Cumulative Trauma Among Probationers with Severe and Persistent Mental Illness

Background: Traumatic experiences lead to a host of negative outcomes including social, criminal, and behavioral risks. Trauma exposure is significantly higher among justice-involved populations than in community samples, with estimates ranging from 4%-42%, and even higher estimates exist among offenders with severe mental illnesses (68%). The wide range in prevalence suggests inconsistencies in the methods used to estimate the prevalence of trauma, including variability in how trauma is defined and measured. Moreover, there has been little research on cumulative trauma among justice-involved persons, especially those with severe mental illnesses. The field of social work is primed to address, and provide evidence for, the relationship among mental health, substance use, and criminal justice outcomes for offenders with SPMI, thus strengthening policy, practice, and research within the criminal justice system.

Methods: As part of a larger, randomized controlled trial of specialty mental health probation among probationers with severe mental illnesses, we collected data from probationers with severe mental illness regarding mental health functioning, social support, relationship with probation officers, exposure to trauma, and social service needs. Study subjects were high-risk offenders who met criteria for one of the following diagnoses: major depression, bipolar disorder, schizophrenia, and/or PTSD.  Participants (n=26) were 32 years of age, on average (SD=9.8), predominately African American (57.7%, n=15) and 57.7% (n=15) were female. 62% (n=16) of the sample met criteria for PTSD. Cumulative trauma was measured using the Life Events Checklist (LEC), which asked if seventeen traumatic events happened to participants, they witnessed these events happening, or learned of these events happening to a close friend or family member. Descriptive and inferential statistics were used to examine overall rates and types of cumulative trauma as well as differences among male and female probationers.   

Results: On average, probationers with severe mental illnesses experienced 5.6 (SD=2.3, range 2 - 10) unique traumatic events in their lifetimes, with no participants experiencing fewer than two different events. Participants experienced physical assault most often (80%, n=20), followed by transportation accidents (77%, n=20) and sexual assault (56%, n=14). Also, participants had witnessed an average of 4.3 (SD=2.7) traumatic events and learned of 4.1 events (SD=3.5), on average, happening to someone close to them. Moreover, male probationers with severe mental illnesses experienced more events (M=6.9, SD=1.9), on average, compared to female probationers (M=4.7, SD=2.2; t(17)=2.20, p<.05). Though not statistically significant, more males experienced physical assault (91%, n=10) compared to females (71%, n=10); and, more female probationers experienced sexual assault (57%, n=8) compared to male probationers (55%, n=6; X²(1)=0.02, p=.9).

Implications: Cumulative trauma is high among probationers with severe mental illnesses and male and female probationers with mental illnesses differ in the types of traumatic events they most often experience. These findings have important implications for how trauma is addressed and included in criminal justice and mental health practice, policy and research. More information is needed to understand the link between trauma and criminal behavior, and gender-specific trauma interventions are warranted to address cumulative trauma among offenders in an informed, effective manner.