Editorial: NM leaders should explore science onteen recidivism
In 1995, the Wisconsin Legislature established a program to study and, ideally, cut recidivism among the toughest of its youthful oﬀenders – those who had committed homicide. Of the group of 200 that was given a year of specially designed therapeutic exercises and games, as well as designated ways to consider the consequences of their actions, not one resorted to homicide again. Eight percent of the Wisconsin group’s untreated peers did kill again.
Now consider that:
New Mexico has had more than its share of violent teens who have shot, stabbed or run over their parents, their grandparents, people they robbed, people they passed on the street, classmates and neighbors.
Researchers from New Mexico’s Mind Research Network have pinpointed with an 81 percent degree of accuracy diﬀerences in MRI brain scans of adolescent killers when compared to those who have not taken a life – reduced gray matter in the deep regions that process emotions and regulate impulses, suggesting delayed development,
For every $10,000 a state invests in a Wisconsin-like program, it saves an estimated $70,000 over four years – in addition to the lives spared.
Kent Kiehl, a professor of psychology, neuroscience and law at the University of New Mexico, the executive science oﬃcer at the Mind Research Network and the lead author of “Abnormal Brain Structure in Youth Who Commit Homicide,” is hopeful this science will help drive programs like Wisconsin’s that intercede in children’s lives and reduce or even prevent violent crimes.
If the Wisconsin example proves nothing else, it’s that it is possible to not only save public money but reduce human suﬀering among potential victims and assailants. It’s an equation New Mexico’s leaders in the Legislature and Governor’s Oﬃce should explore.
This editorial ﬁrst appeared in the Albuquerque Journal. It was written by members of the editorial board and is unsigned as it represents the opinion of the newspaper rather than the writers. PUBLISHED: Friday, June 27, 2014 at 12:05 am
Doctors Can Save Lives- a commentary on Richard Friedman.
Richard Friedman recently wrote a NT Times opinion piece (http://nyti.ms/1mBHLMo) that stated “Mass killers like Elliot Rodger teach society all the wrong lessons about the connection between violence, mental illness and guns — and what we should do about it. One of the biggest misconceptions, pushed by our commentators and politicians, is that we can prevent these tragedies if we improve our mental health care system. It is a comforting notion, but nothing could be further from the truth.”
This statement appears to be at odds with the peer-reviewed literature on violence and mental illness from around the world. Studies have shown the relative rate of homicide committed by untreated patients with serious mental illness is 1 in 629 presentations. In other words, patients with severe mental illness are 40x more likely to commit a homicide than the average North American – where the risk of homicide is 1 in 25,000. The risk for violence, either homicide or suicide, is greatest in the mentally ill patients when they are young; most likely due to the stress and lack of insight associated with the initial fragmentation of mental activity that accompanies early phases of the illnesses.
Critically, studies have shown that the risk for homicide committed by patients with mental illness can be decreased to 1 in 9090 if the patient receives good mental health care. This is a 20 fold reduction in homicidal violence committed by patients with mental health disorders if they get good treatment. In my opinion there is no more compelling reason supporting the argument for early intervention and treatment for patients with mental illness. Unfortunately the latter results only apply to countries that have addressed the issue of mental health and violence head on. I hope policy makers (and doctors) in the United States will someday modernize mental health care and help to address this problem or it will only be a matter of time before the next mass shooting occurs.
It is important to note that Friedman correctly asserts that patients with severe mental illness only account for a small percentage (about 4%) of homicides. This is a relatively small proportion of all homicides, but in my view these homicides are preventable if we act to implement reforms to our mental health system. Moreover, there is no better way to correct the misguided notion that all patients with mental illness are violent than to eliminate such behavior in patients by developing interventions and treatment that cure violence.
With respect to the other 96% of homicides, I think we can do something about that as well. As a forensic neuroscientist I have been studying how treatment changes the brains of high-risk youth and adults in prison settings. A program in Wisconsin, created thru a revision in the mental health policy agenda about 10 years ago, has shown that high-risk incarcerated youth who complete intensive state-of-the-art treatment for behavioral problems are 50% less likely to violently re-offend than their untreated peers in the prison system. Moreover, the 100+ untreated youth who were followed up on release from prison killed 16 people in four years – 16 people died violently at the hands of these untreated youth. The treated youth killed no one in the four years post release.
Mental health treatment can reduce violence.
Do we need more reasons to change our mental health system?
Well, what about the fact that Wisconsin’s mental health treatment of high-risk youth saves money? Peer-reviewed published economic studies show that for every $10,000 the state of Wisconsin invested into the Mendota Juvenile Treatment Center they returned a cost savings of $70,000 in four years. The treated kids did not commit homicides upon release back into the community. They did not incur police costs for investigating murders, prosecution costs for trials, or incarceration costs for long prison sentences. The rate of return on the Wisconsin’s investment is many times the rate of return on a similar investment in SNP500 companies over the same period of time!
I am happy to say that Dr. Friedman is frankly wrong. Doctors in Wisconsin, and around the world, know that we can reduce violence and homicides in high-risk individuals – if we just provide the right mental health care.
Dr. Kent Kiehl has authored over 140 peer-review papers on neuroscience of forensic populations and the recent book The Psychopath Whisperer: The Science of Those Without Conscience (Crown Press). He is Professor of Psychology, Neuroscience and Law at the University of New Mexico and an Executive Science Officer of the non-profit Mind Research Network in Albuquerque, New Mexico.
Other sources: A Different Perspective on the UCSB Mass Murderer Mary O’Toole, PhD, Senior FBI Profiler/Criminal Investigative Analyst (ret.), Behavioral Analysis Unit.
CNN did an article (03.26.14) on moral decision-making – citing a few of our favorite scientists in the field of psychopathy. http://www.cnn.com/2014/03/26/health/brain-moral-judgments/index.html?hpt=hp_c2
The article raises a number of important issues, but one central to our field is:
“Are psychopaths impaired in their ability to make moral decisions?”
The short answer to this question is:
There is ample evidence that psychopaths, compared to the rest of us, commit more moral wrongs in all domains of life. Psychopaths are more likely than the rest of us to commit criminal behavior, to be unfaithful to our wives, to cheat on taxes, to not pay bills, to borrow money from friends and family and never pay it back, to cheat on tests in school, and to steal from employers – all moral wrongs. Thus, to an observer, psychopaths have serious problems making appropriate moral decisions and it makes sense then that psychopath’s moral abilities must be impaired.
However, when you get a psychopath into the laboratory (always be careful with them in such settings J) they appear to pass moral decision-making tasks that scientists give them. That is, when you ask a psychopath if a picture depicts a moral wrong, they get the answer right most of the time. When you ask a psychopath to decide if a vignette depicts a moral violation – they get it right.
Thus, psychopaths present with a conundrum: They appear to know how to act morally, but they just don’t act that way in the real world.
How might we resolve this problem?
The answer may lie in some of the latest neuroscience of moral decision-making. Studies using brain imaging show that moral decision-making includes both cognitive AND emotional regions of the brain.
Studies have shown that when most of us are faced with making an important moral decision, the decision process activates emotional systems in the brain in addition to cognitive systems. These emotional brain systems help to make sure we are paying attention to the importance of the decision before us.
Recent forensic studies show that these emotional brain regions are not working properly in psychopaths. Some scientists have said that psychopaths ‘know the words but not the music’. That is, psychopaths understand that they are making a decision, but the emotion associated with making that moral decision is lost upon them.
A study from my laboratory, lead by Dr. Carla Harenski, found that criminal psychopaths had deficits in the amygdala and orbital frontal cortex when processing moral pictures. The amygdala and orbital frontal cortex are critical brain regions associated with emotional processing. http://www.ncbi.nlm.nih.gov/pubmed/21090881
So, whereas psychopaths appear to be able to make moral decisions in the laboratory, the emotional systems that help govern behavior in the real world are impaired. For more details on this issue, read ‘The Psychopath Whisperer: The science of those without conscience,” a book available for pre-order on Amazon today (delivery 4/22/14).