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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

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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