142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

303574
Criminal offending patterns in adults with serious mental illness: Clinical characteristics and gender as key risk factors

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014 : 8:30 AM - 8:50 AM

Allison G. Robertson, PhD, MPH , Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
Jeffrey Swanson, PhD , Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Duke University, Durham, NC
Linda K. Frisman, PhD , School of Social Work, Department of Mental Health and Addiction Services, University of Connecticut, Hartford, CT
Hsiu-Ju Lin, PhD , CT Dept Mental Health & Addiction Services, Research Division MS # 14 RSD, Hartford, CT
Marvin S. Swartz, MD , Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
Adults with serious mental illness have a relatively high risk of criminal justice involvement. While causal pathways for criminal offending are complex, male gender and co-occurring substance abuse are important known risk factors. Adults with bipolar disorder have substantially higher risk of offending – including violence – than those with schizophrenia. However, the specific interaction of these risk factors has not been examined. This study explores the inter-relationship of gender, substance abuse, and psychiatric diagnosis to identify sub-groups at higher risk for offending. Administrative records of 25,133 adults with schizophrenia or bipolar disorder in Connecticut’s public behavioral health system during 2005-2007 were merged with state records of criminal convictions and incarceration. Categorical-interaction effects of gender, substance abuse, and psychiatric diagnosis on offending risk were estimated using multivariable logistic regression. Men with bipolar disorder and co-occurring substance abuse had the highest absolute risk of criminal offending, including for both violence and minor crimes. Substance abuse increased risk in women more than men, especially among those with schizophrenia. Men and women with bipolar disorder and co-occurring substance abuse had much higher risk of offending than those with schizophrenia, especially those with no substance abuse. Identifying sub-groups of adults with SMI who are at higher risk for offending, including violence as well as minor crimes, could have important implications for jail diversion and other programs that aim to divert defendants away from the justice system and instead into community treatment, by informing program targeting, screening, eligibility assessment, treatment, and monitoring.

Learning Areas:

Public health or related research

Learning Objectives:
Describe patterns of criminal justice involvement – including violence and minor crimes – among adults with serious mental illness and how they vary by gender, primary psychiatric diagnosis, and co-occurring substance use disorders. Identify how gender and clinical diagnoses differentially affect risk for criminal offending, including arrest and incarceration. Discuss implications for identifying sub-groups of adults with serious mental illness at higher risk for different types of offending (e.g., violence as well as minor crimes), and related challenges and opportunities for jail diversion and similar programs.

Keyword(s): Mental Health, Criminal Justice

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been a principal or co-investigator on multiple federal- and foundation-funded research projects that focus on serious mental illness (SMI) and its intersection with criminal justice involvement, as well as legal, policy, and service interventions for improving consumer outcomes and reducing recidivism. A primary research interest of mine is improving implementation of evidence-based practices for adults with SMI and criminal justice involvement.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.