Forging New Paths in Community Mental Health Treatment: Preliminary Findings from a Small-Scale RCT

Background and Purpose: Up to 50% of individuals with serious mental illness (SMI) receiving treatment in community-based mental health services have had some involvement with the criminal legal system. Despite this overlap, there are currently no interventions within this treatment setting that directly address individual-level risk factors for criminal legal system involvement among people with SMI. This paper presents preliminary findings from a small-scale, pilot randomized controlled trial (RCT) of Forging New Paths (FNP), a novel, group-based cognitive-behavioral therapy intervention designed specifically to reduce criminal legal risk factors among individuals with SMI receiving services in the community mental health service system.

Methods: Thirty-eight adults with SMI and moderate to high levels of criminal legal system risk factors were recruited from a community mental health agency to participate in two cycles of the intervention. Participants were randomly assigned to either the FNP treatment group (n = 19) or a Treatment-as-Usual (TAU) control group (n = 19). Fifteen participants (39.5%) were female, and 33 participants (86.8%) had a lifetime diagnosis of schizophrenia or other psychotic disorder. Data were collected through face-to-face interviews at baseline and 3-month follow-up. The primary outcome for this analysis was aggression. Secondary outcomes included impulsivity, interpersonal problem-solving, and criminal attitudes, with mental health symptomatology examined as an exploratory outcome. Linear mixed-effects models assessed within-group changes over time. Group-by-time interaction terms were included to examine between-group differences.

Results: Participants randomized to FNP showed statistically significant improvements in social problem-solving from baseline to 3-month follow-up (b = 1.05, p < .05), though between-group differences were not statistically significant. While not reaching statistical significance, trends in the FNP group indicated reductions in impulsivity (b = -1.78, p = .39), criminal attitudes (b = -2.43, p = .10), aggression (b = -1.81, p = .41), and mental health symptoms (b = -1.08, p = .61), suggesting potential intervention effects.

Conclusions and Implications: The results of this preliminary study suggest that interventions targeting individual-level criminal legal risk factors among people with SMI can be successfully delivered in community-based mental health settings. Forging New Paths represents a promising approach that addresses an urgent gap in care. Moving interventions like Forging New Paths upstream—into community mental health settings—offers a critical opportunity to intervene earlier in the trajectories of criminal legal system involvement among people with SMI. This not only enhances the likelihood of preventing future contact with the criminal legal system among people with SMI but also increases access to interventions for individuals who may never be reached through criminal legal system-based services. By integrating targeted risk-reduction interventions into existing community mental health services, the system is also better equipped to function as the “Ultimate Intercept”—a point of meaningful and preventive engagement that disrupts the cycle of criminal legal system involvement for people with SMI. In doing so, Forging New Paths supports the transformation of community mental health services into a more proactive, equitable, recovery-oriented system.