Mental Health Intervention Reduces Recidivism Rate for Psychosis Patients

Armita Adily, PhD

A community-based approach to mental health services could reduce the rate of reoffending for patients suffering from psychosis.

A team based in Australia and Saudi Arabia, led by Armita Adily, PhD, Kirby Institute, University of New South Wales, examined the link between early contact with mental health services and reoffending after an index offense in individuals with psychosis.

There is currently little known about the relationship between clinical contact with mental health services after a psychosis offense and reoffending. Offender populations are noted for high numbers of individuals with mental illness, including serious mental illnesses like psychosis.

This patient population often suffers from incarceration, which involves a high cost and questionable rehabilitative and deterrent qualities.

Recently, researchers have suggested a move to community-based alternatives for certain offender groups, including diversion into treatment for those with mental illness. There have been international studies showing reduced rates of reoffending and other positive outcomes in those diverted by the courts into community-based mental health treatment.

In the cohort study, the investigators examined individuals diagnosed with psychosis prior to an index offense between July 2001 and December 2012. Each participant received a noncustodial sentence and were identified by linking health and offending databases in

New South Wales.

Of the 7030 participants in the study, 4933 (70.2%) were male, with a median age at the index offense of 34. A total of 2605 individuals had clinical contact with mental health services within 30 days after the index offense.

The researchers examined the incidence and risk factors for reoffending and time to reoffending within 2 years from the index offense using Cox proportional hazards regression and Kaplan-Meier survival estimates.

The team especially examined the link between contact with mental health serviced within 30 days of an offense and reoffending.

The investigators sought main outcomes of reoffending within 2 years of the index offense in individuals with and without clinical contact with mental health services within 30 days following an offense, with adjustment for potential confounders.

Overall, the risk of reoffending was substantially lower in individuals with clinical contact compared to participants without clinical contact (AHR, 0.83; 95% CI, 0.76-0.91), while the risk of reoffending was 30% less in male offenders with 5 or more clinical contacts in comparison to male offenders without clinical contact (AHR, 0.71; 95% CI, 0.59-0.84).

For both males and females, reoffending was associated with a young age (AHR for male offenders aged <18 years, 3.31; 95% CI, 2.39-4.59; AHR for female offenders aged <18 years, 2.60; 95% CI, 1.69-3.99), as well as offending history (AHR for male offenders with ≥4 prior offenses, 2.28; 95% CI, 1.98-2.64; AHR for female offenders with ≥4 prior offenses, 2.22; 95% CI, 1.67-2.96).

“In this cohort, early and frequent clinical contact with mental health services after an offense in individuals with psychosis was associated with reduced risk of reoffending in this group,” the authors wrote. “More support may be needed for early treatment of those with serious mental illness who are at risk of reoffending.”

The study, “Association Between Early Contact With Mental Health Services After an Offense and Reoffending in Individuals Diagnosed With Psychosis," was published online in JAMA Psychiatry.