Introduction

Many studies identify the prevalence of mental disorder amongst prisoners and other offenders (Hodgins, 2000; Lynch and Skinner, 2004). People who develop major mental disorders are more likely than those without such disorders to commit criminal offences. However, the link between offending and mental disorder is unclear and offending is not necessarily a consequence of mental disorder.

McInerney and Minne (2004: 43) suggest that “mentally disordered offenders have special problems; their offending places them apart from other psychiatric patients and major mental disorder separates them from most offenders”. The populist tendency to see crimes committed by people who are either ‘mad’ or ‘bad’ results in mentally disordered offenders being seen as doubly deviant. Mentally disordered people remain among the most vulnerable and marginalised in society (Silver and Miller, 2002; Lynch, 2005; Nolan, 2005), yet many see this group as justifying more restrictive approaches and having fewer civil rights than the rest of the population.

Instead of seeing that only a small number of mentally disordered offenders pose a serious risk of harm, there is a tendency for all mentally disordered people to be regarded by society as high risk. However, as Blackburn (2004: 298) notes, “mentally disordered offenders are a heterogeneous group” and whilst “there is little disagreement that the mental health needs of offenders are a challenge for rehabilitation, there is less agreement on whether mental disorder is a risk factor for criminal or harmful behaviour”.

Practitioners should always pay attention to mental disorder as a potential risk factor, especially when combined with substance abuse or anti-social thinking and behaviour. However, although it is not possible to state for certain that mental disorder is a dynamic risk factor there is an assumption (Andrews, 1995) that mental disorder also affects responsivity and will therefore need to be incorporated as part of interventions.

There is widespread agreement that people suffering with mental health problems are not best served by being locked up in overcrowded prisons; however, statistics show an alarming prevalence of mental disorder in prisons (see, for example, Bebbington, 2005).