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36 Law & Hum. Behav. 1 (2012)

handle is hein.journals/lwhmbv36 and id is 1 raw text is: Law and Human Behavior 2012. Vol. 36. No. 1. 1-12 © 2011 American Psychological Association 0147-7307/11/$12.00 DOI: 10.1037/h0093963 Stopping the Revolving Door: A Meta-Analysis on the Effectiveness of Interventions for Criminally Involved Individuals With Major Mental Disorders Michael S. Martin Carleton University and Correctional Service Canada, Ottawa, Ontario, Canada Shannon K. Dorken, Ashley D. Wamboldt, and Sarah E. Wootten Correctional Service Canada, Ottawa, Ontario, Canada Faced with high and increasing rates of mental disorder within the criminal justice system (CJS), a range of interventions have been implemented in an effort to prevent continued involvement in criminal activities among this population. A meta-analytic review was undertaken to consider the effectiveness of interventions for criminally involved adults with a mental disorder targeting either improved criminal justice or mental health outcomes. Furthermore, characteristics that were hypothesized to predict better outcomes were exam- ined. Studies that considered sex offender interventions, or focused solely on antisocial personality, intellectual and cognitive, or substance use disorders were excluded. Results assuming a fixed-effects model combining 37 effect sizes from 25 studies (N = 15,678) support the effectiveness of these interventions in terms of reductions in any CJS involvement (d = 0.19 excluding one outlier). Interventions had no significant effect on an aggregate mental health outcome (d = 0.00). However, when considering distinct mental health outcomes, intervention participants had significantly better functioning (d = 0.20) and fewer symptoms (d = 0.12). There were no significant effects of the interventions on mental health service or medication use. Moderator analyses identified seven sample, intervention, and design characteristics that were related to the magnitude of the effect sizes for criminal justice outcomes, and suggest implications for service provision, policy, and research. Results suggested some relationship between intervention effects on mental health and criminal justice reinvolvement, although future research is needed in this area, especially given the absence of mental health outcome data in many studies. Keywords: meta-analysis, mental health, criminal justice, interventions, outcomes Supplemental materials: http://dx.doi.org/10.1037/h0093963.supp While precise estimates on the rates of mental disorders in the criminal justice system (CJS) vary, the general view is that they are high and have increased in recent years (American Psychiatric Association, 2004; Correctional Service of Canada, 2009). Brink, Doherty, and Boer (2001) administered the Structured Clinical Interview for DSM-IV (SCID) to 202 federal offenders (i.e., of- fenders serving sentences of 2 years or longer) in British Columbia at admission and found that 31.7% of them met the diagnostic This article was published Online First March 5, 2011. Michael. S. Martin, Department of Psychology, Carleton University, Ottawa, Ontario, Canada; Shannon K. Dorken, Ashley D. Wamboldt, and Sarah E. Wootten, Correctional Service Canada, Mental Health Branch, Ottawa, Ontario, Canada. This research was completed independent of all authors' employment affiliation. The views and findings presented herein have not been re- viewed by, nor do they reflect the position of the Correctional Service of Canada. A previous version of this paper was completed by the primary author to fulfill coursework requirements at Carleton University. SD, AW and SW all contributed equal effort to this project and should be considered second authors. Correspondence concerning this article should be addressed to Michael. S. Martin, Correctional Service Canada, Mental Health Branch, 340 Lau- rier Avenue West, Ottawa, ON KiA OP9, Canada. E-mail: Michael.S.Martin@csc-scc.gc.ca; mmartin@connect.carleton.ca criteria for a current mental health diagnosis, with 12% meeting the criteria for a serious mood or psychotic disorder. Similarly, Fazel and Dinesh (2002) suggest on the basis of a meta-analysis that typically about one in seven prisoners in western countries have psychotic illnesses or major depression (p. 548). These high rates of mental disorder have led to considerable interest in improving outcomes for offenders with mental disorders (OMDs). Given this interest, a meta-analytic review was under- taken to assess the effectiveness of interventions for OMDs. The review also considered the research design, participant and inter- vention characteristics that might be associated with the effective- ness of these interventions. Finally, the review considered the extent to which mental health outcomes are related to criminal justice outcomes. Intervention Characteristics Services for OMDs may include medication, individual or group therapy, social skills training, cognitive-behavioral therapy, anger management or problem solving programming (Blackburn, 2004). A recent move towards integrated substance use and mental health treatment has been observed as the extent to which these disorders tend to co-occur among OMDs has become increasingly evident. Brink et al. (2001) found that over 80% of offenders in their sample meeting the lifetime criteria for mood, psychotic and

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