Addressing Criminogenic Risk Among Individuals with Serious Mental Illness: A Systematic Review

Background and Purpose: Individuals with serious mental illnesses (SMI) are overrepresented in the criminal justice system and disproportionately re-incarcerated following release into the community. An established body of evidence has found that interventions targeting known risk factors for recidivism (i.e. criminogenic risks) reduce justice-involvement among the general correctional population. However, there is a gap in research regarding the use of these interventions among individuals with SMI in the criminal justice system. To address this gap, this systematic review synthesized empirical research on interventions targeting criminogenic risk factors delivered to justice-involved individuals with SMI.

Methods: A comprehensive search string was developed in consultation with a university reference librarian. Inclusion/exclusion criteria were pre-specified in a study protocol and registered with PROSPERO. A systematic search of six computerized bibliographic databases resulted in a total of 6,126 potentially relevant studies. Title and abstract screening, full-text reviews, and data extraction were performed by two researchers independently. Discrepancies were resolved through mutual discussion. To identify additional articles meeting inclusion criteria, experts in the field were contacted and reference harvesting techniques were used. Study quality was assessed using the Mixed Methods Appraisal Tool.

Results: Fifteen studies published between 2004 and 2017 evaluated eight interventions targeting criminogenic risk factors delivered to justice-involved individuals with SMI. All identified programs were group-based and engaged cognitive-behavioral strategies. Most were delivered in correctional settings (n = 11), or hospital settings (n = 3), with only one study evaluating an intervention delivered in the community. Most studies (n = 8) evaluated samples of men, and one study evaluated women specifically. Methods used to adapt interventions for individuals with SMI included the addition of psycho-education modules, incorporation of contingency management strategies, modifying the delivery of program content, and the incorporation of case managers and/or individual therapists into group-based interventions. Notable, all five studies evaluating criminal justice outcomes found significant reductions in recidivism among individuals participating in interventions targeting criminogenic risks when compared to control groups. Additional studies found such interventions effectively reduced criminogenic risk factors (n = 4), and that interventions adapted specifically for individuals with SMI improved rates of treatment retention when compared to general correctional interventions delivered to this population (n = 5).

Conclusions and Implications: This systematic review is the first to evaluate interventions targeting criminogenic risk factors among justice-involved individuals with SMI. Findings suggest that such interventions effectively at reducing rates of recidivism, criminogenic risk levels, and improve treatment retention among individuals with SMI. However, few studies used control groups, and the majority of included studies evaluated samples of men, limiting the generalizability of findings. Additional research is needed to learn about how interventions targeting criminogenic risk factors can be adapted to meet the needs of persons with SMI and to further explore the impact of such interventions on criminal justice outcomes.