Assignment: Psychological Aspects of Criminal Behavior

Learning Resources

Note: To access this week’s library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Bartol, C. R., & Bartol, A. M. (2017). Criminal behavior: A psychological approach (11th ed.). Boston, MA: Pearson.

Chapter 7, “Psychopathy” (pp. 178–212)

Chapter 8, “Crime and Mental Disorders” (pp. 213–246)

Chapter 16, “Substance Abuse and Crime” (pp. 467–500)

Morabito, M. S., Savage, J., Sneider, L., & Wallace, K. (2018). Police response to people with mental illnesses in a major U.S. city: The Boston experience with the co-responder model. Victims and Offenders, 13(8), 1093–1105.

Laureate Education (Producer). (2019). The Keen family [Web site]. Baltimore, MD: Author. Retrieved from https://www.psychiatry.org/patients-families/personality-disorders/what-are-personality-disorders

PBS News Hour (Producer). (2016, May 2). This is what it’s like to be arrested while suffering mental illness [Video file]. Retrieved from https://www.pbs.org/newshour/show/this-is-what-its-like-to-be-arrested-while-suffering-mental-illness

Note: The approximate length of this media piece is 3 minutes.

PUBLIC HEALTH

With More Opioid Use, People Are More Likely To Get Caught Up In The Justice System

July 6, 20182:28 PM ET

RHITU CHATTERJEE

Any amount of opioid use was associated with a higher risk of arrest, parole or probation according to a new study.

Marie Hickman/Getty Images

People addicted to prescription opioids or heroin are far more likely to have run-ins with the law than those who don't use opioids, according to a study published Friday in JAMA Network Open.

The study provides the first nationwide estimate for the number of people using opioids who end up in the American criminal justice system. The results suggest a need to engage law enforcement officials and corrections systems to tackle the opioid epidemic.

The connection between the criminal justice system and substance abuse is well-known. About 65 percent of people who are incarcerated are known to have a substance use disorder, according to the National Institute on Drug Abuse.

And yet there is little national data tracking the intersection of the criminal justice system and the ongoing opioid epidemic.

"There have been reports that jails and prisons are bearing the brunt of the opioid epidemic, but we didn't know nationally how many people who use opioids are involved in the criminal justice system," says Tyler Winkelman, a clinician-investigator at Hennepin Healthcare in Minneapolis and the lead author of the study.

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ECONOMY

Opioid Crisis Takes A Toll On Economic Outlook For Many Americans, Fed Says

To get that national picture, Winkelman and his colleagues analyzed data from 78,976 respondents to the annual National Survey on Drug Use And Health, which collects information on substance use by respondents, as well as information on their socioeconomic status, education and health.

The study reveals that only 3 percent of the general population (with no opioid use) reported being recently arrested or on parole or probation — the study's measure of involvement with the criminal justice system. Any amount of prescription opioid use was correlated with greater involvement. Among people with prescription opioid use disorder, nearly 20 percent had criminal justice involvement. For heroin users, it was 40 percent.

"People who use opioids, including heroin, were up to 13 times more likely to be involved in the criminal justice system," says Winkelman.

The study shows the complexity of the the opioid crisis, according to Josiah Rich, a professor of medicine and epidemiology at Brown University, who wasn't involved in the research. It shows "the spectrum of the disease and its overlap with the criminal justice system, showing that the more you progress along that continuum, the more likely you are to get tangled up in the criminal justice system."

The study also showed that most people with opioid use disorder had other mental illnesses and were also more likely to have certain chronic health conditions, such as asthma and chronic obstructive pulmonary disease.

The study authors argue for the need to engage and involve the criminal justice system in dealing with the opioid epidemic, including reducing overdose deaths.

Most jails and prisons don't offer medication-assisted treatment using the three FDA-approved drugs for the treating opioid use disorder: buprenorphine, methadone and naltrexone. Treatment with medication is the most effective option for people addicted to opioids, says Rich.

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A New Wave Of Meth Overloads Communities Struggling With Opioids

Incarcerating people with addiction without offering treatment makes them more vulnerable to dying from an overdose when they are released, he explains.

Those who were already on treatment have to stop abruptly. And those who weren't on treatment when arrested have to detox.

Over time, "their tolerance [to opioids] reduces," says Rich. So if they relapse when they're released from jail or prison, "that relapse in 2018 is extremely dangerous, because you don't have tolerance, and you need a minuscule amount of fentanyl to kill you," he says.

Most of the heroin and illicit opioid supply today is contaminated with fentanyl and other related synthetic opioids, which are more powerful and deadly, adds Rich.

Study author Winkelman urges alternatives to incarceration for people with addictions. "We need a response that will ideally prevent people from entering the criminal justice system," he says.

"We do have ways of diverting people with mental health crises to acute mental health care. We have ways of diverting juveniles from juvenile detention to some form of community corrections, where they remain in the community," he says.

Similar efforts should be taken to divert people with opioid use disorders to treatment facilities, he says.

Seattle, for example, has a program called Law Enforcement Assisted Diversion, which allows people with small drug offenses to be moved away from prisons to community-based service.

There's a critical need for jails and prisons to provide effective treatment to inmates, says Leo Beletsky, an associate professor of law and health sciences at Northeastern University, who wasn't involved in the new study.

"The criminal justice system needs to be much more equipped to reduce the risks in the population that they encounter," he says. "We need to make sure people have access to evidence-based substance use treatment when they're in prisons. The fact that we don't is shocking."

Some state correctional systems are starting to change their approach.

In July 2016, the Rhode Island Department of Corrections implemented a new comprehensive program to treat inmates' addiction with medications.

"We decided to screen everybody coming into [prison or jail] for opioid use disorder and offer on individualized basis the most effective treatment we have and offer it to people leaving the institution as well," says Rich, who is involved in the program and has monitored its impact.

Earlier this year, he and his colleagues published a study in JAMA Psychiatry showing that the rates of death by overdose of people coming out of Rhode Island's correctional system dropped by almost 61 percent.

"That is unheard of, to have that magnitude of a drop in mortality," says Rich.

The new study shows that it's time prisons across the country have similar treatment programs, he says: "At this point of the epidemic, we can't afford to not put people on treatment."

County Jails Struggle To Treat Mentally Ill Inmates

September 19, 20185:00 AM ET

CHRISTINE HERMAN

FROM

Illinois Public Media - WILL

Lt. Ryan Snyder, who works at the Champaign County jail in Illinois, says it's hard for any such facility to provide the kind of one-on-one mental health treatment many inmates need.

Christine Herman/Illinois Public Media

DeVonte Jones began to show signs of schizophrenia as a teenager. His first public episode was nine years ago at a ballgame at Wavering Park, in Quincy, Ill.

"He snapped out and just went around and started kicking people," says Jones' mother, Linda Colon, who now lives in a Chicago suburb.

The police were called. Jones was arrested, charged with aggravated battery, and placed in Adams County Jail. Colon says Jones had no recollection of what happened.

'Insane': America's 3 Largest Psychiatric Facilities Are Jails

SHOTS - HEALTH NEWS

'Insane': America's 3 Largest Psychiatric Facilities Are Jails

Her son got out on probation and went to therapy. He started on medications, but Colon says they didn't help. When he got caught self-medicating with marijuana, he ended up back in jail.

Jones has been in and out of the criminal justice system ever since. He's among the estimated half-million people incarcerated in the U.S. who have a serious mental illness.

According to federal data from 2011 to 2012, more than 40 percent of jail inmates reported having been told by a mental health professional that they had a mental health disorder. And while about 1 in 4 jail inmates met the threshold for having serious psychological distress at the time of the survey, only about a third of those were receiving treatment for it.

In recent years, county jails across the nation have taken steps to try to keep inmates with mental illness, like Jones, from coming back. One approach involves stepping up mental health screening, coupled with efforts to get inmates plugged into community-based treatment after they are released.

Such efforts require often-unprecedented collaboration between those on the front lines of mental health and criminal justice. But research shows such collaboration is key to addressing the problems many jails face when they become their communities' largest psychiatric facilities.

Colon believes the jail conditions her son faced caused his condition to worsen. He lost access to his medications there, she says, and would experience episodes related to his schizophrenia that landed him alone in a cell.

The mental illness leads to them committing these crimes and there's really no place else for them to go, so they come here. This is not a hospital. This is a jail. You do the best you can.

Lt. Ryan Snyder, Champaign County jail

"But if you're a mental illness patient, there's no way to calm yourself down without any kind of medication or therapy," says Colon, who has been in jail herself and is currently out on probation.

Adams County Sheriff Brian Vonderhaar says he can't comment on Jones' situation because he didn't work in the jail back then. But, he says, all the Adams County inmates are screened for mental illness, and medical providers there administer medications as needed. Inmates who are suicidal may indeed be placed alone in a cell, he acknowledges, with nothing but a mat and a garment they wouldn't be able to use to harm themselves.

Real change needed

Efforts to reduce the number of inmates with mental illness need to involve the jail system, says Richard Cho of the Council for State Governments Justice Center, because it is "the front end of the criminal justice system."

In 2015, the CSG Justice Center, together with the National Association of Counties and the American Psychiatric Association Foundation, launched the Stepping Up Initiative to help jails reduce the number of inmates with mental illness.

More than 400 counties have passed resolutions to join the program, which promotes the use of evidence-based screening tools to identify inmates who have a serious mental illness. Inmates who screen positive are referred to a clinician for a follow-up assessment.

The CSG Justice Center provides counties with technical assistance to collect data to understand the scope of their problem and determine whether efforts to reduce the number of inmates with mental illness are working.

A cell in the Champaign County Jail that's sometimes used to house inmates who are suicidal. For the inmates' own safety, jail officials say, they may be placed alone in the cell with nothing but a mat and a garment that cannot be used to cause self-harm.

Christine Herman/Illinois Public Media

The Champaign County Jail signed onto the Stepping Up Initiative after Deputy Chief Allen Jones realized the majority of the jail's "frequent flyers" — people who landed in jail five or more times a year — had mental health or substance use issues.

Connecting inmates to care

Since then, the deputy chief has implemented a mental health screening tool as part of the intake process.

The jail partners with Rosecrance, a community-based mental health treatment provider, which receives funding from the county to send caseworkers to the jail to help inmates get plugged into treatment after they're released.

And the group Champaign County Health Care Consumers, led by Claudia Lennhoff, sends people to the jail to help inmates sign up for health insurance, to ensure the care they seek in the community will be covered.

"It's very hard for a lot of communities to do this kind of work, because you [often] don't have partners like the sheriff's office willing to cooperate," Lennhoff says. "A lot of what we're doing is building trust, so that people know that help is available."

Many inmates get connected to care for the first time through the jail, Lennhoff says.

Pam Rodriguez is the CEO of TASC-Illinois, another organization that helps inmates successfully make the transition back into the community. She agrees with Lennhoff that jail can be a turning point for people with untreated mental illness. But it's a shame those people didn't find help sooner, she says.

"These are people who were noticed in school, I'm almost certain," but who didn't receive help, Rodriguez says. "These are people whose families have probably tried to get them into care."

Ideally, Rodriguez says, people with mental illness who get arrested would be diverted to treatment instead of to jail where their condition can worsen.

On the one hand, Rodriguez says, being housed alone in a cell can help prevent a mentally ill inmate from being victimized. Federal data finds inmates who show signs of serious mental illness are at higher risk of sexual victimization by another inmate.

What Is The Role Of Jails In Treating The Mentally Ill?

NATIONAL

What Is The Role Of Jails In Treating The Mentally Ill?

"But isolation tends to exacerbate mental illness," Rodriguez says. "Then the jail, which is not prepared to deal with serious mental illness, has to figure out what to do. And that's a huge challenge."

Societal roadblocks to mental health

To keep people with mental illness out of jail entirely, Cho says, the U.S. needs a mental health system that destigmatizes mental illness "and is able to identify people at the very first onset of symptoms."

"We're so far from that in this country," he adds.

Across the U.S., community resources for mental health continue to be stretched thin.

In Illinois alone, for example, mental health services took a hit over the past several years. Lawmakers went months without paying providers who were promised state funding. That led to behavioral health agencies reducing services; some permanently closed their doors.

Lt. Ryan Snyder, who works at the Champaign County jail, says the reduction in mental health services has created a challenging situation for law enforcement.

"The mental illness leads to them committing these crimes and there's really no place else for them to go, so they come here," he says. "This is not a hospital. This is a jail. You do the best you can."

But it's not easy, Snyder says, for any jail to provide the kind of one-on-one mental health treatment that many inmates need.

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HERE & NOW COMPASS

How The Loss Of U.S. Psychiatric Hospitals Led To A Mental Health Crisis

In the omnibus bill approved by Congress in March, appropriations for the Department of Justice's Mentally Ill Offender Treatment and Crime Reduction Act was increased $30 million — more than double the previous year's allocation. The act was initially authorized by Congress in 2004 to facilitate collaboration among those working on the front lines of criminal justice, juvenile justice, mental health services and substance use treatment.

Looking ahead

Deputy Chief Jones is applying for federal funding to hire more caseworkers who can help police officers handle calls for mental health crises in Champaign County. He's working with academic researchers to find out how efforts to reduce the number of inmates with mental illness in the jail are doing.

"I don't know how to fix societal issues," the deputy chief says. "But I'm trying to find ways to get the best outcome that we can get."

In Adams County, Sheriff Vonderhaar says the jail is developing a mental health court that would divert people with mental illness into treatment instead of jail. The county is also building a new jail facility with a layout that would allow for new programs for inmates such as support groups for drug addiction, mental health counseling and GED classes.

Meanwhile, Linda Colon's son, DeVonte Jones, is now 24 and back in jail — this time in Livingston County, Ill. He's charged with production and possession of child pornography and is awaiting sentencing.

Colon says he takes medications but is still not well.

"He's attempted suicide a few times," she says. "So for me, out here as a parent, I'm wondering if I'm ever going to get that phone call one day saying that they went to my son's cell and found him not alive."

Colon says she can't help but wonder whether the right interventions earlier would have kept her son out of the system.

For now, she does what she can to help him stay positive. Colon calls her son almost every day and reminds him that she loves and accepts him unconditionally.

"I just really hope that he doesn't get so low that he gives up," Colon says.

What are Personality Disorders?

Personality is the way of thinking, feeling, and behaving that makes a person different from other people. An individual’s personality is influenced by experiences, environment (surroundings, life situations) and inherited characteristics. A person’s personality typically stays the same over time. A personality disorder is a way of thinking, feeling, and behaving that deviates from the expectations of the culture, causes distress or problems functioning, and lasts over time.1

There are 10 specific types of personality disorders. Personality disorders are long-term patterns of behavior and inner experiences that differs significantly from what is expected. The pattern of experience and behavior begins by late adolescence or early adulthood and causes distress or problems in functioning. Without treatment, personality disorders can be long-lasting. Personality disorders affect at least two of these areas:

Way of thinking about oneself and others

Way of responding emotionally

Way of relating to other people

Way of controlling one’s behavior

Types of Personality Disorders

Antisocial personality disorder: a pattern of disregarding or violating the rights of others. A person with antisocial personality disorder may not conform to social norms, may repeatedly lie, or deceive others, or may act impulsively.

Avoidant personality disorder: a pattern of extreme shyness, feelings of inadequacy and extreme sensitivity to criticism. People with avoidant personality disorder may be unwilling to get involved with people unless they are certain of being liked, be preoccupied with being criticized or rejected, or may view themselves as not being good enough or socially inept.

Borderline personality disorder: a pattern of instability in personal relationships, intense emotions, poor self-image, and impulsivity. A person with borderline personality disorder may go to great lengths to avoid being abandoned, have repeated suicide attempts, displayed inappropriate intense anger or have ongoing feelings of emptiness.

Dependent personality disorder: a pattern of needing to be taken care of and submissive and clingy behavior. People with dependent personality disorder may have difficulty making daily decisions without reassurance from others or may feel uncomfortable or helpless when alone because of fear of inability to take care of themselves.

Histrionic personality disorder: a pattern of excessive emotion and attention seeking. People with histrionic personality disorder may be uncomfortable when they are not the center of attention, may use physical appearance to draw attention to themselves or have rapidly shifting or exaggerated emotions.

Narcissistic personality disorder: a pattern of need for admiration and lack of empathy for others. A person with narcissistic personality disorder may have a grandiose sense of self-importance, a sense of entitlement, take advantage of others or lack empathy.

Obsessive-compulsive personality disorder: a pattern of preoccupation with orderliness, perfection and control. A person with obsessive-compulsive personality disorder may be overly focused on details or schedules, may work excessively not allowing time for leisure or friends, or may be inflexible in their morality and values. (This is NOT the same as obsessive compulsive disorder.)

Paranoid personality disorder: a pattern of being suspicious of others and seeing them as mean or spiteful. People with paranoid personality disorder often assume people will harm or deceive them and don’t confide in others or become close to them.

Schizoid personality disorder: being detached from social relationships and expressing little emotion. A person with schizoid personality disorder typically does not seek close relationships, chooses to be alone and seems to not care about praise or criticism from others.

Schizotypal personality disorder: a pattern of being very uncomfortable in close relationships, having distorted thinking and eccentric behavior. A person with schizotypal personality disorder may have odd beliefs or odd or peculiar behavior or speech or may have excessive social anxiety.

Diagnosis of a personality disorder requires a mental health professional looking at long-term patterns of functioning and symptoms. Diagnosis is typically made in individuals 18 or older. People under 18 are typically not diagnosed with personality disorders because their personalities are still developing. Some people with personality disorders may not recognize a problem. Also, people may have more than one personality disorder. An estimated 9 percent of U.S. adults have at least one personality disorder.2

Treatment

Certain types of psychotherapy are effective for treating personality disorders. During psychotherapy, an individual can gain insight and knowledge about the disorder and what is contributing to symptoms, and can talk about thoughts, feelings, and behaviors. Psychotherapy can help a person understand the effects of their behavior on others and learn to manage or cope with symptoms and to reduce behaviors causing problems with functioning and relationships. The type of treatment will depend on the specific personality disorder, how severe it is, and the individual’s circumstances.

Commonly used types of psychotherapy include:

Psychoanalytic/psychodynamic therapy

Dialectical behavior therapy

Cognitive behavioral therapy

Group therapy

Psychoeducation (teaching the individual and family members about the illness, treatment, and ways of coping)

There are no medications specifically to treat personality disorders. However, medication, such as antidepressants, anti-anxiety medication or mood stabilizing medication, may be helpful in treating some symptoms. More severe or long-lasting symptoms may require a team approach involving a primary care doctor, a psychiatrist, a psychologist, social worker and family members.

In addition to actively participating in a treatment plan, some self-care and coping strategies can be helpful for people with personality disorders.

Learn about the condition. Knowledge and understanding can help empower and motivate.

Get active. Physical activity and exercise can help manage many symptoms, such as depression, stress and anxiety.

Avoid drugs and alcohol. Alcohol and illegal drugs can worsen symptoms or interact with medications.

Get routine medical care. Don’t neglect checkups or regular care from your family doctor.

Join a support group of others with personality disorders.

Write in a journal to express your emotions.

Try relaxation and stress management techniques such as yoga and meditation.

Stay connected with family and friends; avoid becoming isolated.

Source: Adapted from Mayo Clinic, Personality Disorders

Family members can be important in an individual’s recovery and can work with the individual’s health care provider on the most effective ways to help and support. But having a family member with a personality disorder can also be distressing and stressful. Family members may benefit from talking with a mental health provider who can provide help coping with difficulties.

References

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). American Psychiatric Association. (2013).

Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. 2007. DSM-IV personality disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 62(6), 553-564.

Physician Review By:

Rachel Robitz, M.D.

November 2018