Diagnostic Moderators of the Risk-Recidivism Relationship for Offenders with Mental Illness

• Author: Amy Nicole Baker,James J. Cassidy,William Amory Carr
• DOI: 10.1177/0306624X20969944
• Published date: 01 December 2021
• Date: 01 December 2021
• Subject Matter: Articles

https://doi.org/10.1177/0306624X20969944

International Journal of

Offender Therapy and

Comparative Criminology

2021, Vol. 65(16) 1756 –1774

© The Author(s) 2020

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DOI: 10.1177/0306624X20969944

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Article

Diagnostic Moderators

of the Risk-Recidivism

Relationship for Offenders

with Mental Illness

William Amory Carr1, Amy Nicole Baker1,

and James J. Cassidy1

Abstract

Recent research suggests that early onset of criminality is a potential marker for

a subgroup of offenders with mental illness (OMI) for whom general risk/need

factors are more relevant. The present study examines whether the presence of

certain psychiatric diagnostic categories (i.e., Psychotic Disorders, Mood Disorders,

Personality Disorders, Substance use Disorders) moderates the prediction of arrest

outcomes using Level of Service Inventory-Revised (LSI-R) total scores in an archival

sample of N = 179 OMI probationers. Moderator analyses demonstrated that LSI-R

total scores predicted arrest outcomes significantly better for those with a diagnosis

of Personality Disorder using path and survival analytic methods. Hierarchical

regressions using LSI-R subscales as predictors revealed lower pro-criminal Attitudes

for Mood Disordered participants, while more severe Criminal History and Family/

Marital problems characterized those diagnosed with Personality Disorders. This

study adds to the developing literature on subgroups of OMI for whom general

risk/need factors are particularly important and highlights personality disturbance as

another potential characterizing feature.

Keywords

risk/needs, level of service inventory, offenders with mental illness, criminogenic

needs, recidivism

1University of New Haven, West Haven, CT, USA

Corresponding Author:

William Amory Carr, Department of Psychology, University of New Haven, 300 Boston Post Road,

West Haven, CT 06516, USA.

Email: acarr@newhaven.edu

969944IJOXXX10.1177/0306624X20969944International Journal of Offender Therapy and Comparative CriminologyCarr et al.

research-article2020

Carr et al. 1757

Several studies have identified a relationship between mental illness and criminal

behavior. Individuals with severe mental illnesses such as Schizophrenia, Bipolar

Disorder and Major Depressive Disorder, have been found in disproportionately

greater numbers within criminal justice populations as compared to community set-

tings (Bronson & Berzofsky, 2017; Steadman et al., 2009), and have been shown to be

at greater risk for having a criminal conviction in longitudinal research (Hodgins et al.,

1996). Furthermore, arrest trajectories of offenders with mental illness tend to be more

severe compared to literature-based expectations of general offenders (Constantine

et al., 2010).

There is conflicting evidence, however, as to the criminogenic potential of mental

illness per se. Initial explanations for the apparent increased risk of crime among the

mentally ill were that, in the wake of deinstitutionalization of psychiatric hospitals,

former patients were being arrested for behavior previously considered symptomatic.

This criminalization hypothesis (Abramson, 1972), was supported by the finding that

offenders with mental illness (OMI’s) were more likely to be arrested for the same

offense committed by offenders without mental illness (Teplin, 1984). Several subse-

quent strands of research, however, have not supported this hypothesis. For example,

insanity acquittees with and without schizophrenia recidivate at similar rates when

matched on age, index offense and criminal history (Rice & Harris, 1992), and that

post-institutional arrest rates of acquittees were similar to those of matched convicted

felons (Pantle et al., 1980; Pasewark et al., 1982). More recent research has demon-

strated that offenders with a non-substance use psychiatric disorder were at no greater

risk of re-offending as compared to offenders without a psychiatric diagnosis

(Rezansoffet al., 2013)

Clinical risk factors (e.g., psychiatric diagnoses, treatment compliance) have been

found insignificantly related to general and violent recidivism in a comprehensive

meta-analysis of 64 studies (Bonta et al., 1998) and a more recent study of a large

sample of inmates released from state prison (Zgoba et al., 2020). The offense patterns

of OMI have been found similar to offenders without mental illness (Peterson et al.,

2010), and risk factors not unique to persons with mental illness have been found

equally predictive of recidivism for matched samples of both OMI and non-OMI

parolees (Skeem et al., 2014).

These general risk factors form the basis of one popular model of recidivism man-

agement, Risk Need Responsivity (RNR) (Andrews et al., 1990), and its attendant

theory of criminal behavior, the General Personality and Cognitive Social Learning

theory (GPCSL) (Andrews & Bonta, 2010). The most prominent risk factors, hereafter

referred to as general risk/needs, include severity of criminal history, affiliation with

antisocial companions, adoption of pro-criminal attitudes/thinking styles, having an

antisocial personality pattern, having problems with substance use, family/martial

relationships, education/employment, and leisure/recreation (Andrews et al., 2006).

These general risk/needs are typically measured by risk assessment instruments such

as the Level of Service Inventory-Revised (LSI-R) (Andrews & Bonta, 1995).

There is evidence that general risk/needs are significantly elevated among OMI

compared to their non-OMI peers. In samples of state inmates (Morgan et al., 2010;