Early contact with community mental health services lowers risks of reoffence in male offenders with psychosis

Early and frequent contact with community mental health (MH) services after an offence is linked to a reduced risk of reoffending in male offenders with psychosis, and with a lower rate of MH service use in individuals with a history of offence, a recent cohort study shows.

In the study, data of 7,030 individuals (male, 70.2 percent; median age at index offense, 34 years) in New South Wales (NSW), Australia, who were admitted to hospital or presented to emergency department with a diagnosis of psychosis prior to their index offense from 1 July 2001 to 31 December 2012, and who received a noncustodial sentence (ie, no involvement in incarceration in an adult prison or juvenile detention centre), were retrieved by linking health (ie, Admitted Patient Data Collection [ADPC], Emergency Department Data Collection [EDDC] and Mental Health Ambulatory Data Collection [MH-AMB]) and offending (NSW Bureau of Crime Statistics and Research) databases in NSW. [JAMA Psychiatry 2020, doi: 10.1001/jamapsychiatry.2020.1255]

Offending was defined as a criminal charge proven in court, whereas contact to MH service was considered as within 30 days from the date of the index offence during the study period.

At baseline, diagnoses of schizophrenia and related psychoses, substance-related psychoses and affective psychoses were reported in 67.6 percent, 21.9 percent and 10.6 percent of the cohort, respectively. More than 60 percent (61.3 percent) of index offences were nonviolent in nature, with theft being the most frequent (12.2 percent), whilst 29.6 percent of offences were violent acts intended to cause injury.

A vast majority (95.3 percent) of contact with MH service during the follow-up period occurred in the community, rather than through hospital admissions (4.4 percent) or emergency departments (0.3 percent).

Overall, individuals with vs without contact with MH services had a significantly lowered risk of reoffending (adjusted hazard ratio [aHR], 0.83; 95 percent confidence interval [Cl], 0.76 to 0.91).

Frequent contact (ie, ≥5 contacts) with MH services was associated with a 30 percent lowering in risk of reoffending among male offenders compared with those with no contact (aHR, 0.71; 95 percent CI, 0.59 to 0.84). However, MH service contact (ie, 1–≥5 contacts) had no influence on risk of reoffence among female offenders (p=0.20–0.91).

Younger age (ie, ≤18 years) at index offence in both male and female offenders was associated with a substantial increase in risk of reoffending vs older age (ie, ≥46 years) (male: aHR, 3.31; 95 percent CI, 2.39 to 4.59; p<0.001) (female: aHR, 2.60; 95 percent CI, 1.69 to 3.99; p<0.001).

A similar increase in risk of reoffending was observed among male and female offenders with ≥4 prior offences vs no offences prior to the study period (male: aHR, 2.28; 95 percent CI, 1.98 to 2.64; p<0.001) (female: aHR 2.22; 95 percent CI, 1.67 to 2.96; p<0.001).

The time to reoffending was significantly prolonged in male offenders with vs without contact with MH services (p<0.001), as well as those with vs without contact with MH service regardless of type of violence (p=0.003)

An extended exposure window for contact with MH services, from 30 days to 90 days, demonstrated a consistent benefit in lowering the risk of reoffending (aHR, 0.89; 95 percent CI, 0.79 to 0.99) among male offenders.

The incidence of reoffending was 1.27 vs 1.70 per 100 person-years and 1.32 vs 1.42 per 100 person-years in male and female offenders, respectively, for those with vs without contact with MH services during the 2 years of follow-up.