although such measurements may help agencies make decisions in terms of forming/reforming services (eg the use of Atos to carry out health assessments that determine a person’s capability to work – and, hence, assess their entitlement to welfare support), there is much criticism about the use of quantitative measurement within disability research. Quantitative inquiry relies on objective measurement of phenomena and tends to treat mental illness as static and unchangeable, often separating the environment from the ‘biophysical’. Other influential examples of quantitative inquiry include the proliferation of quality of life (QoL) measures, which seek to measure the psychosocial impact of a variety of illnesses. In part, QoL measures assist in reminding health-care professionals (HCPs) that the social context of illness is important. Also, such measures may help 227

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HCPs arrive at clinical decisions best suited to the individual’s life. Nevertheless, in general, these measures do little to challenge the individualising nature of health care within a biomedical discourse. Some argue that a qualitative understanding is required to ascertain a more nuanced understanding of illness that avoids overpathologisation and highlights the social context (Ogden, 2010). Qualitative inquiry into mental health ensures an in-depth understanding and recognises the construct of ‘mental illness’ as fluid and contested. In work such as that by Bogdan and Taylor (1994), a narrative technique has been used to rehumanise the accounts of those deemed ‘mentally ill’. Other qualitative research methods utilised by academics include interviews, observation and methodologies such as ethnography, which have demonstrated the lived experience of mental distress more fully. Fewer examples of qualitative inquiries into mental health exist in professionalised settings and storied accounts are more prevalent within social science research and family support settings. The challenge is to allow for qualitative understandings within clinical settings so that those with mental distress can be more fully understood. CASSANDRA A. OGDEN See also: National Confidential Inquiry into Suicide and Homicide by People with Mental Illness Readings Bogdan, R. and Taylor, S. (1994) The social meaning of mental retardation: two life stories. New York, NY: Teacher’s College Press. Fujiura, G.T. and Rutkowski-Kmitta, V. (2001) ‘Counting disability’, in G.L. Albrecht, K.D. Seelman and M. Bury (eds) Handbook of disability studies. London: Sage, pp 69–96. Ogden, C. (2010) ‘Potential of narrative inquiry approach in developing a psychosocial understanding of Inflammatory Bowel Disease (IBD) in children: an essential addition to health related quality of life (QoL) instruments?’, The International Journal of Narrative Practice, 2(1): 57–71.


R RACE EQUALITY AND MENTAL HEALTH POLICY Race equality within the context of mental health policy refers to the equal treatment, both morally and legally, of citizens regardless of their racial background. Discriminatory treatment that disadvantages one racial group over another is prohibited by law. In addition, there is guidance within mental health services outlining the need for race equality and some practice guidance on how this is to be achieved. However, research has found that people of black African and Caribbean background are disproportionately more likely to be admitted to mental health institutions, such as psychiatric hospitals (Nacro, 2007). This has resulted in accusations of ‘institutional racism’ (see Sashidharan, 2003). Mental health service providers have acknowledged their own problematic practice in relation to particular racial groups – although the role of institutionally based ‘witting’ or ‘unwitting’ racial prejudice (in the 1999 Macpherson Report sense of the term) has been downplayed. Mental health services have also responded to claims of racial bias by making reference to their use of a ‘colour-blind’ approach (Bhavnani, et al, 2005). However, such an approach has been criticised for its essentially based assumptions, which continue to view particular racial categories as genetically or culturally ‘deficient’ (Ahmad, 1996). More recently, mental health services have sought to improve race equality via more formal means, such as race equality policy (see Department of Health, 2005). The Mental Health Act 1983 (as amended 2007), which was produced 229

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in accordance with the duties arising from section 71 of the Race Relations Act 1976 and the Race Relations (Amendment) Act 2000, includes a number of measures that seek to ensure that people from black and minority ethnic backgrounds are not adversely affected or racially discriminated against when using mental health services. Although such legislative measures appear adequate, their actual implementation still remains somewhat problematic. This is evidenced by the negative encounters that people of black and minority ethnic background continue to have within mental health services. Mental health services, and those who make referrals to them, such as criminal justice professionals, have argued that the higher rates of black and minority ethnic encounters with mental health services is not entirely due to racial discrimination. Rather, they argue that it should be seen as reflective of the actual occurring mental health issues that are popular among black and minority ethnic groups. However, the context-specific nature of high referral rates among black African and Caribbean groups in the UK is important when compared with the low rates of psychotic illness among this same ethnic group in Jamaica and Trinidad (Hickling, 1991; Bhugra et al, 1996). This suggests that the socio-economic inequalities and racial discrimination experienced by some black and minority ethnic groups in the UK are significant in terms of referrals, and yet they remain ignored in terms of adverse mental health outcomes (Karlsen et al, 2005). TINA G. PATEL See also: Department of Health; Ethnicity Readings Ahmad, W.I. (1996) ‘Making black people sick: “race”, ideology and health research’, in W.I. Ahmad (edn) ‘Race’ and health in contemporary Britain. Buckingham: Open University Press, pp 11–33. Bhavnani, R., Mirza, H.S. and Meetoo, V. (2005) Tackling the roots of racism. Bristol: The Policy Press. Bhugra, D., Hilwig, M., Hossein, B., Marceau, H., Neehall, J., Leff, J., Mallett, R. and Der, G. (1996) ‘First-contact incidence rates of schizophrenia in Trinidad and one-year follow-up’, British Journal of Psychiatry, 169: 587–92. Department of Health (2005) Delivering race equality in mental health care: an action plan for reform inside and outside services and the government’s response to the independent inquiry into the death of David Bennett. London: Department of Health. Hickling, F.W. (1991) ‘Psychiatric hospital admission rates in Jamaica’, British Journal of Psychiatry, 159: 817–21. Karlsen, S., Nazroo, J.Y., Mckenzie, K., Bhui, K. and Weich, S. (2005) ‘Racism, psychosis and common mental disorder among minority ethnic groups in England’, Psychological Medicine, 35(12): 1795–803. 230

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Macpherson, W. (1999) The Stephen Lawrence inquiry report. London: Her Majesty’s Stationery Office. Nacro (National Association for the Care and Resettlement of Offenders) (2007) Black communities, mental health and the criminal justice system. London: Nacro (Mental Health Unit). Sashidharan, S.P. (2003) Inside outside: improving mental health services for black and minority ethnic communities in England. London: Department of Health.


Rational Choice Theory (RCT) is based upon the premise that all individuals calculate what is in their best interest prior to proceeding on a course of action. Therefore, a cost–benefit analysis is inherently attached to this theory: if the beneficial outcome of a particular action outweighs the potential cost, then it is likely to occur. RCT is inextricably linked to the Classical School of Criminology and utilitarianism. Historically linked to the work of Cesaré Becarria and Jeremy Bentham, it is based on the principle that human beings have natural hedonistic tendencies and, as such, if rules and laws together with appropriate punishment are clearly signposted, people will generally comply with the law. However, for that to happen, the prospect of being caught has to be high and the amount of punishment would have to be higher than any potential reward of the crime. As RCT focuses on the decision-making process of the offender, it has led to a number of innovative approaches to understanding the crime event. This has provided an ideal platform to enable authorities to create policies that attempt to tackle crime through preventive techniques. In essence, if it is perceived by potential offenders that it is too challenging to commit a crime or there is an increased risk that they will be caught, it is believed that the offender will choose not to offend. Situational Crime Prevention strategies are based upon a potential offender’s decision-making process and, as such, will attempt to deter criminality by reducing the opportunity or by making it harder to commit crime. This does not suggest that everyone is exactly the same, as contemporary RCT accepts that there is an element of bounded rationality, meaning that individuals may not have all the information about any given situation, resulting in poor choices being made that, from an outsiders’ perspective, may seem far from rational. There are clear links with the main concepts of RCT and the trial process of the criminal courts, as in many criminal trials, the prosecution not only has to prove actus reus (criminal act) but also mens rea (criminal intent). Here, it is evident that 231

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the choices made by the defendant are integral to any prosecution, as the Crown Prosecution Service highlights the culpability of the defendant by demonstrating the choices made, the act and the motivations for the offence. These are often countered by those acting on behalf of the defendant by highlighting mitigating circumstances that may have impacted on his/her ability to think rationally. However, contemporary RCT does not differentiate offenders from law-abiding citizens based upon biological or sociological conditions, as everyone has the potential to choose actions that are criminal or deviant. STUART AGNEW See also: Actus Reus; Mentally Disordered Offenders Readings Clarke, R. and Felson, M. (eds) (1993) Routine activity and rational choice: advances in criminological theory – volume 5. London: Transaction Publishers. Piquero, A. and Tibbetts, S. (eds) (2002) Rational choice and criminal behaviour: recent research and future challenges. London: Routledge.


Recidivism refers to the repetition of offending behaviour. Over the last decade, the total of convicted offenders with previous criminal records in England and Wales has been rising. In 2012, over three quarters of all adult criminal offences were committed by previous offenders. Approximately one in three of the 302,940 offenders sentenced that year for indictable offences had 15 or more previous convictions (Ministry of Justice, 2013a). Of the 544,000 adult offenders cautioned, convicted or released from prison in 2010/11, almost 140,000 went on to reoffend within a year (Ministry of Justice, 2013b). Attempts have been made to address recidivism by supporting rehabilitative aims. Martinson famously asserted in 1974 that ‘Nothing Works’ in the treatment of offenders, observing that, apart from a handful of exceptions, ‘rehabilitative efforts … have had no appreciable effect upon recidivism’ (Martinson, 1974, p 25). This bolstered the subsequent philosophical shift from rehabilitation to retribution and punishment, paralleled by a greater emphasis on risk management in addressing recidivism.


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More recently, the ‘What Works’ model of intervention, based upon on metaanalytic reviews of offender treatment programmes, aimed to achieve significant statistical reductions in recidivism. Drawing upon cognitive behavioural techniques, it has been widely utilised within the Probation Service. However, evidence confirms that prison is less effective in lowering recidivism. Fortyseven in every 100 prisoners released in 2010/11 reoffended within one year, committing an average of four offences each (Ministry of Justice, 2013b). For many, these offences rendered a return to custody inevitable: the ‘revolving door’ process. For those serving shorter sentences (under 12 months), this figure rose to 58 reoffenders in every 100 prisoners released. By contrast, 34 in every 100 of those starting a court order (Community Order or Suspended Sentence Order) reoffended within a year, indicating probation’s relative efficacy in reducing recidivism. An influential meta-analytical study (Bonta et al, 1998) analysing recidivism and mentally disordered offenders concluded that the major predictors of recidivism were similar for mentally disordered offenders and for other (non-disordered) offenders. The optimum recidivism predictors were rooted in offenders’ criminal histories, rather than clinical variables. This indicated that the risk assessment of mentally disordered offenders may be improved by a greater concentration on social, psychological and criminological evidence and a decreased emphasis on psychopathology. The lack of a single, universally supported standard to quantify recidivism means that its measurement can be problematic. Official statistics may proffer an inexact picture, not least because a significant proportion of crime is under-reported (or not reported at all). The evaluation of interventions to decrease recidivism has mainly depended upon reoffending as a key determinant of success. Official reconviction rates may afford relatively accessible statistics, but their utilisation as the primary barometer of the success of rehabilitative work is contested; they may present an inaccurate gauge of the desistance process. Many of those who become part of the statistics of recidivism confront complex, interlinked social problems; the key to diminished recidivism may be to ensure that these underlying problems are fully addressed. MICHAEL TEAGUE See also: Desistance; Probation Readings Bonta, J., Law, M. and Hanson, K. (1998) ‘The prediction of criminal and violent recidivism among mentally disordered offenders’, Psychological Bulletin, 123(2): 123–43. 233

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Martinson, R. (1974) ‘What works? Questions and answers about prison reform’, Public Interest, 53(Spring): 22–54. Ministry of Justice (2013a) Criminal justice statistics quarterly update to December 2012. London: Ministry of Justice. Ministry of Justice (2013b) Proven re-offending statistics quarterly bulletin: October 2010 to September 2011. London: Ministry of Justice.


Although ‘recovery’ is an ordinary English word, which connotes some sense of getting something back that was previously lost, it has proved to be contentious in mental health debates for the following main reasons (Pilgrim and McCranie, 2013). First, there is no consensual definition of the recovery concept used by policymakers, service managers, clinicians or those who use the mental health system (Slade, 2009). Second, the failure to agree has arisen because recovery is both a polyvalent concept (Pilgrim, 2008), that is, it means different things to different people, and has become a ‘working misunderstanding’ in the politics of mental health policy. Hopper (2007) uses the latter phrase to explain how different parties who actually do not agree on what recovery means can stay in negotiation with one another to pursue their own goals and discover contingent alliances for that purpose. Third, this failure to agree (with its advantages and disadvantages for different parties) means that several notions are emphasised across the recovery literature. At different times, recovery appears as: a personal journey; a critique of service orthodoxy; therapeutic optimism rather than pessimism; and a form of social disability. The latter construction aligns it as a social movement with fellow campaigners in the physical disability movement. A fourth consideration is that mental health problems are very varied in their presence in society; a notion of recovery is difficult to impose as a single policy imperative. For example, for those with common mental health problems, their idea of recovery is to submit to voluntary forms of help in order to feel less miserable and dysfunctional. By contrast, those who receive a diagnosis of psychosis (and so are deemed to ‘lack insight’ by those who are sane by common consent) may not agree that they need to recover or their objectives in the latter regard may not be the same as their significant others or treating professionals. When moving to those with a diagnosis of ‘personality disorder’, why would an abnormal personality be expected to change when a normal personality is not; ‘personality’ connotes stable and enduring personal features. Fifth, if service users fail to recover, what then? Although most services users view the recovery concept favourably, provided they lead its definition and goal 234

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setting, many service users do not find the concept helpful (Wallcraft et al, 2003). Some may feel that they have nothing to recover from or that the concept is being used by the state to withdraw support from them. The latter suspicion has been heightened since the fiscal crisis in Western welfare states after the global financial crisis of 2008, which meant that services have tried to increase their ‘throughput’ and reduce client dependency, a process now dubbed ‘responsibilisation’. Finally, a vulnerability of the recovery concept is that its emphasis on the individual client level of self-responsibility and functional improvement may divert necessary policy analysis away from the supra-personal factors that determine or predispose some individuals more than others to experience mental health problems. The latter factors include macroeconomic factors, stressors linked to oppression (racism, ageism and sexism), poverty and, most importantly from the evidence available at present, childhood adversity (Warner, 1994; Varese et al, 2012). DAVID PILGRIM See also: Crisis Intervention; Resilience; Seclusion Readings Anthony, W.A. (1993) ‘Recovery from mental illness: the guiding vision of the mental health service system in the 1990s’, Psychosocial Rehabilitation Journal, 16(4): 11–23. Hopper, K. (2007) ‘Rethinking social recovery in schizophrenia: what a capabilities approach might offer’, Social Science and Medicine, 65: 868–79. Pilgrim, D. (2008) ‘“Recovery” and current mental health policy’, Chronic Illness, 4: 295–304. Pilgrim, D. and McCranie, A. (2013) Recovery from mental health problems: a critical sociological account. Basingstoke: Palgrave. Slade, M. (2009) Personal recovery and mental illness: a guide for mental health professionals. Cambridge: Cambridge University Press. Varese, F., Smeets, F., Drukker, M., Lieverse, R., Lataster, T., Viechtbauer, W., Read, J., Van Os, J. and Bentall, R.P. (2012) ‘Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective- and crosssectional cohort studies’, Schizophrenia Bulletin, 38(4): 661–71. Wallcraft, J., Read, J. and Sweeney, A. (2003) On our own terms: users and survivors of mental health services working together for support and change. London: The Sainsbury Centre for Mental Health. Warner, R. (1994) Recovery from schizophrenia (2nd edn). London: Routledge.


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REHABILITATION AND MENTALLY DISORDERED OFFENDERS Some authors contend that most offenders have some form of mental disorder; personality disorder (PD), particularly antisocial and borderline, substance use disorders, and both high-prevalence (ie anxiety and depression) and major mental illnesses, as well as intellectual disability, are all more prevalent in offender populations than in community non-offending samples (Fazel and Danesh, 2002). Co-morbidity is common and is associated with negative outcomes. The relationship between mental disorder and offending is complex, and, in some cases (eg antisocial PD), it is fraught with conceptual overlap (Gilbert and Daffern, 2011). Distress resulting from incarceration may be causally related to mental illness and some offending may be either directly or indirectly caused by symptoms of mental illness. Given the range of relationships between mental disorder and offending, an idiographic case-formulation-based approach to rehabilitation is important. The needs of offenders with mental disorder, including mental illness, are similar to those of offenders without mental disorder. However, mentally disordered offenders may have additional needs (eg symptoms of PD or mental illness) that impact on well-being, but also needs that impact directly on offending. As such, the rehabilitation of offenders with mental disorder should adhere to established offender rehabilitation principles (the so-called Risk, Need, Responsivity [RNR] principles; Andrews and Bonta, 2006), but also include additional supports and interventions to meet these ‘other’ needs. Additionally, symptoms of disorder should be regarded as responsivity factors that will require treatment in their own right as a precursor to offence-related treatments and to maintain offenders in offence-related group treatments. For mentally disordered offenders with PD, the treatment should focus on the PD in addition to the offending behaviour (see National Institute for Health and Clinical Excellence, 2010). Psychopathic offenders are a particularly important group of mentally disordered offenders, whose treatment has been contentious. However, there are few methodologically robust studies employing contemporary and systematic interventions that are common to the PD field that also adhere to established offender rehabilitation principles. Although early studies suggested that treatment may have adverse outcomes, the contemporary view is that treatment may be beneficial (Skeem et al, 2011). There is, as yet, little evidence for individual psychotherapy, though individual work may be a critical aspect of multi-modal treatment; individual counselling should target responsivity factors, including interpersonal difficulties and other cognitive and emotional problems that interfere with the client’s capacity to remain in and benefit from treatment. MICHAEL DAFFERN 236

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See also: Desistance; Personality Disorder and Offending Readings Andrews, D.A. and Bonta, J. (2006) The psychology of criminal conduct (4th edn). Newark, NJ: LexisNexis. Fazel, S. and Danesh J. (2002) ‘Serious mental disorder in 23000 prisoners: a systematic review of 62 surveys’, Lancet, 359: 545–50. Gilbert, F. and Daffern, M. (2011) ‘Illuminating the relationship between personality disorder and violence: the contributions of the general aggression model’, Psychology of Violence, 1: 245–58. National Institute for Health and Clinical Excellence (2010) Antisocial personality disorder: treatment, management and prevention. Leicester: The British Psychological Society and the Royal College of Psychiatrists. Skeem, J.L., Polaschek, D.L.L., Patrick, C.J. and Lilienfeld, S.O. (2011) ‘Psychopathic personality: bridging the gap between scientific evidence and public policy’, Psychological Science in the Public Interest, 12: 95–162.


Remand is the process of ordering a person accused of a criminal offence to be either kept in custody or placed on bail pending a further court appearance. Serious and complex cases cannot be fully dealt with the first time an individual appears in court, as time is needed to prepare the case or reports relevant for the defendant; thus, an individual may be repeatedly required to attend court prior to the eventual court verdict. Usually, a defendant has the right to unconditional bail; that is, the defendant has the right to be ‘free’ while investigations into the case are ongoing. However, there are several reasons why an individual could be remanded, including fear of absconding, fear of committing further offences, the need for psychiatric assessment and/or treatment, or a possibility that the accused will interfere with witnesses or obstruct the course of justice. The criteria under which people are arrested, accused or convicted of an offence, or may be detained, are contained within the Bail Act 1976. It provides for four main alternatives: first, unconditional bail, where the individual is free with no conditions; second, conditional bail, where the individual is free but is required to fulfil conditions, such as living at a particular address, not contacting people/going to certain places or reporting to a police station on a regular basis; third, there is the option of releasing the individual if they are subject to some form of surety or security, such as a financial deposit or the surrender of a passport; the final option is that of custody, wherein the individual is detained until a further court appearance. 237

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Remand originally developed as a response to the problems associated with the non-attendance of defendants in court, and in the last 50 years became focused on protecting against future offending. Remand challenges the presumption of innocence and remand decision-making focuses on the question of risk (Newburn, 2013). The Mental Health Act 1983 (as amended 2007) provides special arrangements, including the power to remand defendants to hospital for psychiatric assessment and/or treatment. However, this has not been widely used, as courts routinely send individuals to prison while awaiting assessment (Ashworth and Redmayne, 2010). Ashworth and Redmayne (2010) recognise that the potential consequences of being remanded into custody are vast, and Wahidin and Carr (2013) highlight that those who are remanded into custody and then found not guilty or those whose case is withdrawn are not entitled to any recourse for their detention. This is important as at any one time, approximately 15% of the prison population are individuals on remand, and are either convicted but unsentenced or unconvicted (Her Majesty’s Inspectorate of Prisons, 2012). Moreover, in 2010, 42% of those proceeded against at either the Magistrates’ Court or the Crown Court were either acquitted, not proceeded against or given a non-custodial penalty. LINDA ASQUITH See also: Adversarial Justice; Due Process; Mental Health Act 2007 Readings Ashworth, A. and Redmayne, M. (2010) The criminal process (4th edn). Oxford: Oxford University Press. Her Majesty’s Inspectorate of Prisons (2012) Remand prisoners: a thematic review. London: Her Majesty’s Inspectorate of Prisons. Newburn, T. (2013) Criminology (2nd edn). London: Routledge. Wahidin, A. and Carr, N. (2013) Understanding criminal justice. London: Routledge.


Mental health or illness was an ill-defined condition for most of the 18th century. People suffering from mental health problems were confined within a variety of institutions at this time, including prisons, lock-ups, ‘private madhouses’ and hospitals. In an attempt to try and take hold of the variety of private and public institutions in the late 18th century, Parliament passed an Act in 1774 to regulate, 238

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or at least provide some minimum standards for, the care of the mentally ill. Inspectors were appointed and charged with carrying out an annual inspection of each institution in order to ensure that they deserved to keep their licence to practise, and they reported their findings to Commissioners in London, and to Justices of the Peace in rural areas and the provincial towns and cities. However, standards of care were notoriously poor. Criticism of the asylums by noted Quakers Samuel Tuke and Edward Wakefield received a good deal of public attention in 1813 and 1814, and very quickly a Select Committee was established in 1815 to examine the latest scandals at Bedlam (Bethlem Hospital in London) and York Asylum, and to comment generally on standards of care. The Committee was formed of the great and the good – Lord Lascelles, the Rt Hon George Rose, the Rt Hon Charles Williams-Wynn, the Rt Hon William Sturges Bourne, the Hon Henry Grey Bennet, Charles C. Western, J.A. Stewart Wortley Esq, Thomas Thompson Esq, William Smith Esq – and they seem to have assembled a mass of evidence, and to have carried out their duties very diligently. The Select Committee then published their findings in three reports, which together provided statistics of who was held where, and in what conditions, and the reports strongly decried the practice of patients being chained to the walls, iron bars pinning down arms, restraints being applied for years without any release, poor diets, experimental treatments being applied that appeared to distress those to whom they were applied, and so on. In June 1816, Thomas Monro, Principal Physician at Bethlem Hospital, resigned as a result of scandal when he was accused of ‘wanting in humanity’ towards his patients. For researchers today, however, the Committee’s reports provide reliable evidence about a critical moment in the treatment of mental illness, which has also been viewed by followers of Foucault as proof of the ‘great confinement’ that swept deviant bodies into the prisons, the asylums and the workhouses in the late 18th century and that helped to cement the power of the Enlightenment institutions. BARRY GODFREY See also: Bethlem Royal Hospital Readings Foucault, M. (1965) Madness and civilization. New York, NY. Pantheon.


A companion to criminal justice, mental health and risk

RESETTLEMENT Resettlement can be defined as effective reintegration of imprisoned offenders back into the community (Her Majesty’s Inspectorate of Prisons, 2001). The previous terms associated with this work are ‘aftercare’ and ‘throughcare’. Resettlement has a clearer focus on the outcomes rather than the process of reintegrating offenders. The outcomes are to reduce reoffending, to protect the public and to help prisoners participate effectively in society as law-abiding members of the community (Her Majesty’s Prison Service, 2001; Ministry of Justice, 2010). Effective resettlement is vital to preventing further offending. It is the core function of the Prison Service and is central to government policy. The Prison Service should work in partnership with the Probation Service and statutory and voluntary services to support prisoners in creating and maintaining ties in the local community. Offenders’ families can also play a vital role in supporting offenders, both while in custody and on release. This topic has various implications for policy, services, offenders and research. In England and Wales, major changes are on the horizon, in particular, in respect of how the resettlement of offenders will be managed. For example, the Coalition government intends to introduce ‘payment by results’ schemes to ensure that all prisoners are supervised on release, and to open a number of ‘resettlement prisons’ as part of their so-called ‘rehabilitation revolution’ (see Ministry of Justice, 2010). Resettlement presents a multitude of challenges, not least that prisoners often have multiple and complex needs, including housing, employment, mental health and drug and alcohol issues. Importantly, there is the need to ensure that prisoners have access to services to address these often interlinked issues. Moreover, risk management is fundamental to the successful resettlement and rehabilitation of offenders. The Probation and Prison Service use a risk- and needs-assessment tool called the Offender Assessment System (OASys), which helps to identify and manage an offender’s risk factors. Prisoners experience a higher rate of mental illness than the general population. In some cases, a mental health condition can contribute towards their offending. Health-care services and criminal justice agencies should work collaboratively to manage risk and mental health needs, and so promote continuity of care. A prisoner’s responsible local authority can and should be involved. They have a statutory duty to assess an individual who appears to be in need of community care services, such as health-care services or supported housing (NHS and Community Care Act, 1990).


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Preparing for release from prison can never start too early. Resettlement teams within prisons can support prisoners and provide information, advice and practical assistance. Voluntary agencies are increasingly providing practical assistance through mentoring or ‘Through the Gate’ services. The impact of such services on reoffending rates is mixed, but generally positive (Jolliffe and Farrington, 2007; Ministry of Justice, 2013). POLLY McCONNELL See also: Care Programme Approach; Offender Assessment System; Probation Readings Her Majesty’s Inspectorate of Prisons (2001) ‘Through the prison gate: a joint thematic review by HMIP and Probation’. Available at: www.hmcpsi.gov.uk/ documents/reports/CJJI_THM/CSTC/through-the-prison-gates-sept01-rps. pdf Her Majesty’s Prison Service (2001) PSO 2300: resettlement. London: Ministry of Justice. Jolliffe, D. and Farrington, D. (2007) ‘A rapid evidence assessment of the impact of mentoring on re-offending: a summary’. Available at: www.civilservice.gov. uk/wp-content/uploads/2011/09/rdsolr1107_tcm6-7376.pdf Ministry of Justice (2010) Breaking the cycle: effective punishment, rehabilitation and sentencing of offenders. London: Ministry of Justice. Ministry of Justice (2013) Interim re-conviction figures for the Peterborough and Doncaster payment by results pilots. London: Ministry of Justice. NHS and Community Care Act (1990) ‘Section 47: assessment of needs for community care services’. Available at: www.legislation.gov.uk/ukpga/1990/19/ contents


Although no one authoritative definition of the term ‘resilience’ exists, it is generally understood to mean adaptability when faced with disruption or the ability to overcome certain circumstances when confronting adversity. Commonly referred to as ‘bouncebackability’, and more contemporarily understood to indicate ‘forward-thinking’, the term ‘resilience’ is a concept that has been disparately – and broadly – used in a variety of different disciplines and contexts. These include, but are not limited to, ecology, politics, engineering, psychology, international relations, criminal justice and criminology. 241

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The public narrative of resilience in the UK largely resides in risk-adverse social policy, such as the Civil Contingencies Act 2004. Since its emergence, the emphasis on protecting the UK against the risks of terrorism and disaster have shifted to being ‘resilient’ in the face of such threats, as evidenced in the UK National Resilience Capabilities Programme, the Critical Infrastructure Resilience Program and its supporting documents: the Sector resilience plans for critical infrastructure 2010/2011 (The Cabinet Office, 2011) and the aptly named Keeping the country running: natural hazards and infrastructure (The Cabinet Office, 2011). All these provide an assessment of the UK’s resilience capabilities and guidance for how resilience can be fostered by industry, emergency services and government departments. At the centre of this policy are state-managed emergency responses purporting strong community involvement. In this way, as Walklate (2011, p 186) suggests, ‘the capacity for resilience can be and is harnessed by the policy and political process’. However, such UK policies have a continued dual narrative of risk and resilience that have opened them up to criticism (see Furedi, 2008). The uses of resilience narratives and practices have similarly found their way into the criminal justice system and its processes, with a particular leaning towards mental health. Criminal justice professionals are said to be encouraged to adopt resilient approaches to the unpredictable, competitive and often violent nature of their work, from the stressful periods of study for law students, through to the general resilient (read ethical) ‘persona’ of criminal justice practices (Ball, 2012). So, too, have resilient narratives been differently applied to those who become the subject of criminal justice practices and those impacted by criminal victimisation. Included in such approaches are: the fostering of resilient attitudes in young people to prevent them from remaining in the ‘revolving door’ of the justice system (Corner and Solomon, 2005); the identification of ways to foster resilience in female offenders to help mitigate against the impacts of incarceration (Martin and Hesselbrock, 2001); and establishing resilient support structures to assist victims’ families suffering from the psychological impacts of crime (HuiChing, 2010). However, caution has been drawn to the underdeveloped nature of psychological approaches to resilience in practice with young offenders (Fougere et al, 2012). This final point stands to indicate a serious message regarding how ‘resilience’ should be critically understood and cautiously approached. Indeed, running contrary to the dominant psychological approaches to resilience and mental health evidenced here is an urge for a paradigm shift towards a more sociological imagination of resilience (McGarry et al, 2014). ROSS McGARRY See also: Recovery and Mental Health Policy


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Readings Ball, M. (2012) ‘Self-government and the fashioning of resilient personae: legal education, criminal justice, and the government of mental health’, Current Issues in Criminal Justice, 23(1): 97–110. Corner, J. and Solomon, E. (2005) ‘Lessons in coping and resilience’, Criminal Justice Matters, 61(1): 24–5. Fougere, A., Daffern, M. and Thomas, S. (2012) ‘Toward an empirical conceptualisation of resilience in young adult offenders’, The Journal of Forensic Psychiatry & Psychology, 23(5/6): 706–21. Furedi, F. (2008) ‘Fear and security: a vulnerability-led policy response’, Social Policy and Administration, 42(6): 645–61. Hui-Ching, W. (2010) ‘The protective effects of resilience and hope on quality of life of the families coping with the criminal traumatisation of one of its members’, Journal of Clinical Nursing, 20: 1906–15. Martin, M. and Hesselbrock, M.N. (2001) ‘Women prisoners’ mental health: vulnerabilities, risks and resilience’, Journal of Offender Rehabilitation, 34(1): 25–44. McGarry, R., Walklate, S. and Mythen, G. (2014) ‘A sociological analysis of military resilience: opening up the debate’, Armed Forces & Society, doi: 10.1177/0095327X13513452. Available at: http://afs.sagepub.com/content/ early/2014/01/15/0095327X13513452.abstract Walklate, S. (2011) ‘Reframing criminal victimisation: finding a place for vulnerability and resilience’, Theoretical Criminology, 15(2): 179–94.


The Mental Health Act 1983 (as amended 2007) brought in the role of the Responsible Clinician (RC).This role supersedes the role of Responsible Medical Officer (RMO). The RC is an Approved Clinician (AC) who is given overall responsibility for a patient’s care. The AC can carry out most of the functions previously done by the RMO. Following changes to the Mental Health Act, registered psychologists, first-level mental health or learning disability nurses, registered occupational therapists, and registered social workers may all be RCs. To be an RC, staff must be an AC first. Most RCs are doctors; however, depending on the needs of the patient, a more appropriate professional may be the RC. For example, in a longer-stay rehabilitation unit, it may be an occupational therapist and for patients with personality disorders who require long-term psychotherapy, it may be more appropriate for the treating psychologist to be the RC.


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To be an AC, all professionals must undertake training and have the relevant competencies. ACs must apply through the National Health Service (NHS) England or Wales (there is a separate Act in Scotland). Professionals are required to attend a two-day course, and for those not on the General Medical Council’s Specialist register, a comprehensive portfolio must be produced showing relevant competencies, case studies, 360-degree feedback and a citation from their Medical Director or Chief Executive. A panel comprising of ACs will assess the portfolio and recommend whether or not AC status should be given. All ACs must be reapproved every five years. The RC has a range of powers under the Mental Health Act 1983 (as amended 2007). They are the clinical lead for a patient who is detained, on a supervised Community Treatment Order (CTO) or Guardianship Order. The RC will ensure that the overall care of a detained patient is safe, effective, in line with the Act and the least restrictive of the person’s rights and freedoms. They can review the need for detention, CTO or Guardianship Order, as well as discharge patients from these parts of the Act. Also, they can allow leave (section 17) from an inpatient unit. Along with the Approved Mental Health Practitioner, the RC can make or revoke a CTO. The RC will also report to the Ministry of Justice in relation to restricted patients. An important function of the RC is to ensure that the detained patient’s rights are protected. A key part of a patient’s rights is ensuring that Part 4 of the Act (consent to treatment) is upheld. These include assessing a patient’s capacity to consent to or refuse treatment, or, alternatively, seeking a Second Opinion Approved Doctor to assess the suitability of the treatment. Under the Mental Health Act 1983 (as amended 2007), there is provision for a change of RC when patients move from the community to inpatient settings and vice versa. ANUSHTA SIVANANTHAN See also: Mental Health Act 2007 Readings Mental Health Act (2007) ‘Code of Practice (2008)’. Available at: www. lbhf.gov.uk/Images/Code%20of%20practice%201983%20rev%202008%20 dh_087073[1]_tcm21-145032.pdf


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RESTORATIVE JUSTICE Restorative justice (RJ) represents an alternative approach to conflict resolution to that implemented within Western justice systems.The concept originates from the informal conflict-resolution models of indigenous societies and small ethnic and religious communities. Contemporary interpretations of RJ have developed from its re-conception during the 1970s by academics and theorists responding to the dissatisfaction of victims and well-documented failures of the criminal justice process.The implementation of RJ within Europe and England began in the 1980s, with a migration of those restorative practices that were in operation in the US. Rather than focusing upon the state, RJ postulates that transgressions are first and foremost a conflict between individuals. A broad concept, restorative justice has been described by Marshall (1999, p 5) as ‘a process whereby parties with a stake in a specific offence collectively resolve how to deal with the aftermath of the offence and its implications for the future’. This encompasses a victim-centred response to crime, directly involving, through dialogue and direct accountability, those most affected by the offence, seeking to heal the damage resulting from criminal acts (Braithwaite, 2002). Despite attempts to define the concept, the persistent latent ambiguity of the term ‘restorative justice’ has resulted in the development of a multitude of restorative practices. Such practices include victim–offender mediation, family group conferencing, restorative conferencing, community restorative boards, restorative circles and sentencing circles. This diversity of practice is demonstrated within Hoyle, Young and Hill’s (2002, p 1) description of the Thames Valley restorative cautioning scheme as being ‘one of the many diverse practices that march under the banner of “restorative justice”, a philosophy oriented primarily towards the repair of harm rather than deterrence, rehabilitation or punishment’. In addition to the competing interpretations regarding RJ philosophy, another focus of debate is the extent to which it can, or indeed should, operate within the criminal justice process. Some theorists continue to assert that RJ should operate as being essentially diversionary from the traditional process of trial and imprisonment. However, certain elements are seen as being central to RJ philosophy (Zehr and Mika, 2010). These include assertions that justice should seek to maximise stakeholder participation (with stakeholders being defined as the victim, the offender and the community, but excluding the state) and that offences place obligations upon the offender to rebalance the equilibrium between themselves and the victim that was disturbed through their offending behaviour. Voluntary participation is emphasised, minimising coercive action through prioritising mutually agreed outcomes over any imposed decisions, with the victim defining the context of the discussion and agreement (Zehr and Mika, 2010). In his seminal work, Christie (1977) goes further, asserting that it is those parties 245

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directly affected by the act who should control its resolution, with stakeholder ‘ownership’ of conflicts being a central feature of this work. Such ownership is seen to be achieved via an emphasis upon victim–offender interaction, through either direct or indirect communication, in the presence of a trained official. JAC ARMSTRONG See also: Criminal Justice Readings Braithwaite, J. (2002) Restorative justice and responsive regulation. Oxford: Oxford University Press. Christie, N. (1977) ‘Conflicts as property’, The British Journal of Criminology, 17(1): 1–15. Hoyle, C., Young, R. and Hill, R. (2002) Proceed with caution: an evaluation of the Thames Valley Police initiative in restorative cautioning. York: Joseph Rowntree Foundation. Marshall, T. (1999) Restorative justice: an overview. London: Home Office. Zehr, H., and Mika, H. (2010) ‘Fundamental concepts of restorative justice’, in C. Hoyle (ed) Restorative justice: critical concepts in criminology (vol. 1). London: Routledge, pp 47–56.


Control and Restraint (C&R) is a method of physical restraint designed in 1981 by Her Majesty’s Prison Service to enable prison staff to respond to violent and disruptive prisoners. It continues to be used throughout the public and private prison estate today. Restraint techniques are also utilised in mental health care and have been adapted both in name (Care and Responsibility) and technique (absence of pain compliance techniques). C&R is derived from the martial arts of Aikido. In secure settings, such as hospital and prison, C&R training and use of techniques focus on ascribed roles within teams of staff. For example, a team of four or five C&R staff are required to take control of a prisoner or patient (one to take control of the head, one member of the team for each arm and at least one member of staff to control the legs if the prisoner or patient is taken to the floor). In the prison/prisoner context, C&R may rely on the use of pain compliance techniques, which involve the application of pressure to certain areas of the body, such as the thumb and wrist, to gain


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control of a prisoner. In the mental health setting, the use of pain compliance techniques is prohibited. C&R may be enacted in situations of physical altercation or non-compliance with instructions of staff, to prevent self-injury/harm, to enforce searches of clothing/property, and, in the mental health context, to enforce the injecting of medication where patient consent is withheld (for those detained under the Mental Health Act 1983 [as amended 2007]). Those subject to restraint can be taken to the floor in the supine position (face up) or prone position (face down), which can, due to the restriction on normal breathing, pose additional medical risks. In the prison environment, C&R also allows for the use of batons and mechanical restraints in the form of ratchet handcuffs and body belts (Her Majesty’s Prison Service, 2005). Discerning how and when to restrain requires careful judgement and skill. Force can only be used if: it is reasonable in the circumstances; it is necessary and no more force than is necessary can be used; and it is proportional to the seriousness of the circumstances (Her Majesty’s Prison Service, 2005). To use force unnecessarily or excessively would constitute a criminal assault and, potentially, a breach of a prisoner’s rights under Articles 2, 3 and/or 8 of the European Convention on Human Rights. Restraint is ‘intrinsically unsafe’ (Smallridge and Williamson, 2008), and despite the frequency with which it is used, much still remains unknown regarding the medical risks or psychological harm posed or the causes of restraint-related deaths (Joint Committee on Human Rights, 2005). While the use of restraint for children in penal custody was recently reviewed (Smallridge and Williamson, 2008), a similar review of the use of C&R is long overdue. Concerns have been raised regarding the potential for racial stereotyping, the use of pain compliance techniques and the restraint of children and the mentally ill (Joint Committee on Human Rights, 2005). If physical restraint does become necessary, the health of the prisoner or patient must be monitored and the necessity of force constantly assessed. The failure to do so can have tragic consequences, as illustrated in the death of David Bennett at a National Health Service medium secure unit in 1998 and the death of prisoner Kenneth Severin at HMP Belmarsh in 1995 (INQUEST, 1995). KATE GOOCH See also: Human Rights and Mentally Disordered Offenders; Seclusion


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Readings Her Majesty’s Prison Service (2005) Prison service order 1600: use of force. London: Her Majesty’s Prison Service. INQUEST (1995) Death in prison custody: the report on the death of Kenneth Severin. London: INQUEST. Joint Committee on Human Rights (2005) Deaths in custody. Third report of session 2004–2005. London: Her Majesty’s Stationery Office. Smallridge, P. and Williamson, A. (2008) The independent review of physical restraint in the juvenile secure estate. London: Ministry of Justice and Department for Children, Schools and Families.


Psychiatry’s formal involvement with judicial criminal proceedings can be traced to the introduction of the Criminal Lunatics Act 1800. This legislation was enacted largely in response to debate and questions over the appropriate legal approach to be taken with an individual suffering with mental illness at the time of an offence.This debate was prompted earlier in the same year as the Criminal Lunatics Act received Crown assent as a man named James Hadfield attempted to murder King George III by discharging a firearm in the direction of the Royal Box in the Drury Lane Theatre in London. Hadfield, a military veteran, had sustained cranial trauma during the Battle of Lincelles in Flanders in 1794 and subsequently suffered from delusional beliefs. Given Hadfield’s mental state, at his trial for treason, the judge indicated to the jury that they must find him ‘not guilty’ as it was clear that he was suffering from an altered state of mind at the time of the offence. The case indicated that there was a lack of guidelines on the disposal of the criminally insane, as Hadfield had been found not guilty but there clearly needed to be an intervention in order to secure the safety of the general public, as well as address the unmet needs of the perpetrator. A new category of ‘criminal lunatic’ was created and systems and services were mobilised to deal with these groups of offenders, such as purpose-built accommodation at Royal Bethlem Hospital and later the opening of Broadmoor Criminal Lunatic Asylum. In many cases, the decisions made over the periods of detention of mentally disordered offenders are not simply split between the courts and psychiatry; rather, government ministers may also have a role in cases where restrictions are made. A restricted patient is a patient who is subject to a Restriction Order (section 41 of the Mental Health Act 1983 [as amended 2007]) or a Restriction Direction 248

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(section 49), or an order having an effect where the Crown Court orders the admission of a defendant to hospital at the conclusion of criminal proceedings (Department of Health, 2008). Section 41 is a restriction on discharge, leave of absence and transfer between hospitals to protect the public from serious harm and is a restriction usually without a limit of time. These restrictions can only be rescinded with the explicit approval of the secretary of state for justice or a Mental Health Tribunal. Section 41 is used in conjunction with a section 37 Hospital Order or Guardianship Order made by magistrates and/or the Crown Court for individuals convicted of an imprisonable offence. Similarly, the secretary of state for justice may utilise sections 47 and 48 of the Mental Health Act 1983 (as amended 2007) to direct the transfer of a person from prison to hospital if they are in need of psychiatric treatment. The secretary of state for justice has the power through section 49 of the Mental Health Act 1983 (as amended 2007) to impose restrictions until a point in time when the prison sentence would have ended (Department of Health, 2008). If such restrictions are in force, their effect is that the patient can be transferred to another hospital, or granted leave to be absent from the hospital grounds but only with the secretary of state for justice’s consent. Furthermore, if the patient were to be discharged from hospital, they would require either the secretary of state for justice’s consent or a direction made by them or by the Mental Health Tribunal. A restricted patient’s discharge may initially only be conditional, in which case he/she can be recalled to hospital for further treatment if his/her mental state or behaviour deteriorates or he/she breaches one of the conditions of his/her discharge. A restricted patient remains a patient for the purposes of the Act until such time as he/she is absolutely discharged from the restrictions – that is, regardless of whether or not he/she appears to be suffering from a mental disorder at a particular moment in time. RICHARD MOTTERSHEAD See also: Hospital Order; Mental Health Act 2007; Mental Health Review Tribunal Readings Department of Health (2008) Reference guide to the Mental Health Act 1983. London: Her Majesty’s Stationery Office.


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RISK SOCIETY Based upon the central claim that society in modernity experiences dramatic change and the consequences of industrialisation are impacting on the social world in the form of risks, the work of Beck (1992, 2009) and Giddens (1990, 1991) has altered the worldview of risk. Beck describes how risk is not only national, but global, in relation to the impact on individuals’ lives, and how the production of risks is unpredictable and crosses traditional boundaries, international borders, space and time to affect everyone now and in future generations. An atmosphere of uncertainty in society is emerging, culminating in the ‘risk society’ (Beck, 1992). Giddens suggests that the interrelated processes of social reflexivity, globalisation and de-traditionalisation are changing social life dramatically and that social and political institutions cannot respond to the increasing risk and proliferation of lifestyle choices (Penna et al, 1999). Beck’s (1992, p 19) argument is summed up in his opening lines: ‘In advanced modernity the social production of wealth is systematically accompanied by the social production of risks’. According to Beck (1992, 2009), the paradigm of risk society, based on how risks produced by modernisation can be prevented and distributed in an acceptable way, overlap with the concepts of an industrial, class-based society that aims to distribute socially produced wealth in a legitimate way. In striving to overcome poverty, hazardous side effects previously went unnoticed, but there is a growing critique of modernisation that influences public discussions. Modernisation must become reflexive in order for society to evolve and issues of the political and economic management of risks are overshadowing issues of employment and development. Reflexive modernisation becomes increasingly individualised and this structural change results in further uncertainty and individuals reflexively constructing their own life biographies. Giddens is especially interested in the relationship between modernity and the individual’s management of self-identity (Jary and Jary, 1995). Giddens (1990) concentrates on the central themes of security versus danger and trust versus risk, which Giddens (1991) develops further to argue that the globalising tendencies of modern institutions are accompanied by a transformation in social life, with profound implications for personal activities. He describes how institutionally structured risk environments, with rapidly developing and often contradictory specialised knowledge portrayed through media channels, contribute to the risk society. As awareness increases with the dynamic nature of knowledge, the notion of risk becomes central to society and to individuals as they reflexively construct their own life biographies. Risk is a more or less ‘ever-present exercise, of a partly imponderable character … the risk climate of modernity is thus unsettling for everyone; no one escapes’ (Giddens, 1991, p 124). In the risk society, social classes lose their social identity through the process of individualisation and inequalities remain redefined as an individualisation of social 250

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risks perceived as personal failings and anxieties (Beck, 1992, 2009). As such, self-identity, structured through the consideration of risks, becomes a reflexively organised behaviour in which individuals make choices about lifestyle and life plans (Giddens, 1990, 1991). EMMA BOND See also: Actuarialism; Governmentality Readings Beck, U. (1992) Risk society: towards a new modernity. London: Sage. Beck, U. (2009) World at risk. Cambridge: Polity Press. Giddens, A. (1990) The consequences of modernity. Cambridge: Polity Press. Giddens, A. (1991) Modernity and self-identity: self and society in the late modern age. Cambridge: Polity Press. Jary, D. and Jary, J. (1995) ‘The transformations of Anthony Giddens – the continuing story of structuration theory’, Theory, Culture and Society, 12: 141–60. Penna, S., O’Brien, M. and Hay, C. (eds) (1999) Theorising modernity: reflexivity, environment and identity in Giddens’ social theory. Harlow: Addison Wesley Longman Limited.


S SAFEGUARDING The UK government has made it clear that safeguarding is everyone’s responsibility (Department for Children, Schools and Families, 2007) in the context of both adults and children. In the increasing number of serious case reviews of child deaths and serious injuries in England and Wales, the correlation of parental mental health problems is reflected in childcare social workers’ caseloads, where 50–90% of parents had either a mental health, alcohol or substance misuse problem (Social Exclusion Unit, 2004).There is widespread evidence of the missed opportunities to protect children, which includes adult mental health professionals not considering it to be their role to take into account the children’s welfare (Slack and Webber, 2008). Despite joint protocols providing procedures and guidance about practice in both routine and complex cases, and health and social care professionals being encouraged to share information, a culture of ‘fear’ in relation to accountability may be evoked. Thus, such a situation may result in poor decision-making and a hindering of the rights of parents with mental health issues (Webber et al, 2013). Such circumstances highlight how interagency collaboration is a complex process that cannot simply be fostered by protocols alone (Hudson et al, 1999).This may be further complicated by the fact that the evidence base for the effectiveness of interagency working in safeguarding children is limited (Taylor and Daniel, 2006). Taking this complexity into account, effective communication and an understanding of how mental health issues can impact upon the child’s welfare in the context of neglect and emotional development are imperative. Notwithstanding, it is equally important for the professional to consider the 253

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human rights of those with mental health problems in the context of a ‘right to respect for private and family life’ (Article 8 of the European Convention on Human Rights) in a non-stigmatising way and not to be ‘overprotective’ in the context of the child’s welfare. This shows how safeguarding in the context of vulnerable adults and/or mental health and the protection of rights are equally important. Often referred to as a ‘rights-based approach’, guided by No secrets (Department of Health, 2000) (as people with mental health issues can often face a variety of abuse and victimisation), this reminds practitioners that a ‘paradigm shift’ is required in order to promote more empowering approaches in protecting the rights of vulnerable adults (Whitelock, 2009). Empowering approaches in working with people with mental health problems involve a proactive stance by the practitioner, whereby there is recognition of the multiple disadvantages individuals can face. For example, the criminal justice system leads to abuse not being reported by victims, as well as victims not being believed, and when they do report it, they face a denial of equal access to justice. Thus, the human rights of people with mental health problems should be at the forefront of the practitioner’s decisionmaking in an endeavour to promote rights-based practice. Without knowledge of law and policy, practitioners can become part of the problem as opposed to the solution, further discriminating the rights of vulnerable adults diagnosed as having mental health issues in the context of safeguarding. What emerges from these policy and practice dilemmas is what may be conceived as a responsibility to manage a tenuous balance between protection (safeguarding) and individual rights in a potentially complicated clinical and social context. KAREN D. ROSCOE See also: Human Rights and Mentally Disordered Offenders; Universal Declaration of Human Rights Readings Department for Children, Schools and Families (2007) The children’s plan: building brighter futures. London: Her Majesty’s Stationery Office. Department of Health (2000) No Secrets: guidance on protecting vulnerable adults in care, London: Her Majesty’s Stationery Office. Hudson, B., Hardy, B., Henwood, M. and Wistow, G. (1999) ‘In pursuit of interagency collaboration in the public sector: what is the contribution of theory and research’, Public Management: An International Journal of Research and Theory, 1: 235–60. Slack, K. and Webber, M. (2008) ‘Do we care? Adult mental health professionals’ attitudes towards supporting service users’ children’, Child and Family Social Work, 13: 72–9. 254

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Social Exclusion Unit (2004) Social exclusion and mental health: Social Exclusion Unit report. London: Office of Deputy Prime Minister. Taylor, J. and Daniel, B. (2006) ‘Standards for education and training for interagency working in child protection in the UK’, Nurse Education Today, 26: 179–82. Ward, H., Holmes, L., Moyers, S., Munro, E. and Poursanidou, D. (2004) Safeguarding children: a scoping study of research in three areas. Loughborough: Centre for Child and Family Research, Loughborough University. Webber, M., Corker, E., Hamilton, S., Weeks, C., Pinfold, V., Rose, D., Thornicroft, G. and Henderson, C. (2013) ‘Discrimination against people with severe mental illness and their access to social capital: findings from the Viewpoint survey’, Epidemiology and psychiatric sciences, 23(2):155–65. Whitelock, A. (2009) ‘Safeguarding in mental health: towards a rights-based approach’, The Journal of Adult Protection, 11(4): 30–42.


The term ‘schizophrenia’ was first introduced by Swiss psychiatrist Eugen Bleuler in 1911 and is undoubtedly one of the most controversial and poorly understood concepts in the field of mental health. Informed by popular cultural misrepresentations of insanity (as in the ‘split personality’ Dr Jekyll and Mr Hyde), it has come to epitomise ‘madness’ and the fear of its consequences. Within mainstream clinical psychiatry, schizophrenia is conceptualised and classified as a mental illness – a psychotic disorder, characterised by a fractured relationship to reality and ‘typically’ manifest in hallucinations, delusions, thought disorder, emotional blunting and social withdrawal. Diagnosis is based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM-IV-TR [currently under revision]) (APA, 2000) and the World Health Organization’s International Statistical Classification of Diseases and Related Health Problems (ICD-10 [currently under revision]) (WHO, 1992), and is made according to patients’ self-reported symptoms and observation of behaviours. There is no objective ‘test’ for schizophrenia; nor is there a ‘cure’. Patients are ‘treated’ with antipsychotic medications designed to suppress acute symptoms, though these are also associated with iatrogenic side effects, including acute movement disorders that resemble Parkinson’s disease. Explanations as to what causes schizophrenia span genetic, biochemical and psychosocial theories. Nevertheless, despite over a century of well-funded scientific research, there is no conclusive evidence for the existence of ‘schizophrenia’ as an illness and it remains an illusive and highly contested concept. 255

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Since its inception within Western medicine in the late 19th and early 20th centuries, dissenters within and outside psychiatry have pointed to philosophical and methodological flaws inherent in the concept of ‘schizophrenia’ that raise fundamental questions of reliability and validity of diagnosis (Boyle, 2002; Bentall, 2003). Such doubts also give rise to ethical and human rights concerns. Schizophrenia is one of the most frequent diagnoses under the Mental Health Act 1983 (as amended 2007). People diagnosed with schizophrenia are, unjustifiably, subjected to stereotypical constructions of risk and dangerousness that, in turn, inform repressive mental health law, policy and practice – as seen in the introduction of Supervised Community Treatment (SCT) and Community Treatment Orders (CTOs) in the Mental Health Act 1983 (as amended 2007). Furthermore, schizophrenia is a diagnosis that is used disproportionately among black people, resulting in harsher mental health and criminal justice responses (Fernando, 2010). People who receive a diagnosis of schizophrenia report that it is one of the most damaging aspects of their contact with mental health services – whether in terms of the interventions that can follow diagnosis (such as compulsory detention and/or unwanted treatment with antipsychotic medications) or its stigmatising consequences (Sayce, 2000; Read et al, 2006). As a result, many mental health service users reject the schizophrenia label, preferring to find alternative ways of making sense of, and dealing with, their experiences (e.g. Hearing Voices Network), and many professionals now call for the ‘schizophrenia label’ to be abandoned in mental health law, policy and practice (e.g. Inquiry into the Schizophrenia Label and Campaign for Abolition of the Schizophrenia Label). VICKI COPPOCK See also: Diagnostic and Statistical Manual of Mental Disorders Readings APA (American Psychiatric Association) (2000) Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, 4th Edition (Text Revision). Arlington, VA: American Psychiatric Association. Bentall, R. (2003) Madness explained: psychosis and human nature. London: Allen Lane. Boyle, M. (2002) Schizophrenia: a scientific delusion (2nd edn). London: Routledge. Fernando, S. (2010) Mental health, race and culture (3rd edn). Basingstoke: Palgrave Macmillan. Read, J., Haslam, N., Sayce, L. and Davies, E. (2006) ‘Prejudice and schizophrenia: a review of the “mental illness is an illness like any other” approach’, Acta Psychiatrica Scandinavica, 114: 303–18.


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Sayce, L. (2000) From psychiatric patient to citizen: overcoming discrimination and social exclusion. London: Macmillan Press. WHO (World Health Organisation) (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva, Division of Mental Health, World Health Organization.


Despite variations, definitions of seclusion refer to the confinement of a person (user of mental health services) in a purpose-built locked room without social interaction for an arbitrary period of time (Muir-Cochrane et al, 2002). Seclusion remains highly controversial within mental health services. Research clearly demonstrates its detrimental consequences, most notably, for service users, but also for the nurses who participate in seclusion events. The limited research undertaken from a service-user perspective highlights feelings of punishment, not understanding reasons for seclusion and no debriefing or support offered post-event. The attitudes of service providers, particularly nurses (the profession with the greatest client contact), have been the focus of considerable research activity. While the detrimental effects of seclusion are acknowledged, there is a perception by some of the therapeutic benefits through providing ‘time out’. Seclusion is usually regarded as a necessary intervention of last resort, when the person poses a safety threat to self or others and cannot be reasonably contained in a less coercive manner. Even when nurses are aware of the punitive impact of seclusion, they continue to consider it necessary as an intervention of last resort (Happell and Koehn, 2010). Unfortunately, these attitudes fail to recognise the systemic contributors: for example, the impact of boredom and highly controlled environments is not considered. Simultaneously, the desire to reduce and, if possible, eliminate the use of seclusion has become embedded in mental health policy internationally (Lewis et al, 2009) to reflect a more recovery-oriented approach to care. Many mental health services have been successful in eliminating its use, suggesting that behaviours associated with mental distress can be managed in a less restrictive manner. Alternatives to seclusion have been identified, including: sensory modulation rooms; deescalation; and the provision of meaningful activities to prevent boredom (Champagne and Stromberg, 2004). Given that the focus of mental health services is to contribute to the improvement of mental health, the use of seclusion is highly problematic. There is a clear need 257

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for further research in this area. The research must reflect partnerships between academia, service users and mental health services. The focus of this work should address the attitudes of service providers and how they can be influenced to adopt a more recovery-focused and less coercive approach. Alternatives to seclusion must be more thoroughly researched so that clinicians feel that they have other options in preventing and responding to violent and aggressive behaviour. The theoretical and clinical education of health professionals needs to reflect a recovery and person-centred perspective rather than a medical approach. Research, education and practice must work together to create a sustainable reduction in, or elimination of, seclusion. BRENDA HAPPELL See also: Recovery and Mental Health Policy; Restraint Readings Champagne, T. and Stromberg, N. (2004) ‘Sensory approaches in inpatient psychiatric settings: innovative alternatives to seclusion and restraint’, Journal of Psychosocial Nursing and Mental Health Services, 42(9): 34–44. Happell, B. and Koehn, S. (2010) ‘Attitudes to the use of seclusion: has contemporary mental health policy made a difference?’, Journal of Clinical Nursing, 19(21/22): 3208–17. Lewis, M., Taylor, K. and Parks, J. (2009) ‘Crisis prevention management: a program to reduce the use of seclusion and restraint in an inpatient mental health setting’, Issues in Mental Health Nursing, 30(3): 159–64. Muir-Cochrane, E., Holmes, C. and Walton, J. (2002) ‘Law and policy in relation to the use of seclusion in psychiatric hospitals in Australia and New Zealand’, Contemporary Nurse, 13(2/3): 136–45.


The principle function of the Second Opinion Appointed Doctor (SOAD) is to safeguard the rights of those patients liable to be detained under the Mental Health Act 1983 (as amended 2007).The role is independent from the detaining authority, and is a statutory appointment by the Care Quality Commission (CQC) on behalf of the secretary of state. The CQC assumes responsibility for the recruitment of psychiatrists to this role and receives approximately 12,000 requests for second opinions each year (CQC, 2013).


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Part IV of the Mental Health Act (sections 56–64) introduces additional safeguards against ‘inappropriate treatment’ and details the circumstances where a second opinion is required. In exercising their function under the Act, the SOAD must ‘reach their own view whether to certify proposed treatment as appropriate’ (CQC, 2013, p 73). Section 57 identifies treatment requiring the patient’s consent and an SOAD authorisation and includes psychosurgery and interventions involving the surgical implantation of hormones to reduce male sex drive. Section 58A resulted from the 2007 amendment, and now authorises electro-convulsive therapy (ECT) administration only in cases where the patient has capacity and consents, or on the authorisation of an SOAD in the face of an incapacitated patient. The majority of SOAD work, however, involves section 58 and requires a statutory second opinion for incapacitated or dissenting patients who have been subject to compulsory treatment under detention for a period of three months. Treatment is thus lawful for the first three months, irrespective of the patient’s capacity or willingness to consent. Controversially, this deviates from the fundamental principle of autonomy, where the common law right to refuse medical treatment has been unambiguously reinforced by the courts. With the current emphasis on community-based interventions, the value of the SOAD in this context is questionable. Inpatients subject to enforced medication but discharged within three months will never activate the SOAD safeguard. The previous wording of the 1983 Act provided clear parameters to consider the likelihood of the treatment having an effect, or preventing deterioration in the patient’s condition. Bartlett (2011) asserts that the introduction of the ‘appropriate’ benchmark indicates the SOAD role is to merely certify that the treatment is not unreasonable. This expanded interpretation differs from an expectation that the patient is receiving a second opinion in the true sense. Indeed, significant amendments are not the norm under section 58, with Bartlett (2011, p 523) concluding that ‘the high level of agreement is notable’. The 2007 revision of the Mental Health Act (sections 17A–17G) makes provision for Supervised Community Treatment, extending the SOAD role with the introduction of Community Treatment Orders (CTOs). SOADs are required to certify the appropriateness of treatment (after one month) for patients lacking capacity, or, if refusing, the appropriateness of treatment if recalled to hospital. An SOAD certificate cannot be used to authorise enforced treatment in the community. CTOs have steadily increased in number, placing a huge resource strain on the SOAD service. Consequently, they are no longer required to certify treatment for community patients who have capacity and are consenting. CLAIR TOURISH 259

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See also: Mental Health Act 2007 Readings Bartlett, P. (2011) ‘The necessity must be convincingly shown to exist: standards for compulsory treatment for mental disorder under the Mental Health Act 1983’, Medical Law Review, 19(4): 514–47. CQC (Care Quality Commission) (2008) Guidance for SOADs: consent to treatment & the SOAD role under the revised Mental Health Act. London: Care Quality Commission. CQC (2013) Monitoring the use of the Mental Health Act in 2011/2012. London: Care Quality Commission.


This section of the Mental Health Act 1983 (as amended 2007) allows the police to remove a person they believe is mentally disordered and ‘in immediate need of care or control’ from a public place to a place of safety (a police station, an accident and emergency department, or a mental health unit), in the interest of that person or for the protection of others. The person may be detained for up to 72 hours so that they can be examined by a Registered Medical Practitioner and interviewed by an approved mental health professional to make any necessary arrangements for their treatment or care. In practice, the police face a number of dilemmas with the use of this section of the Act. First, there is the problem of recognising that a person actually is mentally disordered. Studies have shown, however, that the police are effective at identifying such cases and that they do not tend to place people on section 136 unnecessarily (Kelleher and Copeland, 1972). Nevertheless, once in police custody, the appropriateness of a police cell for holding a mentally ill person can rightly be questioned. Not only may it have the effect of criminalising people for what is essentially a health need, but the environment may also exacerbate their mental state and, in the most tragic of cases, lead to deaths in police custody. Second, it may be impractical to take a person detained under this section anywhere other than police custody, for example, if they have committed an offence. Guidance from the Independent Police Complaints Commission suggest that if a person is violent or at risk of self-harm, it may be perceived as acceptable that they should be taken to police custody as it will be safer and easier to restrain them if necessary. Intoxication may further complicate matters


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as influence in decision-making may be responsive to the attitude of the medical facilities (Docking et al, 2008). Several studies report poor communication and information sharing between different agencies (Borschmann et al, 2010). However, what emanates from a police intervention very swiftly becomes a process involving the cooperation of numerous agencies, and while there are still some challenges, many health authorities have developed policies for dealing with persons who have been detained under this section of the Act. The use of police cells is being discouraged, but, as a last resort, many authorities are using Crisis Teams, consisting of a psychiatrist, a social worker and perhaps a psychiatric nurse, to visit police stations, assess patients and decide on the best line of management. BRIAN ROBERTS See also: Bradley Report; Policing and Duty of Care Readings Borschmann, R., Gillard, S., Turner, K., Chambers, M. and O’Brien, A. (2010) Section 136 of the MHA: a new literature review. London: Institute of Psychiatry. Docking, M., Grace, K. and Bucke, T. (2008) IPCC – police custody as a “place of safety”: examining the use of sec 136 MHA 1983. London: IPCC. Kelleher, M.J. and Copeland, J.R.M. (1972) ‘Compulsory psychiatric admission by the police’, Medicine, Science and the Law, 12: 220–4.


A broad definition of self-harm refers to any intentional act of self-poisoning or self-injury carried out by an individual irrespective of the type of motivation or degree of suicidal intent (Hawton et al, 2007). Thus, this definition includes suicide attempts as well as acts where little or no suicidal intent is involved (Royal College of Psychiatrists, 2010). Self-harm can occur at any age but it is most prevalent in young people (NICE, 2011). The UK has one of the highest self-harm rates in Europe and the detailed studies of self-harm suggest that episodes might account for over 200,000 hospital attendances in England every year (Hawton et al, 2007). There is an increased risk of suicide for individuals who self-harm (Chen et al, 2011) and a strong association between self-harm and poor mental health (Haw et al, 2001). With regard to the criminal justice system, the reported rate of male self-harm was 201 incidents 261

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per 1,000 prisoners, while, in contrast, the female incidence was 264 incidents per 1,000 prisoners in 2012 (Ministry of Justice, 2013). The rate of self-harm in female prisons in England and Wales remains significantly higher as women only represent 5% of the overall prison population (Ministry of Justice, 2013). Self-harm is not a specific disorder or even a particular type of behaviour and it can take many forms. It ranges in severity from mild or superficial effects to permanent physical injury and life-threatening risk. Methods of self-harm can be separated into self-poisoning and self-injury. Evidence shows that about 80% of people self-poison with prescribed or over-the-counter medication, most frequently, analgesics (Horrocks et al, 2003). Cutting is the most common method of self-injury but individuals may also engage in burning, head banging, swallowing or inserting objects, self-suffocation, drowning, hanging, and jumping in front of vehicles or from heights (NICE, 2011). Self-harm often occurs due to emotional and psychological distress and it is well established that it is primarily used as a coping strategy. Before self-harming, individuals describe feelings of upset, frustration, inner tension, numbness and anger. Self-harm may also be due to past abuse, relationship problems, family issues or as a way of communicating with or influencing others. Evidence-based interventions for self-harm in prison and mental health centres is rather limited and professionals frequently use strategies that try to ‘de-escalate’ the self-harm by supportively talking to individuals, removing the means of self-harm, observation, distraction strategies or instructing individuals to remain in night attire. Professionals working with people who self-harm describe this area as both challenging and frustrating, and they feel fearful and powerless when caring for people at risk of self-harm. Furthermore, because of these experiences, professionals sometimes feel angry and describe difficulties in developing a therapeutic relationship with individuals who engage in self-harm. Self-harm is very complex and there is a need for more research in this field, particularly in increasing the knowledge and skills of professionals and determining the effectiveness of strategies and interventions for those who self-harm. TAMMI WALKER See also: Assessment, Care in Custody and Teamwork Approach; Missing People; National Suicide Prevention Strategy


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Readings Chen, V.C.H., Tan, H., Chen, C., Chen, T.H., Liao, L., Lee, C.T.C., Dewey, M., Stewart, R., Prince, M. and Cheng, A.T.A. (2011) ‘Mortality and suicide after self-harm: community cohort study in Taiwan’, The British Journal of Psychiatry, 198: 31–6. Haw, C., Hawton, K., Houston, K. and Townsend, E. (2001) ‘Psychiatric and personality disorders in deliberate self-harm patients’, The British Journal of Psychiatry, 178(1): 48–54. Hawton, K., Casey, D., Bale, E., Shepherd, A., Bergen, H. and Simkin, S. (2007) Deliberate self-harm in Oxford. Oxford: The University of Oxford, Centre for Suicide Research. Horrocks, J., Price, S., House, A. and Owens, D. (2003) ‘Self-injury attendances in the accident and emergency department clinical database study’, The British Journal of Psychiatry, 183(1): 34–9. Ministry of Justice (2013) ‘Safety in custody statistics England and Wales: update to December 2012. Available at: https://www.gov.uk/government/uploads/ system/uploads/attachment_data/file/192431/safety-custody-dec-2012.pdf NICE (National Institute of Clinical Excellence) (2011) Longer-term care and treatment of self-harm (Clinical Guidance 133). London: National Institute of Clinical Excellence. Royal College of Psychiatrists (2010) Self-harm, suicide and risk: helping people who self-harm: council report CR158. London: Royal College of Psychiatrists.


The Sex Offenders Risk Appraisal Guide (SORAG) is a predictive actuarial tool for the probability of sexual offence recidivism for sex offenders. SORAG was developed by the same research group that developed the Violent Risk Assessment Guide (VRAG) (Quinsey et al, 2006). SORAG uses two primary definitions of recidivism: sexual recidivism, where an offence is committed against another person that clearly involves sexual contact; and violent recidivism, where an offence involves violence. In terms of the tool, violent recidivism includes all sexual recidivism. Quinsey et al (2006) had demonstrated that VRAG in its unmodified form is an effective tool for the prediction of violent reoffending in some sexual offenders but not necessarily all types of sexual offending. Therefore, SORAG was developed from the multivariate analysis of four studies that included sex offenders (Quinsey et al, 2006). The objective of the tool was to predict at least one reconviction for a sexual or violent offence. SORAG consists of 14 questions that are completed on review of detailed psychosocial histories, a phallometric test for sexual deviancy, the Hare 263

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Psychopathy Checklist-Revised (PCL-R), Diagnostic Statistical Manual of Mental Disorder (DSM) criteria for personality disorder, and the criteria for schizophrenia. Of these 14 questions, nine are also common to the VRAG tool; the five differing variables relate to the nature of the sexual index offence, the case history of violent and sexual offending prior to the index offence, and the results of phallometric testing. The case history of violent offending is quantified using the Comier-Lang Criminal History score for violent offences. The question responses are scored and compared to nine SORAG categories that provide probabilities of recidivism at seven and 10 years from release. SORAG has been adapted for use with the German language and validated for this use by Rossegger et al (2010). This study and others have demonstrated that while SORAG is effective in predicting general violent recidivism, it is less effective for predicting touching/hands-on-only sexual offences (Eher et al, 2008). Other criticisms of SORAG have been its inability to predict the sexual reoffending in the subgroup of rapists (Eher et al, 2008). As with all actuarial predictive tools, the practitioner is advised to use SORAG in combination with other tools and expert clinical judgement to assess risk of recidivism. LISA ARMSTRONG See also: Sex Offender Treatment Programmes; Sexual Offending Readings Eher, R., Rettenberger, M., Schilling, F. and Pfäfflin, F. (2008) ‘Failure of Static-99 and SORAG to predict relevant reoffense categories in relevant sexual offender subtypes: a prospective study’, Sexual Offender Treatment, 3(1). Available at: www. sexual-offender-treatment.org/1-2008_02.html Quinsey, V.L., Harris, G.T., Rice, M.E. and Cormier, C.A. (2006) Violent offenders: appraising and managing risk (2nd edn). Washington, DC: American Psychological Association. Rossegger, A., Gerth, J., Urbaniok, F., Laubacher, A. and Endrass, J. (2010) ‘The Sex Offender Risk Appraisal Guide (SORAG)’, Fortschritte der Neurologie Psychiatrie, 78(11): 658–67.


Efforts to alter sex offender behaviour have consisted of three separate treatment phases: psychoanalytical in the 1960s; behavioural in the 1970s and 1980s; and cognitive behavioural treatment (CBT) from 1990 until today. Behavioural 264

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approaches tackled aggression, sexual issues and masculinities, and encouraged self-esteem, alcohol misuse harm reduction, proper use of leisure, assertiveness and victim empathy. These methods converged with cognitive initiatives, using multi-modal strategies to alter perpetrators’ thought processes, which justify and minimise abuse.The effectiveness of CBT emerged from evidence-based research consisting of meta-analytical studies in the US and Canada (Brown, 2005). In 1992, the UK prison service set up a sex offender treatment programme (SOTP) in line with the 1991 government strategy to provide a punitive but proportionate response to sex offenders. It combined assessment and treatment and prepared the way for accreditation based on best practice in both custodial and non-custodial settings. In 2001, the National Probation Service rolled out standardised community programmes throughout England and Wales, and by 2007, there were 1,300 completions annually across the 42 probation areas (Middleton et al, 2009). Originally, programmes were limited to child abusers, with minimal provision for rapists, and were designed for male sex offenders aged 21 years plus and within the normal intelligence quotient (IQ) range. The goals of the Community Sex Offenders Group Programme, Northumbria Sex Offenders Group Programme and Thames Valley Sex Offenders Group Programme are to increase understanding and awareness of why the offence happened and the harm caused to victims. They emphasise different ways of thinking and behaving to distance the person from the offending. Group sessions use various techniques, involving direct input, practical exercises, role play and offence analysis. Later developments have included programmes for those with different needs and social or learning difficulties (eg SOTP Becoming New Me [BNM], the Adapted SOTP – Community Version [ASOTP – CV] and Internet sex offenders [Internet SOTP – i-SOTP]). The programmes vary in intensity with individuals being assessed according to the Risk, Need, Responsivity (RNR) agenda. The formalised CBT approach within SOTPs has been hotly debated. Mann’s (2009) argument for manualisation states that programme effectiveness is linked to prescription of dosage, interventions and outcomes for practitioners. It is suggested that through comprehensive training and supervision, facilitators can incorporate a therapeutic process. Criticisms are that individuality is negated and creativity is restricted by a rigid application of the script. Tensions can develop between therapeutic features such as empathy and genuineness and more punitive, confrontational and manipulative approaches. Integration of strength-based models, such as desistance and the Good Lives Model (GLM), have more recently gained acceptance, with their orientation towards positive treatment targets. Whereas RNR focuses on avoidant goals, with extensive monitoring of relapse, GLM emphasises flexibility through negotiation 265

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of individualised approach goals. The assumption is (although there is currently limited evidence for or against) that achievements of legal, pleasurable aims will better enable reintegration and reduce reoffending (Willis and Ward, 2010). RACHEL GOLDHILL See also: Circles of Support and Accountability; Sex Offenders Risk Appraisal Guide; Sexual Offending Readings Brown, S. (2005) Treating sex offenders: an introduction to sex offender treatment programmes. Cullompton: Willan Publishing. Mann, R. (2009) ‘Sex offender treatment: the case for manualisation’, Journal of Sexual Aggression, 15(2): 121–31. Middleton, D., Mandeville-Norden, R. and Hayes, E. (2009) ‘Does treatment work with Internet sex offenders?’, Journal of Sexual Aggression, 15(1): 5–19. Willis, G. and Ward, T. (2010) ‘Striving for a good life: the good lives model applied to released child molesters’, Journal of Sexual Aggression, 17(3): 290–303.


The law on sex offences is that part of the criminal law that embodies what is right or wrong in sexual behaviour. In general terms, sexual behaviour is private behaviour between two or more people that the parties concerned have consented to engage in. In the UK, the criminal law was consolidated and updated by the Sexual Offences Act 2003. Sexual behaviour becomes sexual offending if, first, one of the parties has not consented to the activities in question or, second, the law has designated certain sexual behaviour as unlawful regardless of the presence of consent. First, most sexual offending is premised on the absence of consent, whereby one party has been forced into the activities under duress or by deception. Consent may also be absent if one party lacks the capacity to consent. This lack of capacity to consent may be due to age, a mental disorder or any other ‘incapacitating’ factors, such as being under the influence of alcohol or drugs. In terms of children, most societies have an ‘age of consent’ below which the child is deemed unable to give free and informed consent. They are considered to lack the capacity to understand what they may be consenting to and the 266

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full consequences of the behaviour in question. The ‘age of consent’ is a social construction differently decided upon by different societies (eg 16 in the UK, 15 in France, 14 in Germany). This social construction is then formulated into criminal law. Sexual behaviour below such thresholds is construed as sexual offending regardless of any ‘consent’ given by the child. Similar laws apply to people (adults as well as children) with mental disorders, including learning disabilities, which invalidate any consent decisions they may have made. The presence of drugs or alcohol may also temporarily incapacitate a person from giving valid consent. Second, criminal laws are sometimes passed on certain sexual behaviour to make that behaviour an offence even where there has otherwise been freely given consent; in other words, ‘society’ has ruled that it finds such sexual behaviours unacceptable. This includes incestuous sexual behaviour and sexual behaviour considered a ‘breach of trust’. The latter includes, for example, sexual behaviour between school teachers and the young people they teach even when those young people are over the age of consent. The nature of sexual offending and how to deal with it has become a matter of some priority in many Western countries over the last 20 years. Attempts have been made to improve the prosecution and conviction rate of those who commit sexual offences and sentences have become more punitive. Public protection initiatives have included the Sex Offender Register, which was started in 1997 in the UK. Those convicted or cautioned for a designated sexual offence have to notify the police of their circumstances and any changes in those circumstances for a specified period of time and sometimes for an indefinite period. The police have a duty to continually ‘risk-assess’ those on the register. TERRY THOMAS See also: Circles of Support and Accountability; Sex Offenders Risk Appraisal Guide Readings Ireland, J., Ireland, C. and Birch, P. (eds) (2008) Violent and sexual offenders: assessment, treatment and management. Cullompton: Willan Publishing. Thomas, T. (2011) The registration and monitoring of sex offenders: a comparative study. London: Routledge.


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SOCIAL CONTROL THEORY ‘Social control’ is a central, contested term cutting across a number of disciplinary and thematic boundaries and widely used in the social sciences to refer to different forms of organised processes through which individual or group behaviour is regulated. The contested nature of this term arises from the different forms of control (coercive or self-regulating; formal or informal; direct or indirect), the different analytic components of controlling processes (sources, operation and efficacy) and the different contexts in which the concept is used (historical, sociological, anthropological, criminological, political, medical and psychological frameworks). Its direct links with the concept of social order, from its early classical formulations connected with Durkheim (functionalist accounts) and Marx (materialist accounts), to its more contemporary interactionist and dramaturgical interpretations (Goffman), make social control a pervasive feature of society and its normative aspects. A common distinction is between theoretical interpretations of social control as organised, purposive and repressive mechanisms (such as prohibition, surveillance, accusation, punishment and medicalisation), used to regulate and respond to social behaviour perceived as deviant, criminal or delinquent, and interpretations of social control as informal, indirect and tacit mechanisms (such as socialisation, education, peer pressure and persuasion), through which society compels its members to comply to social norms, values, conventions and beliefs. Tribunals, courts, prisons, psychiatric hospitals and other ‘total institutions’ (see Goffman, 1961) are examples of social agencies operating within the first, formal framework, while families, schools, peer groups and the media represent social agencies operating within the second, informal one. Theories of social control differ vastly in terms of the sources of potential constraints on individuals’ behaviour; however, they all share a focus on the reasons why individuals are prevented from participating in deviant or criminal behaviour rather than on those that might instigate such participation. Hirshi’s (1969) influential attempt to put some order into earlier empirical studies on delinquent behaviour (see Nye, Reckless, Reiss, Matza) and to clarify their theoretical assumptions is based on the Durkheimian hypothesis that deviant or delinquent behaviour is linked to (but not caused by) either weakened or broken bonds to society. More specifically, according to Hirshi’s social control theory, the conventional constraints preventing individuals from committing deviant or criminal acts are jeopardised when one of the following elements of the social bond is broken or weakened: • attachment to others (both within and outside the family); • commitment to significant activities and goals; 268

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• involvement in such activities; and • belief in wider social values and norms. While social control theory is appealing for several reasons – including the fact that it allows the separation of deviant or criminal behaviour from social class and race/ethnicity – a number of scholars have questioned its strength. One of the problematic aspects concerns the different efficacy of the theory when empirically tested in cross-sectional versus longitudinal studies. Other criticisms relate to the limited explanatory power of the theory, which would be more effective in explaining minor rather than serious forms of deviance and crime. Nevertheless, the theory still possesses valuable insights, particularly in its ability to identify the factors facilitating desistance from crime, and continues to pave the way for future research on deviant and delinquent behaviour. ALESSANDRO PRATESI See also: Deviance; Medicalisation and Social Control; Surveillance Readings Goffman, E. (1961) Asylums: essays on the social situation of mental patients and other inmates. New York, NY: Doubleday Anchor. Hirshi, T. (1969) Causes of delinquency. Berkeley, CA: University of California Press. Kubrin, C.E., Stucky, T.D. and Krohn, M.D. (2009) Researching theories of crime and deviance. Oxford: Oxford University Press.


‘Social exclusion’ is an ambiguous phrase that refers to the inability of particular social groups to participate in mainstream society due to a combination of factors, which include unemployment, low income, poor housing, high-crime zones, illhealth and/or family breakdown.There are no accurate indicators against which to measure social exclusion due to the difficulty of finding agreement on what it is, or its main causes. Levitas (1998) identifies three different uses of ‘social exclusion’ in political debate, all of which necessitate different responses. First, in redistributive discourse, social exclusion is seen as a consequence of poverty, requiring increased levels of state benefits to address it. Second, social integration discourse posits social exclusion as the result of unemployment or economic inactivity. Here, paid work is presented 269

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as the primary or sole legitimate means of integrating individuals into society, although it fails to account for exclusion resulting from long hours and low pay. Third, a ‘moral underclass’ discourse emphasises moral and cultural causes of poverty, focusing on the consequences of social exclusion for social order and identifying particular groups as ‘dependent’ or ‘dangerous’. In the UK in 1997, the Social Exclusion Unit (SEU) was set up under the New Labour government to reduce social exclusion by providing ‘joined-up solutions to joined-up problems’ and to promote wider interdepartmental work around key social issues. It was intended to make recommendations to other government departments, with the aim of directing existing funding more effectively. Since its establishment, it has produced a number of reports that attempt to provide multidimensional solutions to social problems, including: reoffending by exprisoners, teenage pregnancy, ‘rough sleeping’ and mental health and social exclusion (eg Social Exclusion Unit, 2004). The frequently posited solution for social integration is through employment: encouraging the marginalised and insecure to be reintegrated into society through productive activity. Despite the lack of clarity over the term, ‘social exclusion’ can be viewed as serving a political purpose by creating categories of ‘risk’ through social categories of need (eg long-term unemployed, homeless) and obscuring wider inequalities that reflect structural division. Emerging from the recognition that poverty, both relative and absolute, excluded some groups from citizenship, the original emphasis on inequality shifted during the 1990s to take on a discourse that presented those who had not improved their standard of living in line with mainstream society as being somehow ‘outside’ of society. In doing so, however, the concept failed to address wider inequalities within society, which remain fundamental features of capitalism. The creation of ‘outcasts’ as an unavoidable side effect of economic progress and the quest for order that is characteristic of modernity is evident in Bauman’s (2004) and Wacquant’s (2008) challenge to the concept of social exclusion. MARGARET MALLOCH See also: Deviance; Social Justice; Underclass (Social Construction of) Readings Bauman, Z. (2004) Wasted lives: modernity and its outcasts. Cambridge: Polity Press. Levitas, R. (1998) The inclusive society: social exclusion and New Labour. Basingstoke: Macmillan. Social Exclusion Unit (2004) Mental health and social exclusion. London: Office of the Deputy Prime Minister. Wacquant, L. (2008) Urban outcasts. Cambridge: Polity Press. 270

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SOCIAL JUSTICE Social justice attempts to address the inadequacies of criminal justice, which merely focuses upon wrongs as defined by law. Like zemiology, social justice strives to move beyond the narrow focus of the criminal law on punishing offenders by refocusing upon essential components of justice that criminal justice fails to accomplish. Its concern is that society should ensure the ‘needs’ of all by securing the fair distribution of opportunities, rights and freedoms and more tangible social necessities, ensuring a fundamentally welfarist approach to justice. Resembling and influenced by Marxist and socialist theories and, in some cases, liberation theology, it is critiqued by conservative neoliberals as impinging upon personal freedoms and responsibilities. Thus, social justice is essentially a political challenge to free-market, noninterventionist capitalism, under which if ‘the market is to be free; the people are to be disciplined’ (Hall, 1980, p 5). Social justice rejects the abandonment of the responsibilities of the state to secure the welfare of all. It sees the fair distribution of, and access to, the necessities of life such as housing, health care, education and income as the primary responsibility of the state in any society. Such policies and practices therefore necessitate progressive taxation and wealth redistribution; which can be misrepresented as unjust attacks upon individuals’ wealth and freedoms. As such, social justice principles are the antithesis of the contemporary libertarian free-market economics that have dismantled many of the progressive welfare policies, practices and agencies of the post-war settlement, most prominently, under Thatcherism (see Hall and Jacques, 1983). While caricatured as being too lenient and neglecting personal irresponsibility, advocates of such social controls upon the excesses of free-market capitalism, such as Keynes and Beveridge, were primarily concerned that failure to manage those excesses would stimulate social unrest and jeopardise the existing social order. Thus, social justice may be much less revolutionary than it is portrayed: it may be merely managing and delimiting some of the excesses of laissez-faire economics in order to safeguard capitalism and underpin class harmony. Thus, the welfare state only ever sought to provide a very restricted ‘safety net’ for only those people who encountered very limited genuine needs. Social justice policies are critiqued by the Right as being unfeasible and idealistic as they claim that inequalities are a natural phenomenon and that states’ interferences are an unjust attack upon personal freedoms. The success of such critiques is evidenced in the increasing exclusion of additional categories of people and other ‘transgressors’ who fail to meet strict criteria of eligibility or personal


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responsibilities in order to gain access to welfare support implemented by political parties of both the Left and Right. LIAM McCANN See also: Criminal Justice; Justice; Zemiology Readings Hall, S. (1980) Drifting into a law and order society. London: Cobden Trust. Hall, S. and Jacques, M. (eds) (1983) The politics of Thatcherism. London: Lawrence and Wishart.


The social model of disability can be seen as a political response to the essentialising definitions of disability offered by medical practitioners and institutions such as the World Health Organization (WHO).The definitions provided by the International Classification of Impairments, Disabilities and Handicaps (ICIDH) attempted to distinguish between impairment, disability and handicap; at the crux of their definitions lay the assumption that impairment was the unavoidable cause of any limitations or restrictions of a person’s abilities (Williams, 2001). The disability movement believed that such definitions had a segregating effect upon disabled people by emphasising their differences. Oliver (1990) further explained that ‘personal tragedy models’ individualised and depoliticised problems surrounding impairment and relied on the medical profession’s discovery of cures for diseases to enable true inclusion. In 1976, a document published by the Union of the Physically Impaired (UPI) first outlined the main features of the social model (later developed in Oliver’s seminal work in 1990). In short, the social model argues that disability is a result of disabling attitudes and physical structures that exclude those with physical or mental impairment. Compared to previous definitions, attention is drawn to the social organisation of society, which serves to exclude and discriminate against those with disabilities, and not impairment. Its Marxist influences, therefore, divert the gaze away from the individual and onto social barriers to enable inclusion through social change. Goodley (2011) describes the adoption of the social model within the UK as a ‘social barriers’ approach compared to the North American ‘minority group’ version, which mainly focuses on fighting for positive identities within disability. 272

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The British, therefore, focus on addressing social-structural barriers, while North Americans challenge social-cultural barriers. Both approaches were developed by the Disabled People’s Movements and succeeded in challenging natural links between impairment and social ‘lack’. The model remains influential within disability studies and beyond, and enabled a platform to fight for the rights of disabled people. Despite its uses, the social model of disability has not been without its critics. Shakespeare (2006), for example, critiques the ontological assumptions created by the social model. By dichotomising impairment–disability the former becomes a naturalistic, unchangeable entity and the latter a socially exclusive category with no influence of embodiment. Shakespeare (2006) argues that disability cannot be experienced without impairment and, furthermore, if disability is just about social exclusion, then any minority group can use this term to explain their oppression. Disability studies need to address both impairment and disability to ensure that it can be understood fully. The social model succeeds in terms of providing a critical voice to the oppressive talons of medicalisation and classification and highlights the social dimensions of disability. To ensure a more nuanced understanding of disability, a social understanding of the interaction between impairment and disability is required. CASSANDRA A. OGDEN See also: Essentialism Readings Goodley, D. (2011) Disability studies: an interdisciplinary introduction. London: Sage. Oliver, M. (1990) The politics of disablement. Basingstoke: Macmillan. Shakespeare, T. (2006) Disability rights and wrongs. London: Routledge. Union of the Physical Impaired and Segregation (1976) The fundamental principles of disability. London: UPIAS. Williams, G. (2001) ‘Theorizing disability’, in G.L. Albrecht, K.D. Seelman and M. Bury (eds) Handbook of disability studies. London: Sage, pp 123–44.


Over the past several decades, there has been a significant increase in the number of prisoners who have psychiatric conditions. Some researchers contend that this growth is, in part, a consequence of deinstitutionalisation and the failure of 273

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community mental health to serve people with serious mental health problems. However, since prisons are not equipped to function as a de facto mental health system, the rising number of mentally ill prisoners poses a significant challenge for carceral management. Researchers have consistently argued that prisoners with mental health issues are more likely to have higher numbers of disciplinary infractions, and are more likely to damage property, act out aggressively towards prison staff, throw bodily fluids, self-harm and generally disobey prison officer commands. These sorts of disruptive behaviours often result in prisoners with mental health issues being confined in solitary confinement. There is consistent evidence that housing prisoners with mental health problems in solitary confinement not only fails to improve behaviour, but also actually exacerbates and accentuates psychiatric symptomology (Haney and Lynch, 1997). As a result of being placed in segregation, prisoners with mental health problems are often excluded from the psychiatric treatment programmes offered to prisoners in the general population (Haney, 2003). In fact, Haney (2003) argues that the negative consequences of segregated confinement include: profound sleeping and eating problems; anxiety and panic attacks; uncontrollable rage; paranoia/hallucinations; and self-mutilation. Moreover, Haney (2003) contends that experiencing long-term isolation also has a significant impact on a prisoner’s cognitive function. In his study of ‘supermax’ confinement in the US, Haney found that segregated inmates lost the ability to control their conduct; they fail to recognise how they fit in the wider social world. Each of these things helps to increase prisoner frustration, which often leads to the escalation of violence and sudden outbursts of rage (Kupers, 2006; Haney, 2006). However, custodial systems are left in a situation where the only way to manage this sort of conduct is by using the very techniques of control that produce these sorts of behaviour. In the US context, a number of court cases have been initiated over the use of solitary confinement for psychiatrically compromised prisoners (Reiter, 2012), such as Madrid v Gomez (1995). In Madrid v Gomez (1995), the US Supreme Court looked specifically at the conditions of confinement at Pelican Bay. They ruled that it was unconstitutional for prisoners with psychiatric conditions to be housed in ‘supermax’ facilities, even though they did not find that solitary confinement was a violation of the 8th Amendment against cruel and unusual punishment (Reiter, 2012). Despite the empirical evidence which suggests that experiencing long-term solitary confinement is detrimental to a prisoner’s mental health, the practice continues in the US and elsewhere. AMY KLASSEN


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See also: Pains of Imprisonment; Seclusion Readings Haney, C. (2003) ‘Mental health issues in long-term solitary and “Supermax” confinement’, Crime and Delinquency, 49: 124–56. Haney, C. (2006) Reforming punishment: psychological limits to the pains of imprisonment. Washington, DC: American Psychological Association. Haney, C. and Lynch, M. (1997) ‘Regulating prisons of the future: a psychological analysis of supermax and solitary confinement’, New York University Review of Law and Social Change, 23(4): 477–570. Kupers, T.A. (2006) ‘How to create madness in prison’, in D. Jones (ed) Humane prisons. Oxford: Radcliffe Publishing, pp 47–58. Madrid v Gomez, 889 F.Supp. 1146 (N.D. Cal. 1995). Reiter, K.A. (2012) ‘The most restrictive alternative: a litigation history of solitary confinement in US prisons, 1960–2006’, Studies in Law, Politics, and Society, 57: 71–124.


Solution-Focused Therapy (SFT) is a strengths-based therapeutic approach that is used across a variety of client groups and settings, including within the mental health and criminal justice systems. SFT was pioneered and developed in the Milwaukee Brief Family Therapy Centre by Stephen de Shazer, Insoo Kim Berg and colleagues in the 1980s (DeShazer and Dolan, 2007). Its defining characteristic is its focus on identifying solutions to presenting difficulties rather than dwelling on past problems.The intervention, typically short in duration (up to six weeks), is also commonly known as Brief Solution-Focused Therapy. Key tenets of the approach include an assumption that people want to change and are doing their best to make that happen, and that the solution (or at least part of it) is already happening within a person’s life. SFT is situated within a social-constructionist theoretical framework. Here, reality is viewed as an intersubjective construction, where interactions with others and the language used is seen to create and constrain experiences and perceptions. As such, alternative constructions or re-authoring can change an individual’s views of particular situations and experiences. Some of the techniques associated with SFT include the ‘miracle question’. This involves inviting the service user to imagine that a miracle has occurred and that their problem(s) have been solved, and using this as the basis, to imagine what life would be like if this occurs. Posing the ‘miracle question’ can be likened to asking someone to imagine their destination and then working towards establishing a roadmap to arrive there. 275

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Other techniques associated with the approach include the use of ‘problem-free talk’ and ‘scaling questions’. The latter involves asking the service user to rate their experiences and feelings on a scale and using this as a basis for identifying progress and movement towards a desired goal. SFT is used widely across a range of settings and has become increasingly popular. Some of the reasons for this popularity include its brevity as an intervention and hence its cost-effectiveness when compared to more longer-term interventions. However, some critics point to the relatively limited evidence base on the effectiveness of SFT. In a review of research on the effectiveness of SFT with a variety of client groups, including carers of people with schizophrenia, children of prisoners and criminal offenders, Corcoran and Pillai (2009) note that the evidence for the effectiveness of SFT is ‘equivocal’ and that there is a need for more rigorous evaluative research of this approach. One of the possible reasons for the limited number of studies exploring effectiveness beyond self-reports of client satisfaction is the fact that, by its nature, SFT does not focus on a presenting problem (eg recidivism or depression), and therefore measuring ‘treatment’ effects, that is, whether a problem has been resolved, is difficult (Corcoran and Pillai, 2009). Further criticisms include the charge that SFT is an overly simplistic approach, particularly when dealing with complex personal and social problems, and underplays the structural constraints (eg poverty, racism, gender inequality) in people’s lives. NICOLA CARR See also: Cognitive Behaviour Therapy; Dialectical Behaviour Therapy; Emotional CPR Readings Corcoran, J. and Pillai, V. (2009) ‘A review of the research on solution-focused therapy’, British Journal of Social Work, 39(2): 234–42. DeShazer, S. (1994) Words were originally magic. New York, NY: Norton. DeShazer, S. and Dolan, Y. (with Korman, H., Treper, T., McCollum, E. and Berg, I.K.) (2007) More than miracles: the state of the art of solution-focused brief therapy. New York, NY: Haworth Press Inc.


The experience of mental disorder is compounded by the impact of stigma on the lives of those affected. Equally, an analysis of stigma cannot be undertaken without 276

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understanding its profound and often life-changing impact on those people who live with a mental disorder.Those who stigmatise inflict varying degrees of insult, causing people with mental disorders to feel and to be discriminated against and excluded from the societies and communities in which they live and work. Contemporary sociological analysis of the relationship between stigma and mental disorder has its origins in the work of Erving Goffman (1922–82), beginning with his seminal definition: ‘an attribute that makes him different from others.… He is thus reduced in our minds from a whole and usual person to a tainted discounted one. Such attribute is a stigma’ (Goffman, 1963, p 53). Goffman’s analysis demonstrates a shared identification and meaning for people across societies, pivoting on personal accounts and lived experiences of being and feeling excluded (Mason-Whitehead and Mason, 2007). Goffman’s definition and analysis continues to deepen the knowledge and appreciation of stigma. Building on Goffman’s (1963) work, Faulk (2001) argued that mental illness is ‘the ultimate stigma’. Hinshaw (2007), for example, suggested that many people find mental health service users unpredictable and dangerous, and it has been argued that notions of dangerousness are fuelled by media coverage of mental illness (Green, 2009). Furthermore, once ‘labelled’ as having a mental health disorder, irrespective of whether a person behaves ‘normally’, they may still be stigmatised (Schulze and Angermeyer, 2003). People stigmatised with mental disorders have reported discrimination in all spheres of their lives, including, for example, ‘that mental health users are the only group in society who can be deprived of their liberty without doing anything wrong’ (Green, 2007, p 96). An area of discrimination encountered by people with mental disorders is employment, where employers may be reluctant to employ mental health service users (Hinshaw, 2007; Huxley and Thornicroft, 2003). Unemployment can lead to poverty and exclusion from society and a person’s mental disorder may deteriorate further, leading to self-stigma, where the person feels shame and guilt for their illness. Additionally, courtesy stigma results in families feeling blamed for causing the illness in their relative, resulting, in turn, in experiences of isolation, loneliness and secrecy (Gullekson, 1992). Stigma and discrimination are the most significant obstacles to mental health care and to ensuring a quality of life for people suffering from a mental health illness (Sartorius, 1998). While the obstacles are rooted in ignorance and fear, they will be challenged by education and understanding. ELIZABETH MASON-WHITEHEAD 277

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See also: Dangerousness and Mental Disorder; Media Representations and Mental Disorder; Social Exclusion Readings Falk, G. (2001) How we treat outsiders. New York, NY: Prometheus Books. Goffman, E. (1963) Stigma: notes on spoiled identity. London: Penguin. Green, G. (2009) The end of stigma? Changes in the experience of long-term illness. London: Routledge. Gullekson, M. (1992) ‘Stigma: families suffer too’, in P.J. Fink and A. Tasman (eds) Stigma and mental illness. Washington, DC: American Psychiatric Press, pp 11–12. Hinshaw, S. (2007) The mark of shame: stigma of mental illness and an agenda for change. Oxford: Oxford University Press. Huxley, P. and Thornicroft, G. (2003) ‘Social inclusion, social quality and mental illness’, British Journal of Psychiatry, 182: 289–90. Mason-Whitehead, E. and Mason, T. (2007) ‘Stigma and exclusion in healthcare settings’, in D. Abrams, J. Chrsitian and D. Gordon (eds) Multidisciplinary handbook of social exclusion research. Chichester: John Wiley & Sons, pp 59–78. Sartorius, N. (1998) ‘Stigma: what can psychiatrists do about it?’, Lancet, 352: 1058–9. Schulze, B. and Angermeyer, M.C. (2003) ‘Subjective experiences of stigma: a focus group study of schizophrenic patients, their relatives and mental health professionals’, Social Science and Medicine, 56(2): 299–312.


Structured Professional Judgement (SPJ) risk assessment is a systematic process that guides clinical decision-making in the context of risk. It involves the application of a ‘tool’ or ‘guide’ comprising risk (and, in some cases, ‘protective’) factors that research has shown to be relevant to the specific risk outcome under consideration. Guides exist for a range of outcomes, including violence (Webster et al, 1997) and sexual offending (Hart et al, 2003). SPJ guides invariably include a set of ‘dynamic’ (changeable) factors, accompanied in many guides by ‘static’ or ‘historical’ (slowly changing or unchangeable) factors. Each factor (or ‘item’) in the guide is rated by the clinician according to operationalised instructions, ideally using multiple sources of information.The final risk rating is then determined by the clinician’s overall judgement of the case, allowing a clear role for clinical judgement but only after the items have been systematically evaluated. SPJ attempts to combine the flexibility of pure unstructured clinical approaches with the robustness and consistency of actuarial approaches (Douglas and Reeves, 278

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2010). It allows for individualised assessments, rather than allocating a risk level according to a numerical formula. Webster, one of the authors of the SPJ guide for violence, the Historical-Clinical-Risk Management-20 (HCR-20), notes that it ‘presumes that the relative salience of one class over the other will vary from individual to individual and according to situational considerations’ (Webster and Hucker, 2007, p 84). The assessor, after considering how each of the items in the guide apply to the specific individual, is expected to develop a ‘theory’ with respect to how and under what circumstances risk behaviours emerge in the given case. Such a ‘theory’ (or ‘formulation’) may also take into account unusual but important risk factors (such as morbid jealousy or direct verbal threats of harm) that are too rare to be included as actual items in the guide. The factors that comprise each SPJ tool are based on prior research that demonstrates a clear relationship with the outcome of concern; although a causal relationship between the dynamic factors and the outcome is generally presumed, in practice, such causal links are notoriously difficult to empirically demonstrate. SPJ tools themselves have been subject to research confirming their inter-rater reliability and acceptable levels of predictive validity, that is, the risk ratings developed using the tools show an acceptable level of correlation with outcomes, although the measures involved are the subject of some debate (Singh et al, 2013). Unlike purely clinical approaches that may rely in part on opaque factors such as ‘expert intuition’ or ‘clinical experience’, assessments using SPJ are clear about which factors have been considered. This explicit, transparent approach allows for scrutiny in legal contexts and facilitates communication and therapeutic alliance in clinical contexts where risk assessment is an issue. While facilitating assessment with respect to predicting likelihood of harm, another major strength of SPJ guides is their emphasis on dynamic factors or ‘risk needs’, thus assisting with individualised, evidence-based approaches to management of future risk, and with measurement of changes in risk state. ANDREW CARROLL See also: Actuarial Risk Assessment; Clinical Risk Assessment Readings Douglas, K.S. and Reeves, K.A. (2010) ‘Historical-Clinical-Risk Management-20 (HCR-20) violence risk assessment scheme: rationale, application, and empirical overview’, in R.K. Otto and K.S. Douglas (eds) Handbook of violence risk assessment. New York, NY: Taylor and Francis, pp 147–85.


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Hart, S.D., Kropp, R., Laws, D.R., Klaver, J., Logan, C. and Watt, K.A. (2003) The Risk for Sexual Violence Protocol (RSVP) – structured professional guideline for assessing risk of sexual violence. Vancouver, Canada: Simon Fraser University, Mental Health, Law and Policy Institute. Singh, J.P., Desmarais, S.L. and Van Dorn, R.A. (2013) ‘Measurement of predictive validity in violence risk assessment studies: a second-order systematic review’, Behavioral Sciences & the Law, 31(1): 55–73. Webster, C.D. and Hucker, S.J. (2007) Violence risk assessment and management. Chichester: John Wiley & Sons Ltd. Webster, C., Douglas, K., Eaves, D. and Hart, S. (1997) HCR-20: assessing the risk of violence: version 2. Burnaby, BC, Canada: Simon Fraser University and Forensic Psychiatric Services Commission of British Columbia.


‘Substance-related violence’ is a broad term referring to the correlation between alcohol, drugs and violent behaviour. In the US, the most well-cited model of substance-related violence is Goldstein’s (1985) ‘tripartite conceptual framework’, which recognises three types of drug (including alcohol)-related violence: violence arising from the psychopharmacological effects of ingesting substance(s); violence arising from the economic motivations created by drug use; and systemic violence surrounding the drug market, which is thought to account for the greatest proportion of drug-related violence and homicide in the US. In the UK, alcohol has been associated with a substantial proportion of violent offending (eg Ramsay, 1996; IAS, 2013) and intoxication has been consistently reported as an important factor in homicide. Research shows that significant proportions of homicide offenders and victims are intoxicated at the time of the homicide and many also have a history of problematic alcohol or drug use (Brookman, 2005; Shaw et al, 2006; Dobash et al, 2007; Miles, 2012). Alcohol, either consumed alone or concurrently with drugs, appears to be a fundamental factor in violence and homicide; drug intoxication without alcohol appears to be less prominent, although research suggests a history of illegal drug use to be an important factor in explaining violence and homicide (Bennett and Holloway, 2007; Miles, 2012).The majority of illegal drug-related violence appears to arise from the economic motivations surrounding drug use and the systemic violence surrounding the drugs distribution network. The correlation between intoxication and violence has stimulated a number of governmental policies aimed at reducing substance-related violence, including increasing the price of alcohol, licence reforms, alcohol-free zones and mandatory engagement with drug treatment programmes for drug-using offenders (aimed 280

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more broadly at reducing drug-related crime). These measures imply an assumption of causation between intoxication and subsequent violence; however, research has found little evidence of any direct causal relationship. Although the psychopharmacological effects of alcohol (and some drugs) are known to impair cognition and induce aggression, the majority of people are not violent following intoxication; hence, in isolation, alcohol and drugs are insufficient in explaining substance-related violence (Brookman, 2010). Attempts to explain the relationship between intoxication and violence/ homicide highlight the complexity of the relationship and warn against simplistic interpretations of the concurrence of substances and violence. Although alcohol and/or drugs may play an important role in some violent incidents, a number of factors appear to mediate the relationship, ranging from individual characteristics to situational dynamics, cultural norms and structural-level factors. Parker and Auerhahn (1998) emphasise the importance of social context in examining the indirect relationship between alcohol, drugs and violence. Similarly, Miles (2012) advocates a context-specific approach in attempting to unravel the complex relationship between alcohol, drugs and homicide, which observes how intoxication may interact with multi-level factors to produce a fatal outcome. Although attempts to reduce alcohol consumption and illicit drug use appear to be a sensible starting point for reducing substance-related violence, measures addressing the cultural and social context surrounding violent incidents ought not to be undervalued. CAROLINE MILES See also: Alcohol and Risk; Dual Diagnosis; Violence and Mental Disorder Readings Bennett, T. and Holloway, K. (2007) Drug–crime connections. New York, NY: Cambridge University Press. Brookman, F. (2005) Understanding homicide. London: Sage. Brookman, F. (2010) ‘Homicide’, in F. Brookman, M. Maguire, H. Pierpoint and T. Bennett (eds) Handbook on crime. Cullompton: Willan Publishing, pp 217–44. Dobash, R.P., Dobash, R.E., Cavanagh, K., Smith, D. and Medina-Ariza, J. (2007) ‘Onset of offending and life course among men convicted of murder’, Homicide Studies, 11(4): 243–71. Goldstein, P.J. (1985) ‘The drugs/violence nexus: a tripartite conceptual framework’, Journal of Drug Issues, 39: 143–74. IAS (Institute of Alcohol Studies) (2013) ‘IAS Factsheet – crime and social impacts of alcohol’. Available at: www.ias.org.uk/uploads/pdf/Factsheets/Crime%20 FS%20HM%20May%202013.pdf 281

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Miles, C. (2012) ‘Intoxication and homicide: a context-specific approach’, British Journal of Criminology, 52(5): 870–88. Parker, R. and Auerhahn, K. (1998) ‘Alcohol, drugs and violence’, Annual Review of Sociology, 24: 291–311. Ramsay, M. (1996) The relationship between alcohol and crime: Home Office research bulletin no. 38. London: Her Majesty’s Stationery Office. Shaw, J., Hunt, I., Flynn, S., Amos, T., Meehan, J., Robinson, J., Bickley, H., Parsons, R., McCann, K., Burns, J., Kapur, N. and Appleby, L. (2006) ‘The role of alcohol and drugs in homicide in England and Wales’, Addiction, 101: 1117–24.


Surveillance may exist in face-to-face, paper-filing and digitised forms. It is an information-gathering process relied upon in the management of a whole range of social settings, including travel, consumption and work patterns, and criminal propensities or associations. Surveillance is therefore enmeshed in a broad practice of securitisation. The development of closed-circuit television (CCTV) and DNA databases have, in recent years, alluded to a presumed technical efficiency of surveillance in relation to ‘public well-being’. However, surveillance is categorical: information gleaned aids placing individuals and groups into categories, for example, as ‘worthy’ or ‘unworthy’,‘responsible’ or ‘irresponsible’.As a process of ‘social sorting’, surveillance gathers personal and group data to aid the classification of people in line with prescribed criteria. In turn, this process helps ‘to determine who should be targeted for special treatment, suspicion, eligibility, inclusion, access and so on’ (Lyon, 2001, p 20). As a process of ‘social ordering’, surveillance is central to the maintenance, control and ‘proper’ functioning of spaces, institutions and borders (Coleman, 2004). As a process enmeshed in the stabilisation and furtherance of social relations, proponents of surveillance argue for its predictive and preventive quality – to forestall unwanted ‘threats’ and ‘risks’. One of the key features of contemporary surveillance practice is ‘function creep’, where the intended practice of any surveillance technique morphs outward into areas other than those initially anticipated. While surveillance has long been a tool in managing problem groups, its precise uses and impacts need to be placed within political priorities and social power relations. We can say that surveillance is practised along a continuum of care/ treatment–control/discipline, with a bias towards the latter pole in the 150-year history of policy and practice in relation to mental health, whether in the settings of asylums or community care (Cohen, 1985). An increasingly controlling and ‘tough’ exclusionary response by British governments to handling ‘problem’ 282

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groups such as the mentally ill, problematic ‘youth’ or street criminals has been in evidence over the last 30 years at the expense of a long-term approach where surveillance may be part of a more progressive, ‘caring’ and inclusionary vision. Viewing the mentally ill as ‘risks’ to be managed and as potential threats to public tranquillity makes it less likely that technologies such as CCTV will aid in an understanding of people’s lives. Overwhelmingly, surveillance tools produce only a partial snapshot of a human being and effectively mute or silence his or her story – thus (mis)understanding mental health or the lived experience of any ‘problem group’ (Coleman and Sim, 2000), whether in the community or in an institution. Indeed, the impact of CCTV in mental health wards may be reinforcing a medicalising/‘objective’ gaze of the patient. The need to eradicate subjectivity in mental health diagnosis reflected the 1990s’ prominence of ‘evidence-based mental health’, which may further eschew the question of how a society can ensure a caring, inclusive system of surveillance that is designed to deliver effective treatment. These are the bigger questions within which decisions about the uses of surveillance occur. ROY COLEMAN See also: Medicalisation and Social Control; Psychiatry and Surveillance Readings Cohen, S. (1985) Visions of social control. Cambridge: Polity Press. Coleman, R. (2004) Reclaiming the streets: surveillance, social control and the city. Cullompton: Willan Publishing. Coleman, R. and Sim, J. (2000) ‘“You’ll never walk alone”: CCTV surveillance, order and neo-liberal rule in Liverpool city centre’, British Journal of Sociology, 51(4): 623–39. Lyon, D. (2001) Surveillance and society: monitoring everyday life. Buckingham: Open University Press.


T THIRD WAY POLITICS AND CRIME CONTROL The Third Way emerged during the 1990s as an attempt to reconcile the equality goals of social democracy with the techniques of neoliberalism.The term suggests that capitalism is the first way, and communism the second. After the Second World War, most developed nations accepted that economic progress and social cohesion required a large suite of government services in health, education and benefit payments. This would ensure a strong, well-educated and socially connected workforce, fit for industrial progress. Crime was seen largely as the result of structural factors such as poverty, inequality, poor health and education. It was social exclusion that fostered a criminal environment. Social-democratic parties, in particular, sought to alleviate crime by removing the structural factors that were supposed to be its cause. During the 1980s, conservative parties adopted neoliberal ideas, which situate responsibility at the point of the individual. Crime was not caused by society, but by the criminal’s failure to embrace legal norms. Social programmes did not solve crime; they worsened it by encouraging sloth-like behaviour rather than entrepreneurial creativity. Neoliberals set about removing public services to force all individuals to rely upon the free market to achieve their aims. The spread of neoliberalism caused social democrats to reconsider past ideas, which led to ‘the Third Way’. It was identified early by sociologist Anthony Giddens (1998), and practised openly by Britain’s Tony Blair and Germany’s Gerhard 285

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Schroeder. In short, the Third Way adopted neoliberalism’s individual focus, but sought to utilise rather than destroy government services to foster ‘freedom and potential’ (Blair, 1998, p 3). By 1997, the British Labour Party had adopted a ‘tough on crime’ approach. This included a ‘zero-tolerance’ position on petty crime, following the ‘broken windows’ theory (see Wilson and Kelling, 1982) that ignoring minor offences could normalise crime. The Third Way continued to work upon structural inequality but also sought punitive methods, such as longer prison terms and tougher policing, to build new civil norms and to reduce the impact of criminal activity upon already-disadvantaged communities (Charman and Savage, 1999). This reflected a broader theme within Third Way politics, which Rose (2000) identifies as a shift between ‘society’ and ‘community’. The Blair government sought to create a new civic culture that would build trust between individuals and institutions. The term ‘the Third Way’ is no longer fashionable; however, the development of this civic community remains a goal of much social-democratic policy. BEN REVI See also: Bifurcation; Social Justice Readings Blair, T. (1998) The Third Way: new politics for a new century. London: Fabian Society. Charman, S. and Savage, S.P. (1999) ‘The new politics of law and order: Labour, crime and justice’, in M. Powell (ed) New Labour, new welfare state?. London: The Policy Press, pp 191–212. Giddens, A. (1998) The Third Way: the renewal of social democracy. Cambridge: Polity. Rose, N. (2000) ‘Community, citizenship and the Third Way’, American Behavioral Scientist, 43(9): 1395–411. Wilson, J.Q. and Kelling, G.L. (1982) ‘Broken windows’, Atlantic monthly, 249(3): 29–38.


Mentally disordered offenders represent a significant proportion of the prison population of England and Wales, and a resurgence in the treatment movement drives expectations for provision within the prison estate of appropriate treatment.


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Teams specialising in mental health in-reach, crisis intervention and dual diagnosis go some way towards meeting this demand. Criminal Justice Liaison Teams offer support to those in the early stages of the Criminal Justice System (CJS) and maintain a presence in custody suites, courtrooms and (for remanded prisoners) prisons, offering opportunities for early diversion. There is also growing provision for those with a diagnosis of ‘other mental disorder’, and in the case of learning disabilities, specialist teams are developing, with nurses adopting a forensic focus to their role. There is provision within the Mental Health Act 1983 (as amended 2007) to divert from the CJS mentally disordered offenders. In the context of offenders in prison, the secretary of state, if satisfied that the person is suffering from a mental disorder (which is assessed as being of a nature or degree that warrants detention in hospital for medical treatment, and that the appropriate treatment is available), may issue a warrant for the transfer of the prisoner. This ‘direction’ should be based on the evidence of at least two registered medical practitioners, with at least one being approved under section 12 of the Mental Health Act 1983 (as amended 2007) and usually one practising at the hospital named on the transfer direction. Caution should be exercised to ensure that the transfer direction is made once the assessments have been completed, as failure to do so results in a prisoner with an identified need being detained without appropriate medical supervision, arguably in violation of Article 3 of the European Convention for Human Rights (Prohibition of Torture – no one shall be subjected to torture or to inhuman or degrading treatment or punishment). Transfer under section 47 from prison to hospital results in the same provision for treatment as for offenders made subject to a section 37 Hospital Treatment Order on conviction. When using section 37 where there are concerns regarding high levels of risk, restrictions may be added using section 41 of the Mental Health Act 1983 (as amended 2007). The resulting detention under section 37/41 requires that the secretary of state rather than the Responsible Clinician (RC) approve decisions such as those regarding leave of absence, transfer or discharge. Equally, there is provision to add restrictions to section 47. Here, the restriction order is section 49 of the Mental Health Act 1983 (as amended 2007) and the restricted patient would therefore be detained under section 47/49 of the Mental Health Act. If the sentence expiry is reached and it is considered that treatment is still required, then section 47 would convert to a notional section 37 (section 37(n)) and the patient would continue to be detained under the provisions of the Mental Health Act 1983 (as amended 2007), as per a Hospital Treatment Order.


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When section 47 is applied in cases where the mental disorder is that of learning disability, this must be associated with abnormally aggressive or seriously irresponsible conduct. The potential for injustice here is very real, as unlike periods of mental ill-health, a learning disability is a pervasive, lifelong condition and issues relating to treatment and recovery are very different. Consequently, there is potential for periods of extended detention that go beyond the sentence expiry date. MICHAEL SWINSWOOD See also: Learning Disabilities and Criminal Justice; Mental Health Act 2007 Readings Bradley, K. (2009) The Bradley Report: Lord Bradley’s review of people with mental health problems or learning disabilities in the criminal justice system. London: Department of Health. Kingdon, A. (2009) ‘Forensic learning disability practice’, in M. Jukes (ed) Learning disability nursing practice: origins, perspectives and practice. London: Quay Books, pp 361–78.


U UNDERCLASS (SOCIAL CONSTRUCTION OF) In 2004, Richard Garside launched a critique of the view that there was a statistically identifiable group of people that could be singled out as a problem population. Garside (2004) remarks that the idea that a significant proportion of all crime is committed by a relatively small number of persistent offenders is not new, but the then government placed it at the centre of its criminal justice policy. His attack on New Labour’s fascination with a small hard-core of criminal offenders and problem families was the continuation of a debate that originated 200 years or so earlier. In 1814, Patrick Colquhoun wrote with some confidence that about one in 10 of the population were indigent or criminal (like many others at that time, and since, he conflated poverty, crime, immorality and laziness). Henry Mayhew, who set out to find London’s criminal poor in the 1850s and 1860s, similarly chose to associate those ‘that will not work’ with criminality. Indeed, around this time, the idea of the criminal class arose. This class of people, wholly mythical, were said to make their living not through honest toil, but through crime, having their own languages, moral code and ways of behaving that set them apart from honest and respectable society. By the 1880s, the idea of a criminal class had ebbed away to be replaced by the notion of the residuum – those people who were incapable of coping with the demands of industrial capitalism, and were cast aside to the workhouse, the prison, homelessness and lives of dissolute drunkenness. These late Victorian notions of a ‘lumpen proletariat’ that were a drain on society came to preoccupy policymakers again at the end of the 20th century. Charles Murray’s 289

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(1995) thesis on the ‘underclass’ chimed with contemporary concerns about those who seemed determined to resist the law and social policy initiatives alike. The labels ‘criminal class’, ‘underclass’ and NEETS (Not in Education, Employment or Training) identified the targets for new forms of legal and social control in an attempt to focus, yet again, on the undeserving poor. Both New Labour and the Coalition government have focused on the new underclass despite there being little academic evidence to suggest that the underclass exists. Studies of the Victorian poor and criminals (Godfrey et al, 2007, 2010) found that most people who found themselves before the court did not continue offending for the whole of their lives, and there was a low rate of intergenerational transmission of criminality (sons, on the whole, did not follow their fathers into criminal lives). The vast majority of criminals were remarkably well-integrated into communities, and did not stand apart from respectable citizens. Similarly, an unrecoverable underclass submerged below respectable society – unreachable by social policy, and unwilling to engage with opportunities to better their lot in life – is equally hard to find. The whole notion of an underclass seems an irrelevancy, and, dangerously, one that seems to block progressive policies for the improvement of society and the alleviation of poverty. BARRY GODFREY See also: Social Exclusion Readings Garside, R. (2004) ‘Crime, persistent offenders and the justice gap’, Crime and Society Foundation Discussion Paper Number 1, October. Available at: www. crimeandjustice.org.uk/sites/crimeandjustice.org.uk/files/crime%2C%20 persistent%20offenders.publication.pdf Godfrey, B., Cox, D. and Farrall, S. (2007) Criminal lives: family, employment and offending (Clarendon Series in Criminology). Oxford: Oxford University Press. Godfrey, B., Cox, D. and Farrall, S. (2010) Serious offenders: a historical study of habitual criminals. Oxford: Oxford University Press. Murray, C. (1995) ‘The emerging British underclass’ in Charles Murray and the underclass: the developing debate (Choice in Welfare No 33). London: Institute of Economic Affairs.


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UNFITNESS TO STAND TRIAL (CRIMINAL PROCEDURE (INSANITY AND UNFITNESS TO PLEAD) ACT 1991) A criminal trial has to be fair and involve participation by the defendant; this must involve understanding whether to plead guilty, following the course of the trial and being able to give evidence. An inability to participate (not just an unwillingness to do so) might arise from language difficulties and so be solved by an interpreter; if it arises from a vulnerability such as youth or mental disability, it might be solved by modifying the trial process. However, in an extreme case, the defendant cannot participate even with assistance, but it may be important for victims, society and the defendant to determine whether the defendant was somehow responsible for the criminal allegation. In the Crown Court, this is assessed by the process in the Criminal Procedure (Insanity) (CPI) Act 1964 as amended significantly by the Criminal Procedure (Insanity and Unfitness to Plead) Act 1991 and the Domestic Violence, Crime and Victims (DVCV) Act 2004. The test for unfitness to stand trial (also called fitness to plead, though in the sense of pleading a case, not just entering a plea) is set by the common law (and harks back to R v Pritchard (1836)). It involves assessing ability to participate in the various components of the trial. The statutory provisions set the procedure and the consequences. The question of fitness is for the trial judge (since the DVCV Act 2004). It can be raised by the defence, prosecution or judge (CPI Act 1964, section 4(1)). Once raised, it can be determined immediately or delayed until the end of a weak prosecution case that might lead to a directed acquittal (CPI Act 1964, section 4(2) and (3)). Two or more doctors, at least one being a psychiatrist, must give evidence supporting a finding of unfitness (though that view is not binding on the judge). Historically, a finding of unfitness led to indeterminate detention (‘during Her Majesty’s Pleasure’). The 1991 Act added section 4A to the CPI Act 1964, under which a jury determines whether the defendant committed the act alleged but does not assess whether any guilty mental state was present. What amounts to the act is not always easy to determine, but it is generally not permitted to examine matters of mental state (such as diminished responsibility on a murder charge). If the jury is not satisfied that the defendant committed the act, an acquittal follows; if it is satisfied, the judge cannot impose a punishment (and, hence, the process is not criminal), but can impose a Hospital Order, Supervision Order or absolute discharge (section 5 of the CPI Act 1964, as amended). Various ancillary orders are possible, including registration as a sex offender.


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In the Magistrates’ Court, an equivalent process arises from using the power under section 37 of the Mental Health Act 1983 (as amended 2007) to impose a Hospital Guardianship Order without convicting. KRIS GLEDHILL See also: Domestic Violence, Crime and Victims Act 2004; Insanity and Defect of Reason Readings Gledhill, K. (2012) Defending mentally disordered offenders. London: Legal Action Group, esp chs 9 and 10. Gostin, L., Bartlett, P., Fennell, P., McHale, J. and MacKay, R. (2010) Principles of mental health law and policy. Oxford: Oxford University Press, esp ch 21.


The Universal Declaration of Human Rights (UNDHR) was ratified by the General Assembly of the United Nations on 10 December 1948 in the aftermath of the Second World War. Influenced by ‘the experiences of war, and fascism, occupation and internment in European states’ (Easton, 2011, p 51), it was hoped that a declaration of universal rights could contribute to the prevention of future atrocities. Being the first international document to set out universal civil, political, economic, social and cultural rights, the UNDHR provides the foundation for subsequent international human rights law. Its provisions, together with the International Covenant on Civil and Political Rights (1976) and its optional Protocols and the International Covenant on Economic, Social and Cultural Rights (1976), form what is known as the ‘International Bill of Rights’.Although the UNDHR is not legally binding, its key provisions have been ‘so often applied and accepted’ that they have acquired the status of ‘customary international law’ (Gostin and Gable, 2004, p 32). Thus, the UNDHR is of more than historical significance (Brownlie and Goodwin-Gill, 2010). The preamble to the UNDHR celebrates ‘the inherent dignity’ and ‘equal and inalienable rights’ of all people as the ‘foundation of freedom, justice and peace in the world’. Article 1 proclaims that ‘all human beings are born free and equal in dignity and rights’. Article 2 expresses the entitlement to these rights without discrimination. Of particular relevance for those in conflict with the criminal justice system, especially those imprisoned or in any form of detention, are the right to ‘life, liberty and security of the person’ (Article 3) and prohibition of 292

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slavery (Article 4) and of ‘torture’, ‘cruel, inhuman or degrading treatment or punishment’ (Article 5). The UNDHR forbids ‘arbitrary arrest, detention or exile’ (Article 9). Any person who is charged with a criminal offence has the right to a ‘fair and public hearing by an independent and impartial tribunal’ (Article 10). Innocence must be presumed until guilt is proven ‘according to law in a public trial’, and individuals must not be punished for anything that was not an offence at the time, nor may a heavier penalty be imposed than was applicable when the offence was committed (Article 11). Also protected are the rights to private and family life (Article 12), and the freedom of thought, conscience, religion, expression and peaceful assembly and association (Articles 18, 19 and 20). Article 25 contains specific reference to health, stating that everyone has the right to a ‘standard of living adequate for the health and well-being’ and the right to ‘security’ during times of illness or disability. As Gostin and Gable (2004, p 32) note, the economic, social and cultural rights contained within the UNDHR, such as the rights to social security (Article 22), to work and fair remuneration (Article 23), and education (Article 26), are ‘especially applicable to vulnerable populations’, including those with mental health difficulties or disabilities. Yet, the meaning of the UNDHR is contested, and, as Hoover (2013, p 221) notes, while the consensus narrative considers it a beacon of human solidarity, within a competing discourse, it represents the imposition of a ‘distinctly liberal conception of individual human rights on the rest of the world’. LINDA MOORE See also: Advocacy in Mental Health Care; Human Rights and Mentally Disordered Offenders Readings Brownlie, I. and Goodwin-Gill, G.S. (eds) (2010) Brownlie’s documents on human rights. Oxford: Oxford University Press. Easton, S. (2011) Prisoners’ rights: principles and practice. Oxon: Routledge. Gostin, L. and Gable, L. (2004) ‘The human rights of persons with mental disabilities: a global perspective on the application of human rights principles to mental health’. Available at: http://scholarship.law.georgetown.edu/facpub/98 Hoover, J. (2013) ‘Rereading the Universal Declaration of Human Rights: plurality and contestation, not consensus’, Journal of Human Rights, 12(2): 217–41.


V VAGRANCY ACTS In England and Wales in the mid-16th century, pressure on scarce resources was said to be the reason for the introduction of laws designed to stop roving gangs of vagrants moving up and down the country. Vagrancy legislation was an attempt to control the landless poor and demobilised military personnel who wanted to escape poverty in their home parishes and find new opportunities elsewhere. In practice, the groups of unfortunates who drifted through towns searching for work or shelter with their stories of personal distress and misfortune also contained many drunks, thieves and ‘idle apprentices’ who found themselves before the courts. Vagrants never fared well before the courts since their offences were inevitably and detrimentally linked to their dissolute lifestyles, their personal appearance and characters, and their perceived moral worth. As large urban populations sprung up in the new manufacturing districts of England and Wales in the 1820s and 1830s, the towns came to host resident vagrants. No longer mobile, the poor and homeless posed a problem to the authorities, and the Vagrancy Acts provided a means to deal with them. The Vagrancy Act 1822 expanded powers to act against reputed thieves. The wide-ranging Act for the Punishment of Idle and Disorderly Persons, and Rogues and Vagabonds 1824 brought a vast range of offending behaviour under its remit, covering those who: refused to support themselves or their family; traded without a licence; were a prostitute; acted in a riotous or indecent manner; wandered abroad; begged; were an idle and disorderly person; did not have any visible means of subsistence; were found upon any enclosed area for any unlawful purpose; were a reputed thief; and violently resisted a police 295

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officer, being deemed a Rogue and Vagabond. All of these offences attracted a three-month jail sentence with hard labour. Many residents in the major cities were prosecuted for sleeping out, wandering abroad and various kinds of obscenity (swearing, being undressed, urinating in an alley, etc). If one conceives of the 1824 Act as a composite of today’s Public Order Act 1986, section 5; Anti-Social Behaviour Orders (Crime and Disorder Act 1998 and Anti-Social Behaviour Act 2003); and Dispersal Orders (Anti-Social Behaviour Act 2003), all able to be prosecuted by the police, the Department of Social Security and/or the Child Support Agency, they would not be far wrong. The annually published judicial statistics for 1856 stated that there were over 300,000 vagrants or persons of no stated employment in England, and the Vagrancy Acts continued to be used with increasing regularity throughout the 19th century. There were over 40,000 vagrancy offences prosecuted in 1870, over 50,000 in the 1880s, and over 60,000 by 1910. After the First World War, the numbers of prosecutions for vagrancy were much lower, but despite the refinements and the amendments made by subsequent legislation, the Vagrancy Act 1824 is still in force in both England and Wales. Today, approximately 600 people a year are still prosecuted under vagrancy legislation, largely based upon the 1824 Act. BARRY GODFREY See also: Insanity Readings Vagrancy Act 1824. Available at: www.legislation.gov.uk/ukpga/Geo4/5/83/ contents


Veterans’ mental disorder and criminal justice represent a series of complex social and psychological issues that are increasingly difficult to neatly define.The mental health of veterans (or ex-armed forces personnel) and an association with criminal behaviour is a current and growing concern for the National Health Service (NHS), Ministry of Defence (MoD) and Ministry of Justice (MoJ). Veterans who are suffering from a mental disorder have a unique set of experiences and circumstances that are more frequently placing them at risk of offending. PostTraumatic Stress Disorder (PTSD) is topical; however, depression, anxiety and alcoholism are more prevalent for UK veterans in the criminal justice system.


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War syndromes are said to be subject to culture and have therefore varied over time. Initially understood as nostalgia, war syndromes have become known as ‘medically unexplained’ disorders, and understandings have shifted from Shell Shock to PTSD (Jones and Wessley, 2005). Understandings of ‘Brain Blast Injury’ are also now featuring in the discussions about veteran mental health and consequent behaviour (Okie, 2005). Suggestions that veterans may have mental health needs is not new – what is new is, first, an understanding of war syndromes as an illness and, second, that the subsequent suffering may lead to criminality. Although the majority of veterans cope with the transition back to civilian life post-war and service, it is now generally accepted that experience of combat or alternative wartime exposure can have both short-term and long-term psychological effects for some. The psychological costs are wide-ranging; however, since 1980, PTSD has described the malady of intense fear, nightmares, intrusive thoughts, flashbacks, hyper-arousal and numbing that follow trauma (Stimpson et al, 2003). The growing concern about veterans being disproportionately represented in the criminal justice system, and that those veterans may be suffering from depression, alcoholism and PTSD, has led to the leading report Across the wire: veterans, mental health and vulnerability (Fossey, 2010). A further inquiry into veterans by the Howard League for Penal Reform (2011) found no evidence that military experience makes an individual more likely to end up in custody than members of the general public. However, the report did find that those with military experience were twice as likely to be convicted of a sexual offence as civilians and more likely to engage in violent offending more generally. According to a study published in the Lancet, young men who have served in the armed forces in Britain are three times more likely to be convicted of a violent offence than their non-combatant peer group. The report concluded that of their sample of 2,700 young men under 30 with military experience, 20.6% had a conviction for violence, compared with 6.7% for their civilian counterparts (MacManus et al, 2013). This report can be added to a number of sophisticated studies conducted by King’s College London on veteran resettlement issues (Dandeker et al, 2003; Iverson et al, 2005; Van Staden et al, 2007; Greenberg et al, 2011). The mental health of veterans in contact with the criminal justice system in the UK is an emerging subject for academic research. Literature is only just starting to develop, as are some attempts to address some of the contemporary concerns


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in this area, in particular, in the custodial setting (see Brooks et al, 2010) and within probation (Murray, 2013). EMMA MURRAY See also: Post-Traumatic Stress Disorder; Resilience Readings Brooks, M., Ashton, C. and Hollins, A. (2010) ‘Assisting veterans at HMPs Grendon and Springhill’, Prison Service Journal, 190: 3–9. Dandeker, C., Wessely, S., Iverson, A. and Ross, J. (2003) Improving the delivery of cross departmental support and services for veterans. London: The Institute of Psychiatry and Kings Collage London. Fossey, M. (2010) Across the wire: veterans, mental health and vulnerability. London: Centre of Mental Health. Greenberg, N., Jones, E., Jones, N., Fear, N.T. and Wessely, S. (2011) ‘The injured mind in the UK armed forces’, Philosophical Transactions of the Royal Society of Biological Sciences, 366: 261–7. Howard League for Penal Reform (2011) ‘Report of the inquiry into former armed service personnel in prison’. Available at: www.howardleague.org/ online-publications/ Iversen, A., Dyson, C., Smith, N., Greenberg, N., Walwyn, R., Unwin, C., Hull, L., Hotopf, M., Dandeker, C., Ross, J. and Wessely, S. (2005) ‘“Goodbye and good luck”: the mental health needs and treatment experiences of British ex-service personnel’, The British Journal of Psychiatry, 186(6): 480–86. Jones, E. and Wessley, S. (2005) Shell shock to PTSD: military psychiatry from 1900 to the Gulf War. Hove and New York, NY: Psychology Press. MacManus, D., Kimberlie, D., Jones, M., Rona, R., Greenberg, N., Hull, L., Fahy, T., Wessely, S. and Fear, N. (2013) ‘Violent offending by UK military personnel deployed to Iraq and Afghanistan: a linkage cohort study’, The Lancet, 381: 907–17. Murray, E. (2013) ‘Post-army trouble: veterans and criminal justice’, Criminal Justice Matters, 94(1): 20–1. Okie, S. (2005) ‘Traumatic brain injury in the war zone’, New England Journal of Medicine, 352: 2043–7. Stimpson, N., Thomas, H., Weightman, A., Dustan, F. and Lewis, G. (2003) ‘Psychiatric disorder in veterans of the Persian Gulf War of 1991: systemic review’, British Journal of Psychiatry, 182: 391–403. Van Staden, L. (2007) ‘Transition back into civilian life: a study of personnel leaving the U.K. armed forces via military prison’, Military Medicine, 172(9): 925–30.


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VICTIMS OF CRIME While the term ‘victim’ is commonly applied to someone who has suffered from some kind of misfortune, over the last 50 years that common use has been increasingly joined with that of crime. ‘Crime’, as a concept, is itself problematic; nonetheless, for the purposes of this discussion, its use with the term ‘victim’ is more often that not connected with those kinds of behaviours rendered illegal by law. Thus, the victim of crime is an individual who has suffered as a result of the illegal behaviour of another individual. It should, of course, be noted that once a crime has been recognised and acted upon by the criminal justice process, the term ‘victim’ becomes problematic, since in the legal process, there are complainants, witnesses and defendants, not victims and offenders. In addition to the different ways in which a victim of crime might be referred to in law, there are other problematic issues associated with the notion of a ‘victim’ of crime. Historically, feminists have challenged the use of the term ‘victim’, especially in relation to women’s experiences of sexual violence, since this term implicitly attributes passivity and powerlessness to the individual concerned. These attributes are also, by definition, associated with being female. Thus, they express a preference for the term ‘survivor’ as a better way to capture women’s resistance to male power. In putting to the fore the concept of survivor, feminism also draws our attention to appreciating that being a victim of crime, and acquiring this label, is a process and not necessarily a label achieved simply because an individual has been subjected to an act that has caused them suffering. In this respect, Christie (1986) reflects on how this process of acquiring the victim label is informed by our understandings of the ‘ideal victim’. The concept of the ideal victim points to the important connections to be made between acquiring victim status and whether or not an individual is understood as a ‘deserving’ or an ‘undeserving’ victim. These social processes are a reminder that there can be ‘good’ and ‘bad’ victims, as well as ‘good’ and ‘bad’ offenders, and people with mental health problems can find themselves in each of these categories based upon the nature of the problem they present to wider society. These additional distinctions between victims prompted Carrabine and his colleagues (2004, p 117) to talk of a ‘hierarchy of victimisation’. In this hierarchy, some victims of crime are more visible and easily recognised as victims and find themselves at the top of the hierarchy in terms of responses to their suffering, with others being more invisible, finding themselves at the bottom. As social and legal responses have increasingly recognised the problem of hate crime (including those who face physical and mental challenges who might be subjected to this kind of crime), persons with mental health problems might find themselves higher up this hierarchy as both victims and offenders than perhaps they would have done


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50 years ago. However, such victim status is not easily achieved, especially for those who fall short of the ideal victim stereotype. SANDRA WALKLATE See also: Domestic Violence, Crime and Victims Act 2004; Justice for All; Mental Health Act 2007 Readings Carrabine, E., Iganski, P., Lee, M., Plummer, K. and South, N. (2004) Criminology: a sociological introduction. London: Routledge. Christie, N. (1986) ‘The ideal victim’, in E.A. Fattah (ed) From crime policy to victim policy. London: Macmillan, pp 17–30.


‘Violence’ and ‘mental disorder’ are all-encompassing terms. They cover, on the one hand, fear, harm and aggression, leading to determinate consequences, and, on the other hand, a range of diagnostic taxonomies, detailing possible psychological anomalies that are reflected in behaviour. Both are the subject of extensive commentary and subsequent definition and redefinition. However, the putative link between mental disorder and violence is a recurrent concern of the criminal justice system because it often bears directly on the evaluation of risk and its management. Herschel Prins (1999) encapsulates this anxiety in Will they do it again?. His work, representing a historically significant attempt to ‘measure’ and estimate risk, is influential possibly because it articulates public fears of violence being enacted by those who are mentally disordered. It also has particular resonance when set against the ubiquity of community-based care in the wake of institutional retraction and the subsequent ‘decarceration’ of those who may have propensities towards violent and threatening behaviour. Well-publicised media cases have reinforced the everyday association between disorder and violence, helping to underscore Prins’ (1999) assertion that criminal justice professionals may underestimate the level of risk associated with mental disorder because they become occupationally acculturated to the behaviour, rather like an electrician accustomed to working on live circuits. Prins is careful to place the association in context: first, by reference to the uncertainties involved in establishing a determinate causal link; and, second, by circumspection regarding overestimation of incidence based on excessive generalisation from a small number of cases. This has not, however, prevented the generation of 300

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a popular consciousness where mental disorder is seen as inextricably linked to acts of violence. Clearly, this is substantially reinforced following a criminal act perpetrated by someone who is mentally disordered where the victim is traumatised or, in extremis, killed. The evidence accounting for the association presents a more complex picture. Stuart (2003) suggests that in the US, socio-economic factors remain the major determinants of violent behaviour. Similarly, substance abuse is a major autonomous determinant independent of the mental health status of perpetrators. Fazel et al (2010), in a major study of violence and mental illness, observed that 5.1% of the US population were convicted of violent crime, whereas 8.5% of those diagnosed with schizophrenia were recorded as committing violent criminal acts, with a combination of schizophrenia and substance abuse elevating the proportion of the population convicted to nearly 28%. Fazel et al (2010) found a similar profile in those diagnosed with bipolar disorder. Stuart (2003) draws attention to the potential social construction of the association between mental disorder and violent behaviour, which she sees as based in the contemporary organisation of clinical practice. There are two strands to the explanation: first, the universal development of actuarial risk assessment tools to calculate risk; and, second, its consequences. Their exercise has become a key marker of professional and occupational success in demonstrating ‘socially responsible clinical management’ and has led to the contemporary rehabilitation of mental health and criminal justice professionals’ reputation, originally thought either naive or incompetent in the management of violence. In addition, community-based care selects out ‘the violent’ and assigns them to acute treatment units. The result is an overestimation of the relationship between mental disorder and violence engendered by the dynamics of valorised professional practice combined with an unrepresentative ‘sample’ of the mentally ill. Several implications relating theory to policy emerge from this brief overview. The evidence suggests that the linkage between violence and mental disorder is more tenuous, and certainly more complex, than in the popular imagination. Violence can be related to mental disorder; however, the linkages are nuanced, situation-specific and of insufficient intensity to suggest one-to-one causality. Yet, the substantive involvement of the two phenomena is likely to remain, partly because violence attributed to mental disorder serves to separate the violent individual or violent offender from the bulk of the population. Along with this isolation comes insulation for the majority undetermined by the ostensible aberrations of deeply buried and faulty psychological processes. The association also confers a belief in control: if violence is not meaningless, but the result of discrete processes, the policy impetus is to drive therapeutic interventions and hope for their success.


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In Gorky Park, Martin Cruz-Smith (1981) courted controversy by using the investigation of a series of brutal murders as the centrepiece of his thriller. The principal difficulty was a result of the murders being committed for no directly discernible motive and most definitely not for material gain, the most common reason for the most extreme act of violence in the Soviet Union of the time. His description of so-called existential murder sheds some light upon how individual actions may be related to the social organisation of meanings generated as part of daily life in particular societies. In Gorky Park, the evolution of the Soviet economy from material hardship to relative affluence provides the backdrop. In turn, this transition generates affective meaning structures more closely resembling the US, where violence and murder – desperate acts of ‘self-expression’ in a society of material abundance – are commonplace. Crime fiction does not easily relate to policy; violence and its consequences are serious, sometimes horrific, for victims, whether or not it is perpetrated by someone with a mental disorder. However, in the light of our need to explain violence in its relationship to mental disorder, Cruz-Smith’s novel does shift attention from the use of simple, unreflexive, psychological and sociological variables towards an understanding of how their reality is both made sense of by, and related to, its context. DAVID BALSAMO See also: Dangerousness and Mental Disorder; Media Representations and Mental Disorder Readings Cruz-Smith, M. (1981) Gorky Park. New York, NY: Random House. Fazel, S., Lichtenstein, P., Grann, M., Goodwin, G. and Långström, N. (2010) ‘Bipolar disorder and violent crime: new evidence from population-based longitudinal studies and systematic review’, Archives of General Psychiatry, 67: 931–8. Prins, H. (1999) Will they do it again? Risk assessment and management in clinical psychiatry. London: Routledge. Stuart, H. (2003) ‘Violence and mental illness: an overview’, World Psychiatry, 2(2): 121–4.


The Violence Risk Appraisal Guide (VRAG) is an actuarial tool that was originally designed for the prediction of violent recidivism (reoffending) in mentally disordered males (Harris et al, 1993). VRAG was developed from a 302

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study of 618 male offenders at a secure psychiatric facility in Ontario, Canada. These offenders had been charged with serious offences and would eventually be released, or transferred to a different environment where the potential opportunity to recidivate was possible. The study group consisted of offenders who were receiving treatment at the facility and those who had been admitted in the short term for pre-trial psychiatric assessment. The study identified 12 ‘predictor’ variables for the outcome of any new criminal charge for a violent offence through multivariate techniques that were used to derive and validate the actuarial instrument. The ‘predictor’ variables used can be classified by the following categories: socio-demographic information; childhood problems; adult adjustment; the characteristics of the index offence; and the results of psychological assessments obtained during the period immediately post-index offence admission/detention (Quinsey et al, 2006). The psychological assessments used by the VRAG include the Diagnostic and Statistical Manual of Mental Disorder (DSM) criteria for schizophrenia, the DSM criteria for personality disorder and the Hare Psychopathy Checklist-Revised (PCL-R) score. The conviction and charge history of non-violent crimes prior to the index offence is measured using the Cormier–Lang system for non-violent crimes (Quinsey et al, 2006). The VRAG tool itself is presented as a series of questions that address the ‘predictor’ variables and the responses scored accordingly from the analysis of a psychosocial history report. The total score obtained is referenced against nine equal-sized VRAG categories that have a corresponding probability of recidivism within seven and 10 years from release. The VRAG tool has been subsequently applied to a range of different subject groups, including females, fire setters, sex offenders, institutional settings and non-forensic mental health service users. In these applications, VRAG has been shown to be effective but may require the substitution of parameters for some subject groups. In the case of sex offenders, the Sex Offenders Risk Appraisal Guide (SORAG) has been developed. Quinsey et al (2006) state that the aim of the VRAG is to provide a predictive tool for use by courts, parole teams and clinicians for decisions regarding serious offenders. This is in contrast to the approach of expert opinion by experienced clinicians to give a qualitative assessment of risk. There has been extensive debate as to whether one approach is more appropriate than the other (Fazel et al, 2012). Such debate is clearly evidenced in official documents, whereby the UK’s National Institute for Health and Clinical Excellence (2005) guidance on violence recommends an approach that combines the use of actuarial tools and


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expert clinical judgement, but does not go so far as to specifically recommend one tool over another. LISA ARMSTRONG See also: Actuarial Risk Assessment; Clinical Risk Assessment Readings Fazel, S., Singh, J.P., Doll, H. and Grann, M. (2012) ‘Use of risk assessment instruments to predict violence and antisocial behaviour in 73 samples involving 24827 people: systematic review and meta-analysis’, British Medical Journal, 345: 1–12. Harris, G.T., Rice, M.E., and Quinsey, V.L. (1993) ‘Violent recidivism of mentally disordered offenders: The development of a statistical prediction instrument’, Criminal Justice and Behavior, 20: 315–35. National Institute for Health and Clinical Excellence (2005) ‘Violence: the short-term management of disturbed/violent behaviour in in-patient psychiatric settings and emergency departments’. Available at: www.nice.org.uk/nicemedia/ live/10964/29719/29719.pdf Quinsey, V.L., Harris, G.T., Rice, M.E. and Cormier, C.A. (2006) Violent offenders: appraising and managing risk (2nd edn). Washington, DC: American Psychological Association.


W WOOLF REPORT Lord Justice Woolf ’s report was published in 1991. It has since been branded monumental, unique and exceptionally progressive for its time in penal history. This public inquiry was commissioned by the government in order to examine prison disturbances and unrest (eg the riot at Her Majesty’s Prison Strangeways in Manchester). Woolf appraised the authority, stability and order of prison establishments. The resulting report was widely welcomed and praised. Woolf explored reasons for the riots, proposed solutions to the current problems and made recommendations for future penal policy. To summarise, the Woolf Report stressed the necessity of creating, and then maintaining, a balance between the needs of security, control and justice in prisons.This concept of justice emphasised that prisoners should be treated fairly and humanely. One recommendation of the report was the improvement of sanitation in prisons and an end to, as it was then termed, ‘slopping out’ (ie the use of chamber pots in cells due to the absence of toilets). It was also suggested that prisoners’ contact with the outside community should be addressed and improved via, for example, increased opportunities for home leave, prison visits and telephone calls (Loucks and the Prison Reform Trust, 2000). The issue of justice in prisons was prioritised, and it was recommended that prisoners should have access to an independent complaints system. The quality, timing and procedures surrounding prison food were also questioned; as a result,


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both the practice of communal dining and the serving of meals at more orthodox hours were recommended (Loucks and the Prison Reform Trust, 2000). Regarding the prison system unrest, the failure of successful prison management was linked to the prison riots at that time. Front-line prison managers were held responsible for poor security information management and poor first responses to prison disturbances; however, this is considered in tandem with the difficult nature of career success and progression for prison staff (Brookes et al, 2008). Working conditions for prison staff alongside industrial relations in prisons featured, and improved cooperation between managers and unions was recommended (Bennett and Wahidin, 2008). Extensive prison system reform occurred as a result of the Woolf Report (for a critical review of changes, see Sim, 1994). With ‘justice’ being a key theme of the inquiry and report (alongside the more traditional aims of security and control), the injustices felt by prisoners were unveiled, not least attributed to poor prison conditions (Bennett and Wahidin, 2008). The somewhat novel notion of justice was prioritised; however, at the same time, Woolf also surmised prisoners’ reciprocal responsibilities and an acceptance of a prison’s legitimate authority. MELANIE JORDAN See also: Pains of Imprisonment; Penal Crisis Readings Bennett, J. and Wahidin, A. (2008) ‘Industrial relations in prisons’, in J. Bennett, B. Crewe and A. Wahidin (eds) Understanding prison staff. Cullompton: Willan Publishing, pp 117–34. Brookes, S., Smith, K. and Bennett, J. (2008) ‘The role of middle and first-line managers’, in J. Bennett, B. Crewe and A. Wahidin (eds) Understanding prison staff. Cullompton: Willan Publishing, pp 262–78. Loucks, N. and the Prison Reform Trust (2000) ‘Prison rules: a working guide’. Available at: www.prisonreformtrust.org.uk/Portals/0/Documents/ prisonrulesworkingguide.pdf Sim, J. (1994) ‘Reforming the penal wasteland? A critical review of the Woolf Report’, in E. Player and M. Jenkins (eds) Prisons after Woolf: reform through riot. London: Routledge, pp 31–45.


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WOMEN’S ENHANCED MEDIUM SECURE SERVICES Department of Health (DH) policies and strategies – such as Modernising mental health services (DH, 1998), National Service Framework for Mental Health (DH, 1999a), Secure futures for women: making a difference (DH, 1999b) Safety, privacy and dignity in mental health units (DH, 2000), and the implementation of the Equality Act 2010 – endorse the importance of ensuring dignity, quality and best practice, and the legal requirement for gender-specific mental health services. Studies of service users detained within high and medium secure mental health units identified significant differences in care needs, which were felt to be directly linked to gender, in particular, the differences in biopsychosocial development in women and the impact of life experiences on women’s subsequent biopsychosocial functioning (Sarkar and Di Lustro, 2011). As a consequence, it was felt that women were often inadequately provided for within existing services, which had been designed using generic needs, risks and responsiveness information (Sarkar and Di Lustro, 2011). Specifically, in comparison, it was reported that women were more likely to: have a history of fire setting or criminal damage, but less likely to have committed a violent or sexual offence; have a history of abuse and/or selfharm; have more physical ill-health; be admitted for behaviours for which they were not charged or convicted; be detained under civil sections of the Mental Health Act; and potentially have a diagnosis of personality disorder, particularly borderline personality disorder (Sarkar and Di Lustro, 2011). Female service users may also demonstrate: significantly higher levels of dependence (on other people and services); a greater degree of complexity of need; a greater degree of risk to self and/or others; and higher levels of chronicity (Sarkar and Di Lustro, 2011). Sarkar and Di Lustro (2011) report that female service users are often detained at levels of physical security greater than those they actually require due to lack of availability of appropriate specialist services that are able to provide a more relational and procedural, rather than environmental, security-style of management. This saw a greater degree of containment at a higher secure level than had been necessary financially or clinically, without the availability of alternative specialist gender-sensitive, therapeutic care (see Tilt Report, 2000). Furthermore, this lack of availability of appropriate facilities for women may account for the higher numbers documented in the frequency and prevalence of readmission rates to medium secure care and generally longer high and medium secure care admissions (Sarkar and Di Lustro, 2011). These findings and recommendations led to the development of new tertiary services (women’s enhanced medium secure services), which provided genderspecific care for women and allowed for a more specialist service provision to manage risks within the least restrictive environment (DH, 1999b). Users of 307

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these services would typically be those who were previously in high secure care, who have committed severe offences or who could not be catered for within existing medium secure care, but who are not felt to meet the requirements for Category B high secure care. Women’s enhanced medium secure services, by their nature, necessitate a greater staff–service user ratio and command an enhanced need for staff support through clinical supervision, training and reflective practice (Sarkar and Di Lustro, 2011). ANGELA LLOYD See also: Butler Report and Medium Secure Mental Health Services Readings DH (Department of Health) (1998) Modernising mental health services; safe, sound and supportive. London: DH. DH (1999a) National Service Framework for Mental Health. London: DH. DH (1999b) Secure futures for women: making a difference. London: DH. DH (2000) Safety, privacy and dignity in mental health units: guidance on mixed sex accommodation for mental health services. London: DH. Home Office (2010) Equality Act 2010: public sector equality duty – what do I need to know? A quick start guide for public sector organisations. London: Her Majesty’s Stationery Office. Sarkar, J. and Di Lustro, M. (2011) ‘Evolution of secure services for women in England’, Advances in Psychiatric Treatment, 17: 323–31. Tilt Report (2000) Report of the review of security at the high security hospitals. London: NHS Executive.


X XENOPHOBIA Xenophobia is fear, suspicion or hostility towards ‘strangers’ – those who are identified as not one of us. It can manifest itself in many ways and profoundly undermines social relationships, corroding the reciprocity and trust on which a community depends and generating segregation and tribalism. In this sense, it also harms people who are xenophobic, although the focus here will be on its consequences for those who experience the exclusion and rejection that xenophobia entails. If xenophobia is to be challenged effectively, it seems important to understand its origins, though much here is inconclusive and speculative. Some have suggested that it is a pathological form of a general human tendency to favour one’s own kin, tribe and community and to be wary of others, or that xenophobia is an inevitable consequence of setting a boundary of exclusion around the group that gives people their identity and self-esteem. However, why xenophobia should thrive in some places and not others, and why it should persist long after the newcomer has established their worth, remains very unclear. Although many individuals and groups can be identified as ‘other’, the sentiments and behaviours that constitute xenophobia are most usually directed at newcomers and people from other countries. In Britain, links have often been contrived and politically exploited between ‘foreigners’ and ‘moral panics’ about crime waves, with successive groups of newcomers blamed for perceived increases in, or new types of, crime (Pearson, 1983). The concept of xenophobia and its psychological implications have also been explored in mental health research. The experience of immigration – the unfamiliarity of a new land, uncertainties about status in 309

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the host community, economic challenges – is intrinsically stressful. When this is aggravated by hostility and rejection, overt or latent, the effects on mental well-being can be seriously detrimental. Meeting the psychiatric needs of people from different countries and cultures, in any case, calls for considerable sensitivity and wisdom (Fernando, 2010). The way in which psychological distress is manifested can be very different between cultures. Part of the definition of a ‘delusion’, for example, is that it is a culturally inappropriate belief, and to make this judgement requires cultural knowledge. Some have indeed said that someone who does not share the individual’s cultural background cannot confidently make a diagnosis of schizophrenia. Judgements about appropriate treatment may be similarly culture-bound. Phobia is well known to refer to fear, but it has also come to refer to hostility, as in the term homophobia. Indeed, fear and hostility are symbiotic emotions: hostility is likely to evoke fear and fear may well generate hostility. Both people who have offended and those who are believed to be mentally ill are themselves ‘othered’, so xenophobia is integral to an understanding of social reactions to ‘deviance’. Those so labelled will be treated differently by others, will have social opportunities denied to them and may struggle to sustain their own self-esteem and purpose and to avoid internalising the ways in which they are regarded by other people. Arguably, the designation of the label ‘mentally disordered offender’ is especially detrimental. They may be seen as untrustworthy and undeserving as patients, while criminal justice agencies disown responsibility, urge ‘diversion’ and see a psychiatric diagnosis as a worrying risk marker – even though criminal history and other factors ‘predict’ reoffending more reliably than mental health factors (Bonta et al, 1998). Xenophobia may lead to mental ill-health and marginalise people into circumstances in which offending is much more likely; equally, people who have offended and/or have troubled mental health often meet the fear and hostility of the ‘other’ that defines xenophobia. ROB CANTON See also: Stigmatisation and Mental Disorder Readings Bonta, J., Hanson, K. and Law, M. (1998) ‘The prediction of criminal and violent recidivism among mentally disordered offenders: a meta-analysis’, Psychological Bulletin, 123(2): 123–42. Fernando, S. (2010) Mental health, race and culture (3rd edn). Basingstoke: Palgrave Macmillan. Pearson, G. (1983) Hooligan: a history of respectable fears. London: Macmillan.


Y YORK RETREAT The York Retreat is historically significant as it is one of the first examples of a humanistic approach to the treatment of mental disorders, referred to as ‘moral treatment’ (Digby, 1985). Its history expands over four centuries and was established as a private asylum by the Quaker William Tuke and the Society of Friends. It was founded because of the death of Hannah Mills in 1790, a fellow Quaker, when confined in the York (Public) Asylum (Digby, 1985; Wannell, 2007). The York Retreat opened its gates in 1796, with an aim to offer a mixture of medical and religious treatments for people from the Quaker community, although non-Quakers were admitted shortly after this date due to financial constraints (Charland, 2007). The York Retreat was essentially influenced by the period of Enlightenment, which conceptualised ‘madness’ as a disorder of ‘reason’. Traditionally, individuals labelled as ‘mad’ were considered animalistic and void of humanity (Digby, 1985). From Tuke’s perspective, people with mental illness were not void of rational thought, but their thoughts had become disordered through the stresses of social life. This was ideologically influenced by the Society of Friends’ belief that humans are born with ethical components that are referred to as the ‘inner light’ (Charland, 2007). From this perspective, not even ‘madness’ destroys the inner light; therefore, patients deserve respect and dignity (Charland, 2007). From the outset, Tuke distanced the York Retreat from other asylums by developing a regime of treatment based on respect, kindness and comfort. The 311

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purpose was that, over time, patients would achieve a healthy and meaningful life. The York Retreat made bourgeois family values the core principle of moral treatment, and at mealtimes, staff, community members and patients dined together. In order to treat mental disorders, the solution was not through brutality or medical confinement, but through a therapeutic regime of rest, moral discipline and re-education. In its early years, the York Retreat rejected early forms of medical treatments such as bleeding, drug therapy and blistering by illustrating their ineffectiveness to treat mental illness (Renvoize and Beveridge, 1989). The success of the York Retreat was confirmed by the Select Committee on Madhouses in 1815 and influenced asylum policy throughout the first half of the 19th century (Digby, 1985). By the mid-19th century, the York Retreat experienced a period of medicalisation, and by the end of the 19th century, it was training psychiatric medical practitioners, although the concept of ‘moral treatment’ was never abandoned. In the 20th century, its evolution was somewhat dominated by a medico-psychiatric approach to treating mental disorders (Scull, 1979; Digby, 1985). The significance of the York Retreat for contemporary services is twofold: first, it developed some of the earliest recorded examples of clinical observations and occupational therapy; and, second, the practice of ‘moral treatment’ can be seen as an early predecessor to talk therapies (eg psychotherapy, cognitive/behavioural therapy, etc) (Digby, 1985; Charland, 2007). Unfortunately, even though it has had many successes throughout its history, because of its links with the progression of 19th-century asylum policy, the York Retreat will be forever condemned for ushering in a period of mass confinement for people with mental disorders (Scull, 1979). STEPHEN MacDONALD See also: Insanity Readings Charland, L.C. (2007) ‘Benevolent theory: moral treatment at the York Retreat’, History of Psychiatry, 18(1): 61–80. Digby, A. (1985) Madness, morality and medicine: a study of the York Retreat 1796– 1914. Cambridge: Cambridge University Press. Renvoize, E.B. and Beveridge, A.W. (1989) ‘Mental illness and the late Victorians: a study of patients admitted to three asylums in York, 1880–1884’, Psychological Medicine, 19(1): 19–28. Scull, A.T. (1979) Museums of madness. London: Palgrave Macmillan. Wannell, L. (2007) ‘Patients’ relatives and psychiatric doctors: letter writing in the York Retreat, 1875–1910’, Social History of Medicine, 20(2): 297–313. 312

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YOUTH CUSTODY AND MENTAL DISORDER In the late 1980s and 1990s, the number of violent crimes committed by young people in the US and elsewhere increased. In response, laws aimed at young people were tightened, increasing the number of young people who came into contact with youth and criminal justice systems. Practitioners working in this area reported a concurrent rise in mental health difficulties among young offenders, possibly as a result of the decline of community-based mental health resources (Grisso, 2004). These shifts prompted researchers to examine the relative prevalence of mental disorders among incarcerated children and young people. Results of some studies indicate that incarcerated children and young people have substantially higher rates of mental illness than adolescents in the community. For example, in a study conducted by Teplin, Abram, McClelland, Dulcan and Mericle (2002), 12% of young people in the general population have a functionally impairing mental illness, compared to 60% of boys and 70% of girls entering custody facilities. Predictably, the most common mental disorders among these young people are also risk factors for offending (eg substance use disorders and conduct disorder). Other common diagnoses include attention deficit hyperactivity disorder, mood disorders and anxiety disorders. Rates of co-morbidity are extremely high (50– 90%), and certain populations of young people (eg Caucasian youth, females) are at relatively greater overall risk. Although young people with mental disorders are more likely to become incarcerated, the experience of incarceration itself may be pathogenic. The process of bringing children and young people into custody (eg searches, restraints) can be traumatising, and separating them from their families and community support networks may be detrimental to their mental health. Given the high prevalence of trauma histories among incarcerated young people, they may be particularly sensitive to experiences of perceived victimisation. Among youth incarcerated for nine months or more, the prevalence of mental illness rises to approximately 90% (Karnik et al, 2009). Rather than becoming acclimatised to the custody environment, young people’s mental health may suffer as a result of incarceration. Policymakers, justice officials and community providers should be concerned about the high prevalence of mental illness among incarcerated young people. The presence of children and young people in custodial settings with mental illness and disorders may signal the inadequacy of community mental health services. Although such environments are acting as de facto mental health treatment centres, they are not designed or equipped for this purpose and are struggling to meet the demand. Unfortunately, failure to provide this group with adequate 313

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treatment services places them at greater risk of recidivism. Arguably, these young people have a right to mental health treatment. While some states and nations have recognised this right, it is often vaguely codified and inconsistently applied (Penner et al, 2011). ERIKA PENNER See also: Mental Health In-Reach Services; Pains of Imprisonment Readings Grisso, T. (2004) Double jeopardy: adolescent offenders with mental disorders. Chicago, IL: University of Chicago Press. Karnik, S.N., Soller, M., Redlich, A., Silverman, M., Kraemer, H.C., Haapanen, R. and Steiner, H. (2009) ‘Prevalence of and gender differences in psychiatric disorders among juvenile delinquents incarcerated for nine months’, Psychiatric Services, 60: 838–41. Penner, E.K., Roesch, R. and Viljoen, J.L. (2011) ‘Young offenders in custody: an international comparison of mental health services’, International Journal of Forensic Mental Health, 10: 215–32. Teplin, L.A., Abram, K.M., McClelland, G.M., Dulcan, M.K. and Mericle, A.A. (2002) ‘Psychiatric disorders in youth in juvenile detention’, Archives of General Psychiatry, 59: 1133–43


The Youth Justice Board (YJB) for England and Wales is a non-departmental government body established by the Crime and Disorder Act 1998.Although it sits within the Ministry of Justice, the YJB acts as an independent body and is often referred to as a ‘quango’ (quasi-autonomous non-governmental organisation), an advisory body funded by central government but run autonomously. The YJB is governed by 10–12 executive board members who are appointed by the secretary of state for justice, and employs around 300 staff who maintain the networks between the central YJB and local Youth Offending Teams. Initially set up to oversee youth justice and ensure the safety of young people in custody, the YJB was jointly sponsored by the Department for Children, Schools and Families before the Ministry of Justice took full control in 2010. The YJB currently has responsibility for overseeing the youth justice system in England and Wales for young people aged under 18. Broadly, the YJB’s aims are to prevent offending and reoffending by young people; therefore, its responsibilities include 314

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overseeing the youth courts, secure units and young offenders institutions, and Youth Offending Teams. The YJB fulfils its aims for youth justice through setting out and regularly updating minimum standards of practice (Youth Justice Board, 2013) and through monitoring performance within youth justice, including evaluating Youth Offending Teams against their own yearly Youth Justice Plans. The National Standards (Youth Justice Board, 2013) are a form of statutory guidance that aims to standardise youth justice practice nationally, in particular, maintaining a focus on good practice, safeguarding children and ensuring the protection of the public. Other aspects of the YJB’s role include allocating funding to local Youth Offending Teams, undertaking and commissioning new research into youth crime and justice, and managing all custodial places for young people in England and Wales. Originally hoped to be an independent voice representing the concerns of the youth justice system, the YJB has often been criticised for being ‘toothless’ and not significantly challenging the government over youth justice issues. Rod Morgan, former chairman of the YJB, has been one of its most outspoken critics (Morgan, 2010). The Coalition government announced in October 2010 that the YJB would be abolished and its responsibilities handed to the Ministry of Justice to allow government ministers to gain greater control of the youth justice system (it also criticised the YJB’s response to the August 2011 riots). However, protesters argued that the removal of the YJB as a child-focused body representing a distinct youth justice system would mean that youth justice issues would become subsumed in the broader criminal justice service to the detriment of young people (House of Commons, 2011). The YJB was reprieved in 2011 following support from the House of Lords and a government U-turn, but its future remains precarious. VICI ARMITAGE See also: Children and Adolescent Mental Health Services Readings House of Commons (2011) ‘Justice Committee – tenth report: the proposed abolition of the Youth Justice Board’, November. Available at: www.publications. parliament.uk/pa/cm201012/cmselect/cmjust/1547/154702.htm Morgan, R. (2010) ‘Axing the Youth Justice Board could be a bold step’, The Guardian, 26 October. Available at: www.theguardian.com/society/ joepublic/2010/oct/26/youth-justice-reform-bold-steps Souhami, A. (2011) ‘Inside the Youth Justice Board: ambiguity and influence in New Labour’s youth justice’, Safer Communities, 10(3): 7–16. Youth Justice Board (2013) National standards for youth justice services. London: Youth Justice Board for England and Wales. 315

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YOUTH OFFENDING TEAM Youth Offending Teams, or ‘YOTs’ as they are more commonly known, are multiagency teams that manage young offenders and young people up to 18 years (occasionally longer) who have been identified as ‘at risk’ of offending in a local authority area. YOTs were introduced in England and Wales under the Crime and Disorder Act 1998 – New Labour’s flagship legislation to overhaul youth justice. The Act established the statutory responsibility of all local authorities to set up a YOT in their area in partnership with the police, the Probation Service and health authorities. The work of YOTs is overseen by the Youth Justice Board for England and Wales, which is responsible for ensuring that YOTs are performing according to National Standards, and also share any examples of good practice nationally. YOTs have a statutory requirement to produce a yearly Youth Justice Plan against which the YJB can monitor their performance. A YOT is made up of practitioners from different professional backgrounds, including social work, education, police, health and probation. The day-to-day work of a YOT involves overseeing court orders for young people convicted of a crime, running diversionary activities for young people who have been identified as at risk of becoming young offenders, providing the court with ‘pre-sentence reports’ to advise on the appropriate sentences for young people found guilty of a crime, undertaking restorative interventions with offenders and victims, and providing ‘appropriate adults’ to chaperone unaccompanied young people who have been arrested in the police station. They may also provide mental health and sexual health services, and drug and alcohol support, and assist with broader issues that the young person may be facing, such as housing or educational needs. While the primary focus of a YOT is the young person whom they have been put into contact with, they also take some responsibility for working with the families of young people. When a young person is referred to a YOT, their case is allocated to a caseworker. The caseworker then engages with the young person and undertakes an assessment of their offence and their wider circumstances, including their educational or work status, living arrangements, and family situation. All of this information is entered into ASSET, a standardised tool used by all YOTs nationally for collecting information and evaluating a young person’s needs prior to undertaking any work with them. The information on ASSET is then used to construct an intervention plan for the young person to fulfil their order. ASSET can also trigger other assessments including Mental Health and Risk of Serious Harm (ROSH) evaluations, which may result in referral of the young person to the local Child and Adolescent Mental Health Services or Social Services. The YOT caseworker


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then supervises the young person until they have completed their statutory order or voluntary participation. VICI ARMITAGE See also: Children and Adolescent Mental Health Services; Youth Justice Board Readings Baker, K. (2005) ‘Assessment in youth justice: professional discretion and the use of ASSET’, Youth Justice, 5(2): 106–22. Barry, M. and McNeill, F. (eds) (2009) Youth offending and youth justice. London: Jessica Kingsley Publishers. Souhami, A. (2007) Transforming youth justice: occupational identity and cultural change. Cullompton: Willan Publishing. Stallard, P., Thomason, J. and Churchyard, S. (2003) ‘The mental health of young people attending a Youth Offending Team: a descriptive study’, Journal of Adolescence, 26(1): 33–43.


Z ZEMIOLOGY Zemiology originated as a critique of criminology and the notion of crime. In contrast to individual harms or offences, zemiology is concerned with wider forms of social harm or injury. Zemiologists seek to move beyond the narrow concept of crime and acknowledge that some legal behaviour is socially injurious. Therefore, social harm provides more ‘ontological reality’ than crime and, thus, a useful conceptual platform to engender broader public debates about ‘justice’. During the 1960s and 1970s, a number of critical criminologists raised questions about the concept of crime, suggested alternative ways to consider the broad issue of criminalisation and highlighted the serious consequences of wider violations of rules that are neglected by criminal law. During this turbulent political period, there was a growth of interest in social justice and human rights as part of criminology, perhaps best encountered in the work of Herman and Julia Schwendinger, who proposed that criminology should be the study of the violation of human rights. This, they argued, would provide a more objective unit of study than that offered by the narrow legalistic approach to crime (Schwendinger and Schwendinger, 1970). However, ‘zemiology’, as it is now termed, really emerged during the last decade as part of contemporary global criminology (see Hillyard et al, 2004). Taking its name from the Greek word zemia, meaning harm, zemiologists suggest that the undue attention given to those acts defined as crimes distracts attention from much more pressing and serious social harms, such as air pollution or poverty. 319

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Zemiological approaches attempt to broaden the public and sociological focus to the vicissitudes of daily life in capitalist society, where much less obvious harms are frequently more serious and damaging than those caused by crime. For example, often legally available drugs like alcohol and tobacco products kill more people than prohibited narcotics, but the producers of such products are rarely considered to be committing crime or criminalised. Furthermore, zemiology is more macro in focus and examines the contemporary world, where neoliberal practices associated with free trade are linked to avoidable environmental problems and intergenerational injustices that separate the socially privileged from the rest. A zemiological critique of criminology also involves the later discipline’s ability to endorse punishment and perpetuate social harms and injustice. For example, some zemiologists argue that the criminal justice system has many stages that can inflict pain in a discrete manner: defining, classifying, broadcasting, disposing, punishing and stigmatising the ‘offender’. Furthermore, these social control processes can create wider societal problems and harms that bear little relationship to the initial crime or problem and cause or exacerbate excessive suffering, which is disproportionate to the original problem. For example, jailing an individual for personal drug possession may lead to job loss, family problems and a lack of employment opportunities in the future, in effect, doing more harm than good. JAMES TREADWELL See also: Criminal Justice; Justice; Social Justice Readings Hillyard, P., Pantazis, C., Tombs, S. and Gordon, D. (eds) (2004) Beyond criminology: taking harm seriously. London: Pluto Press. Schwendinger, H. and Schwendinger, J. (1970) ‘Defenders of order or guardians of human rights’, Issues in Criminology, 5: 123–57.


When he launched Modernising mental health services in 1998 (DH, 1998), Frank Dobson, minister for health at the time, announced that ‘community care has failed’.The late 1980s and early 1990s saw a series of high-profile cases of violent crimes or homicides committed by individuals with mental health problems.The media storm around these cases helped to create a negative image of community care that the policy was never able to shake off.The case that was given the most media coverage was the murder of Jonathan Zito by Christopher Clunis. Zito, 320

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a musician, was attacked by Clunis at Finsbury Park tube station in December 1992. The subsequent Ritchie Inquiry into the care and treatment of Clunis painted a portrait of fragmented inner-city mental health services at the point of collapse (Cummins, 2010). Following the murder of her husband, Jayne Zito, who became something of a high-profile media figure, established the Zito Trust in 1994. The Zito Trust was established with two main aims: to campaign for the reform of the Mental Health Act 1983; and to support families and relatives of those who had been murdered by psychiatric patients. The Zito Trust became a highly influential campaigning body. It was unusual in that the majority of mental health charities, for example, Mind, were focused much more clearly on challenging the stigma and discrimination that mental health service users face. The Zito Trust had a clear view that community care was failing both psychiatric patients and the wider community. The Zito Trust argued that services were not meeting the needs of patients – particularly those with the most complex needs. As a result, the wider community was being put at risk. This focus on public protection was explicit in its campaign for the introduction of Community Treatment Orders. The reform of the Mental Health Act in 2007 saw the introduction of powers to allow for conditions to be imposed, such as residence or compliance with medication, on patients who had been detained under section 3 of the Act. In addition to its campaign for reform of legislation, the Zito Trust also published Learning the lessons (Shepherd, 1996), which brought together and identified common themes in recommendations from a series of homicide inquiries. Petch and Bradley (1997) argued that this approach was not productive in tackling the underlying causes of these tragedies. In addition, it was suggested that the work of the Zito Trust added to the stigma that the mentally ill face. In 2001, Jayne Zito was awarded the OBE for her work with the Zito Trust. With the reform of the Mental Health Act, the Zito Trust closed in 2009 and issued the following statement: While it’s clear that one or two pieces of legislation will not bring about all the improvements needed on their own, we are confident they will drive new developments in the care of the severely mentally ill in the community, achieving a much-needed balance between the therapeutic treatment of the patient and the safety of the public. IAN CUMMINS See also: Care in the Community; Dangerousness and Mental Disorder; Inquiries


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Readings Cummins, I.D. (2010) ‘Distant voices, still lives: reflections on the impact of media reporting of the cases of Christopher Clunis and Ben Silcock’, Ethnicity and Inequalities in Health and Social Care, 3(4): 18–29. DH (Department of Health) (1998) Modernising mental health services; safe, sound and supportive. London: DH. Petch, E. and Bradley, C. (1997) ‘Learning the lessons from homicide inquiries: adding insult to injury?’, Journal of Forensic Psychiatry, 8(1): 161–84. Shepherd, D. (1996) Learning the lessons. London: Zito Trust.


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Appendix: International campaign groups and sources of interest American Psychiatric Association: www.psych.org/ Amnesty International: https://www.amnesty.org/en Asylum: an International Magazine for Democratic Psychiatry: www.asylumonline.net/ Basic Needs: www.basicneeds.org/ Black Mental Health UK: www.blackmentalhealth.org.uk Breakthrough: http://breakthroughmhart.com/ Canadian Criminal Justice Association: www.ccja-acjp.ca/ Centre for Crime and Justice Studies: www.crimeandjustice.org.uk/ Centre for Mental Health: www.centreformentalhealth.org.uk/ Combat Stress: www.combatstress.org.uk/ Community Care: www.communitycare.co.uk/ CRI (social care and health charity): www.cri.org.uk/ Criminal Justice Alliance: www.criminaljusticealliance.org/ Depression Alliance: www.depressionalliance.org/ Hearing Voices Network: www.hearing-voices.org/ Howard League for Penal Reform: https://www.howardleague.org/ Human Rights and Justice Group: www.justicegroup.us/ Imagine: www.imaginementalhealth.org.uk/ Innocence Network: www.innocencenetwork.org.uk/ International Prison Watch Network: www.prisonwatchnetwork.org/ Make Justice Work: www.makejusticework.org.uk/ Mental Health Foundation: www.mentalhealth.org.uk/ Mental Health Research UK: www.mhruk.org/ Mind (mental health charity): www.mind.org.uk/ NACRO (crime reduction charity): https://www.nacro.org.uk/ Offender Health Research Network: www.ohrn.nhs.uk/ Penal Reform International: www.penalreform.org/ Prison Reform Trust: www.prisonreformtrust.org.uk/ Reprieve: www.reprieve.org.uk/ Rethink Mental Illness: www.rethink.org/ 323

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Royal College of Psychiatrists: www.rcpsych.ac.uk/ SANE (mental health charity): www.sane.org.uk/ Scottish Association for Mental Health: www.samh.org.uk/ South Australia Mental Health Observatory: www.thehealthobservatory.org.au/people/sa-mental-health-observatory Sova (criminal justice charity): www.sova.org.uk/ Stonewall: www.stonewall.org.uk The Antipsychiatry Coalition: www.antipsychiatry.org/ The John Howard Society of Canada: www.johnhoward.ca The Royal Australian and New Zealand College of Psychiatrists: https://www.ranzcp.org/ Together (mental health charity): www.together-uk.org/ Transforming Mental Health: www.joinmq.org/ World Health Organization www.who.int/ World Health Organization Europe: Prisons and Health: www.euro.who.int/en/health-topics/health-determinants/prisons-and-health Young Minds: www.youngminds.org.uk/


Legislation and policy index Managing Dangerous People with Severe Personality Disorder 1999 71 Mental Capacity Act 2005 78, 121, 162-3, 163-5, 169, 170 Mental Capacity Act Code of Practice 2007 162-3 Mental Health (Care and Treatment) (Scotland) Act 2003 7 Mental Health Act 1959 128, 173, 174 Mental Health Act 1983 71, 91, 132, 169, 321 Mental Health Act 2007 7, 15-6, 40, 42, 54, 55-7, 59, 71, 78, 116-7, 121, 132, 149, 164, 166, 169-70, 173-4, 181, 213, 214, 229-30, 238, 243, 244, 247, 248-9, 256, 258-9, 260-1, 287-8, 292, 321 Mental Health Act Code of Practice 2008 42, 55-6, 244 National Health Service Act 2006 115 National Health Service and Community Care Act 1990 240 Police and Criminal Evidence Act 1984 14, 94, 210-11 Police and Criminal Evidence Act Code of Practice 2013 210 Poor Law 1834 191-2 Prisons Act 1898 123 Public Order Act 1986 296 Race Relations Act 1976 230 Race Relations (Amendment) Act 2000 230 Serious Organised Crime and Police Act 2005 210 Sexual Offences Act 2003 181, 266 Trial of Lunatics Act 1883 131 Tribunals, Courts and Enforcement Act 2007 173 Universal Declaration of Human Rights 292-3 Vagrancy Act 1824 295-6 Youth Justice and Criminal Evidence Act 1999 135

Bail Act 1976 237 Breaking the Cycle: Effective Punishment, Rehabilitation and Sentencing of Offenders 2010 240 Children Act 1989 78 Civil Contingencies Act 2004 242 Code of Practice for Victims 2013 140 Coroners and Justice Act 2009 87-8, 135, 136, 152-3 Corporate Manslaughter and Homicide Act 2007 5 County Asylums Act 1845 27 Crime and Disorder Act 1998 45,296, 314, 316 Criminal Appeal Act 1968 91,213 Criminal Justice Act 1967 200 Criminal Justice Act 1991 28-9 Criminal Justice Act 2003 63-4, 89, 100, 175, 181 Criminal Justice and Courts Services Act 2000 181 Criminal Lunatics Act 1800 248 Criminal Lunatics Asylum Act 1860 116 Criminal Procedure (Insanity) Act 1964 91, 132, 213, 291 Criminal Procedure (Insanity and Unfitness to Plead) Act 1991 22, 91, 132, 155, 291 Domestic Violence, Crime and Victims Act 2004 90-2, 132, 140, 170, 291 Electoral Administration Act 2006 214 Equality Act 2010 307 European Convention on Human Rights (ECHR) 120–1, 177, 211, 254, 287 Family Law Act 1996 90 Health and Social Care Act 2008 40 Health and Social Care Act 2012 115 Homicide Act 1957 87 Human Rights Act 1998 120, 140, 212 Infanticide Act 1938 112, 126 Justice for All 2002 140-1 Legal Aid, Sentencing and Punishment of Offenders Act 2012 64, 175 Lunacy Act 1845 27


Subject index Page numbers of main subject entries are indicated in bold Assessment, Care in Custody and Teamwork (ACCT) approach 17–19 ASSET 316 asylums inquiries 127–8 Magdalen Asylums 157–8 Report on the Select Committee of the House of Commons on Madhouses, 1815 238–9 York Retreat 311–12 see also hospitals Asylums (Goffman) 13, 37, 44, 103, 268 attention deficit hyperactivity disorder (ADHD) 19–20, 58 Attica State Prison 119 Auerhahn, K. 281 Auld, Lord Justice 6 Aurora cinema shootings 159 Australia adversarial justice 6 evidence of insanity 156 Mental Health First Aid 170 prisoner voting 214 Autism Spectrum Disorder (ASD) and criminal justice 20–1 automatism 22–3, 76 aversion therapy and homosexuality 23–4

A Abel-Smith, Brian 31 ableism 192–3 abolitionism 203–4 Across the wire (Fossey) 297 actuarial risk assessment 3–4, 50 PCL-R (Psychopathy Checklist-Revised) 202–3, 263–4, 303 Sex Offenders Risk Appraisal Guide 263–4, 303 Violence Risk Appraisal Guide 302–4 actuarialism 1–2, 190, 278–9, 301 actus reus 4–5, 231 Adshead, G. 59, 174 adversarial justice 5–6 advocacy in mental health care 7–8, 169 age of consent 266–7 Ahmad, N. 11 alcohol and risk 8–10 and violence 280–1 altruism 10–12 Alzheimer’s disease 197 American Psychiatric Association (APA) 84 anti-psychiatry movement 13–14, 24, 129–30 anti-terrorism legislation 94 Antisocial Personality Disorder (ASPD) 206, 207 Appleby, Louis 187 appropriate adult 14–15, 136 Approved Clinician (AC) 243–4 approved mental health professional (AMHP) 15–17, 56, 244 approved social worker (ASW) 16 Ashim, B. 181, 182 Ashworth, A. 156, 238 Ashworth Hospital 103–4, 115, 116 Asperger Syndrome 20–1

B Bartholomew, D. 178–9 Bartlett, P. 118, 259 Batson, C. 11 battered women syndrome 25–6, 112 Bauman, Z. 270 Becarria, Cesaré 231 Beck, Aaron 51 Beck, U. 250 Becker, H.S. 69, 82, 148


A companion to criminal justice, mental health and risk behaviour therapy 51, 264–5 see also Cognitive Behaviour Therapy Belmarsh prison 247 Bennet, Henry Grey 239 Bennett, David 97, 247 Bentham, Jeremy 43–4, 223, 224, 231 Berg, Insoo Kim 275 Bethlem Royal Hospital 26–8, 116, 158, 239 Bickley, H. 183 bifurcation 28–9 Bini, Lucio 61 biosocial theory 85–6 bipolar disorder 29–31, 301 Birmingham Centre for Contemporary Cultural Studies 68, 108–9 Birmingham Six 211 Black, Sir Douglas 31 Black Report 31–2 Blackwood, Orville 97 Blair, Tony 285, 286 Bleuler, Eugen 255 Blom-Cooper Inquiry 103 Blume, Stuart 31 Boards of Visitors 123 Bogdan, R. 228 borderline personality disorder (BPD) 85–6 Bottoms, A. 216 Bourne, William Sturges 239 Bournewood gap 78 Bowers, L. 178 Bradley, C. 321 Bradley Report 14–15, 32–4, 52–3, 92, 149 Brain Blast Injury 297 Brief Solution-Focused Therapy 275–6 British Association of Social Workers 16 Brittan, Leon 28 Broadmoor Hospital 27, 71, 72, 104, 115, 116 Bronte, Charlotte 27 Brooke case 201 Bruno, Frank 159 Bulger, James 29 Butler Report 34–5 bystander effect 11

C Cabinet Office 242 Calverley, A. 79 Campbell, Sarah 18 Canada adversarial justice 6 Circles of Support and Accountability 46 female sex offender assessment and management 105 populist punitiveness 217 sex offender treatment programmes 265 Violence Risk Appraisal Guide 302–3 capacity see mental capacity Caparo Industries Plc v Dickman 211–12 capitalism 66, 160–1, 271, 319–20

Caplan, G. 65 carceral society 43–4 care in the community 37–8, 240, 320–1 Care Programme Approach (CPA) 38–40, 128 Care Quality Commission (CQC) 40–1, 78–9, 258 carers and carers’ rights of mentally disordered offenders 42–3 Carr, N. 238 Carrabine, E. 299 Carstairs hospital 115–16 Carter Review 185, 186 Castle, Barbara 77 Cavadino, M. 205 Cerletti, Ugo 61 Changing the outlook (Department of Health and HM Prison Service) 172 Chief Constable of The Hertfordshire Police v Van Colle 212 children conduct disorder 57–8 Fallon Inquiry 103, 104 infanticide 112, 126–7 mental health services 45–6, 316 safeguarding 253–4 and sexual offending 266–7 see also young people Children and Adolescent Mental Health Services (CAMHS) 45–6, 316 Christie, N. 245–6, 299 Church of England Temperance Society 221 Circles of Support and Accountability (CoSA) 46–7 civil death 215 Clark, P. 140 clinical governance and risk management 48–9 clinical risk assessment 49–50 Structured Professional Judgement (SPJ) 278–9 closed-circuit television (CCTV) 223, 282, 283 Clunis, Christopher 37, 128, 183, 320–1 coercion 55, 59 Cognitive Behaviour Therapy (CBT) 51–2 Dialectical Behaviour Therapy 85–6 sex offenders 264, 265 cognitive therapy 51 Cohen, Stanley 82–3, 108, 148 Coles, Deborah 18 collectivism 11 Collishaw, S. 19–20 Colquhoun, Patrick 289 Comier-Lang Criminal History 264 Commissioner for Victims and Witnesses 140 community care see care in the community community forensic mental health teams 52–4


A companion to criminal justice, mental health and risk Subject index Community Mental Health Teams (CMHTs) 53 Community Order 64, 175–6 Community Sex Offenders Group Programme 265 Community Treatment Orders (CTOs) 37–8, 54–5, 169, 256, 321 Approved Mental Health Professional 16–17 Mental Health Review Tribunal 173–4 Responsible Clinician 244 Second Opinion Appointed Doctor 259 compulsory hospitalisation 55–7, 59, 248–9 Mental Health Review Tribunal 173–4 and political participation 213–14 Comte, Auguste 10–11 conduct disorder (CD) 57–8 conflict resolution 245–6 consent to treatment 59–60 contractarian theory 215 Control and Restraint (C&R) 246–7 controversial treatments in psychiatry 60–1 Cooper, David 130 Corcoran, J. 276 Cormier-Lang system 303 Corner, J. 242 Court of Protection 164 Cox, Edward 221 Criminal Injuries Compensation Authority 140 criminal justice 62–3, 139 due process 93–4 populist punitiveness 216–17 Criminal Justice Liaison Teams 287 criminology critical 66–8 cultural 68–9 desistance 79–80 folk devil 109 and governmentality 113 Intelligence Quotient and delinquency 132–4 labelling perspectives 147–8 Rational Choice Theory 231–2 zemiology 319–20 crisis intervention 65–6 Crisis Resolution Home Treatment (CRHT) 65–6 critical criminology and critical criminologies 66–8 Crown Prosecution Service 166 Cruz-Smith, Martin 302 cultural criminology 68–70 cycle theory of violence 25

D Dangerous and Severe Personality Disorder (DSPD) programme 71–3, 208

dangerousness and mental disorder 2, 39, 73–4, 187 Darwin, Charles 191 Davies, Dame Sally 77 defect of reason 131–2 defence automatism 22–3 diminished responsibility 87–8 insanity 75–6, 88, 91, 116, 155–6 loss of control 152–3 deinstitutionalisation 176–7 DeKeseredy, W. 67 delinquency and IQ 132–4 labelling perspectives 148 delirium 197–8 dementia 197 Department of Health 76–7 Care Programme Approach (CPA) 38–9, 128 gender-specific mental health services 307 A guide for the management of dual diagnosis in prisons 92 Health of the nation strategy for England 183 Improving health, supporting justice 15, 33 inquiries 128 Mental Health First Aid 170 mental health in-reach services 172 National Service Frameworks 187, 188 No health without mental health 171 No secrets 254 personality disorder pathway 208–9 Preventing suicide in England 188–9 Saving lives 188 Deprivation of Liberty Safeguards (DoLS) 40–1, 78–9, 121, 170 deShazer, Stephen 275 desistance 79–80 deviance 81–2, 108–9 deviancy amplification 82–3, 108 Di Lustro, M. 307 diagnosis, dual diagnosis 92–3 Diagnostic and Statistical Manual of Mental Disorders (DSM) 45, 84–5, 161, 165, 264 bipolar disorder 29–30 conduct disorder 57 post-traumatic stress disorder 217, 218 schizophrenia 255 and Violence Risk Appraisal Guide 303 Dialectical Behaviour Therapy (DBT) 85–7 dialectical philosophy 85, 86 Dignan, J. 205 diminished responsibility 87–9 disability hate crime 89–90 and normalcy 192–3 and political participation 213 social model 272–3 disciplinary society 43–4, 145–6


A companion to criminal justice, mental health and risk Discipline and punish (Foucault) 43–4 Dobson, Frank 37, 320 domestic violence battered women syndrome 25–6 Domestic Violence, Crime and Victims Act 2004 90–1 loss of control 152 women prisoners 111 Dreyfus, H.L. 130 drinking see alcohol drug-related violence 280–1 dual diagnosis 92–3 due process 93–4, 201–2 Durkheim, Émile 268 duty of care 211–12

E Easton, S. 224–5, 292 Edgar, K. 18 egoism 11 electro-convulsive therapy (ECT) 60, 61, 169, 259 Ellis, B. 98 emotional CPR (eCPR) 95–6 empathy-based altruism 11 empowerment 8, 254 England health policy 76 suicide prevention strategy 188 Ennals, David 31 equality 229–30 essay on the principle of population, An (Malthus) 191 essentialism 98–9 ethnicity 96–7, 229–30 European Convention on Human Rights (ECHR) 120–1, 177, 211, 254, 287 deprivation of liberty 78 prisoner voting 214 restraint 247 European Court of Human Rights 120, 174 deprivation of liberty 78 post-tariff detention 101 prisoner voting 214 existential murder 302 expert witness 99–100 extended sentences for public protection 101–2

F Falk, G. 277 Fallon Inquiry 103–4 Farrall, S. 79 Fazel, S. 301 Federal Bureau of Investigation 118–19 Feeley, M. 189–90 Feinberg, J. 137, 224 female sex offender assessment and management 104–6

Ferrell, J. 69 filicide 126 film and mental illness 106–8 Finnegan, F. 157 first aid 170–1 fitness to plead see unfitness to stand trial folk devil 108–9 Fossey, M. 297 Foster, J.H. 9 Foucault, Michel carceral society 43–4 dividing practices 204 governmentality 113–14 insanity 129–30, 239 knowledge-power nexus 145–6 medicine 160 psychiatry 71–2 surveillance Freeman, W. 60

G Gable, L. 292, 293 Garland, D. 205 Garside, Richard 289 gender essentialism 98 and madness 159 mental health and offending 111–13 see also men; women George,Vanessa 104 Giddens, Anthony 250, 285 Giordano, S. 59 Glancy Report 34 Glueck, E. 80 Glueck, S. 80 Goffman, Erving 13, 37, 44, 103, 268, 277 Goldstein, P.J. 280 Good Lives Model (GLM) 265–6 Goodley, D. 272–3 Gorky Park (Cruz-Smith) 302 Gostin, L. 292, 293 governmentality 113–14, 146 Green, G. 277 Griffiths, Hugh 77 Grubin Screen 19 Guardianship Order 173–4, 244

H Hadfield, James 116, 248 Hall, S. 271 Halliday Report 63, 205 Haney, C. 274 Hannah-Moffat, K. 190 Hare Psychopathy Checklist-Revised (PCL-R) see PCL-R harm 68 hate crime 89–90 Hayward, K. 107 Health and Safety Executive 48


A companion to criminal justice, mental health and risk Subject index health inequalities 31–2 Hertman, K.C. 19 Hesselbrock, M.N. 242 Higgins, Godfrey 127 high-security hospitals 103–4, 115–16 Hill, R. 245 Hill v Chief Constable of West Yorkshire 212 Hillyard, P. 68 Hinshaw, S. 277 Hippocratic Oath 11, 12 Hirshi, T. 268–9 Hirst v UK 214 Histoire de la Folie (Foucault) 129–30 Historical-Clinical-Risk 20 (HCR20) 49, 50, 279 Hogarth, William 26, 27 Home Office dangerous and severe personality disorder 71 Justice for all 140–1 missing people 179, 180 NOMS Offender Management Model 185 homicide 183–4 see also murder homosexuality 84–5 aversion therapy 23–4 Hoover, J. 293 Hopper, K. 234 Hospital Guardianship Order 292 Hospital Order 116–18, 132, 155, 174, 249, 291 Hospital Treatment Order 287 hospitals Bethlem Royal Hospital 26–8 high-security hospitals 103–4, 115–16 see also compulsory hospitalisation; medium secure mental health services Hostage/Crisis Negotiations (H/CNs) 118–20 Howard, John 157 Howard, Michael 29 Howard League for Penal Reform 64, 221, 297 Hoyle, C. 245 Hudson, B. 67 Hui-Ching, W. 242 human rights and mentally disordered offenders 120–2, 253–4 Police and Criminal Evidence Act 1984 211

Improving health, supporting justice (Department of Health) 15, 33 in-reach teams 171–3 Increasing Access to Psychological Therapies (IAPT) 52 Independent Mental Capacity Advocates (IMCAs) 7, 164 Independent Mental Health Advocacy (IMHA) 7, 169 Independent Monitoring Boards (IMBs) 123–4 Independent Police Complaints Commission 260 Indeterminate Sentences for Public Protection (IPPs) 64, 125–6 inequalities 31–2, 270 infanticide 112, 126–7 inquiries 127–9 Fallon Inquiry 103–4 inquisitorial system 6 insanity 129–31, 248 automatism 22 and defect of reason 131–2 defence 75–6, 75–6, 88, 91, 116, 155–6 Intelligence Quotient (IQ) and delinquency 132–4 intermediary 135–6 International Classification of Diseases (ICD) 45, 165 bipolar disorder 29 Post-Traumatic Stress Disorder 218 schizophrenia 255 International Classification of Impairments, Disabilities and Handicaps (ICIDH) 272 International Society for Traumatic Stress Studies 218 Ireland 156, 157



I, Pierre Rivière (Foucault) 130 identity 90, 96–7 Illich, I. 160 imprisonment see prisoners; prisons Imprisonment for Public Protection (IPP) 101

Keane, A. 100 Keeping the country running (Cabinet Office) 242 Khalfa, J. 130 kidnapping 119 King’s College London 297 Kitchener, Betty 170

J Jones, O. 81 Jorm, Tony 170 Journal of Traumatic Stress 218 judicial discretion 29 just deserts 28, 137–8 justice 138–40 adversarial justice 5–6 restorative justice 245–6 social justice 139, 271–2, 319–20 Woolf Report 305–6 see also criminal justice


A companion to criminal justice, mental health and risk knowledge (sociology of) 143–5 knowledge-power nexus 145–6

L labelling perspectives 82, 83, 147–8 Lacey, N. 138 Laing, J.M. 13 Lancet 297 Lascelles, Lord 239 Lasting Power of Attorney (LPA) 163, 164 Law Commission 87, 152, 156 Lawrence Inquiry 140 learned helplessness 25 learning disabilities 169 and criminal justice 133, 148–50 Learning the lessons (Shepherd) 321 Levitas, R. 269 Lewis, L. 121–2 Lewy Body dementia 197 Life Without Parole 101 Linehan, Marsha 85–6 Livingston, K. 107 Lloyd Review 123 lobotomy 60–1 Local Social Services Authority (LSSA) 16 long-term imprisonment and mental health 150–2 loss of control 152–3 Lucy Faithful Foundation 105 Lyon, D. 282

M McBarnett, D. 140–1 Mackay, R.D. 87 M’Naghten, Daniel 75, 116 M’Naghten Rules 75–6, 88, 116, 131, 155–6 McNeill, F. 80 McRobbie, A. 109 Madness and civilisation (Foucault) 129–30 Madrid v Gomez 274 Magdalen Asylums 157–8 Mair, G. 205 Malthus, Reverend Thomas 191 manic-depression see bipolar disorder Mann, R. 265 Marshall, T. 245 Martin, M. 242 Martinson, R. 221, 232 Maruna, S. 79, 80 Marx, Karl 268 Mathiesen, Thomas 199 Maudsley Hospital 27 Maurutto, P. 190 Mayhew, Henry 289 media representations and mental disorder 106–8, 158–60 medicalisation and social control 2, 13, 44, 160–2 medium secure mental health services

Butler Report 34–5 women 307–8 men infanticide 127 mental health and offending 111–12 self-harm 261–2 mens rea 4–5, 22, 133, 231 mental capacity 162–3 Deprivation of Liberty Safeguards (DoLS) 78–9, 170 Mental Capacity Act 2005 163–5 mental disorder 165–7 compulsory hospitalisation 55–7 deviancy amplification 83 and infanticide 127 insanity and defect of reason 131–2 media representations 158–9 Mental Health Act 2007 169 organic disorders 197–8 Post-Traumatic Stress Disorder 217–19 and stigmatisation 276–7 veterans 296–8 and violence 300–2 York Retreat 311 see also Diagnostic and Statistical Manual of Mental Disorders mental distress 167–9 mental health 171 Bradley Report 32–4 defence of insanity 75–6 dual diagnosis 92–3 and ethnicity 96–7 and film 106–8 gender and offending 111–13 Histoire de la Folie 129–30 and Indeterminate Sentences for Public Protection 125 and long-term imprisonment 150–1 missing people 180 national service framework 187, 188 qualitative and quantitative inquiry 227–8 and race equality 229–30 recovery 234–5 and safeguarding 253–4 and xenophobia 309–10 Mental Health Act Commission (MHAC) 40, 41 Mental Health Alliance 16 Mental Health First Aid (MHFA) 95, 170–1 mental health in-reach services 171–3 Mental Health Review Tribunal (MHRT) 43, 169, 173–5 mental health services advocacy 7–8 anti-psychiatry movement 13 Bethlem Royal Hospital 26–7 Butler Report 34–5 care in the community 37–8 Care Programme Approach (CPA) 38–9


A companion to criminal justice, mental health and risk Subject index Care Quality Commission 40–1 Children and Adolescent Mental Health Services 45–6 community forensic mental health teams 52–3 Community Treatment Orders 54–5 consent to treatment 59 crisis intervention 65–6 emotional CPR 95–6 in-reach services 171–3 missing patients 178–9 Report on the Select Committee of the House of Commons on Madhouses, 1815 238–9 restraint 246–7 tsar 77 women’s enhanced medium secure services 307–8 Zito Trust 320–1 see also asylums; hospitals; therapy Mental Health Treatment Requirement 175–6 Mental Health Tribunal 56, 249 mental impairment 169 mentally disordered offenders (MDOs) 166, 176–8, 310 and altruism 11–12 Bradley Report 32–4, 52–3 carers and carers’ rights 42–3 community forensic mental health teams 52–3 Criminal Justice Act 2003 63–4 Dangerous and Severe Personality Disorder (DSPD) programme 71–2 and dangerousness 73–4 Hospital Order 116–18 human rights 120–2 medium secure mental health services 34–5 police intervention 260–1 recidivism 233 rehabilitation 236–7 resettlement 240 solitary confinement 273–4 transfer from custody 286–8 women’s enhanced medium secure services 307–8 young people 313–14 Miers, D. 140 Milburn, Alan 186 Miles, C. 281 Mills, Hannah 311 Milwaukee Brief Family Therapy Centre 275 Mind 321 mindblindness 21 Ministry of Defence (MoD) 296 Ministry of Justice (MoJ) intermediaries 135 Parole Board 201 personality disorder pathway 208–9

probation 222 Responsible Clinicians 244 veterans 296 Youth Justice Board 314, 315 miracle question 275 missing patients 178–9 missing people 179–81 Modernising mental health services (Department of Health) 307 Monro, Thoma 239 Monster 106 Moore, M. 138 moral panic 82–3, 108 moral treament 311–12 Morgan, Rod 315 Morris, Jerry 31 Moss Side Hospital 116 Multi-Agency Public Protection Arrangements (MAPPAs) 53, 181–2 murder existential 302 loss of control 152–3 see also infanticide Murray, Charles 289–90

N National Coalition for Mental Health Recovery (NCMHR) 95–6 National Confidential Inquiry into Suicide and Homicide by People with Mental Illness 183–5, 227 National Council for Civil Liberties 128 National Council for Independent Monitoring Boards (NCIMBs) 124 National Deviancy Symposium 147 National Health Service (NHS) Approved Clinicians 244 Approved Mental Health Professional 16 Bethlem Royal Hospital 26, 27 Care Quality Commission 40 and Department of Health 76, 77 high-security hospitals 115 medium secure mental health services 34 National Service Frameworks 187 prison health care 151 risk management 48 veterans 296 National Institute for Health and Care Excellence (NICE) 186 ADHD 19 conduct disorder 58 post-traumatic stress disorder 218 risk assessment tools 303–4 National Institute of Mental Health in England (NIMHE) 188 National Mental Health Development Unit 179 National Offender Management Service (NOMS) 185–6, 201, 220


A companion to criminal justice, mental health and risk national service framework (NSF) 186–8 National Suicide Prevention Strategy 188–9 natural justice 139 Nearest Relative (NR) 42–3, 56 neoliberalism 285 neonaticide 126 neuropsychiatric disorders 197, 198 New Penology 1–2, 101, 189–91 new Poor Law 191–2 New Zealand 101 Nicholson, Sir David 77 Nietzsche, Friedrich 11 No health without mental health (Department of Health) 45, 171, 189 No secrets (Department of Health) 254 normalcy 192–3 Northern Ireland approved social workers 57 domestic violence law 90 health policy 76 high-security hospitals 115–16 intermediaries 136 suicide prevention strategy 188 Northumbria Sex Offenders Group Programme 265

O O’Brien, Una 76 Observer,The 159 Offender Assessment System (OASys) 195–6, 240 Offender Health Research Network 172 offender management 1–2, 80 see also probation offenders see mentally disordered offenders; sex offenders Office of the Public Guardian (OPG) 164 Oliver, M. 272 One flew over the cuckoo’s nest 61, 106 Optional Protocol to the United Nations Convention Against Torture (OPCAT) 124 Order for Lifelong Restriction 101 organic disorders 197–8 Organisation of Economic Co-operation and Development 32 Osman v Ferguson 212 Ostrander, R. 19

P pains of imprisonment 199–200 panoptic power 223 Park Lane Hospital 116 Parker, R. 281 parole 200–2 Parole Board 200, 201 participation 213–16 patients missing 178–9

restricted 248–9 PCL-R (Psychopathy Checklist-Revised) assessment tool 202–3, 263–4, 303 Pearson, G. 81 penal abolitionism 203–4 penal crisis 28, 205–6 penal populism 94, 216–17 personality disorder (PD) 161 Dangerous and Severe Personality Disorder (DSPD) programme 71–2, 71–3, 208 and offending 206–8 personality disorder pathway (PDP) 208–10 recovery 234 and rehabilitation 236 Violence Risk Appraisal Guide 303 Petch, E. 321 Pilkington, Fiona 89 Pillai,V. 276 Piper, C. 224–5 Plato 143 Police Court Mission 221, 222 policing appropriate adult 14–15 and duty of care 211–13 and mentally disordered offenders 260–1 missing people 179–80 Police and Criminal Evidence Act 1984 210–11 political participation 213–16 Poor Law Commission 191 poor relief 191–2 populist punitiveness 94, 216–17 Post-Traumatic Stress Disorder (PTSD) 217–19 veterans 296, 297 Powell, Enoch 37 power critical criminology 67–8 disciplinary 43–4, 223 governmentality 114 and knowledge 144, 145–6 psychiatry 13 prefrontal lobotomy 60–1 Preventing suicide in England (Department of Health) 188–9 preventive psychiatry 65 principlism 11 Prins, Herschel 300 Prison Service ACCT approach 17 health care 151 mental health in-reach services 172 resettlement 240 restraint 246–7 prisoners long-term imprisonment and mental health 150–2 pains of imprisonment 199–200 parole 200–2


A companion to criminal justice, mental health and risk Subject index political participation 214–15 resettlement 240–1 self-harm 261–2 prisons ACCT approach 17–19 carceral society 43–4 dual diagnosis 92–3 Independent Monitoring Boards 123–4 mental health in-reach services 171–3 Offender Assessment System 195–6 penal abolitionism 204 penal crisis 205–6 privatisation 219–20 recidivism 233 remand 238 restraint 246–7 sex offender treatment programme 265 solitary confinement 273–4 transfer from custody 286–8 Woolf Report 305–6 privatisation 219–20 probation 221–2 National Offender Management Service 185–6 Offender Assessment System 195–6 and recidivism 233 sex offender treatment programme 265 Probation Service 140, 233, 240 problem-free talk 276 prostitution 157–8 provocation defence 152 psychiatry actuarialism 2 altruism 11–12 anti-psychiatry movement 13–14 controversial treatments 60–1 Diagnostic and Statistical Manual of Mental Disorders 84 essentialism 98–9 Histoire de la Folie 129–30 medicalisation and social control 161 preventive 65 and surveillance 222–3 Psycho 106 psychoanalysis 264 psychopathy PCL-R 202–3, 263–4, 303 and rehabilitation 236 psychosis 171–2, 234 schizophrenia 255–6 psychosurgery 60–1 public protection actuarialism 1–2 and automatism 23 bifurcation 28–9 Criminal Justice Act 2003 63 DSPD programme 71, 72 extended sentences 101–2

Indeterminate Sentences for Public Protection 125–6 Multi-Agency Public Protection Arrangements 181–2 punishment 137–8, 224–5, 232

Q Quakers 239, 311 qualitative and quantitative inquiry in mental health research 227–8 quality of life (QoL) measures 227–8 Quinsey,V.L. 263, 303

R R v Commissioner of Police of the Metropolis, Ex parte Blackburn 212 R v Pritchard 291 R v Sanders 100 R v Silverlock 99 Rabinow, P. 130 race equality and mental health policy 229–31 Rainer, Frederic 221 Rampton Hospital 71, 104, 115, 116, 128 Rational Choice Theory (RCT) 231–2 recidivism 232–4, 263–4 recovery and mental health policy 234–5 Redmayne, M. 238 Reed Report 33 Registered Intermediary (RI) 135–6 rehabilitation 63, 232 and mentally disordered offenders 236–7 remand 237–8 Report of the Committee on Mentally Abnormal Offenders see Butler Report Report on the Select Committee of the House of Commons on Madhouses, 1815 238–9, 312 Report of the Working Group on Inequalities and Health see Black Report resettlement 240–1 resilience 241–3 responsibilisation 235 Responsible Clinician (RC) 174, 243–4, 287 Responsible Medical Officer (RMO) 243 restorative justice (RJ) 47, 139, 245–6 restraint 246–8 restricted patient 248–9 Restriction Direction 248–9 Restriction Order 132, 248 retribution 28–9, 224–5, 232 retributive justice 139 Rich v Pierpoint 100 Rickford, D. 18 risk 48 and alcohol 8–10 Care Programme Approach 39 Multi-Agency Public Protection Arrangements 181–2


A companion to criminal justice, mental health and risk New Penology 189–90 risk assessment 49–50 actuarialism 1–2 approved mental health professional 15–17 Offender Assessment System 195–6 see also actuarial risk assessment; clinical risk assessment ; Structured Professional Judgement risk assessment risk management 48–9 Risk, Need, Responsivity (RNR) principles 236, 265 Risk of Serious Harm (ROSH) evaluation 316 risk society 144, 201, 250–1 Ritchie Inquiry 128, 321 Robinson, G. 196 Robinson, J. 183 Rose, George 239 Rose, N. 286 Rossegger, A. 264 Royal College of Psychiatrists 35 Royal Commission into the Operation of the Poor Laws 191 Royal Commission on the Law Relating to Mental Illness and Mental Deficiency 128 Royal Society of Public Health 170 Russell, Lin and Josie 71

S safeguarding 253–5 Safer Custody Teams (SCTs) 17–18 Safety, privacy and dignity in mental health units (Department of Health) 307 Samaritans 188–9 Sandland, R. 118 Sarkar, J. 307 Sarkar, S. 174 scaling questions 276 Scheff, T.J. 148 schizophrenia 255–7, 264, 301, 303 Schlossberg, Harvey 119 Schroeder, Gerhard 285–6 Schur, E. 148 Schwendinger, Herman 319 Schwendinger, Julia 319 Scotland advocacy 7 health policy 76 high-security hospitals 115–16 mental capacity 165 Mental Health First Aid 170 mental health officers 57 Order for Lifelong Restriction 101 Poor Law 191 suicide prevention strategy 188 Scull, A. 13, 27 seclusion 257–8 Second Opinion Appointed Doctor (SOAD) 244, 258–60

section 136 of the Mental Health Act 1983 (as amended 2007) 260–1 Sector resilience plans for critical infrastructure (Cabinet Office) 242 Secure futures for women (Department of Health) 307 Security Information Reports (SIRs) 124 Select Committee on Madhouses 238–9, 312 self-harm 17–18, 261–3 Senior, J. 172 sentencing bifurcation 28–9 Criminal Justice Act 2003 63–4 diminished responsibility 87 extended sentences for public protection 101–2 Halliday Report 63, 205 Hospital Order 116–18, 132 Indeterminate Sentences for Public Protection 125–6 Mental Health Treatment Requirement 175–6 populist punitiveness 216–17 Restriction Order 132 severity 205 Supervision Order 132 Sentencing Guidelines Council 63 Serious and Organised Crime Agency (SOCA) 135 Severin, Kenneth 247 Sex Offender Register 267 sex offenders aversion therapy 24 Circles of Support and Accountability 46–7 Cognitive Behaviour Therapy 51 female sex offender assessment and management 104–5 Multi-Agency Public Protection Arrangements 181 treatment programmes 264–6 Violence Risk Appraisal Guide 303 Sex Offenders Risk Appraisal Guide (SORAG) 3, 263–4, 303 sexual offending 266–7 Shakespeare, T. 273 Shaw, I. 83 Shepherd, D. 321 Showalter, E. 159 Silence of the lambs,The 106 Simon, J. 189–90 Smallridge, P. 247 Smith, Cyril 31 Smith, William 239 Snowden, P. 181, 182 social control theory 268–9 deviancy amplification 82–3 and medicalisation 160–1 surveillance 282–3 social exclusion 269–70


A companion to criminal justice, mental health and risk Subject index Social Exclusion Unit (SEU) 270 social justice 139, 271–2, 319–20 social model of disability 272–3 Society of captives (Sykes) 199 Society of Friends 239, 311 sociology 143 of knowledge 143–4 labelling perspectives 147 solitary confinement and mental illness 273–5 Solomon, E. 242 Solution-Focused Therapy (SFT) 275–6 South London and Maudsley NHS Trust 27 Stewart, D. 178 stigmatisation and mental disorder 276–8 Still, A. 130 Stocks, E.L. 11 Stone, Michael 71 Strangeways prison 305–6 Structured Professional Judgement (SPJ) risk assessment 50, 278–80 HCR20 49, 50, 279 Stuart, H. 301 Styal prison 18 substance use dual diagnosis 92–3 prisoners 151 see also alcohol substance-related violence 280–2 suicide 17–18 National Confidential Inquiry 183–4 National Suicide Prevention Strategy 188–9 recently released prisoners 151 and self-harm 261 Sun,The 159 Supervised Community Treatment (SCT) see Community Treatment Orders Supervision Order 132, 291 surveillance 44, 55, 222–3, 282–3 Sweden 126 Swinson, N. 39 Sykes, Gresham 199 Szasz, T.S. 13

T Tannenbaum, F. 148 Tapper, C. 99 Taxi driver 106 Taylor, S. 228 Teplin, L.A. 313 Thames Valley Sex Offenders Group Programme 265 Theory of Mind 21 therapeutic jurisprudence 11 therapy Cognitive Behaviour Therapy 51–2 consent to treatment 59–60 controversial treatments in psychiatry 60–1 Dialectical Behaviour Therapy 85–6 emotional CPR 95–6

Post-Traumatic Stress Disorder 218 sex offenders 264–5 Solution-Focused Therapy 275–6 York Retreat 311–12 Third Way politics and crime control 285–6 Thompson, Thomas 239 Thornicroft, Graham 187 Thornton, S.L. 109 Tilt, Sir Richard 104 time out see seclusion Townsend, Peter 31 transfer from custody 286–8 transinstitutionalisation 177 transvestism 23, 24 treatment see therapy Trenčín Statement on Prisons and Mental Health 177 true altruism 11 tube murder case 37 Tuke, Samuel 239 Tuke, William 311

U Uglow, S. 100 underclass 270, 289–90 unfitness to stand trial 291–2 Union of the Physically Handicapped (UPI) 272 United Nations Basic Rules for the Treatment of Prisoners 177 Convention on the Rights of Persons with Disabilities 213 Universal Declaration of Human Rights 292–3 US adversarial justice 6 Battered Woman Syndrome 25–6 emotional CPR 95 female sex offender assessment and management 105 hate crime legislation 89 labelling perspectives 147, 148 PCL-R 202 post-sentence civil commitment 101 prefontal lobotomy 60 prisoner voting 214 restorative justice 245 sex offender treatment programmes 265 solitary confinement and mental illness 274 violent crime 301, 302 utilitarian justice 139 utilitarianism punishment 224 Rational Choice Theory 231

V vagrants 295–6 vascular dementia 197


A companion to criminal justice, mental health and risk Velody, I. 130 veterans, mental disorder and criminal justice 296–8 victims of crime 299–300 Domestic Violence, Crime and Victims Act 2004 91 Justice for all 140–1 Mental Health Act 2007 170 resilience 242 restorative justice 245 Victims Fund 140 violence battered women syndrome 25–6 and mental disorder 37, 300–2 Violence Risk Appraisal Guide (VRAG) 3, 49, 50, 263, 264, 302–4 Von Hirsch, A. 224

W Wacquant, L. 270 Wahidin, A. 238 Wahl, O.F. 107 Wakefield, Edward 239 Wales health policy 76 suicide prevention strategy 188 Walker, Lenore 25 Walklate, S. 242 Watson, J.B. 51 Watts, J.W. 60 Webster, C. 279 Western, Charles C. 239 Whitemoor prison 71 Whole Life Tariff 101 Wilkins, L. 82 Will they do it again? (Prins) 300 Williams-Wynn, Charles 239 Williamson, A. 247 witnesses intermediaries 135–6 see also expert witness women battered women syndrome 25–6 and criminal justice system 140 Dialectical Behaviour Therapy 85–6 domestic violence 152, 153 enhanced medium secure services 307–8 infanticide 126, 127 and madness 159 Magdalen Asylums 157–8 mental health and offending 111–12 resilience 242 self-harm 262 sex offender assessment and management 104–5 victims of crime 299 Woolf Report 305–6 workhouses 191–2 World Health Organization (WHO)

disability 272 health inequalities 32 homosexuality 24 mental health 111 Trenčín Statement on Prisons and Mental Health 177 see also International Classification of Diseases Wortley, J.A. Stewart 239 wrongful acts 4–5

X xenophobia 309–10

Y Yar, M. 67 Yonatan Lefkowits, J. 107 York Asylum 127, 239, 311 York Retreat 311–12 Young, J. 82 Young, Jock 148 Young, R. 245 Young, S.J. 19 young people Mental Health Act 2007 169 Mental Health First Aid 170 mental health services 45–6 resilience 242 youth custody and mental disorder 313–14 see also children Youth Justice Board (YJB) 314–15, 316 Youth Offending Teams (YOTs) 45–6, 314, 315, 316–17

Z zemiology 67, 319–20 Zito, Jayne 321 Zito, Jonathan 37, 128, 183, 320–1 Zito Trust 320–2 Zola, I. 160


“An original contribution that bridges an important gap in the criminal justice literature and reference base. This volume will be of interest to students, academics, policy makers and practitioners across multiple fields – criminology and criminal justice, social policy, social work and community justice.” Professor Majid Yar, University of Hull, UK Within the domains of criminal justice and mental health care, critical debate concerning ‘care’ versus ‘control’ and ‘therapy’ versus ‘security’ is now commonplace. Indeed, the ‘hybridisation’ of these areas is now a familiar theme.

Included in this book is recommended further reading and an index of legislation, making it an ideal resource for students at undergraduate and postgraduate level, together with researchers and practitioners in the field.

criminology / Social studies

Taylor, Corteen and Morley

Dr Paul Taylor is a Senior Lecturer in Criminology and Deputy Head of the Department of Social and Political Science, University of Chester, UK. Dr Karen Corteen is a Senior Lecturer and Programme Leader for Criminology in the Department of Social and Political Science, University of Chester, UK. Dr Sharon Morley is a Senior Lecturer in Criminology and Deputy Head of the Department of Social and Political Science, University of Chester, UK.

a companion to

criminal justice, mental health & risk

Ed it e d b y

This unique and topical text provides an array of expert analyses from key contributors in the field that explore the interface between criminal justice and mental health. Using concise yet robust definitions of key terms and concepts, it consolidates scholarly analysis of theory, policy and practice. Readers are provided with practical debates, in addition to the theoretical and ideological concerns surrounding the risk assessment, treatment, control and risk management in a cross-disciplinary context.

a compan ion to c r i mi n al ju st ic e, men ta l h e a lt h & r i s k

“A highly pertinent, useful and user-friendly book. A must for personal and institutional libraries.” Professor Dave Holmes, University of Ottawa, Canada


Paul Taylor Karen Corteen Sharon Morley

ISBN 978-1-44731-034-1

www.policypress.co.uk policypress


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