Psychosis and Criminal Offending: A Population-Based Data-Linkage Study
| Published date | 01 February 2021 |
| Author | Handan Wand,Olayan Albalawi,Peter W. Schofield,Stephen Allnutt,Nabila Z. Chowdhury,Grant Sara,Colman O’Driscoll,Tony Butler,Armita Adily,Azar Kariminia,David M. Greenberg |
| Date | 01 February 2021 |
| DOI | 10.1177/0093854820964834 |
| Subject Matter | Articles |
research-article2020
Psychosis and criminal offending
a Population-Based data-linkage study
NABILA Z. CHOwDHURy
University of New South Wales
OLAyAN ALBALAwI
University of New South Wales
University of Tabuk
HANDAN wAND
STEPHEN ALLNUTT
ARMITA ADILy
AZAR KARIMINIA
University of New South Wales
GRANT SARA
The University of Sydney
PETER w. SCHOFIELD
The University of Newcastle
COLMAN O’DRISCOLL
St John of God Health Care
DAVID M. GREENBERG
Justice Health & Forensic Mental Health Network
TONy BUTLER
University of New South Wales
This population-based case-control study examines the association between psychosis and criminal convictions in New South
wales (NSw), Australia, using data from several health and offending administrative data collections. Cases were individuals
diagnosed with psychosis between 2001 and 2012 (n = 86,461). For each case, two age- and sex-matched controls with no
diagnosis of psychosis were selected. Criminal convictions were identified using the NSw Reoffending Database. Cases were
approximately 5 times more likely to offend compared with controls, adjusted odds ratio (aOR) = 4.68, 95% confidence
interval (CI) = [4.55, 4.81], and accounted for 10% of all criminal convictions in NSw between 2001 and 2015. The preva-
lence of at least one criminal conviction was 30% among cases compared with 6% among controls. The results from this
study confirm previous work regarding the association between psychosis and criminal convictions. More work is needed to
better articulate the mechanisms for this association to enable prevention strategies to be developed.
Keywords: psychosis; offending; violent crime; nonviolent crime; data-linkage
authors’ note: We have no conflict of interest to disclose. Correspondence concerning this article should
be addressed to Tony Butler, School of Population Health, University of New South Wales, Australia, Sydney,
New South Wales 2052, Australia; e-mail: tbutler@unsw.edu.au.
CRIMINAL JUSTICE AND BEHAVIOR, 2021, Vol. 48, No. 2, February 2021, 157 –174.
DOI: 10.1177/0093854820964834
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© 2020 International Association for Correctional and Forensic Psychology
157
158 CRIMINAL JUSTICE AND BEHAVIOR
Significant challenges exist at all stages of the criminal justice system for those with seri-
ous mental illness, including during apprehension by the police, processing by the
courts, detention by custodial authorities, and reintegration back into the community on
release from prison. Studies have consistently shown increased rates of offending in people
diagnosed with psychosis including schizophrenia (Morgan et al., 2013; Mullen, 2006;
Schanda et al., 2004). A 2009 meta-analysis of 204 studies, covering 166 individual data
sets, showed psychosis to be associated with a 49% to 68% increase in the odds of a crimi-
nal conviction for violence than those without psychosis (Douglas et al., 2009). A system-
atic review of 27 studies reported a significant increase in the risk of reoffending in those
with psychosis than those without psychosis, but no association in comparison with people
with psychiatric disorders other than psychosis (Fazel & yu, 2011). Skeem et al. (2016),
using data from the MacArthur Violence Risk Assessment study, showed that 12% of vio-
lent incidents were immediately preceded by psychosis (Skeem et al., 2016).
More than one third of all convictions of homicides in England and wales from 1996 to
1999 occurred in those with a mental disorder, with 5% having schizophrenia (Shaw et al.,
2006). Almost 9% of all homicides in New Zealand from 1970 to 2000 were associated with
serious mental illness (Simpson et al., 2004), and 8.8% of all homicides in New South
wales (NSw) Australia were found to have been committed during a psychotic episode
between 1993 and 2002 (Nielssen et al., 2007). Another Australian study of 435 people
convicted of homicide reported that schizophrenia was 13 times higher in the homicide
group than the general population (Bennett et al., 2011).
Although the above evidence is compelling, the relationship between psychosis and
offending is more complex and the mechanisms leading to these findings have not been
well articulated by empirical studies. Serious mental illness is associated with an increased
likelihood of having criminogenic factors, such as homelessness, poor social relationships,
being unmarried, unemployment, substance use, poor education, and antisocial behaviors.
Indeed, it has been suggested that, in many instances, mental health symptomology does not
have a direct causal effect on most offending behavior (Peterson et al., 2014). Although
symptoms of mental illness are generally not good predictors of criminal behavior, and are
not as strongly associated with offending as some other criminogenic factors, there is how-
ever a modest association (Bonta et al., 2014). Bonta et al. (2014, p. 278) states that “From
both a risk prediction and a recidivism reduction perspective, symptoms of mental illness
do not appear to play a major role.” Notwithstanding this, explanations of the association
between psychosis and offending include the following: (a) a direct relationship whereby
psychotic symptomology is related to offending (e.g., where hallucinations tell a person to
offend); (b) an indirect relationship in which symptomology has some bearing on offend-
ing, such as depressive symptoms and irritability, causing the person to act aggressively;
and (c) a mediated relationship whereby symptomology is affected by external crimino-
genic factors, such as alcohol and other drugs, causing an individual to offend (Peterson
et al., 2014). There is evidence that treatment in prison significantly delayed the time to
reoffending following release among individuals with schizophrenia (18% reduction;
Igoumenou et al., 2015).
Substance use is also likely to confound the association between mental illness and
offending. A meta-analysis of 20 studies showed that the risk of violent offending in indi-
viduals with psychosis and comorbid substance abuse was similar to that for substance
abuse alone without psychosis (Fazel et al., 2009). However, an Australian study found that
Chowdhury et al. / PSyCHOSIS AND CRIMINAL OFFENDING 159
individuals with schizophrenia without comorbid substance-use disorders were 2 times
more likely to have a violent conviction compared with those who had never been diag-
nosed with schizophrenia (Short et al., 2013). Although the risk of offending among people
with serious mental illness has been reported to be high, evidence suggests that comorbid
substance use can trigger violence in this group. Moreover, Swanson et al. (2015) found that
other risk factors such as substance abuse had a stronger association with gun violence than
mental illness (Swanson et al., 2015).
No population-based study of psychosis and offending has been conducted in NSw,
which the current study aimed to address. Furthermore, whereas much of the evidence has
focused on the association between serious mental illness and violence, less attention has
been given to the relationship with other types of offending. we examined the association
between psychosis and violent and nonviolent offenses in NSw between 2001 and 2015
using data linkage of health and justice administrative data collections. we also investi-
gated the association between criminal convictions and psychosis due to psychoactive
substance use.
method
data sources
we used the de-identified whole of population administrative data linked across several
NSw Health and Justice systems. The NSw Ministry of Health’s Admitted Patient Data
Collection (APDC) includes records for all hospital separations from all NSw public and
private hospitals and day procedure centers. The APDC records include demographic infor-
mation, administrative data, and coded diagnostic information. The NSw Emergency
Department Data Collection (EDDC) provides information about presentations to emer-
gency rooms in public hospitals. we extracted data on diagnosis type (see definition of
psychosis), age at diagnosis, treatment episode start and end dates, gender, Aboriginality
(yes, no, and missing/unknown), marital status (married including de facto, single, and
missing/unknown), date of birth, and statistical local area (SLA) from the APDC and EDDC.
with Aboriginal people significantly overrepresented in the justice system in Australia
(28% of the total Australian population in prison are Aboriginal compared with around 3%
in the general population; Australian Bureau of Statistics, 2019), we included Aboriginality
in the analysis. Aboriginal status is based on any record of endorsement of Aboriginality in
the data for a service contact. “Single” marital status refers to those who are single or wid-
owed or divorced or permanently separated from their partner. The index of relative socio-
economic disadvantage (IRSD) is used to rank the socioeconomic status in each SLA by the
Australian Bureau of Statistics (Australian Bureau of Statistics, 2016). IRSD is one of the
four socioeconomic indexes for areas (SEIFA), which provides scores to rank the socioeco-
nomic status in each geographic area, using data on income, education, employment, occu-
pation, and housing. The lowest rank indicates the most disadvantaged area and the highest
rank the most...
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