Mentally Ill Violent Criminals Benefit from Cognitive Skills Treatment

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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  • Celeste C

    Celeste C

    March 12th, 2012 at 3:51 PM

    This brings up a very good question then.
    I am sure that there have been numerous studies that have been done to indicate how many violently ill criminals truly have some for of mental illness.
    I would have to think that the numbers would be large, because for some of these crimes it has to take someone very mentally sick to commit them.
    But then I wonder what kind of training the prison guards are given to deal with this kind of population?
    Are the people who are hired to work in these prison settings honestly educated enough and trained well enough to handle their very specific issues? I think that we can all guess the answer to that.

  • Grant


    March 12th, 2012 at 5:37 PM

    This sounds like it could be a wonderful program to not only help criminals remediate while in prison but maybe a good way to keep the recidivism rate down too.



    March 12th, 2012 at 11:00 PM

    A ray of hope to those who are often forgotten.No everybody in prison is there by choice or because they like it.Some individuals with mental health issues have paid more than thy bargained for.They need a treatment different from others and this is a step in the right direction.

  • Hollis S

    Hollis S

    March 13th, 2012 at 4:19 AM

    This is definitely something that should be studied at an early age in the mentally ill, perhaps so that we can be a little more preventive in terms of keeping them from eventually committing crimes to begin with.

    With that being said, I know that that is not always going to happen, that in some cases hindsight is 20/20 and we have to make do with the situation that we have.

    In that case then offering this kind of treatment to prisoners sounds like a really wonderful thing, if they are working with someone that they are able to trust and really make progress with.

  • Johnna


    March 13th, 2012 at 4:00 PM

    There is made mention in this article toward the end that perhaps pursuing a stronger therapeutic relationship between the counselor and the offender might strengthen the effects of therapy. Really? Someone is just now figuring out that for any therapy to have lasting and positive benefits there has to be some sort of relationship built on trust between the client and the therapist?

  • Jennifer R

    Jennifer R

    March 14th, 2012 at 10:53 AM

    When I 1st graduated from college I went to work in a 1/2 way house for federal inmates. Real eye opener.
    Not that any of these guys were mentally ill, far from it in most cases. But I saw the damage of treatment as usual.
    Yes they had all had counseling while serving their term, even drug abuse counseling.
    But most of them were doing it to simply jump through the hoops that their sentences had set out for their release, not because it had any real and meaningful impact on them.
    If we are coming up with better ways to reach these guys then I do think that’s great.
    But treatment as usual? Waste of taxpayer money and the prison system’s time.

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