Treating Offenders With Mental Illness: A Research Synthesis

Texas Tech University, Lubbock, Texas, USA.
Law and Human Behavior (Impact Factor: 2.16). 02/2012; 36(1):37-50. DOI: 10.1037/h0093964
Source: PubMed


The purpose of this research synthesis was to examine treatment effects across studies of the service providers to offenders with mental illness. Meta-analytic techniques were applied to 26 empirical studies obtained from a review of 12,154 research documents. Outcomes of interest in this review included measures of both psychiatric and criminal functioning. Although meta-analytic results are based on a small sample of available studies, results suggest interventions with offenders with mental illness effectively reduced symptoms of distress, improving offender's ability to cope with their problems, and resulted in improved behavioral markers including institutional adjustment and behavioral functioning. Furthermore, interventions specifically designed to meet the psychiatric and criminal justice needs of offenders with mental illness have shown to produce significant reductions in psychiatric and criminal recidivism. Finally, this review highlighted admission policies and treatment strategies (e.g., use of homework), which produced the most positive benefits. Results of this research synthesis are directly relevant for service providers in both criminal justice and mental health systems (e.g., psychiatric hospitals) as well as community settings by informing treatment strategies for the first time, which are based on empirical evidence. In addition, the implications of these results to policy makers tasked with the responsibility of designating services for this special needs population are highlighted.

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Available from: David B Flora
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    • "Thus, although we know the use of intensive (Bourgon & Armstrong, 2005; Wormith & Olver, 2002) and empathic human services that rely on a therapeutic alliance (see Andrews & Bonta, 2010; gendreau, 1996b) improve outcomes for offenders without mental illness, we have not examined whether these same principles hold true for OMI. Similarly, using cognitive-behavioral therapeutic strategies (e.g., cognitive and modeling strategies; gendreau, 1996a, 1996b) that are grounded in social learning theory (see, for example, Andrews & Bonta, 2010), implement structure (Leak, 1980; Morgan & Flora, 2002), and integrate out of treatment homework exercises (Morgan & Flora, 2002; Morgan, Flora, et al., 2012) have proven to be effective practices for nonmentally ill offenders, but we do not know whether these practices prove equally effective with OMI. Similarly, Illness Management and Recovery (IMR; Mueser & MacKain, 2005) is an evidence-based practice for individuals suffering from severe and persistent mental illnesses; however, it has not been demonstrated that standard treatment approaches for severe mental illness alone are effective interventions for OMI because these approaches do not typically target issues which have been shown to be related to criminal behavior, such as criminal thinking styles and attitudes (see Andrews & Bonta, 2010). "
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    ABSTRACT: In this article, we present the results of a preliminary evaluation of a comprehensive treatment program specifically designed to treat co-occurring issues of mental illness and criminal risk in persons with mental illness (PMI) that are criminal justice involved. Participants include 47 incarcerated male PMI in a secure psychiatric prison or a residential treatment facility. Of the 47 participants, 31 (66%) completed the program, attended 94% of all sessions, completed 83% of assigned homework, and actively participated in treatment sessions as evidenced by participation ratings. Change was examined using a four-tiered assessment strategy, including pre–post significance testing, magnitude of effect sizes, clinical cutoffs, and reliable change indices. Results showed evidence of strong therapeutic alliance and treatment program satisfaction, as well as symptom reduction and some evidence for reduced criminal thinking. Program modifications and implications for enhancing service delivery to justice involved PMI are discussed.
    Full-text · Article · Jul 2014 · Criminal Justice and Behavior
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    • "Similarly, Skeem et al. (2011) reviewed exemplary studies of first generation interventions and found no relationship between the reduction of symptoms of mental illnesses and reduced recidivism across the interventions. Morgan et al. (2011), however, in a meta-analysis of 26 studies (with minimal overlap with Martin et al.) found that psychological interventions effectively reduced mental health symptoms, as well as preliminary evidence for reduced criminal and psychiatric recidivism. Given that these first generation interventions are largely focused on the goal of increased mental health treatment through standard (e.g., intensive case management, assertive community treatment (ACT)) or forensically-enhanced community-based interventions (e.g., forensic intensive case management or forensic assertive community treatment (FACT)) as a means of reducing criminal justice involvement , these reviews shed considerable doubt on the assumption that treating the symptoms of mental illness will address the tendency of individuals with serious mental illnesses to engage in illegal or antisocial behaviors. "
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    ABSTRACT: Specialized interventions, such as police and jail diversion, mental health courts, specialized probation, forensic assertive community treatment, designed to engage justice-involved persons with serious mental illnesses, have expanded over the past two decades. Some of these "first generation" interventions have demonstrated efficacy and several have earned recognition as evidence-based practices. Yet, overall, they have not appreciably reduced the prevalence of persons with serious mental illnesses involved in the criminal justice system. To understand how to make the next generation of interventions more effective, a survey of a national sample of community-based programs serving these clients was conducted. Surveys were completed on-line by direct service staff affiliated with 85 programs and collected data on the characteristics and needs of the client base; characteristics and challenges associated with difficult-to-engage clients; service needs and obstacles; and recommendations for improving program effectiveness. A sample of the survey participants (19 programs from 18 states) attended a day-long workshop to discuss the survey findings and ways to improve treatment adherence and client services. Respondents reported that their clients have a constellation of problems with different origins, etiologies, and symptoms, often crossing over the boundaries of mental illness, addictions, and antisocial pathologies. According to the practitioners working with justice-involved clients with mental illnesses, responding effectively requires knowledge of many different problems, expertise to respond to them, and an understanding of how these problems interact when they co-occur. The poly-problems of these clients suggest the need for an integrated and comprehensive approach, which is challenged by the fragmented and diverse ideologies of the behavioral health, criminal justice, and social service systems.
    Full-text · Article · Nov 2012 · International Journal of Law and Psychiatry
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    No preview · Article · Aug 2012 · Social Psychiatry
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