Treatment general considerations

If a clearly identified mental illness appears directly related to the offending behaviour, the prognosis could be good for both the illness and the offending behaviour. For example, a man with schizophrenia who smashes up a television shop because he believes it is transmitting harmful rays will be unlikely to repeat this behaviour if his delusions resolve with treatment. However, mental disorder may coexist with offending behaviour without being a significant causative factor, so that treatment of the disorder has little impact on the behaviour.

Substance misuse is very common among offenders. If, for example, a chronic alcoholic can be rehabilitated, he will be less likely to commit drunkenness and public order offences. Many prisons run AA groups for this reason. However, it is not always appropriate to remove a person from the criminal justice system on the grounds of substance misuse alone. Motivation to stop substance misuse may appear higher before an impending court appearance than later proves to be the case.

Psychological or behavioural treatments have been tried, irrespective of the presence or absence of mental disorder, for a variety of habitual offenders, such as those convicted of car theft, 'road rage', and assault. Few if any of these treatments have been shown to be effective in randomized, controlled trials, and they tend to be regarded cautiously by psychiatrists. If they are to be provided, prison psychology services, probation, or social services are the best source.

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