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Running head: MENTAL ILLNESS AND CRIME Research Design, Instrumentation, and Data Analysis: Relating Mental Illnesses such as Schizophrenia, stress disorder, and Substance Abuse Disorder to violence and mass shootings 1 2 MENTAL ILLNESS AND CRIME Abstract The number of people being diagnosed with mental illnesses is increasing at a rate of 1.8% in the United States (Levin, 2005). This number is alarming and threatening considering the fact the good percentage of mental ills end up engaging in criminal activities. Schizophrenia and people under alcoholism rehabilitation are known to be high risk due to their violent nature, for instance (Mulvey & White, 2014). The relevance of conducting a study in this field is to reduce the risk posed by the mentally ill people in the societies, and to reduce the issue of stereotyping mental ills as violent criminals (Faruqui, 2011). An investigation into the filed will embrace an interview with mentally ill individuals found guilty with various crimes. The investigation will look into their mental illnesses, and relate this to the type of crimes they were found guilty of. Data will be collected in mental health asylums, prisons, and substance abuse rehabilitation centers. 3 MENTAL ILLNESS AND CRIME Introduction According to Faruqui (2011), a lot of focus on research has been with the association between mental disorders, and crime, via the use of both longitudinal and cross-sectional research designs. Relatively, most people who are mentally ill or suffer from mental disorders are not involved in any violent acts, and those who are involved in violent acts like crime do not suffer from any form of mental illness (Faruqui, 2011). According to a report released in 2016 by the World Health Organization (WHO), following a qualitative research study carried out in 2014 and 2015, it shows that more than two-thirds of the inmates in almost half of the prisons in the United States suffer from mental disorders both chronic and those induced by drug usage. Finding a relationship between mental disorders such as schizophrenia and violent criminal activities is of critical relevance (Faruqui, 2011). A study carried out by Levin (2005), a psychologist in Guatemala Maximum Prison in 2014 on related substance abuse and violent crimes. It noted a positive relationship, with a large number of violent crime prisoner’s confession to have abused at least a drug or substance. Most of the prisoners who were in for non-violent crimes were found to be either: clean of substance abuse, or mild substance abusers. Other than the interviews with the prisoners, the researchers had access to prison data and personal history of the offenders presented to them when the offender was first incarcerated. The idea which is being propagated is that the researcher created a correlation between the abuse of drugs and the engagement to violent crime, especially when it comes to mass shootings. With the effect of changing normal desired and priorities, the researcher thus describes substance use as a mental disorder (Levin, 2005). 4 MENTAL ILLNESS AND CRIME Purpose of the Research This research seeks to identify whether there is a relationship between mental disorders and criminal activities. It also seeks to identify whether, if there is any; how mental disorders influence the type and effects of the crime they participate in. Additionally, it also tried to offer some recommended courses of action appropriate in reducing the effect of mental disorder on social order, if at all mental disorders are found to influence and trigger criminal activities. In most cases, when it comes to mass shootings, there are four assumptions which apply in the U.S. First, the first assumption is that mental illness is the main cause of mass shootings. Secondly, psychiatric diagnoses can lead to prediction of crime, and mass shootings are the epitome of deranged individuals that are mentally ill. Lastly, gun control cannot come to deal with such issues and people in the society. While the research will not dwell on mass shootings, there is a need to note that the paper seeks to understand the role of substance abuse and mental illnesses on violent crimes, and thus, the overall conclusion of weapons not being exposed to people with mental illnesses. Importance of the Study The first benefit of this study is restoring social order. As aforementioned in the objectives, it seeks to reinstate social order. The study will achieve this benefit by giving proper recommendation to reduce criminal occurrences due to substance abuse. Secondly, this study will work towards the reduction of the number of people incarcerated in prisons, yet they are supposed to be in rehabilitation or a mental health asylum centers for mental illnesses and substance abuse. Thirdly, the study will be beneficial to the general community because it will 5 MENTAL ILLNESS AND CRIME serve as a warning against the effects of mental illnesses on the people they live with. It will be a guide on how they will live with these types of people (Levin, 2005). Furthermore, there is a need to try and call for more funding to the mental programs in the prisons, since research indicates that there is massive underfunding towards mental welfare in the prison system. There is a need to have an objective framework through which all the people who have been engaged in violent crime, and mass shootings in America are accorded the expected mental care, rather than being subjected to the media bias and vindictive approach. Literature Review Mulvey and White’s Research (2014) found out that the members of the studied society could not merge properly with people with a history of mental illnesses. The authors realized that this was mainly because people feared the violence level that a mental ill person is capable of. The study realized that the mentally ill were treated like violent criminals in the society. The researchers further suggest that this stereotyping caused some psychological effects on the people who had a history of mental illnesses, and made them introverted (antisocial); a trait that makes people paranoid and violent (Mulvey & White, 2014). Additionally, Mulvey also realized that social media and other technologies play a role in worsening mental illnesses and these platforms have shown a frequency of relating mental illnesses to violence (Mulvey & White, 2014). According to a quantitative research study conducted by Stevens (2013), in the year 2010, involving 30 participants suffering from mental disorders from Guatemala Maximum Prison, results showed that the occurrence of violence in mentally ill patients is board variability, in correspondence to the treatment being given. Minimal incidence rates of violence have been MENTAL ILLNESS AND CRIME 6 recorded at a percentage range of between 22% to 46% in involuntarily committed patients, 13% to 38% in the acute care setting and 3% to 12% to outpatients (Stevens, 2013). According to Stevens (2013), approximately 11% of individuals with schizophrenia or other mental disorder behave violently compared to 3% in public. He suggested that the treatment model of schizophrenia also affects the individuals’ aggressiveness and violence. He suggests that is better to treat them from home and not in a mental health asylum because schizophrenia is full of episodes. He mentions that treating this population and following up with their progress can reduce their perceived threat to the public through a reduced rate of violent acts (Stevens, 2013). Fazel, Långström, Hjern, Grann, and Lichtenstein, (2009) studied the effect of substance abuse and schizophrenia on criminal activities. They realized that alcohol and other commonly abused substances such as heroin increase chances of violence. Schizophrenia was found to increase an individual’s chances of participating in violent actions. Some substances commonly abused such as marijuana was found to reduce chances of violence, but users were commonly found doing non-violent criminal activities such as stealing. Schizophrenia subjects in the study showed positive outcome to treatment, as their participation in violent activities declined. Former substance users who showed violent acts also showed positive changes after rehabilitation (Fazel, Långström, Hjern, Grann, and Lichtenstein, 2009). In another the same study, it was found out that one-year populace attributable risk of a crime connected to severe psychological disorder was attained to be 4% of the Epidemiologic Catchment area survey even though the previous statistics suggested mental illness does not contribute to risk violence. 95% of the crime currently taking place could continue even when MENTAL ILLNESS AND CRIME 7 the risk of abuse in individual suffering mental disease is minimized to moderate danger to those with no psychological illness (Stevens, 2013). Fazel, Gulati, Linsell, Geddes, & Grann, (2009) researched on schizophrenia and violent crimes. The investigation realized that schizophrenias are more likely to engage in violent activities, including violent crimes. However, it also found out that those who were schizophrenic and abused substances were at a higher risk of participating in violent crimes like homicide. In fact, the study realized that comorbidity heightened the chances of the individual’s participation in violent acts severally (Fazel, Gulati, Linsell, Geddes, & Grann, 2009) Anderson (2017) argues in his report released in 2017 following a meta-analysis research conducted in 2016 that people with mental disorders usually feel unsafe. It also concludes that, for this reason they end up becoming violent. He argues that one of the major symptoms that people with mental disorders experience include hallucinations which makes them feel like their minds are being vanquished or crushed by certain external forces they are experiencing and when this happens there is a high chance that they might resolve in violent acts like committing suicide or murdering those he or she feels threatened by. Due to this, it is therefore evident that people with mental disorders are four times more likely to indulge in such violent acts as compared to healthy people in a society (Anderson). In an article by Metzl & MacLeish 2015, there are some systematic issues which become apparent when they observe that “scripts linking guns and mental illness arise in the aftermath of many US mass shootings in no small part because of the psychiatric histories of the assailants. Reports suggest that up to 60% of perpetrators of mass shootings in the United States since 1970 displayed symptoms including acute paranoia, delusions, and depression before committing their crimes”. It implies that there has been a long failure to deal with all the mental issues which have MENTAL ILLNESS AND CRIME accumulated over time, but have not been addressed to this age. It is the realization on the complexity of the correlation between mental illness and gun violence which the authors mainly allude to. No one disputes the trend in which people who are known to be violent are socially marginalized and have mental problems (Goldstein, 2015). In most cases, it has caused to a situation in which most of the decisions on gun violence are negated to health professionals and psychologists, yet they do not have the competence of experience to understand the dynamics of such issues. Knoll et al., 2016 makes a fair argument on gun violence. The authors argue that most gun violence are not primarily out of mental issues but rather a combination of various factors, and which are poorly understood. The authors make a point that “although some mass shooters are found to have a history of psychiatric illness, no reliable research has suggested that a majority of perpetrators are primarily influenced by serious mental illness as opposed to, for example, psychological turmoil flowing from other sources”. The main relevance of the authors to the overall topic is their ability to form a relationship to issues such as mass murder, the bias of the media, politicization of gun issues and a general inability to deal with gun violence in the US which all culminates in the condition in which most people do not have any clue on how to move forward. For instance, in most of the gun violence which are fatal, the perpetrators feel indulged to leave a message, a final mark which will bear testimony to their existence. It could be a problem on self-perception, or a general unawareness on what to do in most instances. Paranoia, even which may not reach psychotic levels, is one factor which is found to remain constant in most cases of gun violence, and the people are inclined to exact revenge on the people they feel have not been pleasant to them (Lankford, 2016). 8 MENTAL ILLNESS AND CRIME 9 The most recent case of mass shootings in Florida saw the US President continue with a stereotype which has defined most gun violence issues. The president argued on the mental state of the perpetrator, citing the historical background of delinquency and lack of character as justifications for such a premise. However, according to Fox & DeLateur, 2014, this generalization has been counterproductive. In most instances, the correlation between gun violence and mental illnesses has been found to be lower than most people expect. Statistics indicate that “at most, only around 5 percent of crimes in the U.S. are performed by people with mental illness and that the percentage is the same for violent crimes—which means that 95 percent of violent crimes are committed by non-mentally ill individuals”. Perhaps, this is where the whole idea of substance abuse comes to focus. Hirschtritt & Binder, 2018 continue to offer an insight in gun violence in the US by saying that the stereotyping of gun violence to people with mental issues is a perpetuation of an already vulnerable and socially marginalized population. The idea is that such points have only served to deviate the objectivity of the debate on gun violence, and development of policy matters that can address the deficit which has been pointed out earlier. In most cases, the people do not understand that substance abuse has been one of the causes of crime, and the US criminal justice has failed to reform the often moribund obligatory sentences in some possession cases. It could be an indicator of a political unwillingness among the concerned parties. In the US, taking it as a lead example, in 2007, according to the Bureau of Justice Statistics “more than 750,000 crimes linked to alcohol or drug intoxication were committed in the United States alone”. Interestingly, this trend is not confined to the US alone. A research study done by Fox & Fridel, 2016, shows that “homicide rates across nine different countries found that 48 percent of homicide offenders had alcohol in their systems at the time of their 10 MENTAL ILLNESS AND CRIME offense while 37 percent were intoxicated”. It all shows why the common assumption on mental illness and gun violence is not only misleading but also biased. It is a way of feeding into the very idea of individuals being systematically targeted because of impairment. It is the ‘why’ question that has been found to be wanting because there is a variation on the crimes which are committed. For instance, there are some who are engaged in domestic abuse due to substance abuse, while some resort to extremes such as gun violence. To try and bridge this gap, researchers have sought to use meta-analysis, which means different findings are compared over the years to try and have an objective finding. A team from Yale University led by Duke, 2018, used a meta-analysis and alcohol and substance abuse was constant across many studies as being significant in causing crime and violence. There was an interesting finding which needs further research that alcohol and substance abuse was more pronounced on the perpetrators rather than the victims. It is an area that needs further research. Lastly, the American Addiction Centers has argued that substance abuse and alcohol is a ‘cause and consequence’ relationship; which means that there is a co-dependence. Furthermore, the Journal of Studies on Alcohol and Drugs found that “before seeking treatment for substance abuse, the rate of violent acts was as high as 72 percent among men and 50 percent among women” (Chermack & Blow, 2012 and this should give a framework on the hypothesis being analyzed in the paper. Hypothesis This paper has two hypotheses; a null hypothesis and an alternative hypothesis. Alternative hypothesis: 11 MENTAL ILLNESS AND CRIME There is a relationship between the mental illnesses such as schizophrenia, stress disorder, and others and engagement in criminal activities. It all depends on having a significant relationship backed by empirical research which establishes a significant positive correlation between substance abuse and mental issues to gun violence and mass shootings. Null Hypothesis: There is no relationship between substance abuse and violent crimes. It means that after analyzing the data, there will be no significant relationship between the rate of gun violence and substance abuse and mental issues. Problem Statement According to Hare (2015), there is an on-going debate that deliberates the association between mental illness and crime. Approximately 18.5% of people in the United States only are diagnosed with a mental illness. If these people are positively related to criminal activities, it means that this high percentage of new crimes will be experienced every year. Even worse, the large numbers are. Schizophrenia, for instances, is associated with violence. 1% of Americans are diagnosed with the mental disorder every year. 1.2% of Americans are living with the mental conditions and only less than 50% of the schizophrenia patients have access to psychological therapy. If the relationship holds to be true, then there are a good number of violent people out there who are not undergoing mental treatment (Hare, & Hart, 2015). The focus will be on seeking to understand how mental issues and substance abuse makes an individual to be prone to gun violence and other forms of crime. There has been a significant increase in the US of gun violence, and while there have been several indicators, there needs to be an objective debate 12 MENTAL ILLNESS AND CRIME which seeks to understand the dynamics of this debate to establish a correlation which can be empirically applied objectively. Purpose of Research A lot of research studies have been done over the years to determine whether there is a relationship between mental disorders or rather mental illness and crime. The results that have been obtained are still contradicting as others support while others differ. The goal of the research study is to investigate the nature of the dynamic relationship between gun violence and mental disorder and substance abuse. What factors are at apply? The paper endeavors to establish the interaction of mental issues and substance abuse, and how they lead to, or not lead, to gun violence. The paper covers the effects of drug substance abuse on the mental health and more specifically how mental health disorder can lead to increased criminal activities for addicts. According to Faruqui (2011), there is no general conclusion that people involved in criminal offenses suffer from mental illnesses or that people suffering from mental illnesses are involved in criminal offenses Methodology Research Design A descriptive research design will be used in this study. Descriptive research design usually answers the question “what” via the use of statistical characteristics of the population under investigation (Hare, 2015). In this case, will involve the collection of quantifiable data MENTAL ILLNESS AND CRIME 13 tabulated in a continuum mathematical formula. This data will then be analyzed, and a conclusion drawn upon a discussion on how mental illness and crime are related. The resign will also allow the accretion of both quantitative and qualitative data which will be analyzed to determine the type of relationship between mental illness and crime which will be generated from the questionnaires and its analysis. In the process of data collection, permission will be sought to speak to several prisoners incarcerated due to different crimes. Further information will also be sought from the prison authorities about the histories of their prisoners with a specific interest on three factors: the type of crime committed; involvement in substance abuse, and any prior or current diagnosis with any mental disorder. These parameters will be correlated on SPSS data analysis software using Spearman’s correlation or person’s correlation, depending on the trend of data. A paired t-test will be used to compare means of the given sets of data. Seeking permission requires an identification of the prisoners who have may generate the information required, and this will be done upfront through writing to the authorities for facilitation. After the plausible list is generated, then the researcher will use an analysis to determine the representative sample, and then liaising with authorities on availability, accessibility and voluntary participation. Other principles of research will be explained and only after consensus will the interviewing continue. Target Population The study will require 300 individuals with mental illnesses and disorders from correctional centers, rehabilitation centers, and mental hospitals. To ensure even representation, a random selection of 100 individuals will be selected from a prison, a mental asylum, and a rehabilitation center. The reason why this amount of number is required is that according to Anderson (2017), the more the number of participants in a study, the more accurate the results MENTAL ILLNESS AND CRIME 14 and the easier it becomes to draw conclusions upon a discussion of the findings. Moreover, the individuals will be selected from the three areas to ensure ease in research since these the areas where individuals have been selected from have the needed personnel required to perform the experiments including the psychiatrists and at the same time they have the files of the participants and hence ease in finding other needed details. It will also save the time on research and experiments. The best area to explore is a county since it is not too extensive. The county should have a mental health asylum, a prison, and rehabilitation center. Sample Size and Sampling Procedure To ease and fasten the process of collecting data from the participants, a relatively minor sampling size will be chosen. A sampling size of 20 participants will be chosen from the three locations; which are correctional centers, rehabilitation centers, and mental hospitals. This is to mean that there will be 15 groups of participants from the 300 individuals from the three areas. To come up with this estimate, the sampling procedure used will be the normal distribution method. This is to say that all data will be collected without bias, having equal number of representatives from each point of study and in line with the international framework on research process that involve human beings. According to Stevens (2013), normal distribution increases the ease of coming up with the normal distribution graph to compare the variables under investigation of which in our case are mental illness and crime. Research Instruments One research instrument to be used is an interview questionnaire in the collection of primary data. It will be administered on the aforementioned population of some offenders who are incarcerated, those who are in mental health asylums, and those who are in rehabilitation MENTAL ILLNESS AND CRIME 15 centers for substance abuse and crime cases. Questionnaires increase the chances to Read the respondent’s facial expressions when talking to them. This is beneficial in the evaluation of whether they are honest or not (Faruqui, 2011). Another requirement for the study, other than the filled in questions for the interviews is an audio recorder to collect the information Also needed will be consent forms, signed from the school to prove to the authorities that I am conducting an educational research. Data Collection Procedure Data will be collected via various methods including camera recordings, and forms filled by the participants in questionnaires and interview sessions. The collected data will then be scaffold as per the data. To ensure that ethics of research are followed, a consent of agreement will be obtained from the Rehabilitation Center, Correction Center, and from the Institute of Mental Health Care Facility. This will be done by an associate researcher who has undergone training for the sake of ethics of the research. The professionals will also participate in the development of the questionnaire to ensure that the questions asked to their patients and other participants are not too sensitive or personal. It will have few and guiding questions with multiple choice answers for higher ease of quantifying the output. Questionnaires will then be employed for acquiring evidence form the participants easily (Levin, 2005). All the data will then be soughed and put together in terms of whether they are quantitative or qualitative data before analysis of the same is done. 16 MENTAL ILLNESS AND CRIME Data Analysis The collected data will be tabulated and sorted to pool all the similar results. After pooling and tabulating data, it will be important to calculate the measures of central tendency and skewness. More specifically, it will be relevant to calculate the mean, which will show the average measures of the data. I intend for the data to be analyzed quantitatively, given the data size of 300 participants. Skewness will be measured using the standard deviation or variance. These parameters will be used in the paired t-test analysis. With data sets that exceed 30 participants, the study should be quantitative and not qualitative. Additionally, the data will be paired in a paired t-test. The tests compare the means of the given data sets. Another way to confirm the comparison will be Pearson’s correlation coefficient which is used for normally distributed data. The IBM SPSS software will be of absolute importance in these data analysis processed. Conclusion Mental ills are stereotyped as criminals in the society (Anderson, 2017). Where stereotyping is wrong, it should be investigated whether they are really what they are stereotyped to be. According to research, certain mental illnesses such as schizophrenia make people violent (Faruqui, 2011). The effect of substance abuse is also closely related to mental illnesses, and there has been some cases relating substance abuse to criminal activities. Schizophrenia and alcohol abuse are related to violent crimes, for instance (Hare, & Hart, 2015). In a bid to investigate the two parameters, identifying the relationship between mental illnesses, substance abuse and criminal activities is essential (Levin, 2005). The specific criminal activities, for instance, violent crimes should be looked into alongside their relationship with mental illnesses. It is helpful to mentally ill individuals in the society in overcoming the influence of their MENTAL ILLNESS AND CRIME 17 conditions and substance abuse, thus becoming more acceptable and less stereotyped as criminals. It can also reduce the fear of the community living with people suffering from mental illnesses (Mulvey, White, 2014). 18 MENTAL ILLNESS AND CRIME References Anderson, M. (2017). Mental illness and criminal behavior: A literature review. Journal of Psychiatric and mental health nursing, 4(4), 243-250. Retrieved on September 15, 2018, from; https://www.ncbi.nlm.nih.gov/pubmed/9362827 Chermack, S. T., & Blow, F. C. (2012). Violence among individuals in substance abuse treatment: The role of alcohol and cocaine consumption. Drug and alcohol dependence, 66(1), 29-37. Duke, A. A., Smith, K. M., Oberleitner, L., Westphal, A., & McKee, S. A. (2018). Alcohol, drugs, and violence: A meta-meta-analysis. Psychology of violence, 8(2), 238. https://americanaddictioncenters.org/rehab-guide/addiction-and-violence/ Faruqui, R. (2011). P01-525-Mental illness and moral panic: a qualitative study of perceptions of A link between violent crime and mental illness. European Psychiatry, 26, 529. Fazel, S., Långström, N., Hjern, A., Grann, M., & Lichtenstein, P. (2009). Schizophrenia, substance abuse, and violent crime. Jama, 301(19), 2016-2023. Fazel, S., Gulati, G., Linsell, L., Geddes, J. R., & Grann, M. (2009). Schizophrenia and violence: systematic review and meta-analysis. PLoS medicine, 6(8), e1000120. Fox, J. A., & DeLateur, M. J. (2014). Mass shootings in America: moving beyond Newtown. Homicide studies, 18(1), 125-145. MENTAL ILLNESS AND CRIME 19 Fox, J. A., & Fridel, E. E. (2016). The tenuous connections involving mass shootings, mental illness, and gun laws. Violence and gender, 3(1), 14-19. Goldstein, P. J. (2015). The drugs/violence nexus: A tripartite conceptual framework. Journal of drug issues, 15(4), 493-506. Hare, R. D., & Hart, S. D. (2015). Psychopathy, mental disorder, and crime. Hirschtritt, M. E., & Binder, R. L. (2018). A Reassessment of Blaming Mass Shootings on Mental Illness. JAMA psychiatry, 75(4), 311-312. Knoll, J. L., & Annas, G. D. (2016). Mass shootings and mental illness. Gun violence and mental illness, 1. Lankford, A. (2016). Public mass shooters and firearms: A cross-national study of 171 countries. Violence and victims, 31(2), 187-199. Levin, A. (2005). People With Mental Illness More Often Crime Victims. Psychiatric News, 40(17), 16-16. Metzl, J. M., & MacLeish, K. T. (2015). Mental illness, mass shootings, and the politics of American firearms. American journal of public health, 105(2), 240-249. Mulvey, P., White, M. (2014) "The potential for violence in arrests of persons with mental Illness", Policing: An International Journal of Police Strategies & Management, Vol. 37 Issue: 2, pp.404-419. Retrieved on September 15, 2018, from; https://www.emeraldinsight.com/doi/abs/10.1108/PIJPSM-07-2013-0076 MENTAL ILLNESS AND CRIME Stevens, H. (2013). Crime and mental disorders. Aarhus University, Aarhus. Retrieved on September 15, 2018, from; http://www.antoniocasella.eu/archipsy/Stevens_2013.pdf 20
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