REVIEW QUESTION

What interventions are effective in helping to reduce drug use or criminal activity (or both) in offenders with mental health problems?

TYPE OF REVIEW

A systematic review of 13 studies involving 2,606 participants.

RELEVANCE FOR NURSING

Studies have found that people involved in the criminal justice system are more likely to experience mental health problems, including severe depression or psychosis. Further differentiation has been made by sex, with more female prisoners having serious mental health problems than male prisoners, and violent female offenders more likely to present with anxiety disorders than their male counterparts.

Age is also considered a factor, and many juveniles in detention have a mental health disorder severe enough to influence their ability to function.

Studies have also found that offenders with mental health problems and a history of drug use are more likely to reoffend and to suffer premature mortality after release. Little is known about the success of interventions and therapies in addressing these comorbidities.

CHARACTERISTICS OF THE EVIDENCE

This review aimed to identify and assess the effectiveness of interventions to help reduce drug use or criminal activity (or both) in offenders with mental health problems within the criminal justice system.

The authors gathered data on any intervention that was wholly or partially designed to reduce, eliminate, or prevent relapse to drug use and criminal activity, irrespective of the sex, age, or ethnicity of the participants. These interventions were psychosocial and included therapeutic community (the aim of which is to change attitudes and lifestyles), cognitive behavioral therapy, motivational interviewing, interpersonal psychotherapy, and case management.

Thirteen studies involving 2,606 participants were identified. Interventions were carried out in prison (eight studies), in court (two studies), in the community (two studies), and at a medium secure hospital (one study).

All reviewers independently assessed the risk of bias using the criteria recommended by the Cochrane Handbook for Systematic Reviews of Interventions.

Male offenders who engaged with therapeutic community interventions were less likely to return to prison than those who received their usual treatment or no intervention (moderate-certainty evidence), whereas female offenders who engaged with therapeutic community interventions were not less likely to reduce drug use or criminal activity compared with those who took a cognitive behavioral course (low-certainty evidence).

Juvenile offenders who engaged with a mental health court, receiving court supervision and contact with case managers, as well as those who received family-based multisystemic therapy, may be less likely to reoffend or take drugs than those given their usual treatment (low-certainty evidence).

There was no strong evidence that motivational interviewing, mindfulness, interpersonal psychotherapy, or cognitive skills reduced the likelihood of drug use or recidivism.

BEST PRACTICE RECOMMENDATIONS

This review attempted to identify interventions that can successfully promote health among this vulnerable population. Nurses can have initial contact with offenders in police custody; provide nursing care in courts and within prisons; and contribute to the multidisciplinary team in the community, where they work alongside the probation services. This review does not provide conclusive evidence that any intervention was found to significantly reduce drug use or criminal activity (or both) in this population, thus this is an area requiring further exploration. It remains appropriate that usual care continue to be provided until further research evidence identifies interventions that can help offenders reduce or eliminate their drug use.

SOURCE DOCUMENT