Mental health service use reduces criminal reoffending among those with psychosis

Individuals with psychosis appeared less likely to reoffend if they received early and frequent clinical contact with mental health services after an initial criminal offense, according to study results published in JAMA Psychiatry.

“This study demonstrated that early and frequent contact with mental health services in the short-term (within 30 days) after an offense by non-incarcerated male offenders (but not female offenders) diagnosed with psychosis was associated with a reduced rate of re-offending and longer time to re-offense over a follow-up period of 2 years,” Armita Adily, PhD, of the Justice Health Research Program at Kirby Institute in Australia, told Healio Psychiatry. “This was the case for both violent and non-violent offenders.”

Results of a population-based data-linkage study showed reduced reoffending among individuals with psychosis who received a treatment order from local courts compared with those who received punitive sanctions, such as community orders, bonds or fines. Several studies examined the effect of mandating contact with mental health services on reoffending as part of prison-to-community transitioning, and others showed reduced violent and nonviolent offenses among individuals with psychosis associated with psychotropic medication use. However, no population-level study has evaluated the association between offending behavior among those with psychosis and the frequency of contact with community mental health services beyond court-mandated treatments.

To address this research gap, Adily and colleagues conducted the current cohort study, in which they used linked health and offending databases in New South Wales, Australia, to identify individuals diagnosed with psychosis before their index offense between July 2001 and December 2012, and who received a noncustodial sentence. They used Cox proportional hazards regression and Kaplan-Meier survival estimates to examine the incidence of and risk factors for reoffending and time to reoffending within 2 years of the index offense. They examined the association between reoffending and contact with mental health services within 30 days of an offense.

Exposures included hospital admission, emergency department presentation and contact with psychosis-associated mental health services. As main outcomes and measures, the investigators used reoffending within 2 years of the index compared among individuals with and without clinical contact with mental health services within 30 days of an offense, and they adjusted the analysis for potential confounders.

Among 7,030 offenders with psychosis, of whom 70.2% were men, 2,605 (37.1%) had clinical contact with mental health services within 30 days of the index offense. Among those with vs. without clinical contact, the risk for reoffending was significantly lower (adjusted HR [aHR] = 0.83; 95% CI, 0.76-0.91). The risk for reoffending was 30% lower among male offenders with five or more clinical contacts compared with male offenders with no clinical contact (aHR = 0.71; 95% CI, 0.59-0.84). Men and women who reoffended were more likely to be younger and have a history of offending.

“This study supports the enhancement and maintenance of early engagement of offenders with psychosis within mental health services, which is a potentially cost-effective way to reduce community harm by offenders with psychosis compared with incarceration,” Adily told Healio Psychiatry. “However, further attention should be paid to the treatment needs of female offenders with psychosis. Further work is needed to see these findings extend to other forms of mental illness."