Mental illness is not usually associated with criminal behavior. However, some people diagnosed with mental illness do commit violent acts. Mentally disordered offenders (MDOs)—the term used by the criminal justice system for people with a diagnosed mental health condition—are at increased risk for repeat offending if they do not receive treatment. Evidence exists suggesting that cognitive behavioral therapy is an effective approach for reducing violent and criminal behavior in individuals without mental illness. However, until recently, little research has looked at how similar programs might work on MDOs. To address this issue, Alexis E. Cullen, of the Department of Forensic and Neurodevelopmental Sciences at the Institute of Psychiatry at King’s College in London, recently conducted a study comparing two separate interventions on a sample of 84 male MDOs.
Reasoning and rehabilitation (R&R) is a cognitive behavioral program that targets violent offenders and strives to reduce aggression and antisocial behavior. Half of the participants were assigned to 36 sessions of R&R, and the other half were assigned to treatment as usual (TAU). They were followed for 12 months and assessed for level of verbal aggression, behavioral violations, and substance abuse. Cullen found that the MDOs in R&R had significant reductions in leave violations and verbal aggression when compared to those in TAU. Although only half of those enrolled in R&R completed it, those who did maintained their gains at 12-month follow-up. Upon further examination, Cullen noticed that substance-use rates did not differ between the groups, regardless of whether they completed treatment.
Future work should address limitations of this study. First, this study did not include female participants. It would be valuable to assess how this type of treatment could reduce aggression in female MDOs. Also, the analysis between completers and noncompleters should be expanded. Finally, future studies should look at additional ways to reduce substance use in MDOs, as this behavior could influence aggression and violence. Despite these shortcomings, the current randomized controlled trial (RCT) provides evidence that R&R may be a viable option for reducing recidivism in offenders with mental illness. “We have shown that it is feasible to conduct an RCT within a medium secure setting; we hope that this will encourage further randomized trials targeting this under-researched group,” Cullen said.
Cullen, A. E., Clarke, A. Y., Kuipers, E., Hodgins, S., Dean, K., Fahy, T. (2012). A multisite randomized trial of a cognitive skills program for male mentally disordered offenders: Violence and antisocial behavior outcomes. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0030291
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