Reducing Violence in Offenders Diagnosed with Mental Illness

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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  • fallon h

    fallon h

    October 23rd, 2012 at 11:48 AM

    I am assuming that these offenders with mental illness could be more prone to outbursts of rage and violence simply because for many of them this is the only language that they know and it is hard for them to express those feelings any other way than through that violence.

    certainly does not make the act right, or even acceptable, but it does open up some way to understand what they are trying to convery and perhaps even get them some well deserved help, hopefully before they are forced to act out in a violent manner once again.

  • Elvin B

    Elvin B

    October 23rd, 2012 at 1:49 PM

    Always better to treat offenders rather than punishing them outright.That will only make them even hardened criminals.Be it for those with or without mental health problems.

  • S.P


    October 23rd, 2012 at 5:33 PM

    This sounds like what we should be doing.Also,they should consider a person’s mental health while handing over a term to him.If he really has a problem and has committed a violent act,sending him to treatment would be a better option than putting him in jail and exacerbating his symptoms!

  • Tania


    October 23rd, 2012 at 5:43 PM

    The more I read on this site the more that I see proclamations that treatment as usual isn’t working.

    Well if that is true across the board then why aren’t more therapists listening and doing more than TAU?

    I just can’t believe that there are so many practitioners out there who are still so strictly by the book that they can’t think beyond the proverbial box.

  • roger


    October 24th, 2012 at 10:05 AM

    I certainly do not want to be involved in a shooting involving someone who was disturbed.Losing something as precious as your life or someone close to you because of someone else’s issues is not fair.And so these people,offenders and others,who are harmful and potential danger to others really should be treated.

    And when it comes to offenders,it can prevent future instances of violence stemming from their mental health problems.

  • arnold r

    arnold r

    October 24th, 2012 at 3:55 PM

    This is like the forgotten demographic in the corrections system.

    No one really wants to help violent offenders to begin with.

    When you add into the mix the fact or the impression that the prisoner may also be mentally ill, then I think that will cause even fewer people to want to touch that issue and the money for that kind of help will dry up fast.

  • Sullivan


    October 25th, 2012 at 4:20 AM

    So let’s say that we want to treat and rehab mentally ill violent offenders. Is this really the population that we want to return to the streets? I mean, I am all for healing and therapy and things like that, but I don’t know that this is the group I really want to devote that much time and energy toward. I would much rather help rehab the people who are in for small time crimes but who really have a chance to make it again over those who are not only prone to committing violent acts but also are going to need a lifetime of ongoing treatment for their mental health issues as well.

  • hewitt


    October 25th, 2012 at 8:20 AM

    how easy is it living in prison?how easy is it living with a mental health condition with little access to treatment?now combine the two and I’m sure it becomes easier to understand the multitude of problems such individuals face!

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