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Hodgins S. What do we know now about evidence-based treatment for psychosis and aggressive behaviour or criminality that we did not know when community care was implemented? Nord J Psychiatry 2024; 78:649-658. [PMID: 39331403 DOI: 10.1080/08039488.2024.2403586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 08/02/2024] [Accepted: 09/09/2024] [Indexed: 09/28/2024]
Abstract
PURPOSE Community care replaced institutional care for people with psychosis without guidance about what constituted effective treatment. In a Swedish birth cohort, many of those who developed schizophrenia or bipolar disorder as community care was being implemented were subsequently convicted of violent and non-violent crimes. Studies from other countries that were implementing community care at this time also reported elevated proportions of patients acquiring criminal convictions. Since community care was first implemented, much has been learned about factors that promote and treatments that limit aggressive/antisocial behaviour/criminality (AABC) among people with psychosis. Without the benefit of this knowledge, did mental health policy and practices that were in place as the asylums were closed inadvertently contribute to criminality? MATERIAL AND METHODS This article provides a narrative review of current evidence of effective treatments and management strategies to reduce AABC among patients with psychosis. RESULTS Reductions in AABC are associated with stable contact with psychiatric services, second-generation antipsychotic medication, clozapine for patients with schizophrenia and elevated levels of hostility and/or a history of childhood conduct disorder, abstinence from substances, avoidance of trauma, and constant monitoring of both illness symptoms and AABC. CONCLUSIONS Failure to adopt evidence-based practices allows the problem of AABC to persist, prevents patients from experiencing independent, safe, community tenure, and puts those around them at risk. Many challenges remain, including implementing effective assessment and interventions at first-episode and convincing patients with antisocial attitudes and behaviours to participate in treatment programs to reduce AABC and to learn prosocial behaviours.
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Affiliation(s)
- Sheilagh Hodgins
- Département de psychiatrie et addictologie, Université de Montréal, and Centre de Recherche Institut national de psychiatrie légale Philippe-Pinel, Montréal, Canada
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Hodgins S, Sivertsson F, Beckley A, Luigi M, Carlsson C. The burden for clinical services of persons with an intellectual disability or mental disorder convicted of criminal offences: A birth cohort study of 14,605 persons followed to age 64. Nord J Psychiatry 2024; 78:411-420. [PMID: 38613517 DOI: 10.1080/08039488.2024.2337192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/19/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Intellectual disability (ID), schizophrenia spectrum disorder (SSD), bipolar disorder (BD), substance use disorder (SUD), and other mental disorders (OMDs) are associated with increased risks of criminality relative to sex-matched individuals without these conditions (NOIDMD). To resource psychiatric, addiction, and social services so as to provide effective treatments, further information is needed about the size of sub-groups convicted of crimes, recidivism, timing of offending, antecedents, and correlates. Stigma of persons with mental disorders could potentially be dramatically reduced if violence was prevented. METHODS A birth cohort of 14,605 persons was followed to age 64 using data from Swedish national health, criminal, and social registers. RESULTS Percentages of group members convicted of violence differed significantly: males NOIDMD, 7.3%, ID 29.2%, SSD 38.6%, BD 30.7%; SUD 44.0%, and OMD 19.3%; females NOIDMD 0.8%, ID 7.7%, SSD 11.2%, BD 2.4%, SD 17.0%, and OMD 2.1%. Violent recidivism was high. Most violent offenders in the diagnostic groups were also convicted of non-violent crimes. Prior to first diagnosis, convictions (violent or non-violent) had been acquired by over 90% of the male offenders and two-thirds of the female offenders. Physical victimization, adult comorbid SUD, childhood conduct problems, and adolescent substance misuse were each associated with increased risks of offending. CONCLUSION Sub-groups of cohort members with ID or mental disorders were convicted of violent and non-violent crimes to age 64 suggesting the need for treatment of primary disorders and for antisocial/aggressive behavior. Many patients engaging in violence could be identified at first contact with clinical services.
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Affiliation(s)
- Sheilagh Hodgins
- Département de psychiatrie et addictologie, Université de Montréal, and Centre de Recherche Institut national de psychiatrie légale Philippe-Pinel, Centre de Recherche Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada
| | | | - Amber Beckley
- School of Behavioural, Social and Legal Sciences, Örebro University, Örebro, Sweden
| | - Mimosa Luigi
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Christoffer Carlsson
- Department of Criminology, Stockholm University, Stockholm, Sweden
- Institute for Futures Studies, Stockholm, Sweden
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Parisi A, Wilson AB, Villodas M, Phillips J, Dohler E. A Systematic Review of Interventions Targeting Criminogenic Risk Factors Among Persons With Serious Mental Illness. Psychiatr Serv 2022; 73:897-909. [PMID: 34911352 DOI: 10.1176/appi.ps.202000928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Individuals with serious mental illness are overrepresented in the criminal justice system. Research has found that interventions targeting risk factors for recidivism (i.e., criminogenic risks) reduce justice involvement in the general correctional population. However, more needs to be learned regarding use of these interventions among individuals with serious mental illness. To this end, this systematic review synthesized research on interventions that target criminogenic risk factors and are delivered to justice-involved individuals with serious mental illness. METHODS A systematic search of six computerized bibliographic databases from inception to 2021 yielded 8,360 potentially relevant studies. Title and abstract screening, full-text reviews, and data extraction were performed independently, and discrepancies were resolved through discussion. To identify additional articles meeting inclusion criteria, experts in the field were contacted, and reference-harvesting techniques were used. Study quality was assessed with the Mixed Methods Appraisal Tool. RESULTS Twenty-one studies were identified that evaluated nine interventions delivered to justice-involved individuals with serious mental illness. All identified programs targeted criminogenic risk factors, were group based, and used cognitive-behavioral strategies. Study quality was moderate to high. Interventions were associated with improvements in recidivism, violence, and criminogenic risk factors. CONCLUSIONS This review is the first to evaluate interventions targeting criminogenic risks among justice-involved individuals with serious mental illness. Findings suggest that outcomes associated with these interventions are promising. Given the overrepresentation of persons with serious mental illness in the criminal justice system, these findings provide an important step toward identifying services that curb justice involvement in this population.
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Affiliation(s)
- Anna Parisi
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Salt Lake City (Parisi); School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill (Wilson, Villodas, Phillips, Dohler)
| | - Amy Blank Wilson
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Salt Lake City (Parisi); School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill (Wilson, Villodas, Phillips, Dohler)
| | - Melissa Villodas
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Salt Lake City (Parisi); School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill (Wilson, Villodas, Phillips, Dohler)
| | - Jon Phillips
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Salt Lake City (Parisi); School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill (Wilson, Villodas, Phillips, Dohler)
| | - Ehren Dohler
- Center on Mindfulness and Integrative Health Intervention Development, College of Social Work, University of Utah, Salt Lake City (Parisi); School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill (Wilson, Villodas, Phillips, Dohler)
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Hodgins S, Moulin V. Le nouveau défi des services destinés aux personnes présentant un premier épisode de psychose : intégrer des interventions pour prévenir et réduire les agressions physiques. SANTÉ MENTALE AU QUÉBEC 2022. [DOI: 10.7202/1094146ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Hodgins S. Could Expanding and Investing in First-Episode Psychosis Services Prevent Aggressive Behaviour and Violent Crime? Front Psychiatry 2022; 13:821760. [PMID: 35242064 PMCID: PMC8885584 DOI: 10.3389/fpsyt.2022.821760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/21/2022] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Some persons developing, or presenting, schizophrenia engage in aggressive behaviour (AB) and/or criminal offending. Most of these individuals display AB prior to a first episode of psychosis (FEP). In fact, approximately one-third of FEP patients have a history of AB, some additionally display other antisocial behaviours (A+AB). The large majority of these individuals have presented conduct problems since childhood, benefit from clozapine, have extensive treatment needs, and are unlikely to comply with treatment. A smaller sub-group begin to engage in AB as illness onsets. A+AB persists, often for many years in spite of treatment-as-usual, until a victim is seriously harmed. This article proposes providing multi-component treatment programs at FEP in order to prevent aggressive and antisocial behaviours of persons with schizophrenia. METHOD Non-systematic reviews of epidemiological studies of AB among persons with schizophrenia, of the defining characteristics of sub-types of persons with schizophrenia who engage in AB and their responses to treatment, and of FEP service outcomes. RESULTS Studies have shown that mental health services that simultaneously target schizophrenia and aggressive behaviour are most effective both in reducing psychotic symptoms and aggressive behaviour. Evidence, although not abundant, suggests that a multi-component treatment program that would include the components recommended to treat schizophrenia and cognitive-behavioural interventions to reduce A+AB, and the other factors promoting A+AB such as substance misuse, victimisation, and poor recognition of emotions in the faces of others has the potential to effectively treat schizophrenia and reduce A+AB. Patients with a recent onset of AB would require few components of treatment, while those with prior conduct disorder would require all. Such a program of treatment would be long and intense. CONCLUSIONS Trials are needed to test the effectiveness of multi-component treatment programs targeting schizophrenia and A+AB at FEP. Studies are also necessary to determine whether providing such programs in hospitals and/or prisons, with long-term community after-care, and in some cases with court orders to participate in treatment, would enhance effectiveness. Whether investing at FEP would be cost-effective requires investigation.
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Affiliation(s)
- Sheilagh Hodgins
- Département de Psychiatrie et Addictologie, Université de Montréal et Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada.,Haina Institute of Forensic Psychiatry, Haina, Germany
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Young S, Emilsson B, Sigurdsson JF, Khondoker M, Philipp-Wiegmann F, Baldursson G, Olafsdottir H, Gudjonsson G. A randomized controlled trial reporting functional outcomes of cognitive-behavioural therapy in medication-treated adults with ADHD and comorbid psychopathology. Eur Arch Psychiatry Clin Neurosci 2017; 267:267-276. [PMID: 27752827 PMCID: PMC5357275 DOI: 10.1007/s00406-016-0735-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 09/25/2016] [Indexed: 11/29/2022]
Abstract
Studies assessing psychological treatment of attention deficit hyperactivity disorder (ADHD) in adults are increasingly reported. However, functional outcomes are often neglected in favour of symptom outcomes. We investigated functional outcomes in 95 adults with ADHD who were already treated with medication and randomized to receive treatment as usual (TAU/MED) or psychological treatment (CBT/MED) using a cognitive-behavioural programme, R&R2ADHD, which employs both group and individual modalities. RATE-S functional outcomes associated with ADHD symptoms, social functioning, emotional control and antisocial behaviour were given at baseline, end of treatment and three-month follow-up. The Total composite score of these scales is associated with life satisfaction. In addition, independent evaluator ratings of clinicians who were blind to treatment arm were obtained on the Clinical Global Impression scale at each time point. CBT/MED showed overall (combined outcome at end of treatment and 3-month follow-up) significantly greater functional improvement on all scales. Post-group treatment effects were maintained at follow-up with the exception of emotional control and the Total composite scales, which continued to improve. The largest treatment effect was for the RATE-S Total composite scale, associated with life satisfaction. CGI significantly correlated with all outcomes except for social functioning scale at follow-up. The study provides further evidence for the effectiveness of R&R2ADHD and demonstrates the importance of measuring functional outcomes. The key mechanism associated with improved functional outcomes is likely to be behavioural control.
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Affiliation(s)
- Susan Young
- Centre for Psychiatry, Imperial College London, Du Cane Road, London, W12 0NN, UK. .,Broadmoor Hospital, WLMHT, Crowthorne, UK. .,Reykjavik University, Reykjavik, Iceland.
| | - Brynjar Emilsson
- Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK ,Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | - Jon Fridrik Sigurdsson
- Reykjavik University, Reykjavik, Iceland ,Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland ,University of Iceland, Reykjavik, Iceland
| | - Mizanur Khondoker
- Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK ,Department of Applied Health Research, University College London, London, UK
| | - Florence Philipp-Wiegmann
- Broadmoor Hospital, WLMHT, Crowthorne, UK ,Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Gisli Baldursson
- Landspitali -The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Gisli Gudjonsson
- Broadmoor Hospital, WLMHT, Crowthorne, UK ,Reykjavik University, Reykjavik, Iceland ,Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
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Young S, Das M, Gudjonsson GH. Reasoning and Rehabilitation cognitive skills programme for mentally disordered offenders: Predictors of outcome. World J Psychiatry 2016; 6:410-418. [PMID: 28078205 PMCID: PMC5183993 DOI: 10.5498/wjp.v6.i4.410] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/24/2016] [Accepted: 10/24/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate factors predicting treatment completion and treatment outcome of the Reasoning and Rehabilitation Mental Health Programme (R&R2MHP) cognitive skills programme for mentally disordered offenders.
METHODS Secondary analysis of data previously obtained from 97 male patients who were sectioned and detained under the United Kingdom Mental Health Act in low, medium and high security hospitals and who had completed R&R2MHP. Predictors of treatment completion included background variables and five outcome measures: Four self-reported measures of violent attitudes, social problem-solving skills, reactive anger and locus of control and an objective measure of behaviour on the ward that was completed by staff. Completion of the 16 session programme, which was delivered on a weekly basis, was classified as ≥ 12 sessions.
RESULTS It was found that the R&R2MHP is appropriate for delivery to participants of different ages, ethnic background, and at different levels of security without the completion rate or treatment effectiveness being compromised. Participants taking oral typical psychotropic medication were over seven times more likely to complete the programme than other participants. Behavioural disturbance on the ward prior to commencing the programme predicted non-completion (medium effect size). As far as treatment completion was concerned, none of the background factors predicted treatment effectiveness (age, ethnic background, level of security, number of previous convictions and number of previous hospital admissions). The best predictor of treatment effectiveness was attitude towards violence suggesting that this should be the primary outcome measure in future research evaluating outcomes of the R&R2MHP cognitive skills program.
CONCLUSION The findings suggest that a stable mental state is a key factor that predicts treatment completion.
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Jotangia A, Rees-Jones A, Gudjonsson GH, Young S. A multi-site controlled trial of the R&R2MHP cognitive skills program for mentally disordered female offenders. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2015; 59:539-559. [PMID: 24293225 DOI: 10.1177/0306624x13512092] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
This study aimed to evaluate the acceptability and efficacy of delivering the Reasoning and Rehabilitation Mental Health Program (R&R2MHP) to female mentally disordered offenders detained in medium and low secure hospital settings. Group treatment participants (N = 18) and control participants receiving treatment as usual (N = 20) completed self-report measures pre- and post-group. An informant measure of ward behavior was also completed by staff. Violent attitudes and locus of control were assessed at 3-month follow-up. Program completion was excellent (89%). A conservative intention-to-treat analysis found significant treatment effects post-group for positive problem-solving orientation, rational problem-solving style, and locus of control (medium-large effect), but no treatment effect for violent attitudes, anger, and ward behavior. At follow-up, a large treatment effect was found for locus of control. Ad hoc per protocol analyses found a large treatment effect for ward behavior. The findings provide preliminary support for the feasibility and utility of delivering R&R2MHP to females in secure psychiatric settings.
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Affiliation(s)
| | | | | | - Susan Young
- King's College London Institute of Psychiatry, UK Imperial College London, Centre for Mental Health, UK
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Waugh A, Gudjonsson GH, Rees-Jones A, Young S. A feasibility study of the Reasoning and Rehabilitation Mental Health Programme (R&R2MHP) in male offenders with intellectual disability. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2014; 24:222-224. [PMID: 25042837 DOI: 10.1002/cbm.1907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 02/18/2014] [Indexed: 06/03/2023]
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