Mental Disorder & Offending 

Crime and Mental Disorder

The impact of mental disorder on crime is highly significant - all the information about persistent offending and the 'prison revolving door' have indicated that for well over a decade. 'Mentally Disordered Offenders' have become recognised as a definite group within criminal justice but the links between crime and disorder reduction and tackling mental disorder although certain are complex and difficult to access. So, when dealing with hundreds or thousands of crime per year, it may seem to a police service or community safety partnership a supreme luxury to be concerned with an individual's psychopathy. 

There are large numbers of people who can be defined 'most at risk of offending and reoffending' who have a mental health problem for whom forensic psychiatric and other mental health service intervention is a random occurrence. These include young  and adult offenders in prison and significant numbers supervised on various community based orders; whose offence determines their sentence rather than their mental health needs.

Policing Mentally Disordered Offenders*

It is estimated that up to 15% of incidents dealt with by the UK police include a mental health concern, however mentally disordered offenders are difficult to define: are they offenders who happen to have a mental disorder, or are they people with a mental disorder which has led them to commit an offence? Should they come under the jurisdiction of the police or mental health services? Specifically, a mentally disordered offender is someone who meets the diagnostic criteria set out in the Mental Health Act 1983 and who has also been convicted of a criminal offence. In practice, the term has a broader definition and there are generally considered to be three types of mentally disordered offender:

  1. People who have an existing mental disorder, and who have committed an offence (but not necessarily been convicted).
  2. People who have been convicted of an offence or are on remand and subsequently develop a mental disorder(3).
  3. People with a mental disorder serious enough to prevent them from making a valid plea when brought to trial, or who may be found ‘not guilty’ for the same reason.

An individual who has committed a minor offence is most likely to fall into the first category and a proportion of these offenders will never be charged. The second type of offender might be someone who has been diverted from prison to hospital following a diagnosis of a mental disorder. A much smaller number of offenders will have committed an offence serious enough for the police to consider prosecution and a minority will fall into this final category. This Briefing, however, is primarily concerned with those who fall into the first category.

Since the large-scale closure of psychiatric hospitals and the implementation of ‘care in the community’in the UK in the early 1990s, the police are often the first professionals to respond when the mentally ill are in crisis. The police are charged with protecting the safety of the individual and the community, so it falls upon them to control and contain an individual who presents a risk to himself and/or others, particularly if they are at large in the community or live alone. While being mentally ill is certainly not a criminal offence, a mentally ill person in crisis might easily be deemed to have broken the law, for example by threatening members of the public or behaving in a disorderly manner.

* Link to full briefing from the Police Foundation

Prisons - As Alternatives to Psychiatric Hospitals

UK Office of National Statistics, in its comprehensive research of prisoners in England and Wales, found that nine out of ten prisoners showed evidence of one of the five disorders considered in their survey (personality disorder, psychosis, neurosis, alcohol misuse and drug dependence) and eight out of ten had two or more disorders. There can be little doubt that the quality of care for mentally disordered prisoners does not compare with the standards achievable 'on the outside' but there seems little willingness either by government services or Crime and Disorder Reduction Partnerships to challenge the use of prisons as psychiatric dumping grounds.

The Bradley Report

The Review of People with Mental Health Problems or Learning Disabilities in the Criminal Justice System was published on 30 April. From our point of view it is the most important and timely of government reports to have been published during the current government's tenure. At that very moment that rehabilitation of offenders is threatened by major cuts as the Ministry of Justice tries to balance its books - along come an unlikely knight in shining armor.

 

To quote from the report "Evidence suggests that there are now more people with mental health problems in prison than ever before. While public protection remains the priority, there is a growing consensus that prison may not always be the right environment for those with severe mental illness. Custody can exacerbate mental ill health, heighten vulnerability and increase the risk of self-harm and suicide."

The prison service urgently needs to adopt the recommendations contained in Anne Ower's excellent report Disabled Prisoners: A short thematic review on the care and support of prisoners with a disability . The principles contained within that report, of effective oversight and appropriate intervention to tackle the disability needs of those in prison, must also apply to the rest of the Criminal Justice System (CJS) otherwise we will need to await the a successful judicial review of the CJS failure to  implement the requirements of the Disability Discrimination Act (DDA).

Multi-Agency Public Protection Arrangements (MAPPA)

MAPPA is the name given to arrangements in England and Wales for the "responsible authorities"  tasked with the management of registered sex offenders, violent and other types of sexual offenders, and offenders who pose a serious risk of harm to the public. The "responsible authorities" of the MAPPA include the National Probation Service, HM Prison Service and England and Wales Police Forces. MAPPA is coordinated and supported nationally by the Public Protection Unit within the National Offender Management Service and was introduced by the Criminal Justice and Courts Services Act 2000 (amended in the Criminal Justice Act 2003).

Following the Criminal Justice Act 2003, Lay Advisors were introduced to sit on Strategic Management Boards (SMBs) who have the strategic oversight of MAPPA. These are members of the public who have been selected to help with the development and monitoring of Multi-Agency Public Protection Arrangements and aim to boost public confidence in the arrangements. There should be two Lay Advisers on each SMB in England and Wales, a total of 84 nationally.

The legislation requires a three stage process for managing dangerous offenders. First, these three agencies in conjunction with partner agencies, such as social services and health agencies, need to identify three types of offender living in their area:

  • Category 1: Registered Sex Offenders (RSOs),
  • Category 2: All offenders who have received a custodial sentence of 12 months or more in prison for a sexual or violent offence and whilst they remain under Probation supervision.
  • Category 3: Anyone else who poses a "risk of serious harm to the public" who has received a conviction and whose risk would be better managed in a multi-agency setting.


An offender cannot be in more than one MAPPA Category, and if multiple offences are committed, they will default to the lowest number category. For instance, if an offender committed an attempted murder, but also committed a sexual assault, they would be a Category 1 offender rather than a Category 2 for the duration of their Sex Offender Registration. Following the completion of their registration, if they were still under Probation supervision/licence then they would become a Category 2 offender. If the supervision/licence had expired, then it would be up to the local area MAPPA if they qualify for Category 3 status.

The legislation then requires that the agencies conduct a formal risk assessment of each offender and allocate them to a tier of multi-agency management — known as level one, two or three.

  • Level One represents the normal inter-agency management of the offender in the community by one agency, with some liaison.
  • Level Two means that Multi Agency Public Protection meetings (MAPPs) will be held where the offender's management will be discussed between various parties involved in their case.
  • Level Three is essentially the same as Level Two, except that senior management representatives will be in attendance and greater resources are expected to be used in the management of the offender.


Level Three are sometimes called the "critical few". These are offenders posing the highest possible level of risk to the public and normally necessitates a specific case conference to pool unusual agency resources and ensure a strategically coordinated risk management plan. These might be predatory sex offenders, recidivist arsonists, extremely violent offenders, dangerously mentally ill offenders, domestic terrorists or people with dangerous personality disorders. At each MAPP meeting agencies have to share often confidential information, and will in many cases adopt a press strategy.

Risk assessment

Before a management plan is put in place a detailed risk assessment will take place to identify the circumstances and opportunities that are most likely to lead to a further serious offence in this particular offender and the steps that can help reduce this risk. This will study the offender's previous offending history, life circumstances, include psychological assessments (where relevant) and any work in prison that the offender has completed. The Police and the National Probation Service use a risk assessment tool called Risk Matrix 2000 which is assesses the statistical likelihood of re-offending by adult male convicted sex offenders only. The Probation Service use a nationally validated risk assessment tool called OASys which help predict the likelihood and circumstances of future offencing behaviour. For young offenders, the Youth Justice Board uses a system called ASSET which is specifically designed to understand the behaviours of offenders under the age of eighteen.

Management plan

A management plan is thus highly specific to each offender and their offending history, but might include any of the following:

  1. Accommodation at an Approved Premises (AP) where the offender can be monitored.
  2. A set of licence conditions such as having contact with children, or going within an exclusion zone in a town/city.
  3. A Civil Order such as a Sex Offender Prevention Order (SOPO) to prevent the offender doing certain activities, such as not entering a town where a victim resides, not to have unsupervised contact with children.
  4. A duty to report to an Offender Manager every week to undertake offending reduction counseling and work as part of their licence.
  5. In some very extreme cases there may be covert monitoring of offenders to protect the public.
  6. A disclosure of information to a member of the public for their protection.


The MAPPA system does not guarantee the protection of the public as such, but can only "manage" the risks through the limited powers of each agency as effectively as possible. This means that all steps that can be legitimately taken by the agencies should be taken. MAPPA decision making is frequently fraught with dilemmas. For example, it is not uncommon for a MAPPA meeting to decide to disclose to a member of the public about an offender's risk to protect that individual or somebody else. However each time that a disclosure is made the Panel loses control of the way that information is used. Some sex offenders have been attacked and killed as a result of public animosity, and others "driven underground" where agencies can't manage them at all.

CDRPs, Effective Crime Reduction and Mental Disorder

Key to effective crime reduction is tackling the causes of crime - it is not just the usual range of social causes (poverty, education unemployment) but also those which prompt criminal behaviour; drug abuse, alcohol abuse and mental disorder. From the point of view of 'successful crime management', a  failure by crime and disorder partnerships to ensure the provision of effective psychiatric and rehabilitative services - both in the controlled environment of prisons and in the community - ignores a critical area of crime prevention and reduction. 

Mental Disorder Practitioner Links

Ministry of Justice - Mentally Disordered Offenders

Webpage with guidance and service linksand detailed technical papers for work with mentally disordered offenders.

The Crown Prosecution Service Legal Guidance on Mentally Disordered Offenders

The English and Welsh Crown Prosecution Service (CPS) guidance on Mentally Disordered Offenders describing princles, key documents and containing legal definitions etc.

Multi Agency Public Protection (MAPPA) Scotland

Link to the Scottish central site for public protection

Mentally Disordered Offender Victim Information Scheme (Northern Ireland)

The information scheme for victims of mentally disordered offenders marks the provision of a new and statutory service aimed at informing victims about their case and offering them an opportunity to let their voice be heard when
considering applications for leave of absence or for the discharge of mentally disordered offenders.

Mental Disorder  Research Links

Mentally Disordered Offenders - UK National Statistics

This bulletin is an annual publication that summarises information about people subject to a restriction order (restricted patients) admitted to, detained in, or discharged from psychiatric hospitals (high secure and other hospitals in England and Wales which admit mentally disordered offenders).