Violence is a major concern among those who are responsible for the care of mentally ill prisoners. People with mental problems are more prone to violence than healthy individuals, especially people who have significant psychological impairment. Programs that target violence reduction and prevention in mentally disordered offenders (MDOs) have low adherence rates and do not always provide significant improvement. One of the most common techniques used to reduce violence in the MDOs is reasoning and rehabilitation (R&R), which teaches the mentally impaired how to develop better coping and problem-solving skills and encourages them to change the way they view criminal behaviors. Although there have been many randomized control trials (RCTs) on the use of R&R with the general population, a recent study conducted by Alexis E. Cullen of the Department of Forensic and Neurodevelopmental Sciences at King’s College Institute of Psychiatry is the first to test the effectiveness of R&R on incarcerated MDOs.
Cullen believes that these criminals have significant deficits in emotional control, social skills, and behavior regulation. Helping them develop cognitive skills could enhance their attitudes and behaviors and decrease their level of impulsivity and negative coping, which directly impacts their violent behavior. For her study, Cullen evaluated 84 violent MDOs and enrolled half of them into R&R and the other half into treatment as usual (TAU). She assessed their levels of anger, blame, problem solving, and criminal behaviors and attitudes throughout treatment and for 1 year after. Cullen discovered that although many of the participants dropped out before the program was completed, those who did complete the R&R had significantly better problem-solving skills and attitudes than those in TAU. The study also showed that the results of the R&R were maintained for the full 12 months after the treatment.
Cullen believes the findings of her study provide hope for those treating MDOs. The results of this study demonstrate that the attitudes of MDOs toward criminal behaviors can be transformed through cognitive skills training and that R&R is a viable and effective treatment for incarcerated individuals with mental health challenges. Overall, those who completed R&R not only changed the way they thought and dealt with problems, but they also exhibited far less violence after the training than they did before they experienced R&R. Cullen believes clinicians and clients who are willing to put in the effort required to complete this type of program will benefit greatly. She suggested that for those who are extremely impaired, such as individuals with psychosis and schizophrenia, delivering the R&R in shorter, more tolerable sessions may increase the chance of completion. Cullen added, “Improving therapeutic alliance might also help to reduce drop-out; for example, dialectical behavioral therapy, which specifically focuses on developing a strong therapeutic relationship, demonstrates high retention rates in treatment-resistant patients.”
Cullen, A. E., Clarke, A. Y., Kuipers, E., Hodgins, S., Dean, K., Fahy, R. (2012). A Multi-site Randomized Controlled Trial of a Cognitive Skills Programme for Male Mentally Disordered Offenders: Social-cognitive Outcomes. Psychological Medicine 42.3, 557-69. Print.
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