Schizophrenia and offending: area of residence and the impact of social disorganisation and urbanicity

Schizophrenia is the most common of the psychotic disorders and is characterised by fundamental distortions of thought (delusions), perception (hallucinations) and emotional response. It is a disabling illness, with a lifetime population prevalence of 0.5 to 1.7 percent (Jablensky et al. 1992). The estimated one-month treated prevalence of psychotic illness in Australia is 4.7 per 1,000 estimated resident population aged 18–64 years (Jablensky et al. 2000). The place in society and the care of people with severe mental illness such as schizophrenia constitutes one of the thorniest issues in public health and social policy worldwide. In recent years, changes in the management of this disorder have made it possible for an increasing number of individuals with schizophrenia to lead semi-dependent or independent lives in the community. However, irrespective of the deinstitutionalisation of mental health care and the concomitant focus on the human rights of the mentally ill, the capacity of communities and of society at large to deal with emerging problems of marginalisation, homelessness, poverty, victimisation and criminal behaviour has been put to a severe test. This has been compounded by widespread stereotyping and stigmatisation of individuals with mental illness. The 1996 General Social Survey (US) revealed ‘an underlying negative attitude toward persons with mental health problems, an exaggeration of the impairments or “threat” associated with these disorders, and a startling negativity toward individuals with substance dependence problems’ (Pescosolido et al. 1999: 1345). Information on the prevalence of police contact for individuals diagnosed with schizophrenia and other psychiatric disorders is of vital importance for public policy. Resources are available in courts and corrective services to identify and provide support for individuals with mental health problems. However, the adequacy of service levels and their geographic coverage is unknown. There is a corresponding need to identify trends in the demand for services over time. These issues are increasingly important in the context of deinstitutionalisation, with some arguing that inadequate specialist and community support Foreword | It is well-documented that crime rates and the prevalence of mental illness are both higher in areas with pronounced levels of social disorganisation. Far less is known about the association of disadvantaged community conditions with criminal behaviour and mental illness. This study aimed to identify the influence of residential location (characterised by degrees of socioeconomic disadvantage, residential mobility, ethnic heterogeneity and internal inequality) on the prevalence of schizophrenia and incidence of arrests in urban and rural postcode areas of Western Australia between 1985 and 1996. It found that the socio-structural characteristics of an area were related to the incidence of arrest, the prevalence of diagnosed schizophrenia and the incidence of arrest of diagnosed schizophrenics. The results suggest that schizophrenia did not have a multiplier effect on arrest levels but that the same socio-structural characteristics that generated high arrest rates for individuals with schizophrenia also generated high arrest rates for the population as a whole. These findings have important implications for policy and program development in both criminal justice and mental health. They suggest that geographic areas characterised by high levels of social disorganisation require more investment in crime prevention, mental-health services and criminal justice responses.