Recidivism, Treatment, and Quality of Life Outcomes in Research on Prison and Jail Reentry for Persons with Mental Illnesses: A Scoping Review

Background and Purpose: Research on reentry interventions for persons with mental illnesses leaving jail and prison have focused on recidivism as a primary outcome and treatment and quality of life (QOL) indicators as secondary outcomes. Furthermore, these outcomes have been operationalized differently making comparisons and systematic reviews difficult to conduct and interpret due to the lack of consistency. This study aims to provide clarity about reentry outcomes by: a) ascertaining which outcomes are measured; b) understand how outcomes are defined in the literature; and c) identify commonalities or gaps in outcomes commonly measured. 

Methods: As the goal of this scoping review was to clarify the working definition and conception of recidivism, treatment, and QOL outcomes in reentry research, methods were informed by Peters and colleagues (2015). Databases searched were Medline, Academic Search Complete, JStor, PsychInfo, Scopus, Web of Science, Google Scholar and Google. Inclusion criteria included English language articles published since 1988 in academic journals, dissertations, white papers, and research reports. The content of the study or report had to include: adults, mental illnesses, and prison or jail release. Since the focus was on the conceptualization and operationalization of outcomes, the type and quality of the study was not inclusion criteria.

Results: Almost all studies included recidivism as an outcome, which was most commonly operationalized as a new arrest (reoffending) or a return to jail or prison (re-incarceration). Other measures of recidivism included technical violations, type of arrest, and time to an event (i.e. re-arrest or re-incarceration). Studies typically included more than one measure of recidivism. Treatment was most often conceptualized as involvement in outpatient services, but also included medication, hospitalization, case management, and psychiatric symptoms. Studies tended to operationalize treatment on only one or two of these constructs. Very few studies also measured receipt of drug or alcohol services, use of alcohol or drugs, or any type of QOL outcomes. There was a lack of measures on criminal risk, recovery, or desistance.

Implications: There is a lack of consistency in outcome measurement in reentry interventions for individuals with mental illnesses as recidivism and treatment are conceptualized and operationalized differently across studies. Outcomes commonly reported, like recidivism and treatment, are often treated as individual level outcomes, but are more accurately measures of systems outcomes and susceptible to reproducing systemic racial and economic inequalities. Very few studies reported on individual level outcomes like criminal risk, mental health recovery, substance misuse, and desistance, which may be connected to reoffending or not reoffending. Outcomes need to be defined and reported on consistently across studies as to help determine intervention effectiveness. Additionally, the outcomes currently being measured tell us little about which mechanisms of change should be targeted and which behaviors may be linked to reoffending, participation in treatment, or quality of life.