ABSTRACT
Our three opening epigraphs are intended to provide the focus and indicate the content of this chapter. The first is a reminder of the many myths that surround "madness"; the second suggests the fear of "madness"; the third is indicative of our efforts to replace madness with sanity in offenders and offender-patients. The myths and fear surrounding "madness" (particularly if "madness" is linked to "badness") accounts for the problems involved in establishing various forms of community provision - notably units and hostels. In a study carried out by Holden et al. into the use of public consultation exercises in relation to establishing secure mental health facilities (Holden et al. 2001), the authors found that health trusts "tended to underestimate the depth of public feeling and this fostered residents' suspicions and hostility". To offset these problems, the authors suggest that their findings "highlight the need for trusts to be open with all interested parties as early as possible. The maintenance of an on-going dialogue with local residents, politicians, media, service-user groups, community health councils and statutory bodies is essential" (Holden et al. 2001: 513). In a
thought-provoking paper highly relevant to this problem, Pilgrim and Rogers critically examine the extent to which politicians (in particular) "remain concerned about the special threat which psychiatric patients allegedly pose to public safety". They note "three contextualising factors: public prejudice; the widening remit of deviance control by psychiatry during the twentieth century; and inconsistent societal sanctions about dangerousness (Pilgrim and Rogers 2003: 7). In providing a degree of support for this view Walsh et al. (2003) found that in a study of some 700 patients with established psychotic disorders, those with psychosis were found to be "at considerable risk of violent victimisation in the community" (p. 233). This is a helpful countervailing view to the political and public notion of the dangers posed by the mentally ill. In preceding chapters, I made reference to certain forms of mental disturbance and their possible relationship to criminal behaviour. Such reference was in very general terms; in this chapter, I consider aspects of mental disturbance and its relationship to criminality in more detail. The term "mental disturbance" is used here, as in preceding chapters, to include mental disorder as currently defined in the Mental Health Act 1983 in England and Wales; (although, as indicated in Chapter 2, a new definition is being proposed, which, in effect, will be more all embracing). As I write this chapter (November 2003) the anticipated Mental Health Bill is yet not in the Queen's Speech; the minister promises further consultation (The Independent, 27 November). Currently, the definition includes mental illness (not further defined), mental impairment, severe mental impairment, psychopathic disorder and any other disorder or disability of mind. I have chosen to use the term "mental disturbance" because it enables us to consider a wide range of other disorders and abnormalities, some of which would not necessarily satisfy the criteria for compulsory admission under the Mental Health Act. Admittedly, "mental disturbance" is a somewhat vague term and, as we have seen, it has certainly led to difficulties for the courts in attempting to determine what constitutes such an abnormality within the meaning of the Homicide Act 1957. The term is used in this chapter merely to encompass a range of disordered mental states, but its imperfections are recognized. (For a more detailed definition see NACRO 1993: 4.) As I hope to demonstrate, it is reasonably easy to define mental illnesses, especially those with clear-cut aetiology (cause); it is harder to define, with a degree of acceptable precision, such conditions as mental handicap (learning disability), particularly in its milder presentations, and conditions such as personality (psychopathic) disorder. However, what we do know with some degree of certainty, is that mental disturbance is likely to be present in all cultures (although it may present in a variety of ways) and at all levels of society, including political and other influential figures. This possibility can have frightening possibilities as Freeman has so ably demonstrated (see, for example, Freeman 1991).
