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Original Investigation
July 15, 2020

Association Between Early Contact With Mental Health Services After an Offense and Reoffending in Individuals Diagnosed With Psychosis

Author Affiliations
  • 1Justice Health Research Program, Kirby Institute, University of New South Wales, Sydney, Australia
  • 2Kirby Institute, University of New South Wales, Sydney, Australia
  • 3Department of Statistics, Science Faculty, Tabuk University, Tabuk, Saudi Arabia
  • 4School of Psychiatry, University of New South Wales, Sydney, Australia
  • 5School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
  • 6Faculty of Medicine and Health, University of Sydney, Sydney, Australia
  • 7Centre for Forensic Behavioural Science, Swinburne University of Technology, Alphington, Australia
  • 8St John of God Health Care, Burwood, Australia
  • 9New South Wales Statewide Community and Court Liaison Service, Justice Health Forensic Mental Health Network, University of New South Wales, Sydney, Australia
  • 10School of Psychiatry, University of New South Wales, Sydney, Australia
  • 11Corrective Services New South Wales, Sydney, Australia
JAMA Psychiatry. Published online July 15, 2020. doi:10.1001/jamapsychiatry.2020.1255
Key Points

Question  What is the association between early clinical contact with mental health services and reoffending after an index offense among individuals diagnosed with psychosis?

Findings  In this cohort study of 7030 offenders with psychosis, 2-year follow-up showed an association between increased contact with community mental health services within 30 days after an offense and reduced reoffending in male but not female offenders. Reoffending was associated with younger age and history of offense in male and female offenders, nonviolent offense type in male offenders, and being divorced, separated, widowed, or of unknown marital status in female offenders.

Meaning  These findings suggest that increased early contact with community mental health services after an offense may reduce the risk of reoffending in male offenders with severe mental illness; however, specific support may be needed for female offenders and those with less secure social relationships.

Abstract

Importance  Psychosis is a known risk factor for offending behavior, but little is known about the association between clinical contact with mental health services after an offense and reoffending.

Objective  To examine the association between early contact with mental health services and reoffending after an index offense in individuals with psychosis.

Design, Setting, and Participants  In this cohort study, individuals diagnosed with psychosis before their index offense from July 1, 2001, to December 31, 2012, and who received a noncustodial sentence were identified by linking health and offending databases in New South Wales, Australia. The incidence of and risk factors for reoffending and time to reoffending within 2 years from the index offense were examined using Cox proportional hazards regression and Kaplan-Meier survival estimates. Specifically, the association between contact with mental health services within 30 days after an offense and reoffending was examined. Data were analyzed from July 1, 2019, to March 5, 2020.

Exposures  Hospital admission, emergency department presentation, and contact with community mental health services associated with psychosis.

Main Outcomes and Measures  Reoffending within 2 years of the index offense was compared in individuals with and without clinical contact with mental health services within 30 days after an offense, with adjustment for potential confounders.

Results  Of the 7030 offenders with psychosis (4933 male [70.2%]; median age at the index offense, 34 [interquartile range, 26-42] years), 2605 (37.1%) had clinical contact with mental health services within 30 days after the index offense. The risk of reoffending was significantly lower in those with vs without clinical contact (adjusted hazard ratio [AHR], 0.83; 95% CI, 0.76-0.91). The risk of reoffending was 30% less in male offenders with 5 or more clinical contacts compared with male offenders with no clinical contact (AHR, 0.71; 95% CI, 0.59-0.84). Reoffending in both male and female offenders was associated with younger age (eg, AHR for male offenders aged <18 years, 3.31 [95% CI, 2.39-4.59]; AHR for female offenders aged <18 years, 2.60 [95% CI, 1.69-3.99]) and offending history (eg, AHR for male offenders with ≥4 prior offenses, 2.28 [95% CI, 1.98-2.64]; AHR for female offenders with ≥4 prior offenses, 2.22 [95% CI, 1.67-2.96]).

Conclusions and Relevance  In this cohort, early and frequent clinical contact with mental health services after an offense in individuals with psychosis was associated with reduced risk of reoffending in this group. More support may be needed for early treatment of those with serious mental illness who are at risk of reoffending.

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