Former inmates given psychotropic drugs significantly less likely to violently reoffend, study finds

The Oxford University study explores the role untreated psychological illness can play in violent crime.

A study released today in JAMA compares time periods in which former inmates were prescribed psychotropic drugs for mental illness and periods in which they were not given these medications. In total, 22,275 released prisoners in Sweden were included in the study. Researchers found significant reductions in violent reoffending during medicated periods: a 42 percent reduction with antipsychotics, 38 percent with psychostimulants, and 52 percent with drugs for addictive disorders. Seena Fazel, a doctor from the University of Oxford and the study’s lead author, told us what impact his findings could have on the criminal justice system.

ResearchGate: Could you explain the significance of the findings of your research?

Seena Fazel: Many criminal justice agencies have focused on psychosocial therapies as part of rehabilitation programs for prisoners, some of which extend into the community on release. What our study shows is that three major classes of psychotropic medication are associated with reductions in violent reoffending. This is important insofar as it suggests that the effects of these medications go beyond relief from symptoms and into reducing the risks of real-world adverse outcomes. As the study cannot prove causality, triangulation with other designs is required, and in particular trials.

RG: What prompted you to look into the impact psychotropic drugs have on criminal reoffending?

Fazel: A striking finding is that reoffending rates have not decreased despite reductions in crime in the general population. And they remain very high – more than a third of prisoners are re-convicted within two years of release in the US and the UK, for example.

RG: You mention that most individuals who could benefit from psychotropic treatment do not receive it after prison release. Why is this the case?

Fazel: Ensuring links with community health and addiction services is difficult as many prisoners move to new areas or lose contact with their previous healthcare providers. In addition, surveys of US prisoners have shown that around a third of those with severe mental illnesses (such as schizophrenia or bipolar disorder) do not receive medication while they are in prison.

RG: Do you believe that there is a problem with incarcerating people who have psychological disorders? What alternatives could be valid?

Fazel: Different jurisdictions will have various legal approaches to this issue, and what criteria need to be met for an individual to be diverted to a secure hospital (instead of prison). It is difficult to make any clear statement about this due to the very different legal traditions involved. As for alternatives, some have argued that community sentences should be considered in individuals who represent low risk of serious reoffending – I don't have a view if this should be specific to subgroups.

RG: What are the next steps in this research?

Fazel: One is to understand whether this association is causal or explained by other factors. Another is to figure out how to improve the identification of mental illness in prisoners, links to community health and addiction services, and adherence to medication on release.

Another important next step is to develop scaleable and accurate methods to predict reoffending risk as a way to leverage community treatments and target resources at those with the highest risk. The same team has been involved in developing one such approach in Sweden, which uses an online risk calculator and is free to use.

Image courtesy of Dave Nakayama.