Mental disorder grossly overrepresented in criminal justice population (Teplin, 1990, 1994)

Transcription

1 Understanding barriers to re-entry for parolees with mental disorder Jennifer Skeem, Eliza Nicholson & Christine Kregg Funded by the California Policy Research Center Statement of the problem Mental disorder grossly overrepresented in criminal justice population (Teplin, 1990, 1994) Relative to their healthy counterparts, parolees with mental disorder (PMDs) are 60% more likely to return to prison within one year of release (Dickinger, Eno Louden, et al., 2007) Prototypic re-entry program for PMDs assumes that the problem is mental disorder, and the way to fix it is by providing psychiatric treatment.

2 The unvalidated model of what works for PMDs Parole Treatment mandate Treatment - Social Services Access Amount PMD Outcomes Symptoms & Functioning Recidivism Risk Mental illness weakly influences involvement in crime Junginger, Claypoole, Laygo, & Cristina (2006)

3 Over time, symptoms are weakly linked with violence Skeem, J., Schubert, C., Odgers, C., et al. (2006). Psychiatric symptoms and community violence among high-risk patients: A test of the relationship at the weekly level.journal of Consulting & Clinical Psychology, 74, A (somewhat) less simplistic view Parole Treatment mandate Unmet Dynamic Risk Factors Treatment - Social Services Access Amount e.g., anger, substance abuse, antisocial attitudes, criminogenic peers - PMD Outcomes Symptoms & Functioning Recidivism Risk

4 Study Aims 1. To compare general and unique risk factors for parolees with- and without- mental disorder 2. To assess whether PMDs are more likely to incur technical violations, commit new offenses, and return to custody than non-pmds 3. To identify the risk factors that maximally predict failure (are they unique to mental disorder?) Method Design Administer a risk assessment tool designed for (a) general offenders (LS/CMI), and (b) mentally disordered offenders (HCR-20) to matched sample of 221 parolees without- and withmental disorder Follow to track technical violations, re-arrest, and return to custody (average 9 mo. follow-up) Risk assessment measures HCR-20 modifications (goal: isolate unique factors) disaggregate items that mix unique with shared factors (totals that do, and do not, include unique factors) no PCL-R Training and reliability (to total ICC=.90; refresher cases) Recruitment (refusal rate appx. 25%)

5 Sample match MD diagnoses Primary diagnosis % of MD sample Scz/Sczaffective/Psychosis NOS 52% Bipolar 15% Major Depression 16% Other (PTSD, anxiety, etc.) 16% Of all with diagnoses, 52% had a co-occurring substance abuse disorder

6 Study Aims 1. To compare general and unique risk factors for parolees with- and without- mental disorder 2. To assess whether PMDs are more likely to incur technical violations, commit new offenses, and return to custody than non-pmds 3. To identify the risk factors that maximally predict failure (are they unique to mental disorder?) Comparison on general risk/needs (LS/CMI) Total Scores MD Non-MD General risk/need (Section 1)*** 27.5 (5) 24.8 (5) Specific risk/need (Section 2)*** 6.5 (3) 4.7 (3) Parolees with mental disorder are at significantly greater risk for general and violent recidivism than their healthy counterparts on the usual risk factors

7 General risk/needs (LS/CMI) A Closer Look: particularly on antisocial pattern General Risk/Need Factor Scores MD Non-MD Criminal History 17.3 (7) 15.8 (7) Education/Employment 4.1 (2) 3.7 (2) Family/Marital** 4.2 (2) 5.0 (2) Leisure/Recreation 1.7 (1) 1.9 (1) Procriminal Attitudes 3.1 (1) 3.3 (1) Antisocial Pattern*** 2.5 (1) 1.8 (1) Alcohol/Drug Problems 5.6 (1) 5.5 (1) Criminogenic Companions 3.2 (1) 3.1 (1) B S.E. Wald df Sig. Exp(B) Antisocial Pattern Constant Comparison on general and unique risk/needs (HCR-20) Strong overlap in assessing general risk/needs HCR-20 Total and LS/CMI Section 1 r =.72 HCR-20 Total sans unique item components r =.78 PMDs obtain higher scores, both with and without (shown) unique factors excluded Total Scores MD Non-MD HCR-20 Total*** 33.8 (6) 24.1 (6) Historical Scale*** 15.4 (2) 12.3 (3) Clinical Scale*** 9.1 (3) 5.2 (2.5) Risk Scale*** 9.2 (3) 6.5 (2)

8 General and unique risk/needs (HCR-20) But at item level, chiefly unique factors distinguish between mentally disordered > non-disordered parolees (K-S test, p <.01) Historical: major mental illness, personality disorder Clinical: active symptoms, lack insight about MD, unresponsive to MH treatment Risk: noncompliance with MH treatment, stress may cause psychiatric decompensation Logistic regression, significant stepwise predictors of MD status: major mental illness personality disorder noncompliance with MH treatment Study Aims 1. To compare general and unique risk factors for parolees with- and without- mental disorder 2. To assess whether PMDs are more likely to incur technical violations, commit new offenses, and return to custody than non-pmds 3. To identify risk factors that maximally predict failure (are they unique to mental disorder?)

9 Failure rates for MD and non-md At this (early) date, no significant differences in violations, arrests, or return to custody (trend, B=1.28) Study Aims 1. To compare general and unique risk factors for parolees with- and without- mental disorder 2. To assess whether PMDs are more likely to incur technical violations, commit new offenses, and return to custody than non-pmds 3. To identify risk factors that maximally predict PMDs failure (are they unique to mental disorder?)

10 LS/CMI and PMDs recidivism Survival analyses At the total score level, General Risk/Needs (Section 1) significantly predicts violations (shown) and arrests (not shown), but not return to custody At the competitive scale level, only Family/Martial predicts violations (shown), arrests (not shown), and return to custody (not shown) inversely HCR-20 and PMDs recidivism At the total score level, the HCR-20 does not predict violations, arrests, or RTC (with, or without unique factors included) But final risk judgments predict RTC (shown) At the competitive scale level, the HCR-20 Clinical scale significantly predicts violations (shown) and arrests (not shown), but not RTC. Significance achieved only when unique factors were included

11 Incremental utility of LS/CMI and HCR-20 Focus LS/CMI General Risk/Needs & HCR-20 Clinical w/unique factors Violations and arrests Neither has incremental utility over the other in predicting violations or arrest Preliminary Conclusions According to leading tools, MDs are at significantly greater risk than non-pmds both with respect to risk factors that are general ( big eight ) and unique to MD (e.g., psychiatric treatment noncompliance) problematic personality features seem key At this early date, PMDs are not significantly more likely to recidivate than non-pmds Porporino & Motiuk (1995) found more parole suspensions (without new offenses) at 24 months, but not 6 months after release Leading risk factors for PMDs failure extend beyond those unique to MD to embrace those shared with general offenders implications for planning rehabilitation services

12 Thanks California Policy Research Center UC Irvine, South Central Team Region III, South Central Parole Office Tom Hoffman (CEO, Parole, CDCR) and Joan Petersilia (Director, Center for Evidence-Based Corrections)