Can a Case be Made for Developing Specialist Forensic Geriatric Psychiatry Services?

• Author: Ajit Shah
• Position: Professor of Ageing, Ethnicity and Mental Health, University of Central Lancashire, Preston, United Kingdom and Consultant Psychiatrist, West London Mental Health NHS Trust, London, United Kingdom
• Pages: 1-5

The Open Law Journal, 2008, 1, 1-5 1

1874-950X/08 2008 Bentham Open

Open Access

Can a Case be Made for Developing Specialist Forensic Geriatric

Psychiatry Services?

Ajit Shah*

Professor of Ageing, Ethnicity and Mental Health, University of Central Lancashire, Preston, United Kingdom and

Consultant Psychiatrist, West London Mental Health NHS Trust, London, United Kingdom

Abstract: The proportion of elderly in the general population is increasing worldwide. Although society may view elderly

offenders leniently, crimes rates among the elderly are increasing in several countries. Elderly offenders have a high

prevelance of psychiatric morbidity, which is often undetected and untreated. A number of potential risk factors are

identified from the literatutre. Specialist tertiary forensic geriatric psychiatry services are suggested to meet the psychiatric

needs of this very vulnerable group of patients.

INTRODUC TION

Traditionally, crime rates in elderly were thought to be

very low (Taylor and Parrot, 1988; Barak et al., 1995;

Jacoby, 1997). Crime committed by the elderly may not be

detected or reported and there may reluctance to prosecute

the elderly (Lynch, 1988; Needham-Bennett et al., 1996;

Nnatu et al., 2005).

WHY IS THE REPORTED CRIME RATES LOW IN

THE ELDER LY?

Society may view elderly offenders leniently, particularly

if they are unwell (Lynch, 1988; Kratcoski, 1990; Needham-

Bennett et al., 1996; Nnatu et al., 2005); although this may

be unlikely for more serious crimes (Kratcoski, 1990). The

police or the public prosecutor may not take further action if

there is denial of intent and unclear or unreliable admission

of the alleged offence, or if there is evidence of mental

illness (Needham-Bennett et al., 1996). The police may

serve a caution rather than prosecute based on their

perception of the attitude of the alleged offender and if there

is no previous offending history (Needham-Bennett et al.,

1996). Furthermore, families may chose to hide deviant

behaviour conducted by the elderly (Amir and Bergman,

1973). Nevertheless, the low reported crime rate in the

elderly may also be genuine because: physical change may

prevent involvement in activities demanding stamina and

physical effort; passivity, rigidity, inertia and conservatism

may inhibit risk-taking behaviour; and, withdrawal from

social contact may reduce temptation and opportunity to

commit crime (Amir and Bergman, 1973).

ARE CRIME RATES INCREASING IN THE

ELDERLY?

The mean age of federal prisoners in the United States

(US) is increasing (Koenig et al., 1995). The number of

*Address correspondence to this author at the John Connolly Unit, West

London Mental Health NHS Trust, Uxbridge Road, Southall, Middlesex

UB1 3EU, United Kingdom; Tel: 0208 354 8191; Fax: 0208 354 8898; E-

mail: ajit.shah@wlm ht.nhs.uk

convictions and the proportion of total criminal activity has

increased among those aged 60 years and older in England in

recent years (Fazel and Jacoby, 2002). The proportion of

those aged 60 years and over in prisons increased from 1.3%

to 2.4% between 1992 and 2002 in England (Home Office,

2002); this included an increase in sex offenders from 25.9%

to 38.1% between 1990 and 1999 (Home Office, 2000).

These figures are increasing more rapidly than those for the

general prison population (Tomar et al., 2005). A similar

trends has been observed in the US and Canada (Fazel et al.,

2001a; Fazel and Grann, 2002).

HOW COMMON ARE MENTAL DISORDERS IN

ELDERLY OFFENDERS?

Studies of psychiatric disorders among elderly offenders

have emerged from several countries including England and

Wales, United States, Canada, Sweden and Israel in a range

of settings. The offences or alleged offences studied include

fatal and non-fatal violent offences, arson, sexual offences,

acquisitive offences (e.g. theft), damage to property, drug

and alcohol-related offences, and driving offences. In some

studies cited below, because of comorbid psychiatric

disorders, some individuals had more than one diagnosis.

1. Offenders in the Community

The prevalence of psychiatric disorders among alleged

offenders aged 60 years and over in the community in an

English county was 28% (Needham-Bennett et al., 1996);

the prevalence of psychiatric disorders in a sub-sample of

shop-lifters was 38%, with depression and organic brain

syndromes being the most prevalent diagnosis. In the same

study, 77% of those with psychiatric disorder were shop-

lifters - most had history of previous offending.

2. Offenders Referred for Forensic Psychiatric

Evaluation by the Courts and Other Sources

The prevalence of psychiatric disorders among first-time

offenders aged 65 years and over, referred for forensic

psychiatry evaluation, in Israel was 50% (Barak et al., 1995);

the most prevalent diagnosis were dementia (21%) and

personality disorders (18%). The prevalence of psychiatric