Risk of Reincarceration Among Prisoners with Co-occurring Severe Mental Illness and Substance Use Disorders

This study examined whether the presence of a comorbid substance use disorder increased the risk of criminal recidivism and reincarceration in prison inmates with a severe mental illness. Our analyses of more than 61,000 Texas prison inmates showed that those with a co-occurring psychiatric and substance use disorder exhibited a substantially higher risk of multiple incarcerations over a 6-year period compared to inmates with psychiatric disorders alone or substance use disorders alone. Further research is needed to identify the factors associated with criminal recidivism among released prisoners with co-occurring disorders.     

Police-registered offenses and psychiatric disorders among young males

OBJECTIVE: To study associations between crime and psychiatric disorders among adolescent males in a representative population-based cohort study. METHOD: The sample includes 2,712 Finnish boys born in 1981. Information on criminality consists of offenses registered in the Finnish National Police Register 1998-2001. Crime was classified according to frequency and type (drug, violent, property, traffic, and drunk driving offenses). Information on psychiatric diagnoses between 1999 and 2004 was collected from the Finnish National Military Register. RESULTS: Of the 2,712 boys, 22% had a crime registration during the 4-year period, and 10% had at least one psychiatric disorder according to the Military Register. Those with psychiatric disorders accounted for 49% of all crimes. Of those with more than five crimes (n = 98), 59% had psychiatric diagnoses. After adjusting for other crime types and childhood socio-economic status, property crime was independently associated with several diagnoses: antisocial personality (APD), substance use (SUD), psychotic, anxiety, and adjustment disorders. Drug offending was independently associated with APD, SUD, and psychotic disorder, and traffic offenses with APD. CONCLUSIONS: Youth crime is predominantly associated with antisocial personality and substance use disorders. Crime prevention efforts should focus on boys showing a risk for antisocial and substance use problems. In particular, property, drug, and repeat offenders need mental health and substance use assessment. There is a need to develop integrated mental health and substance use treatment services for young offenders within or alongside the criminal justice system.     

Substance use,substance use disorders,and comorbidity patterns in a representative sample of incarcerated male Dutch adolescents

The aim of this study was to investigate the prevalence of substance use and substance use disorders (SUDs) among incarcerated boys, and comorbidity patterns and the relationship between SUDs and violent offending and criminal recidivism. The presence of SUDs and other psychiatric disorders was assessed in a representative sample of 204 incarcerated boys aged 12 to 18 years using the Diagnostic Interview Schedule for Children (DISC). Ninety-two percent had used alcohol, 86% had used cannabis, and 33% had used other substances. The 6-month prevalence of SUDs was 55%, and 22% reported polysubstance abuse or dependence. SUDs were positively associated with comorbid externalizing and psychotic disorders. Substance dependence was negatively associated with violent offending but not with criminal recidivism. These high prevalence rates call for more attention to diagnosis and management of SUDs among incarcerated male adolescents. The negative association between substance dependence and the violent nature of the index offense needs further investigation.     

Recidivism among male subjects incarcerated for illicit drug use in Taiwan

Illicit drug users are generally considered both patients and criminals in Taiwan. This study presents drug use behaviors and criminal recidivism of male subjects incarcerated for illicit drug use in Taiwan after detoxification at a detention center. This study also examined the relationship between drug use behaviors and subsequent recidivism. Charts and crime records of 794 male patients from the acute detoxification unit in a detention center in northern Taiwan were reviewed. These subjects were incarcerated for methamphetamine or/and heroin use. The authors examined the relationship between the variables collected during detoxification and subsequent recidivism of illicit drug use in the following 5 years after detoxification. Of 794 subjects, 539 (67.9%) were repeat offenders during the following 5 years after detoxification. Their recidivism occurred primarily within the first 2 years after being released into the community. The recidivism rate for heroin users was significantly higher than that of methamphetamine users. Aged under 30 years, a previous criminal record, and a positive urine analyses test for illicit drugs upon entering the detoxification unit were significantly associated with recidivism. Recidivism rates of illicit drug users in Taiwan after detoxification in the detention center were substantially high. The efficacy of detoxification programs at detention centers in Taiwan needs to be re-evaluated.     

A 33-year follow-up of narcotics addicts

BACKGROUND: This study examined longitudinal patterns of heroin use, other substance use, health, mental health, employment, criminal involvement, and mortality among heroin addicts. METHODS: The sample was composed of 581 male heroin addicts admitted to the California Civil Addict Program (CAP) during the years 1962 through 1964; CAP was a compulsory drug treatment program for heroin-dependent criminal offenders. This 33-year follow-up study updates information previously obtained from admission records and 2 face-to-face interviews conducted in 1974-1975 and 1985-1986; in 1996-1997, at the latest follow-up, 284 were dead and 242 were interviewed. RESULTS: In 1996-1997, the mean age of the 242 interviewed subjects was 57.4 years. Age, disability, years since first heroin use, and heavy alcohol use were significant correlates of mortality. Of the 242 interviewed subjects, 20.7% tested positive for heroin (with additional 9.5% urine refusal and 14.0% incarceration, for whom urinalyses were unavailable), 66.9% reported tobacco use, 22.1% were daily alcohol drinkers, and many reported illicit drug use (eg, past-year heroin use was 40.5%; marijuana, 35.5%; cocaine, 19.4%; crack, 10.3%; amphetamine, 11.6%). The group also reported high rates of health problems, mental health problems, and criminal justice system involvement. Long-term heroin abstinence was associated with less criminality, morbidity, psychological distress, and higher employment. CONCLUSIONS: While the number of deaths increased steadily over time, heroin use patterns were remarkably stable for the group as a whole. For some, heroin addiction has been a lifelong condition associated with severe health and social consequences.     

Effectiveness of a mental health court in reducing criminal recidivism and violence

OBJECTIVE: In response to the large-scale involvement of people with mental disorders in the criminal justice system, many communities have created specialized mental health courts in recent years. However, little research has been done to evaluate the criminal justice outcomes of such courts. This study evaluated whether a mental health court can reduce the risk of recidivism and violence by people with mental disorders who have been arrested. METHOD: A retrospective observational design was used to compare the occurrence of new criminal charges for 170 people who entered a mental health court after arrest and 8,067 other adults with mental disorders who were booked into an urban county jail after arrest during the same interval. A matching strategy based on propensity scores was used to adjust analyses for nonrandom selection into mental health court. RESULTS: Propensity-weighted Cox regression analysis, controlling for other potential confounding variables (demographic characteristics, clinical variables, and criminal history), showed that participation in the mental health court program was associated with longer time without any new criminal charges or new charges for violent crimes. Successful completion of the mental health court program was associated with maintenance of reductions in recidivism and violence after graduates were no longer under supervision of the mental health court. CONCLUSIONS: The results indicate that a mental health court can reduce recidivism and violence by people with mental disorders who are involved in the criminal justice system.     

Examining the Impact of Mental Illness and Substance Use on Time till Re-incarceration in a County Jail

This paper examines the role that substance use and serious mental illness play in criminal justice recidivism by examining the time to return to jail for a cohort of people admitted to jail in 2003 (N = 16,434). These analyses found that people with serious mental illness alone experienced the longest time in the community before returning to jail and were found to have a risk of re-incarceration that did not differ significantly from individuals with no psychiatric or substance use diagnoses. People with co-occurring disorders had a risk of re-incarceration that was over 40 % higher than that of individuals with no diagnosis.     

Mentally disordered offenders in Sweden: differentiating recidivists from non-recidivists in a 10-year follow-up study

Background: Forensic psychiatric patients present a challenge as they manifest severe mental disorders together with criminal behaviour. There are well-known risk factors for criminal behaviour in the general population, yet knowledge of what predicts reconviction in the Swedish forensic population in the long-term perspective is still insufficient.

Aims: The study aims to (1) describe background and clinical characteristics of forensic psychiatric patients in a 10-year follow-up, (2) analyse risk factors associated with recidivism, and (3) test the predictive validity of risk factors for general and violent criminality.

Methods: Detailed information on all offenders from the Malmö University Hospital catchment area sentenced to forensic psychiatric in-patient treatment from 1999–2005 (n?=?125) was collected. Court decisions were collected up until the end of 2008 (median follow-up time?=?6.2 years, range?=?0.6–9.7 years).

Results: Relapse in general crime (n?=?30) was predicted by low educational attainment, mental disorder in a first degree relative, and low age at first sentenced crime. Relapse in violent crime (n?=?16) was predicted by low educational attainment and low GAF scores. Patients with a restriction order were less likely to relapse in both crime categories.

Conclusions: Signs of childhood adversities together with early debut in criminality appeared as important risk factors for general and violent recidivism. Forensic psychiatric treatment combined with a restriction order was demonstrated as a protective factor against recidivism, suggesting that the risk of recidivism is strongly related to the level of supervision. Although the low number of recidivism cases is highly desirable, it unfortunately reduces the power of the analyses in this paper.     

Targeting Criminal Recidivism in Mentally Ill Offenders: Structured Clinical Approaches

Decreasing criminal recidivism in justice-involved individuals with mental illness, is among the most consistently desired outcomes by programs, policy makers and funding agencies. Evidencebased practices with track records of effectiveness in treating mental illness and co-occurring substance abuse, while important clinically, do not necessarily address criminal recidivism. Addressing recidivism, therefore, may require a more targeted criminal justice focus. In this paper, we describe recent challenges to decriminalization approaches and review factors associated with recurrent criminal behavior. In particular, we focus on structured clinical interventions which were created or adapted to target the thoughts and behaviors associated with criminal justice contact.     

Risk of Future Offense Among Probationers with Co-occurring Substance Use and Mental Health Disorders

The criminal justice system is the primary service delivery system for many adults with drug and alcohol dependence, mental health, and other health service needs. The purpose of this study was to examine the relationship between risk of future offense, mental health status and co-occurring disorders in a large substance abuse diversion probationer population. A purposive sample of 2,077 probationers completed an assessment to screen for mental health disorders, substance use disorders, risk of future crime and violence, and several demographic characteristics. Probationers who screened positive for co-occurring substance use and mental health disorders were significantly more likely to be at higher risk of future crime and violence compared to probationers who screened positive for only substance use, only a mental health disorder, or no substance use or mental health disorder. Implications for substance use and mental health service delivery are discussed, and recommendations are made for further research.     

Self-injurious behavior among Greek male prisoners: Prevalence and risk factors

BackgroundSelf-harm among prisoners is a common phenomenon. This study aims to estimate the prevalence of self-injurious behavior (SIB) among Greek male prisoners, record their motives and determine independent risk factors.MethodsA self-administered, anonymous questionnaire was administered to 173 male prisoners in the Chalkida prison, Greece. The questionnaire included items on self-harm/SIB, demographic parameters, childhood history, family history, physical and mental disease, lifestyle and smoking habits, alcohol dependence (CAGE questionnaire), illicit substance use, aggression (Buss–Perry Aggression Questionnaire [BPAQ] and Lifetime History of Aggression [LTHA]), impulsivity (Barrat Impulsivity Scale-11) and suicidal ideation (Spectrum of Suicidal Behavior Scale). Univariate nonparametric statistics and multivariate ordinal logistic regression were performed.ResultsOf all the participants, 49.4% (95% CI: 41.5–57.3%) disclosed self-harm (direct or indirect). The prevalence of SIB was equal to 34.8% (95% CI: 27.5–42.6%). Most frequently, SIB coexisted with indirect self-harm (80.7%). The most common underlying motives were to obtain emotional release (31.6%) and to release anger (21.1%). At the univariate analysis, SIB was positively associated with a host of closely related factors: low education, physical/sexual abuse in childhood, parental neglect, parental divorce, alcoholism in family, psychiatric condition in family, recidivism, age, sentence already served, impulsivity, aggression, alcohol dependence, self-reported diagnosed psychiatric condition and illicit substance use. Childhood variables were particularly associated with the presence of diagnosed psychiatric condition. At the multivariate analysis, however, only three parameters were proven independent risk factors: self-reported diagnosed psychiatric condition, illicit substance use and aggression (BPAQ scale).ConclusionThe prevalence of SIB is particularly high. Psychiatric condition, illicit substance use and aggression seem to be the most meaningful risk factors; childhood events seem only to act indirectly.     

Service Referral for Juvenile Justice Youths: Associations with Psychiatric Disorder and Recidivism

Secondary multiple regression analyses related disorder profile, probation officers’ mental health/substance use service referrals, and recidivism in 361 juvenile justice youths. Those with externalizing (disruptive behavior or substance use) disorder or substance offenses were most likely to receive service referrals. Substance disordered youths with service referrals had lower recidivism risk compared to counterparts without referrals; referral lowered the recidivism odds to approximately that for youths without a substance use disorder. Providing juvenile justice youths with systematic mental health assessment and linking those with substance use disorder to mental health and substance use services likely reduces recidivism risk.     

Borderline personality disorder symptoms and criminal justice system involvement: The roles of emotion-driven difficulties controlling impulsive behaviors and physical Aggression

ObjectiveBorderline personality disorder (BPD) is associated with elevated risk for a variety of risky behaviors, including criminal behaviors. Yet, limited research has examined the relation of BPD to criminal justice (CJ) involvement, or the mechanisms underlying this relation.ProceduresThis study examined the role of two mechanisms, emotion-driven difficulties controlling impulsive behaviors and physical aggression, in the relation between BPD symptom severity and CJ involvement among 118 patients in residential substance abuse treatment (76% male; 62% African-American). Participants completed measures of BPD symptom severity, CJ contact, diversity of CJ charges, emotion-driven impulse control difficulties, physical aggression, and covariates (substance use severity and antisocial personality disorder symptoms).ResultsBPD symptom severity was associated with CJ contact through emotion-driven difficulties controlling impulsive behaviors, and with diversity of CJ charges through emotion-driven difficulties controlling impulsive behaviors and physical aggression; however, the indirect relations to diversity of CJ charges became non-significant when covariates were included.ConclusionsResults highlight the important role of emotion-driven difficulties controlling impulsive behaviors in criminal behaviors among individuals with BPD symptoms, as well as the potential clinical utility of targeting this mechanism to prevent CJ involvement and/or recidivism.     

Violent recidivism among mentally disordered offenders in Japan

Background A new forensic mental health law was enacted in Japan in 2003, enabling development of specialist services. Before their establishment, it is important to determine the nature, frequency and correlates of the problems they are designed to ameliorate. Aims To establish rates of violent recidivism among mentally disordered offenders before the new legislation, and examine associated risk factors. Method Data were extracted from one complete annual (1980) national cohort of people judged by the Court or prosecutor to be without responsibility for a criminal offence, or of sufficiently diminished responsibility for it to be diverted for psychiatric treatment. The outcome measure was violent recidivism after community discharge and before 1991. Results Fifty‐two (10%) of 489 in the cohort were arrested or convicted of further violent offences. Violent recidivism was most strongly associated with a substance‐related disorder, but histories of violence, homelessness and short index admissions were independently related. Conclusions Violent recidivism was so unusual that, on this outcome, it could take many years to show any effect of the new service. Desistance from substance use, compliance with treatment and maintenance of stable housing may be better indicators of success, and their achievement a good preventive strategy. Copyright © 2007 John Wiley & Sons, Ltd.     

'Kindling theory' in arson: how dangerous are firesetters?

OBJECTIVE: This article aims to review the literature on firesetters particularly looking at recidivism rates. The early literature described firesetters as dangerous individuals. This article reviews the more recent empirical data to examine if it supports the early literature. METHOD: A literature review was performed examining papers which described firesetters with any reference to recidivism. These were divided into three broad categories based on where studies have been performed, namely in forensic psychiatric settings, the criminal justice system and general and psychiatric hospitals. RESULTS: The literature has been poorly focused and provides little help when assessing an individual firesetter. Risk factors associated with general criminology have been cited. CONCLUSIONS: The empirical literature cannot support the hypothesis that firesetters are inherently dangerous. More research should target different groups of firesetters and examining individual risk within that group with an aim of researching treatment for the different groups.     

Understanding and preventing criminal recidivism among adults with psychotic disorders

The high prevalence of adults with psychotic disorders in the criminal justice system has received much attention recently, but our understanding of this problem is marked by diverging opinions. Mental health professionals point to deinstitutionalization and our fragmented mental health system as primary causes. Criminologists minimize the role of mental illness and contend that persons with and without mental illness are arrested for the same reasons. Meanwhile, practice guidelines offer little guidance to clinicians about how to address the problem. Drawing upon contemporary crime prevention principles as well as current knowledge of psychotic disorders and their treatment, this article presents a conceptual framework for understanding and preventing criminal recidivism. The framework highlights the importance of individual and service-system risk variables and emphasizes the central role of treatment nonadherence as a mediator between modifiable risk variables and recidivism. On the basis of the conceptual framework described in this article, three necessary elements of intervention are presented for preventing recidivism among adults with psychotic disorders: competent care, access to services, and legal leverage. Research is needed to further define and test these intervention elements as foundations for future service delivery efforts.     

La législation actuelle face à l’évaluation des comportements criminels violents : l’urgence d’une réforme

The clinical examination of mental patients committed to specialized hospitals as well as the practice of criminal psychiatric expertise do not at present allow the serious assessment of the dangerousness and risk of violent recidivism. The use of diagnostic and predictive scientific methods has become indispensable. In criminal cases, the expert must also take into account the actual facts of the offense: degree of premeditation, organization of the crime scene, dynamics and typology of violence, relational and environmental context, victimology, judicial information. Traditional psychiatric expertise must now give way to a comprehensive, multidisciplinary criminological form of analysis combining all individual and collective factors of a subjective and objective nature.     

Psychiatrische Erkrankungen und die Prognose krimineller Rückfälligkeit

The risk for criminal recidivism of mentally ill offenders is, unlike the general risk of delinquency, not well established. The relationship between psychiatric diagnosis and criminal recidivism was examined in the context of the Munich project on risk assessment. A total of 185 offenders had been examined on the question of culpability between 1992 and 1993. Re-offenses committed before the end of 2001 were recorded according to the Federal Registry of court sentences (Bundeszentralregister); 38.8% of the total group recidivated. High rates of recidivism were observed for individuals with substance abuse (45.5%) and with personality disorders (46.6%). The combination of the two illnesses increased the rate for recidivism to 50%. For individuals with organic, affective and neurotic disorders the rates for recidivism were below the average. Rates of recidivism for schizophrenic offenders were slightly higher, if re-offenses in the state of inculpability were included. The HCR-20 predicted recidivism equally well for offenders with and without a psychiatric diagnosis. In both groups, individuals with HCR-20 scores above the mean recidivated more often and after shorter periods of time.     

Daily Assessment of Acute Dynamic Risk in Paroled Offenders: Prediction,Predictive Accuracy and Intervention Effect

Few studies have assessed acute dynamic risk repeatedly among paroled offenders to investigate the relationship between changes in acute dynamic risk and recidivism in crime. The present study investigates whether one-month changes in ten stress-related acute dynamic risk factors, collected through automated telephony while the participants were still in prison and over 30 consecutive days following parole, predict one-year criminal recidivism, including its predictive accuracy. The study also investigates whether a brief feedback intervention in conjunction with the daily assessments reduces recidivism compared to an assessment-only control group. Changes in five risk factors were found to be associated with increased risk of criminal recidivism after controlling for the results in prison, the initial value after parole, and the intervention. The predictive accuracy is marginally accurate: Summary score (AUC) = .666; Level of stress (AHSS) = .644; Psychiatric symptoms (SCL-8D) = .641; Anxiety symptoms = .673; Severity of most stressful daily event = .690. No differences in one-year recidivism rates were established between the intervention group and the control group. The study shows that daily assessments can usefully be made of dynamic risk factors in paroled offenders.     

Crime,Culture and Ethnicity

Links between ethnicity and crime are pan of the wider field of cultural influences on crime. Despite a dubious past and associations with the eugenicist movement, it remains important, partly to enable ethnic monitoring of the criminal justice system. There are many methodological problems, including the difficulty of measuring ethnicity, a euphemism for skin colour in some studies. Such a crudely measured variable may produce spurious associations, due to less obvious, confounding Variables. Offending rates differ between ethnic groups and cannot be explained by discrimination in the criminal justice system. Differences between cultures are both qualitative and quantitative; they change rapidly over time, favouring cultural or economic explanations. Crude statistical associations are merely the starting point for study and the challenge is to identify the mediating variables. For black-white differences in the United States and Britain, discrimination, unemployment and poverty are important but other factors may be more difficult to identify. Black patients are statistically over-represented in most populations of mentally disordered offenders. Existing studies do not confirm a tendency to discriminate against black patients by detaining them unnecessarily and black people may also be overrepresented among mentally disordered prisoners. Monitoring the ethnic origin of referrals and admissions to secure psychiatric facilities should be a basic pan of clinical audit.