Criminal Thinking, Psychiatric Symptoms, and Recovery Attitudes Among Community Mental Health Patients: An Examination of Program Placement

• Author: Stephanie A. Van Horn,Robert D. Morgan,Nicole R. Bartholomew,Sean M. Mitchell
• DOI: 10.1177/0093854817734007
• Date: 01 February 2018
• Published date: 01 February 2018
• Subject Matter: Articles

https://doi.org/10.1177/0093854817734007

CRIMINAL JUSTICE AND BEHAVIOR, 2018, Vol. 45, No. 2, February 2018, 195 –213.

DOI: 10.1177/0093854817734007

© 2017 International Association for Correctional and Forensic Psychology

195

CRIMINAL THINKING, PSYCHIATRIC

SYMPTOMS, AND RECOVERY ATTITUDES

AMONG COMMUNITY MENTAL HEALTH

PATIENTS

An Examination of Program Placement

NICOLE R. BARTHOLOMEW

Federal Bureau of Prisons

ROBERT D. MORGAN

SEAN M. MITCHELL

STEPHANIE A. VAN HORN

Texas Tech University

Research suggests it is important to consider criminogenic needs among individuals with severe mental illness. This study

aimed to determine the severity of criminal thinking in community-based clinical samples, understand the association

between criminal thinking and psychiatric and criminal justice outcomes, and compare these associations between consumers

enrolled in Assertive Community Treatment (ACT) and Forensic Assertive Community Treatment (FACT) programs.

Participants (N = 234) were male and female consumers enrolled in ACT and FACT programs in five states. Results revealed

no significant differences in criminal thinking when comparing participants by program type or history of criminal justice

involvement. There were significant positive relations between general criminal thinking and psychiatric symptomatology

and the number of lifetime arrests, a negative association between recovery attitudes and general criminal thinking, and ACT

participants reported a greater number of lifetime psychiatric hospitalizations than FACT participants. Result implications are

discussed with specific reference to treatment programming.

Keywords: criminal thinking; recovery attitudes; criminal justice involvement; psychiatric symptoms

People who engage in crime evidence thinking styles that support and reinforce antiso-

cial behaviors such as manipulation, impulsivity, and irresponsibility (Walters, 1990;

Yochelson & Samenow, 1976). Andrews and Bonta (2010) identified criminal thinking as

one of the “Big Four” risk factors that increase one’s likelihood of engaging in criminal

AUTHORS’ NOTE: Opinions expressed in this article are those of the authors and do not necessarily repre-

sent the opinions of the Federal Bureau of Prisons or the Department of Justice. This project was funded by the

Center for Behavioral Health Services & Criminal Justice Research. Correspondence concerning this article

should be addressed to Nicole R. Bartholomew, Federal Medical Center Carswell, P.O. Box 27066 –“J” St.,

Bldg. 3000, Fort Worth, TX 76127; e-mail: lnb4023@gmail.com.

734007CJBXXX10.1177/0093854817734007Criminal Justice and BehaviorBartholomew et al. / Criminal Thinking in a Community

research-article2017

196 CRIMINAL JUSTICE AND BEHAVIOR

behavior. Criminal thinking not only contributes to engagement in criminal behavior, but

also influences prolonged and persistent involvement in criminal activity. Specifically, “a

criminal belief system supports the evolving criminal lifestyle by shielding it from the light

of corrective environmental experience” (Walters, 2006, p. 5). Research has begun to exam-

ine the role of criminal thinking in the disproportionate involvement of persons with mental

illness (PMI) in the criminal justice (CJ) system; however, the severity of criminal thinking

and its association with psychiatric and criminal justice outcomes remains unclear.

Research with CJ populations has found that PMI who are incarcerated evidenced crimi-

nal thinking styles that were consistent with nonmentally ill offenders (Morgan, Fisher,

Duan, Mandracchia, & Murray, 2010; Wilson et al., 2014; Wolff, Morgan, & Shi, 2013;

Wolff, Morgan, Shi, Huening, & Fisher, 2011). In addition, the psychiatric symptomatology

of the incarcerated PMI was similar to that of inpatient psychiatric samples (Morgan et al.,

2010; Wolff et al., 2011). Furthermore, PMI admitted to a short-term psychiatric facility

with a history of, but no current, CJ involvement reported criminal thinking similar to incar-

cerated PMI (Gross & Morgan, 2013). Finally, Girard and Wormith (2004) found that CJ

involved PMI evidenced higher total scores on the General Risk/Need scale of the Level of

Service Inventory/Case Management Inventory (LS/CMI; a commonly used measure of

criminal risk assessment; Andrews, Bonta, & Wormith, 2004) than CJ involved individuals

without mental illness. Taken together, it appears that PMI who are CJ involved “are both

mentally ill psychiatric patients and criminals” (Morgan et al., 2010, p. 333) with complex

criminogenic and mental health treatment needs.

Interestingly, criminal thinking may be a psychiatric risk factor for PMI who are not CJ

involved. For example, civil psychiatric patients scored significantly higher on five out of

eight criminal thinking style scales than an incarcerated sample without mental illness

(Carr, Rosenfeld, Magyar, & Rotter, 2009). This increased severity of criminal thinking

among PMI appears to affect both CJ and psychiatric outcomes (e.g., reincarceration or

psychiatric rehospitalization). When compared with offenders without mental illness, PMI

who are placed on community supervision (i.e., parole) after being released from a correc-

tional facility are significantly more likely to recidivate (i.e., continue criminal behavior

resulting in an arrest and/or reincarceration; Messina, Burdon, Hagopian, & Prendergast,

2004). Similarly, it is estimated that approximately 53% of PMI released from mental health

facilities psychiatrically recidivate (i.e., decompensate and are consequently readmitted to

a mental health facility) within 12 months of being discharged (Millman, 1993; Segal &

Burgess, 2006). The increased risk for criminal recidivism and the high rate of psychiatric

recidivism may be attributable to shared risk factors that affect both criminal and psychiat-

ric recovery. For example, PMI receiving community mental health services attributed fac-

tors such as unemployment, lack of education, lack of housing, and economic difficulties as

contributing to their likelihood of psychiatric recidivism (Mgustshini, 2010), and these fac-

tors also correspond to risk factors used to predict criminal behavior (Andrews & Bonta,

2010; Draine, Salzer, Culhane, & Hadley, 2002). In addition, incarcerated PMI were found

to have psychiatric hospitalization rates that were three times higher than PMI who were not

CJ involved (Fisher et al., 2002), suggesting a unique feature that may increase the potential

for psychiatric hospitalization.

Given the poor CJ and psychiatric outcomes related to traditional mental health treat-

ment, treatment programs that address both criminogenic (e.g., substance abuse, emotion

management, criminal attitudes, criminal associates) and psychiatric (e.g., mental illness