You know what I’m referring to here, don’t you? Just that term, “the dangerously mentally ill” tells you all you need to know about the group of people I’m referring to. It’s such a self-justifying, explanatory term that it doesn’t really need any further explanation or clarification – you’re delivered straight to a vision of those in our society that are caught by this classification, right? Surely, as a policeman, I meet people from this strata of our society all the time and they’re easy to recognise – maybe it’s those who would do harm to strangers or their close family and friends?
But what do you think I mean by ‘dangerous’? … and what do I mean by ‘ill’ or ‘mentally ill’?!
If you haven’t already realised: these words take us almost nowhere at all – let me briefly explain why and let me tell you the reasons behind labouring the point —
Have you ever listened to a psychiatrist and a lawyer discussing terminology and definitions, especially legal ones? It’s worth buying popcorn and setting aside time because those discussion can go on and on and they’re highly entertaining – lawyers are from Mars and psychiatrists from Venus. You see, the concept of ‘dangerousness’ was so problematic when the Mental Health Bill 2004 was making its way through Parliament that the whole thing fell and we were deprived of a new Mental Health Act. The previous government had hoped to create new laws for dangerous and severe personality disorder, allowing pre-emptive detention of individuals like Michael STONE who was convicted of murdering Lin and Megan RUSSELL in Kent in 1996. But once discussion began about the ethics, the labelling and the role of psychiatrists in our society, it became clear that it would be very difficult indeed to work out who was ‘out’ and who was ‘in’.
So the whole Bill collapsed and we lost potentially decent reform of other legislative problems like the inadequacy of sections 135 and 136 of the 1983 Act, again being reviewed by the Government ten years down the line.
PROBLEMS OF DEFINITIONS
There are some of us in society who live with mental distress every day and in some circumstances we know that violent or dangerous things have occured. It’s not merely semantics to ask that we try to define what we mean by ‘dangerously mentally ill’, if we are going to use the appropriateness of that term to determine responses to complex situations. We know that the interface between policing, mental health and criminal justice is about creating pathways and diversions for those we decide are covered by the terms and language, whilst leaving others to the exclusive majesty of the police, courts and prisons. So if special procedures need to exist, we have to know how to identify those of us who are ‘in’ and ‘out’.
All becomes rather difficult, if we can’t get very far with that!
So what do we mean by mentally ill? … and by ‘dangerous’?! — well the Michael STONE case highlighted this issue too – he was diagnosed with a personality disorder. In terms of mental health law, it means he’s ‘mentally ill within the meaning of the Mental Health Act’. So he’s ‘in’, right?! Not necessarily. A feature of inquiries in recent years has been that people who in hindsight appear to have been very likely to do dangerous or violent things, were not detained under the Act and when those risks and threats became realised, there was outcry that ‘nothing’ had been done. This is far from a British problem. The book Neither Mad nor Bad, by Deirdre GRIEG is devoted to the discussion of one man in the context of how psychiatry interfaces with the law.
Garry DAVID from Melbourne, Australia was a convicted criminal with a serious personality disorder who spent time in prison making very serious threats to inflict incredible harms upon the public when he was released. These threats, along with the seriously mutilating self-harm that he used to undertake, prompted much debate about how to ensure the public remained protected from his potential given that he was “obviously mentally ill”. But for some years, the Victorian state authorities could find no psychiatrist in the land who would put their professional reputation to a diagnosis of mental illness. In the end, the Parliament of Victoria introduced legislation specifically for him: the Community Protection Act 1990. It allowed for his detention after the expiration of his sentence on the grounds of his dangerousness. A quite remarkable case and a book worth reading.
Another book for your reading list that I would highly recommend is Mental Health and Crime by Professor Jill PEAY. This book, perhaps more than any other, drives home the problems of attempting to doubly classify people and their conduct under the term ‘mentally disordered offender’. Even harder to extrapolate further and label people as ‘the dangerously mentally ill’. These words seem to defy easy explanation because science is still struggling with objective classification of what the medical textbooks call ‘mental disorder’ and almost everywhere, that leads to legal definitions that seem to suit no-one. It is probably for that reason that our modern mental health law is still derived from the 19th century definitions we saw of vagrancy and insanity – we know it’s not great, but can’t seem to agree on anything better.
This post was motivated by an article I came across online: from the US e-magazine Police One. Entitled, “The Dangerously Mentally Ill: spotting the signs to prevent tragedy” I admit I struggled to get beyond the first four words in the headline but forced myself to try. I wrote last year about the many differences in the US compared to the rest of the world and I was reminded of them all whilst reading this article.
The United States typically sees mental distress through a far more medical lens than elsewhere, has particular challenges around its healthcare system and has a culture around law enforcement and criminal justice that is sufficiently different to matter. So put that all together and you are not comparing apples with apples when you discuss the comparative issues that arise. We see in this article references to Kendra’s Law (New York) and Laura’s Law (California) which alludes to the legal frameworks which allow preventative detention of individuals on the basis of their propensity for future types of behaviour – this would include dangerousness and violent behaviours. These are the kinds of laws to which UK psychiatrists objected in the lead up to the collapse of the 2004 Mental Health Bill.
I’ve long since thought that police jargon is not suited to the kind of discourse we need to see about mental ill-health and distress. The legal tendency to label in all kinds of different ways; the very fact that legal processes have to determine who is ‘in’ and who is ‘out’ of consideration for the application of those processes – these things has a propensity to reinforce stigma, especially in terms as awful as ‘mentally disordered offender’. Given these problems of labels and discrimination also arise from lived experience of significant mental distress, it’s a real doubly whammy when access to mental health systems comes via the criminal justice system and people find themselves labelled as ‘the dangerously mentally ill’.
Most police officers have seen plenty of danger in crisis situations, but by far the most severe of it has been the danger that some people pose to themselves, not to others. In the most serious crisis related events of my career, I have been worried mainly about whether someone would cause themselves significant harm – not whether they pose a risk to others or the public at large. Indeed, some of those incidents that will stay with me forever are those where people have done exactly that. So whatever it is that we mean by ‘dangerously mentally ill’, we need to see that the use of such a term, in itself, creates and perpetuates the stigma that attends mental health disorders by implying most often, that danger is outward facing. We know that does happen, but we know that the reverse is often true. So the term is not necessarily a helpful one and it emphatically does not inherently indicate a cogent group of people to whom it will apply.
We need to do better than this otherwise police attempts to argue that we have improved attitudes towards this most sensitive of subjects will never really be taken seriously.
In case you’re wondering about the Anthony HOPKINS picture, above – it’s from one of his more famous films in which you’ll remember he played a psychiatrist.
Winner of the Mind Digital Media Award.