Causal, Contributory or Coincidental

The relationship between mental ill-health and crime is far from straight-forward.  I’ve quoted Professor Jill PEAY many times after she remarked that work at the interface of mental health and criminal justice is amongst the most challenging that either group of professionals will undertake and I think she’s correct.  Perhaps because of the extent of that challenge we see simplification – actually we see over-simplification! – in the debate about offending and mental health.  It is this simplification that I want to write about here.

So often we read of cases where a defendant’s case was resolved with reference to mental health problems and then hear expressions from professionals or media that amount to, “oh, right” as if someone’s mental health problem explains the crime.  It is too often and too casually assumed that if someone has committed an offence whilst ill, they must have committed the offence because they were ill.  That, in turn, links to assumptions or observations about people being unable to be held responsible for their offences.

I have seen this a lot over the years, not just from police officers who fall foul of this trap when asked to investigate things.  I’ve also heard victims of crime, including mental health professionals and relatives of suspects, talk about how they don’t want to see a prosecution because they know someone is ill.  There’s nothing necessarily wrong with a victim’s decision not to seek a prosecution – the criminal justice system is victim led; but I do wonder sometimes about the assumptions that may sit behind that decision.  What if the allegation in question arises in no way because of someone’s illness or it is only part of the background?  What role does substance (ab)use play, what about other factors that are precisely connected with liability like a wilful intent to legal wrongdoing?


I want to put forward the argument that this over-simplicity – about the fact that illness and criminal conduct are inherently linked – is actually the conflation of three seperate kinds of relationships.

  • The causal relationship – the one where someone has offended, precisely because of their illness.  These types of case will be far rarer than the others: those, for example, where someone is responding to auditory hallucinations, command hallucinations and delusions to hurt others.
  • The contributory relationship – the one where someone has offended, partially because of their illness.  These types of cases are the most difficult to identify but it is vital that we do if we are to explain
  • The coincidental relationship – the one where someone has offended, irrespective of their illness.  I wonder whether these types of case are under-identified because we are too quick to assume a link between ill-health and crime.  We don’t see these cases in the media very often because they are lower level despite being far more frequently occurring than either of the other two.

Something of a disclaimer >> I’m going to exemplify these claims with reference to cases you will have heard about or can look up.  I’ve wrestled in writing this post with the fact that those cases where you can read more for yourself tend to be the more serious cases.  Although it is certainly the case that offending is more frequently less serious, or even acquisitive crime – that doesn’t offer much scope to use examples familiar to us all.  It is also true that the level of proof of “intent” that is required for more serious offences of violence serves to make the point that this post is intended to highlight: that of how illness may or may not be related to crime.


Examples of this kind of case are there to be seen in high-profile, because they are the stuff of stigma and generalisation across our whole media system and include the random attacks against strangers that so often make front page headlines.  If you remember from reading my piece on restricted hospital orders, you will recall that they can be imposed either after the full criminal conviction of a suspect for an offence, or following a finding of “unfitness” and finding by the court that the defendant “did the act” charged or was “insane” at the time.

So, that shows that the law recognises this distinction: one where criminal responsibility is not proven, but where the offence arose from behaviour caused by someone’s (often serious) mental illness.  I would argue that we see a very recent example in the conviction of Richard SVAGELJ in Hertfordshire – he was seriously mentally ill at the time, found “unfit” to plead and stand trial and given a hospital order to ensure his ongoing treatment, without having been criminally convicted.  The same applied to Darren BOOTH in Staffordshire, earlier in the year:  he was found responsible for a sexual attack, but not convicted because he was unfit to plead and stand trial and given a hospital order to ensure his ongoing care.


Any murder prosecutions where the outcome at court was a finding of manslaughter on the grounds of diminished responsibility will fall into these categories – convicted of a criminal offence but where responsibility for that act was substantially impaired without being fully set aside.  So here we will recall the convictions of Philip SIMELANE for killing Christina EDKINS, John WARD who killed two big issue vendors in Birmingham and Matthew TVRDON in Cardiff.

In each of these cases, it was accepted that a serious mental illness provided a background which cannot be dissociated from the incidents, but where there was sufficient evidence of criminal liability within.  We see further examples in the cases of Nicola EDGINGTON (although that case is pending an appeal) as well as Christopher HAUGHTON who attacked a number of police officers in north London in 2011.  Both defendants were fully convicted by the courts of the serious matters they were charged with, as was Matthew TVRDON of lesser charges that were included in addition to murder, and sentenced accordingly.  Nicola EDGINGTON in particular was sentenced to prison.


The coincidental cases we see are usually far less high-profile and certainly more numerous.  These are cases I researched for my MSc dissertation about ten years ago – volume crimes, committed by people living with complex mental health and social problems who either fall into gaps between services or are just below the thresholds for admission to hospital.  It is these people, for me, that would benefit most from much better and improved liaison and diversion services – if only we can get them to work for a greater part of the 24/7 period and based upon a model that seeks to integrate health and criminal justice decision-making.

There are not many examples to highlight here, because our media are far less interested in shoplifters, burglars and street robbers who live with substance abuse and / or mental health problems but who are not acutely ill.   This probably does reflect the legal reality, but it also means that we see things like “mental health treatment requirements” not really being used effectively.  It was reported some years ago that they are under-used by the courts, often because of a lack of services to “require” people to engage with and also because of a lack of training for prosecutors and magistrates about their potential benefits.


All I’m saying in this post: we need to get better at examining this relationship in order to weigh the evidential and public interest tests for allegations that are made.  If we better understood the nature of any relationship, we would better understand how to design and interweave criminal justice and mental health disposals that reflect it.

I remind you that although the examples used here are serious crimes, it is for the deliberate purpose of demonstrating the legal point: that mental illness is less frequently the cause of crime than is imagined and represented in our media.  It is more often directly unrelated to the commission of offences but provides a background that is too often exploited to provide a stigmatising narrative.  This also shows the extent to which mental health services are not really structured at all to work with offenders across this domain:  they mainly just respond to sentencing decisions by the courts, way after things have gone horribly wrong in a minority of cases that do not reflect the daily reality for many people with complex, unmet needs.

IMG_0053IMG_0052Winner of the President’s Medal from
the Royal College of Psychiatrists.

Winner of the Mind Digital Media Award.


One thought on “Causal, Contributory or Coincidental

  1. I wonder if you could add a fourth c, which is consequential. I am thinking about someone who has committed a serious crime then either goes on to feel so guilty about that this leads to mental health problems, or who gets caught. For example, a person who has been arrested for a serious crime and goes on to self harm or attempt suicide because they have been found out and their life, relationships, employment etc, are crashing down

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