Stopping the revolving door: a meta-analysis on the effectiveness of interventions for criminally involved individuals with major mental disorders

Faced with high and increasing rates of mental disorder within the criminal justice system (CJS), a range of interventions have been implemented in an effort to prevent continued involvement in criminal activities among this population. A meta-analytic review was undertaken to consider the effectiveness of interventions for criminally involved adults with a mental disorder targeting either improved criminal justice or mental health outcomes. Furthermore, characteristics that were hypothesized to predict better outcomes were examined. Studies that considered sex offender interventions, or focused solely on antisocial personality, intellectual and cognitive, or substance use disorders were excluded. Results assuming a fixed-effects model combining 37 effect sizes from 25 studies (N = 15,678) support the effectiveness of these interventions in terms of reductions in any CJS involvement (d = 0.19 excluding one outlier). Interventions had no significant effect on an aggregate mental health outcome (d = 0.00). However, when considering distinct mental health outcomes, intervention participants had significantly better functioning (d = 0.20) and fewer symptoms (d = 0.12). There were no significant effects of the interventions on mental health service or medication use. Moderator analyses identified seven sample, intervention, and design characteristics that were related to the magnitude of the effect sizes for criminal justice outcomes, and suggest implications for service provision, policy, and research. Results suggested some relationship between intervention effects on mental health and criminal justice reinvolvement, although future research is needed in this area, especially given the absence of mental health outcome data in many studies.     

Designing Programming and Interventions for Women in the Criminal Justice System

Women are the fastest growing segment of the criminal justice population, yet the majority of research on criminal justice populations has been focused on men. Programming and interventions that reduce women’s involvement in the criminal justice system and ameliorate the negative consequences associated with criminal justice involvement are urgently needed. The overall aim of this paper is to provide a comprehensive framework for developing evidence-based, gender-specific programming and interventions to reduce criminal justice involvement and its associated consequences among women in the criminal justice system. The first section of the paper offers a conceptually guided review of the three primary factors that facilitate and complicate women’s involvement in the criminal justice system: victimization; mental disorders; and substance use. In the second section of the paper, findings from focus groups conducted with women on probation or parole identify strategies to engage this population in psychosocial interventions. The third and final section of the paper provides comprehensive recommendations for designing programming and interventions for women in the criminal justice system.     

Toward undergraduate education in the interface of mental health and criminal justice

The relationship between the mental health and criminal justice systems is a controversial one and of growing importance. Formal education in the interface of mental health and criminal justice is a prerequisite to progress in this area. While some educational opportunities are currently available on the graduate and post-graduate levels, there appears to be no reason for this restriction. The present paper describes an undergraduate course on the interface of mental health and criminal justice, and analyzes its contribution to the field in terms of priming future graduate and law students for specializing in this area.     

Treating offenders with mental illness: a research synthesis

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.     

Interventions with women offenders: a systematic review and meta-analysis of mental health gain

Currently, a conjunction of policy, legislative change in health and social care and the criminal justice system, combined with funding for innovative services make it opportune to assess the evidence base for interventions with women offenders. Women offenders have a distinctive criminological, health and social profile and a gender specific approach to their difficulties is advocated. This systematic review and meta-analysis focus on mental health gain in adult women offenders in forensic health settings, criminal justice institutions and in the community, following therapeutic interventions. Interventions were assessed in terms of specific outcome measures of depression, trauma symptomatology and global mental health status. Comprehensive search strategies yielded 3018 articles, from which we obtained 199 full text articles. Seventeen articles were included in the final review, of which six were excluded from the meta-analysis as there was no comparator group. There is a modest, but increasing, body of evidence for the utility of some interventions, notably those addressing the consequences of earlier trauma, including interventions which also address comorbid substance misuse. This does not amount, to date, to a robust evidence base. Limitations of these studies are discussed and include small sample sizes, their restriction mainly to prison populations and that they were substantially undertaken in the US. Variations in outcome measures follow-up and the difficulties inherent in measuring change in this complex population are also detailed. However, the review delineates definite avenues for further work. To achieve this, those responsible for policy, practice and purchase of services should both be mindful of existing evidence and promote additional, high quality research into interventions which are designed around a coherent, theoretical approach.     

The social,relational and mental health characteristics of justice-involved men in the south-west England

The aim of this article is to describe the social, relational and mental health characteristics of a sample of offenders serving prison or community sentences in the south-west England. About 100 adult male offenders were screened for anxiety and depressive disorders, post-traumatic stress disorder (PTSD), drug and alcohol dependence, and likely personality disorder using validated instruments. Fifty-eight per cent of the sample reported at least one common mental health problem, of these only 26% reported receiving treatment. Participants exposed to traumatic events and/or participants with past mental health problems were more likely to score positive for current common mental health problems. Our study identified factors that may increase the risk of a first episode or recurrent anxiety and/or depression for offenders. Health and criminal justice services should create partnerships and develop interventions that address the risk factors which lead and/or contribute to offenders' mental health difficulties.     

A qualitative exploration of the experience of restorative approaches in a forensic mental health setting

Restorative justice (RJ) is an intervention gaining worldwide recognition in criminal justice systems and other settings. There is a growing evidence base demonstrating positive outcomes in a number of domains, but we found no previous research focussed upon the use of RJ in a forensic mental health setting. This study used a constructivist grounded theory analysis of semi-structured interviews to explore and develop a deeper understanding of RJ practices interventions in such a setting. Ten participants including RJ facilitators, patients and mental health staff took part in research interviews. Restorative interventions were found to be congruent with models of mental health and offender recovery. Processing emotions, developing thinking and coherent narrative, and immediacy are found to be key components of the intervention. The emergent model highlights the role of containment and a high level of facilitator skill when working with a complex, vulnerable and potentially unstable client group.     

Perceived criteria used by criminal justice and mental health professionals to predict dangerous behavior of mentally ill persons

A group of 163 Colorado mental health and criminal justice professionals were asked to rate the effectiveness of a set of predictors of violent behavior for mentally ill persons. Violent behavior and the characteristics of the offense were rated highest, followed by mental health and social factors respectively. Little variation existed between mental health and criminal justice groups with respect to which predictors were perceived as important. The rankings of the dangerous behavior predictors by criminal justice and mental health workers were highly correlated, suggesting agreement between the groups. A moderate correlation was found for the rankings of mental illness predictors. These factors were similar to those identified in previous research. Both groups perceived their predictors to be accurate.     

A model process for forensic mental health screening and evaluation

This article describes an operational definition and a model process for forensic mental health examinations developed on the bases of field research, reviews of literature and other documentary materials, and a survey of forensic mental health programs. Forensic mental health screening and evaluation is defined as the process conducted by mental health personnel, at the direction of criminal justice authorities, for the purposes of delineating, acquiring, and providing information about the mental condition of client-offenders that is useful in decision making in the criminal justice system. The proposed model encompasses 14 pragmatically oriented steps within three major structural components of the examination process—delineation, acquisition, and provision—in a manner that places the entire process in the functional context of the criminal justice and mental health systems. The definition and model are aimed at practitioners, program evaluators, and policy makers to be used as a starting point for the establishment of standards against which the practices and policies relating to forensic mental health screening and evaluation can be compared and improved.The preparation of this article was supported in part by a grant (No. 79-NI-AX-0070) by the National Institute of Justice. The views expressed are those of the author and do not necessarily reflect the positions of the National Institute of Justice or the National Center for State Courts. The author thanks his colleagues for their assistance and advice during the study upon which this article is based, as well their critical reviews of earlier documents related to this work. The comments and suggestions of Amiran Elwork and an anonymous reviewer are also gratefully acknowledged.     

Correctional Policy for Offenders with Mental Illness: Creating a New Paradigm for Recidivism Reduction

Offenders with mental illness have attracted substantial attention over the recent years, given their prevalence and poor outcomes. A number of interventions have been developed for this population (e.g., mental health courts). They share an emphasis on one dimension as the source of the problem: mental illness. Their focus on psychiatric services may poorly match the policy goal of reducing recidivism. In this article, we use research to evaluate (a) the effectiveness of current interventions, and (b) the larger viability of psychiatric, criminological, and social psychological models of the link between mental illness and criminal justice involvement. We integrate theory and research to offer a multidimensional conceptual framework that may guide further research and the development of efficient interventions that meaningfully reduce recidivism. We hypothesize that the effect of mental illness on criminal behavior reflects moderated mediation (i.e., the effect is direct in the case of one subgroup, but fully mediated in another); and that the effect of mental illness on other “recidivism” is partially mediated by system bias and stigma. We use this framework to propose three priorities for advancing research, articulating policy, and improving practice.     

Integrating the American criminal justice and mental health service systems to focus on victimization

Although most research and policy in the mental health and criminal justice arenas have operated independently of one another, there is a growing consensus suggesting the need for an integration of these two disparate, yet complementary systems. Furthermore, in light of the adverse mental health consequences that often accompany victimization experiences, it is apparent that these two systems should develop and foster overlapping services for crime victims. The research reviewed herein provides an examination of issues such as these, identifies some of the barriers that stand in the way of a successful integration of the two systems, and attempts to provide some guidance and direction for future integrated mental health and criminal justice system approaches. An outline of research gaps and directions for future study are offered for the integration of criminal justice and mental health systems, as such collaborations are likely to alleviate some of the deleterious mental health outcomes evident among crime victims and at the same time reduce the occurrence of repeat victimization.     

Demographic and clinical characteristics of 1092 consecutive police custody mental health referrals

The 43 police forces in England and Wales have made over 13 million arrests in the last decade. Yet, despite this high volume criminal justice system activity, and evidence of substantial health morbidity across the criminal justice pathway, mental health services in police custody have only been patchily developed, and the literature in this area is limited. Referrals (n = 1092) to a pilot mental health service operating across two police stations in a London borough were examined over an 18-month period in 2012/2013. The referred group had high levels of mental health and substance misuse problems (including acute mental illness, intoxication and withdrawal), self-harm, suicide risk and vulnerability (including intellectual disability), with some important gender differences. Although this work has limitations, the findings are broadly consistent with the small existing literature and they confirm the need for services that are sufficiently resourced to meet the presenting needs.     

Recognition and understanding of goals and roles: The key internal features of mental health court teams

The increasing involvement of people with mental illness in the criminal justice system has led to the formation of specialty programs such as mental health courts (hereafter MHCs). We discuss MHCs and the teams serving these courts. Specifically, we examine team members' perceptions of MHC goals and their own and others' roles on the MHC team. Using a semi-structured interview instrument, we conducted 59 face-to-face interviews with criminal justice and mental health treatment personnel representing 11 Ohio MHCs. Findings from our qualitative data analyses reveal that MHC personnel understand individuals' roles within the teams, recognize and appreciate the importance of different roles, and share common goals. MHCs could foster this level of understanding and agreement by working to recruit and retain individuals with experience in or willingness to learn about both the criminal justice and mental health systems. Future research should explore the impact of MHC team functioning on client outcomes.     

Information pathways into prison mental health care

Police and court liaison and diversion services provide important specialist mental health input along critical stages of the criminal justice pathway. Effective sharing of information between the services and relevant justice agencies is essential. However, various problems exist with the flow of information between agencies and services across the criminal justice pathway. This service evaluation explored how clinically relevant information is transferred, by drawing on the perspectives of prison health care staff in a large urban UK male prison. A qualitative service evaluation was conducted using semi-structured interviews with a purposive sample of 11 prison staff. The main themes included: gaps in the transfer of essential information, (particularly concerning risk and offending information); information gathering to fill these gaps; the importance of professional relationships, information sharing between agencies; and information solutions. Improving information transfer across the criminal justice pathway could prevent treatment delays and ensure more timely mental health care in prison.     

Short-term outcomes for offenders with mental illness released from incarceration

Using data on 247 offenders with mental illness, this analysis seeks to identify characteristics that distinguish those who are returned to prison or a psychiatric hospital with those who remain in the community. Sociodemographic, mental health, criminal history, and service variables are compared across a range of outcome categories with a focus on those reinstitutionalized and those reincarcerated. Those returning to institutions have somewhat different mental health service and criminal justice histories than the engaged/community group. In particular, the group that is reincarcerated is more likely released from misdemeanor sentences, and the group being released from felony sentences is more likely to be found in a psychiatric hospital after release from correctional custody. These findings have implications regarding the cumulative effects of engagement with the criminal justice system and the process through which persons with mental illness and a criminal history cycle through institutions.     

A quasi-experimental test of the effects of criminal justice involvement on later mental health

Objectives

While many criminological theories posit causal hypotheses, many studies fail to use methods that adequately address the three criteria of causality. This is particularly important when assessing the impact of criminal justice involvement on later outcomes. Due to practical and ethical concerns, it is challenging to randomize criminal sanctions, so quasi-experimental methods such as propensity score matching are often used to approximate a randomized design. Based on longitudinal data from the Cambridge Study in Delinquent Development, the current study used propensity score matching to investigate the extent to which convictions and/or incarcerations in the first two decades of life were related to adverse mental health during middle adulthood.

Methods

Propensity scores were utilized to match those with and without criminal justice involvement on a wide range of risk factors for offending.

Results

The results indicated that there were no significant differences in mental health between those involved in the criminal justice system and those without such involvement.

Conclusions

The results did not detect a relationship between justice system involvement and later mental health suggesting that the consequences of criminal justice involvement may only be limited to certain domains.

     

Mental health, gender, and drug court completion

Drug-involved offenders report high rates of mental health problems that can negatively impact criminal justice outcomes. Yet, relatively little attention has been given to the mental health issues of drug court offenders. Therefore, this study examined 449 participants in a Delaware drug court and investigated relationships between mental health, gender, and program completion. Bivariate results indicated that gender was related to both mental health status and completion status. Multivariate findings revealed that two indicators of mental health, depression and being prescribed drugs for a psychological or emotional problem, were significant predictors of drug court completion. Policy implications include assessing the mental health status of all drug court participants at program entry so that services can be provided which aim to improve offender health and increase the likelihood of successful program outcomes. Drug courts must better meet the needs of participants with co-occurring disorders if they are to remain an effective and viable criminal justice intervention. This research was supported by grant RO1 DA12424 “Drug Court Offenders in Outpatient Treatment,” by the National Institute on Drug Abuse.     

THE INFLUENCE OF EARLY SCHOOL PUNISHMENT AND THERAPY/MEDICATION ON SOCIAL CONTROL EXPERIENCES DURING YOUNG ADULTHOOD

The use of suspensions and expulsions by American public school administrators has increased dramatically over the past 40 years. Meanwhile, a growing number of childhood misbehaviors have been diagnosed by doctors as medical conditions and are being treated with therapy or medication. As these trends develop at different rates for boys of different racial and ethnic groups, the connection between childhood and adult social control remains untested empirically. By using a prospective panel of 3,274 White, Black, and Hispanic males (15,675 person‐years) and multilevel logistic models, I examine whether and how school punishment and/or the use of therapy or medication during childhood contributes to involvement in the criminal justice or mental health systems during young adulthood. The findings suggest that school punishment is associated with greater odds of involvement in the criminal justice system but not the mental health system. The use of therapy and/or medication during childhood is associated with higher odds of involvement in the mental health system but not the criminal justice system. Finally, although the relationship between school punishment and involvement with the criminal justice system is similar for White, Black, and Hispanic men, the relationship between medicalized social control during childhood and young adulthood is stronger for Whites than for non‐Whites.     

REEVALUATING THE CUSTODY-THERAPY CONFLICT PARADIGM IN CORRECTIONAL MENTAL HEALTH SETTINGS*

It has become almost axiomatic in sociological analyses of interactions between mental health and criminal justice personnel that their respective ideologies are inherently contradictory and produce conflict within organizations in which both groups are working. Because key components of the mental health system have changed dramatically since the seminal research in this area was conducted and because these concepts were never tested in certain criminal justice organizations, many commonly accepted generalizations about custody-therapy conflicts warrant new examination. Interview and questionnaire data from a national sample of 43 county jails with mental health programs were analyzed. In contrast to earlier research, fundamental conflicts between mental health and correctional staff were not frequent. Rather, Pondy's concept of frictional Conflicts, which are not fundamental to either individual interactions or organizational operations, were more typical. Jails, as short-term people-processing organizations, cannot be assumed to fit organizational research results generated from state prisons.     

A mixed methods study of the mental health and criminal justice histories of missing persons

Approximately 35,000 people are reported missing each year in Australia; rates elsewhere are even higher, with a recent UK study suggesting that a person goes missing every 2 min. Missing persons place a significant burden on police services; it is interesting, therefore, that very little research attention has been paid to this topic. This mixed methods study aimed to address this significant gap by analysing the mental health and criminal justice histories of a sample of missing persons and comparing them to rates in the general community. The study found that both mental health and criminal justice histories were significantly overrepresented among missing persons compared to those in the general community, and that young people reported missing commonly displayed suicidal behaviour. Results highlight at risk groups and suggest that criminality is much more commonly implicated in missing person incidents than previously thought.