Targeting Criminogenic Risk Factors Among Persons With Serious Mental Illness

Using a systematic review, the authors of this study synthesized research to examine whether criminogenic risk interventions can effectively curb criminal justice involvement for individuals with serious mental illness.

Criminogenic interventions have had some success in the treatment of individuals with serious mental illness involved in the justice system, according to a systematic review published in Psychiatric Services.

Researchers searched in 6 databases for studies regarding interventions involving adults that addressed criminogenic risks among justice-involved persons with serious mental illness or directly targeted or studied 1 of the 4 criminogenic risk factors: antisocial personality, antisocial behavior, antisocial cognition, and antisocial associates. “Serious mental illness” in the review included schizophrenia, schizoaffective disorder, psychotic disorders, major depressive disorder, and bipolar disorder.

The 21 selected studies, which evaluated 14 samples (n=1,175), analyzed 9 programs with qualitative and quantitative methods. A total of 11 studies had high methodological quality and 3 had moderate methodological quality.

Of the 6 studies that analyzed antisocial personality patterns, 3 comparing outcomes of participants who received the Reasoning and Rehabilitation Mental Health Program (R&R2MHP) found that social problem skills improved, as assessed by the Social Problem Solving Inventory Revised-Short Form and its rational problem-solving subscale.

There were 2 studies that utilized the Crime Pics II inventory in evaluating how the Reasoning and Rehabilitation (R&R) program impacted antisocial cognitions of individuals with serious mental illness at medium-security forensic hospitals. They found that the treatment did not significantly improve antisocial attitudes. Verbal aggression among individuals who participated in R&R tended to decrease during the treatment period and at the 1 year follow-up compared with among control individuals.

A modified therapeutic community (MTC) program benefited a sample of incarcerated men with mental and substance use disorders in secure forensic outpatient facilities compared with a standard prison-based mental health program in 2 of the studies. In 1 study, participants in the program and in aftercare were less likely to commit an alcohol or drug offense in the community, compared with those in the standard mental health program (OR 0.36 P =.03). In another study, at 1 year, they were less likely to use substances (OR 0.34 P =.01), illegal drugs (OR 0.43 P =.05), or use alcohol to intoxication (OR 0.34 P =.02).

Violence Risk Scale (VRS) scores and Goal Attainment Scale for Violence (GAS-V) scores significantly improved for the majority (52% and 60%, respectively) of Violent Offender Treatment Program (VOTP) participants, and about one-quarter of the individuals experienced decreased Firestone Assessment of Violent Thoughts (FAVT) and State Trait Anger Expression Inventory (STAXI) scores following the treatment, 1 study found.

Limitations of the studies include the possibility researchers missed relevant articles, challenges to the generalizability of their findings, and the fact that only 2 studies examined intermediate targets’ association with recidivism.

“The results of this review show that a growing number of interventions targeting criminogenic risk factors are being adapted for use among justice-involved persons with serious mental illness and reveal promising outcomes associated with these interventions,” the researchers said.

“Given the overrepresentation of individuals with serious mental illness in the criminal justice system, these findings provide an important step toward understanding the services that most effectively curb criminal justice involvement in this population. To this end, this review helps organize and provide direction for future research on the use of interventions that target criminogenic risk factors among persons with serious mental illness.”


Parisi A, Blank Wilson A, Villodas, M, et al. A systematic review of interventions targeting criminogenic risk factors among persons with serious mental illness. Psychiatric Services. Published online December 16, 2021. doi:10.1176/