4.4.1 Conduct Disorder: An example of a mental condition affecting crime, that could be
caused by imperfect brain development would be conduct disorder, which is the commonest psychiatric disorder in childhood, with a prevalence of seven percent in boys and three percent in girls, and is consistently also the commonest reason for referral of children and adolescents to mental health services (Audit Commission 1999) and (NICE 2013, p5). The financial cost to society of dealing with young people with this disorder, was ten times that of those with no problems, and crime was the biggest factor in that cost (Scott et. al. 2001). The prevalence of conduct disorders in the UK varies across ethnic groups; for example, their prevalence is lower than average in young people of south Asian family origin and higher than average in young people from African-Caribbean family origin (NICE 2013, p5). It is also an example of where behaviour is associated with social and educational disadvantage, as the condition occurs four times more often in families with unskilled occupations than in professional families (Metzler et. al. 2000). The importance of dealing with conduct disorders was emphasised by the National Institute for Health and Clinical Excellence (NICE), which said that support for parents of children at risk of developing conduct disorders could prevent them developing into offenders. Gillian Leng, the deputy chief executive of NICE said:
‘Conduct disorders, and associated anti-social behaviour, are the most common mental and behavioural problems in children and young people. Around half of children with conduct disorder not only miss out on parts of their childhood but go on to have serious mental health problems as adults’ (Leng, G. 2013).
4.4.2 Anti-Social Personality Disorder: A further, slightly more extreme condition, is
Anti-Social Personality Disorder (ASPD) with studies in the US and Europe indicating that between one percent and three percent of the population suffer from this condition (Moran and Hagell 2001). To be diagnosed with ASPD, the subject must have suffered from conduct disorder and displayed symptoms before the age of fifteen, and be over the age of eighteen. It encompasses a range of behaviours and traits including committing unlawful acts, deceitfulness, impulsiveness, failure to plan ahead, aggressiveness, recklessness and a lack of
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remorse. Clinical interviews conducted on a sub-sample of prisoners showed that forty nine percent of male prisoners and thirty one percent of female prisoners were diagnosed as having ASPD (Moran and Hagell 2001).
4.4.3 Summary of the effect of poor mental health: As can be seen from the evidence
above, the brain plays an important part in how we choose to behave, or not, and it is not just a few people who suffer from issues connected with the brain. A substantial minority of children, up to forty five percent are likely to experience moderate or severe psychological problems at some point in childhood or early adulthood. It is suggested that at any one time, up to twenty percent of children and young people may be affected by emotional and behavioural problems, most commonly anxiety disorders, disruptive disorders and attention deficit hyperactivity disorder (Buchanan, A., 1999, p1). Longitudinal studies in the UK, USA and elsewhere in the Western world show that a range of factors in children’s early lives have been consistently associated with increased risk of mental health problems in adolescence and adulthood (Mental Health Foundation (MHF) 1999, p7). The greater the number of risks, and the more severe the risks, the greater the likelihood of the child developing a mental health problem. If a child has only one risk factor in their life, their risk of developing a mental health problem has been defined as being one to two percent. However, with three risk factors the likelihood increases to eight percent and with four or more risk factors the likelihood of the child developing a mental health problem is increased to twenty percent (MHF, 1999, p7). Evidence suggests that children’s emotional well-being can improved if the number of risk factors is reduced, and the number of protective factors is increased.
A central finding in the literature on psychosocial adversities is that some individuals are more resilient than others. There are children who, against all odds survive intact and develop into competent, confident and caring adults despite prolonged and negative experiences. An important key to promoting children’s mental health is, therefore, a greater understanding of these protective factors that enable some children to be resilient (MHF 1999, p.9). Intervening effectively yields huge benefits in reducing a number of problems that are of concern to government, school, parents and children (MHF 1999, p7). It therefore seems strange that a subject dealing with issues involving personal, social, health, and economic (PSHE) subjects is not compulsory in schools and this subject will be tackled later in this chapter.
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Sadly if young people do not get treatment or help with these issues as a child they follow them to adulthood and often play a part in offending patterns, and some would say decisions. Young adult offenders are three times more likely to have mental health issues than people of the same age who do not offend. It was also estimated that up to ninety percent of young people in prison have a diagnosable mental illness, substance abuse problem, or both (Lyon, Dennison & Wilson, 2000). They are thirteen times more likely than other children to be looked after by their local authority, and twenty times more likely to have been excluded from school. Rather than resolving the difficulties of these young people, prison often compounds their problems (Lyon, J., 2002).
The Sainsbury centre for Mental Health estimates sixty to eighty percent of male prisoners and fifty percent of female prisoners have a form of personality disorder, compared with just five to fifteen percent of the general population, and about half the deaths in police custody involve detainees with some sort of mental health problem (Docking, Grace, and Burke 2008). According to National Health Service definitions, personality disorders are conditions in which an individual differs significantly from an average person, in terms of how they think, perceive, feel or relate to others.
Again, without seeking to prove a causal link to poverty the figures are enlightening. The Marmot Review highlighted the potential importance of both maternal mental health and low birth weights which may be associated with lower levels of development (Marmot 2010). Rates of maternal depression are nearly twice as high among mothers living in poverty and three times as high for teenage mothers (Dept. of Health 2010). Maternal depression is in turn associated with low birth weight, emotional or conduct disorders and children’s later intellectual development (Dept. of Health 2010). Half of all adult mental health problems start by the age of fourteen and seventy five percent by the mid-twenties (HM Govt 2011). People in the most deprived communities have the poorest mental and physical health and there is a threefold increased risk of mental health problems between the highest and lowest socio-economic groups, five percent and fifteen percent respectively (Green et. al. 2005). A problem that the government and local authorities need to deal with is the ability of young people who may be suffering from mental health issues actually accessing care. If the young person or their carer does not wish them to be treated, then regardless of the need to refer them to the Child and Adolescent Mental Health Services (CAMHS), they will not be treated. A few of the young people questioned for this thesis, who had been assessed by professionals
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as having need, never received the treatment required, but this is not a problem exclusive to one borough as the author is aware of two other boroughs in London where the same issue exists.
A very specific point involving mental health was highlighted by the Justice Committee when they pointed out that a high proportion of young offenders with speech, language and communication needs and/or a learning disability face enormous difficulties in understanding court proceedings, which may jeopardise their right to a fair trial. They considered that section 104 of the Coroners and Justice Act 2009, which would allow young people prosecuted for an offence to apply to the court to give evidence through an intermediary, as witnesses currently do, could provide an important safeguard for their rights. Parliament had decided that this provision is needed, and they therefore recommended that the Ministry of Justice brings this section into force. The Government decided to defer implementation of section 104 of the Coroners and Justice Act 2009 until full consideration could be given to the practical and resource implications, but later in its response the government admitted it had no plans to adopt section 104 (Justice Committee Parliament 2013). The government admits it has no plans to adopt the idea of intermediaries for defendants which appears to be one of several examples of treating the mental age of defendants differently to those of other people, in this case, other witnesses.
A witness can use an intermediary, but at the moment courts are using criminal practice directions as a means of appointing intermediaries to vulnerable defendants. This only applies post-charge, so up until then they would have to use an Appropriate Adult. Defendants are also not permitted to access the NPIA register of intermediaries unlike the prosecution and therefore have to source available people by alternative means, all of which appears discriminatory (O’Mahony 2014). With some research suggesting that as many as sixty percent of young defendants experience some form of communication difficulty, swift identification of the problem and the appropriate adaptation of questioning methods are essential (Youth Justice Agency 2009). Mental health is just one area where people are different, and this area of research known as positivism will be discussed below.
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The research into brain development is a fairly new phenomenon but over several decades, numerous investigators have found statistically significant relationships between crime and certain inherited and biologically identifiable characteristics such as skull formation, body type, chromosomal abnormalities, and glandular or neurological anomalies (Klein 1971). Other theories have been put forward with roots in psychology, sociology; theories based on the individual, the family, based on social control or social strain, on labelling or interactionism (Muncie, 2009). So, various theories have been put forward for the causes of crime and delinquency, with much debate and no agreement.
In the 1870’s Cesare Lombroso initially studied Italian army recruits and started to consider that certain physical attributes indicated a propensity towards crime. These views are now commonly known as the Italian school, and are also known as positivism. The main thrust of his argument, was that people could be born with criminal tendencies, possibly recognisable by physical attributes, and therefore not be making a rationale choice but merely following a pre-determined path. These views are now largely discredited by many academics (Siegal 2003, p139), and as can be seen from the brain research above, scientific development has overtaken such ideas.
However a related school of thought with more credence is that of biological positivism. There have been various studies looking at genetics in terms of offending, or put simply is it ‘nature or nurture’? (Newburn 2007, p135-6). People may be born with unusual chromosomes, neurotransmitters, excessive testosterone and unusual hormones, and recently studies concerning nutrition, in terms of behaviour. So there are several ways we may all be different in terms of brain development, academic and emotional intelligence, together with various chemicals within us. Since we may all have such differences it would be logical to teach young people about them and how to deal with their own emotions and feelings, but this is an area where there is massive difference between schools on how they deliver in this area known in schools as teaching about personal, social, health and economic education (PSHE).
The finding of the most comprehensive assessment of PSHE education in England published in January 2011 on behalf of the Department of Education by Hallam University concluded that both the quantitative and qualitative evidence demonstrated that delivery of PSHE education in England is inconsistent and at secondary level, often infrequent. It also stated
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that up to ninety percent of teachers delivering the lessons in PSHE did not have a specialist qualification to do so, which is not the same for any other subject. The same Department of Education held a PSHE education review at the end of 2012, but its findings appeared to ignore much of what was in the comprehensive review and concluded continuing PSHE as a non-statutory subject was adequate. This appears to be the government ignoring evidence that is presented to it if it doesn’t like the conclusions of any report. As a result of these differences between us we may react differently to some of the influences in our lives, and some of these possible influences will be discussed in the next section.