Introduction
To decrease reoffending over the past ten years, several Western countries have changed how they deal with offenders through the criminal justice system (Jones and Chaplin, 2020). This has had two effects: first, it has led to harsher penalties and prison terms; second, it has increased funding for the creation of intervention programs for those with and without mental impairments (Nicholls et al, 2018).
Most individuals with mental disabilities will never commit a crime (Beaudry et al, 2021). However, it is frequently said that compared to other violating behaviors, this group commits more offenses (Howner et al, 2018). Due to several methodological problems, it is challenging to determine the actual proportion of people with mental issues who commit crimes based on the available evidence (Mak and Chan, 2018). According to estimates, criminals with mental disabilities are convicted of crimes at a rate of 3.7%, compared to 4% for offenders without mental disorders (Batastini et al, 2021). Numerous studies have found that individuals with mental disabilities are disproportionately overrepresented among offenders carried out in high-security hospitals, medium-security prisons, or other settings and are, therefore, not representative of the overall population of individuals with mental disabilities (Valuri et al, 2021).
Cognitive-behavioral interventions, which aim to lower the likelihood of reoffending by altering the offender’s cognition and attitudes, appear to have supplanted psychoanalytical and behavioral techniques in the field of psychological intervention for criminals (Walsh, Wells & Gann, 2020). To lessen the chance of repeat offenses, the offending behaviour is addressed immediately, or an underlying mental condition is treated (MacInnes and Masino, 2019).
Everyone agrees that people with mental disabilities are far more likely to experience mental health issues (Brouwers, 2020). In addition, they are classified as a group that receives few mental health treatments. It is observed that various reasons make it difficult for people with mental disabilities to receive treatment for mental health issues. Professionals’ belief that psychological therapies are unsuccessful due to cognitive deficiencies and language restrictions is one frequently mentioned barrier to intervention (Brouwers, 2020). This assumption would be refuted, and more experts would be inspired to offer services by publications describing successful intervention outcomes.
Several review articles published in the past year reached different findings about the degree of advancement in the study of psychological interventions for people with mental disabilities and mental illnesses. There were several published case studies as well as one group research. Work on an assessment tool that utilizes cognitive therapy and a new depressive scale is ongoing (Townsend et al, 2018). Introducing a new mental diagnostic classification system is arguably the most critical development in recent years.
Literature Review
Theoretical review
Constructivist Grounded Theory
In contrast, the traditional constructivist grounded theory approach aims to establish a conceptual vantage point that goes beyond mere descriptive language and instead zeroes in on abstracted patterns of behavior (O’Connoret al., 2018). Concerning the researcher’s participation in this process, the social constructivist method encourages the researcher to collaborate with the participant in order to build knowledge that accurately reflects their experience (Charmaz, 2017). Despite Ravitch and Carl (2019) acknowledgment of the researcher as a potential source of bias in the data, the search for objectivity persists because of the value placed on avoiding researcher bias. Researchers in this study are cognizant of the possibility that their prior knowledge and beliefs about what constitutes “excellent practice” in the field of offender treatment will color their findings. In light of Ravitch and Carl (2019) caution that the researcher’s contact with the data runs the risk of dominating the participant’s presence, this study will actively involve the researcher, yet it will also be careful to keep the participant’s voice in focus.
However, it has been claimed that grounded theory must be addressed with caution to avoid becoming yet another methodological variety, despite the widespread acceptance and encouragement of its principles of development, adaptation, and flexibility (Rezapour Nasrabad, 2018). As a result, it is assumed in this study that the information gathered will be fabricated and based on the researcher’s and participants’ mutual perceptions of reality. Still, there’s room for these anecdotes to strike a chord with a wider audience and for these theories to evolve in light of future comparisons with alternative interpretations that advance professional practice.
Social Capital Network Theory
The study of social networks has been influenced by a wide range of theoretical and conceptual frameworks. Because of its emphasis on the importance of having both internal and external resources for managing stress, stress and coping theory has relevance for studies of social networks (Biggs, Brough and Drummond, 2017). In addition, Parpouchi (2021)’s study emphasized how incarceration isolates individuals from their social circles, resulting in smaller networks overall. This finding is broadly applicable to social work therapies that include distancing the client from their usual surroundings (e.g., foster care, residential treatment). However, there are often unforeseen ramifications and implications for reconnecting the client to their former network after treatment, even when separation has a positive impact, such as when interaction with an abusive, negative, or antisocial network is reduced (Evans, 2020). In such cases, it can be difficult to reconnect with loved ones and resume normal life after placement. There may be a hint for such endeavors in the creative studies, projects, and organizational structures that motivated researchers to study social networks in the first place. Pancoast and Collins would likely include Young and Willmott’s exquisite and detailed description of “family and kinship” in East London, as well as the ambitious community intervention known as the Dinnington Neighborhood Services Project in England, which sought to close the gap between formal and informal aid sources in a local authority (Seeking, 2020).
Phyllis Silverman mentions Gerald Caplan’s (1964) pioneering Laboratory for Community Psychiatry at Harvard when discussing seminal works in the field. This groundbreaking facility allowed mental health professionals and lay people to coexist and learn from one another. Bill Reid’s innovative use of the agency practice setting as a crucible for the formation of new knowledge is the icing on the cake for his many contributions, which will forever be studied by specialists in the field (Evans, 2020). As far as Reid (1978) was concerned, the nonprofit organization was a well-oiled “research machine” (Robinaugh et al, 2020). In addition to providing promising new avenues for future empirical research, social network analysis also provides intriguing new frameworks for what Bronfenbrenner (1979) once called the “transforming experiment.” Reducing social isolation and establishing links among individuals has been considered one of the big challenges for social work; therefore, the time is ideal for such endeavors (Blanchard & Heeren, 2020).
Empirical review of the past studies
Biliunaite et al (2021) provided specific guidelines in 1989 for tailoring conventional psychotherapy procedures to the cognitive and developmental capacities of people with mental impairments. Despite the limited number of studies reports she examined, overall encouraging results were found. A call for research was issued to provide more information on practical strategies and to concentrate efforts on people participating in community residential programs.
Koppers et al, (2021) studied group psychotherapy, behavioural therapy, and psychodynamic techniques in outpatient interventions with patients with mental illness and disabilities. The following recommendations were included in a research agenda that was presented: group designs with homogenous samples, random allocation, multimodal assessment, accurate and valid assessment measures, emphasis on the clinical and practical importance of results, analysis of generalization effects, targeting of socially significant problems to increase community integration, and use of therapies correlated with a particular outcome measure.
Alonso (2019) looked at reports on psychotherapy from the 30 years between 1968 and 1998. The review included face-to-face interventions by competent people focused on feelings, values, attitudes, and behaviours but excluded those that teachers or paraprofessionals predominantly carried out. 92 studies met these requirements. Three qualified raters rated the degree of change and importance of the results in agreement. Only 9 of the studies met the requirements for a meta-analysis, as the others lacked an intervention group, a control group, and the required data needed to calculate effect sizes. There was a reported mean effect size of somewhat more significant than 1.0 (Alonso, 2019).
Biliunaite et al (2021) provided specific guidelines in 1989 for tailoring conventional psychotherapy procedures to the cognitive and developmental capacities of people with mental impairments. Despite the limited number of studies reports she examined, overall encouraging results were found. A call for research was issued to provide more information on practical strategies and to concentrate efforts on people participating in community residential programs.
Koppers et al, (2021) studied group psychotherapy, behavioral therapy, and psychodynamic techniques in outpatient interventions with patients with mental illness and disabilities. The following recommendations were included in a research agenda that was presented: group designs with homogenous samples, random allocation, multimodal assessment, accurate and valid assessment measures, emphasis on the clinical and practical importance of results, analysis of generalization effects, targeting of socially significant problems to increase community integration, and use of therapies correlated with a particular outcome measure.
Several review articles published in the past years reached different findings about the degree of advancement in the study of psychological interventions for people with mental disabilities and mental illnesses. There were several published case studies as well as one group research. Work on an assessment tool that utilizes cognitive therapy and a new depressive scale is ongoing (Townsend et al, 2018). Introducing a new mental diagnostic classification system is arguably the most critical development in recent years.
Methodology
The current review used two methods for finding published and unpublished publications evaluating interventions for mentally ill offenders. First, a search was done electronically in three well-known databases: PsychINFO, MEDLINE, and SocialSciAbs. We searched the titles and abstracts of documents using keywords pertaining to offenders and mental illness. Keywords linked to offenders were included together with specific keywords pertaining to mental illness, such as “mentally sick,” “mental illness,” “therapy,” “treatment,” “psychiatric illness,” “psychiatric disorder,” “persistent and severe,” and “chronic illness” (i.e., jail, prison, inmate, penitentiary, and offender). The three computerized databases were thus the subject of 40 different searches.
In addition to conducting an electronic search, we looked through journal tables of contents, electronic journal releases, and government reports that frequently disclose information pertaining to treatment initiatives with the Open Medical Institute. The references for articles that comprised literature reviews of research studies on the therapy of OMI were also examined. 1,497 through the SocialSciAbs search: 2,700 in MEDLINE, 7,935 in PsychINFO, 20 in the reference lists of articles that provided literature reviews of research related to the intervention of mentally ill offenders, and 20 in the content’s pages of journals and government articles that regularly publicly release documents about treatment efforts with mentally ill offenders. As a result, 12,154 papers on interventions with mentally ill offenders were found. The final 20 documents were retrieved and examined after these were further whittled down using the year of publication (less than five years) and those closely related to the point.
Findings and Discussion
Issues were getting enough eligible participants to participate. If a participant’s cognitive disability was deemed too severe to be of use to the study, for example, if they lacked appropriate verbal abilities, studies tended to omit them (Gibbon et al, 2020). Given the limited number of participants or offender who are eligible with mental disabilities receiving psychological intervention—the heterogeneity of participation between the trials constituted an additional methodological problem (McIntosh et al, 2021). Additionally, they varied on several factors, including security level, service type, legal standing, co-morbid conditions, and histories of prior offences, making comparisons between studies more difficult. Additionally, a wide variety of offender types were considered; for instance, rapists, stalkers, exhibitionists, and offenders whose index conduct consisted of making lewd phone calls were all included in studies on mental disorders.
Since the trials lacked a significant number of controlled comparisons, it was challenging to determine whether the treatment plan was indeed responsible for the treatment results. There would have just been one manuscript to review if we had limited the inclusion criterion to adequately controlled trials (Van der Zweerde et al, 2019). Insufficient data was found despite the recommendation given in one of the included studies to gather data for “waiting list” controls; as a result, these findings were not included in the analysis (Melvin et al, 2020).
Psychological Intervention
The included research’s assessment methods and operational definition of reoffending varied significantly. Many studies utilized a holistic approach of reoffending that encompassed all known abusive behaviors and people who are at risk of offending (Heppell, Jones & Rose, 2022). As a result, they could provide a more thorough overview by consulting only official records and only reporting charges and reconvictions. Using official sources to gauge further offences presents a challenge because these sources are notorious for underestimating reoffending rates (Retz et al., 2021).
According to a review by Gulati et al (2020), caregivers may not even report alleged crimes like rape if the person who perpetrated them had a mental condition. Therefore, using non-official sources and official records may result in a more realistic portrayal of the repeat offender (Godfrey, 2022). It is extremely difficult to accurately evaluate the efficacy of study because of the variance in the definition and measurement of reoffending during the intervention and follow-up phase. This is most likely the cause of the striking differences in reoffending rates between research studies, within the group, in the immediate follow-up period, and the longer follow-up period. In the literature, various psychometric instruments have been used to examine changes in categories that are directly associated with sexual offending, such as knowledge, cognitive distortions, or victim empathy. The chosen metrics must be valid and reliable for the target group, in this case, offenders with mental disabilities.
The research considered in this review used a variety of metrics that were both particular to and not specific to mental disabilities. The QACSO and SOSAS were both utilized in one of the included researches to evaluate changes in cognitive distortions; however, the SOSAS tended to indicate less significant improvements than the QACSO (Gray, 2020). Some writers proposed that SOSAS may be a less sensitive measure and that the double negative questions may have been challenging for people with mental problems to understand, even though the reasons for these results were not totally clear (McIntosh et al, 2021).
The included studies’ follow-up intervals, which spanned from 6 months to 6.5 years, unavoidably had an impact on the number of additional offences reported. Similar to how the length of the treatment programs, which ranged from 7 to around 36 months and considerably varied across trials. Contrary to other studies, participants in all SOTSEC-ID trials were mixed and comprised both individuals who volunteered and those who were legally obligated to attend therapy under a probation order (Specker et al., 2018).
According to Anguah et al (2019), voluntary offender treatment produces marginally better results than required participation. The most popular method of providing CBT to offenders was through group therapy; however, there does not appear to be much experimental support for using individual CBT with this population of offenders (Ticknor, 2018). Providing CBT to criminals in a group environment seems to have several advantages. According to Parks (2020) group therapies are at least as successful as one-on-one therapies. Groups provide members with a supportive network that may make it easier for people to share their difficulties during group conversations.
Additionally, other group participants are crucial to the therapy process because they encourage altering cognitive distortions and denial through peer challenges (Chan et al, 2021). Additionally, they offer a chance to address particular criminogenic requirements of the offender population that cannot be addressed in individual therapy. For instance, developing social skills, facilitating the development of compatible relationships with other group members, and providing the opportunity to experience collective appreciation all enhance a person’s self-esteem (Collyer, Eisler and Woolgar, 2020).
Improving some of these crucial areas might make reoffending less likely. Additionally, group therapy is seen to be more practical and economical due to its very nature (Belur et al., 2020). However, Marshall and Marshall (2022) argued in a meta-analysis that treatment programs administered in a group setting were less successful than programs that either contained some individual therapy sessions or were wholly individual. This study suggests that differentiation may be important in satisfying the needs of criminals. It has been shown that the effectiveness of offending behavior programs is influenced by the quality of treatment delivery and the nature of the therapeutic alliance between clinician and participant (Young et al, 2018). Only one of the studies we reviewed suggested that staff members could serve as therapeutic change agents. However, it was difficult to address it in the qualitative analysis because they could not explain how this would affect treatment outcomes (Belur et al., 2020).
Researchers often need to consider how supervision affects results. In situations where constraints mean that there is little chance of reoffending, it is challenging to draw legitimate comparisons, and it is challenging to compare the success of offender treatment programs. The need for more supervision may arise during a study; Walton et al, (2020) observed that up to 1 out of every 8 participants required this because they continued to participate in abusive behaviors. Moving to locations with lesser levels of security is a valid measure, especially for individuals moving there (Walton et al, 2020). This outcome indicator was not examined in any of the other studies.
The amount of daily oversight and support offered is likely to have an impact on future recidivism. For instance, participants in research by Geraets et al. (2021) who received 24-hour supervision exhibited no symptoms of reoffending, in contrast to trials with little to no supervision, which usually revealed increased reoffending rates (Taylor et al, 2018). Since it is likely to limit the inferences that can be made from the data, this must be considered when evaluating the research results that have already been published.
Conclusion and Recommendations
Finding an effective psychological intervention for offenders with mental disorders is a key significant area of concern that has an impact on a variety of different stakeholder groups, including policymakers, clinicians, and those receiving care. Each of these groups will have a different stake in the treatment’s success. Professionals are in a moral bind, given the scant evidentiary foundation identified in this review (Eher et al, 2019). They are required to provide therapy to criminals with mental illnesses to lessen the likelihood that they would commit new crimes; in some situations, this treatment is even required. Despite this, they lack a strong evidence base for their choices. There is a shortage of high-quality information in this area. Without it, it is impossible to draw conclusive judgments about the efficacy of treating criminals who have mental disabilities. Because of this, earlier analyses have questioned whether it is moral to treat such a fragile and high-risk population (Turner and Briken, 2019).
To improve the corpus of knowledge in this field, stricter experimental designs, particularly RCT evidence, are required. The ability to choose interventions based on trustworthy methodological evidence rather than information from populations without mental impairments and clinical expertise will allow doctors to better serve patients (Basanta et al, 2018). The truth is that there are many strange scientific procedures and moral conundrums in this field of health and social care. The need for effective offender therapies for those with mental disorders must be continued despite these obstacles because the problem will not disappear.
Both criminal justice organizations and therapists will continue to be concerned about it. Future studies could help evaluate the efficacy of therapies for various offence kinds or across various treatment facilities since it tends to focus on them as a single homogeneous group. This group of offenders exhibits considerable variability, and as a result, several approaches may be required to meet their various criminogenic demands (Harrison et al, 2020). Further research should be done on the unique requirements of offenders with mental disabilities, such as those who have ASD, in relation to their risk of reoffending.
