Stopping the Revolving Door: A Meta-Analysis on the Effectiveness of Interventions for Criminally Involved Individuals with Major Mental Disorders

  • Michael S. Martin
  • Shannon K. Dorken
  • Ashley D. Wamboldt
  • Sarah E. Wootten
Original Article


Faced with high and increasing rates of mental disorder within the criminal justice system (CJS), a range of interventions have been implemented in an effort to prevent continued involvement in criminal activities among this population. A meta-analytic review was undertaken to consider the effectiveness of interventions for criminally involved adults with a mental disorder targeting either improved criminal justice or mental health outcomes. Furthermore, characteristics that were hypothesized to predict better outcomes were examined. Studies that considered sex offender interventions, or focused solely on antisocial personality, intellectual and cognitive, or substance use disorders were excluded. Results assuming a fixed-effects model combining 37 effect sizes from 25 studies (N = 15,678) support the effectiveness of these interventions in terms of reductions in any CJS involvement (d = 0.19 excluding one outlier). Interventions had no significant effect on an aggregate mental health outcome (d = 0.00). However, when considering distinct mental health outcomes, intervention participants had significantly better functioning (d = 0.20) and fewer symptoms (d = 0.12). There were no significant effects of the interventions on mental health service or medication use. Moderator analyses identified seven sample, intervention, and design characteristics that were related to the magnitude of the effect sizes for criminal justice outcomes, and suggest implications for service provision, policy, and research. Results suggested some relationship between intervention effects on mental health and criminal justice reinvolvement, although future research is needed in this area, especially given the absence of mental health outcome data in many studies.


Meta-analysis Mental health Criminal justice Interventions Outcomes 

Supplementary material

10979_2011_9274_MOESM1_ESM.docx (20 kb)
Supplementary material 1 (DOCX 21 kb)


Studies included in the meta-analysis are indicated by a superscript number at the beginning of the reference, which corresponds to references in Tables 1 and 2. Sacks, Sacks, McKendrick, Banks, & Stommel (2004) and Sullivan et al. (2008) were both assigned the same number as the former reported CJS outcomes, and the latter reported mental health outcomes for the same sample.

  1. Adair, C. E., McDougall, G. M., Beckie, A., Joyce, A., Mitton, C., Wild, C. T., et al. (2003). History and measurement of continuity of care in mental health services and evidence of its role in outcomes. Psychiatric Services, 54(10), 1351–1356. doi:10.1176/ Scholar
  2. American Psychiatric Association. (2004). Mental illness and the criminal justice system: redirecting resources toward treatment, not containment. Resource document. Arlington: Author.Google Scholar
  3. Andrews, D. A. (2000). Principles of effective corrections. In L. Motiuk & R. Serin (Eds.), Compendium on effective correctional programming (Chapter 2). Ottawa: Correctional Service Canada.Google Scholar
  4. Andrews, D. A., & Bonta, J. (2003). The psychology of criminal conduct (3rd ed.). Cincinnati: Anderson Publishing Co.Google Scholar
  5. 1Ashford, J. B., Wong, K. W., & Sternbach, K. O. (2008). Generic correctional programming for mentally ill offenders: A pilot study. Criminal Justice and Behavior, 35, 457–474. doi:10.1177/0093854807313356.Google Scholar
  6. Beech, A., Bourgon, G., Hanson, K. R., Harris, A. J. R., Langton, C., Marques, J., et al. (2007a). The Collaborative Outcome Data Committee’s Guidelines for the Evaluation of Sexual Offender Treatment Outcome Research. Part 2: CODC Guidelines. Ottawa: Public Safety Canada.Google Scholar
  7. Beech, A., Bourgon, G., Hanson, K. R., Harris, A. J. R., Langton, C., Marques, J., et al. (2007b). Sexual Offender Treatment Outcome Research: CODC Guidelines for Evaluation. Part 1: Introduction and Overview. Ottawa: Public Safety Canada.Google Scholar
  8. 2Belfrage, H. (1991). The crime preventive effect of psychiatric treatment on mentally disordered offenders in Sweden. International Journal of Law and Psychiatry, 14, 237–243. doi:10.1002/bsl.605.
  9. Blackburn, R. (2004). “What works” with mentally disordered offenders. Psychology, Crime & Law, 10(3), 297–308. doi:10.1080/10683160410001662780.CrossRefGoogle Scholar
  10. Bloom, B., Owen, B., & Covington, S. (2003). Gender-responsive strategies: Research, practice, and guiding principles for women offenders. Washington: National Institute of Corrections.Google Scholar
  11. Bonta, J., Law, M., & Hanson, K. (1998). The prediction of criminal and violent recidivism among mentally disordered offenders: A meta-analysis. Psychological Bulletin, 123(2), 123–142. doi:10.1037/0033-2909.123.2.123.PubMedCrossRefGoogle Scholar
  12. Borenstein, M. (2009). Effect sizes for continuous data. In H. Cooper, L. V. Hedges, & J. C. Valentine (Eds.), The handbook of research synthesis and meta-analysis (2nd ed., pp. 221–236). New York: Russell Sage Foundation.Google Scholar
  13. Brink, J. H., Doherty, D., & Boer, A. (2001). Mental disorder in federal offenders: A Canadian prevalence study. International Journal of Law and Psychiatry, 2, 330–356. doi:10.1016/S0160-2527(01)00071-1.Google Scholar
  14. 3Broner, N., Lattimore, P. K., Cowell, A. J., & Schlenger, W. E. (2004). Effects of diversion on adults with co-occurring mental illness and substance use: Outcomes from a national multi-site study. Behavioral Sciences and the Law, 22, 519–541. doi:10.1002/bsl.605.
  15. 4Chandler, D. W., & Spicer, G. (2006). Integrated treatment for jail recidivists with co-occurring psychiatric and substance use disorders. Community Mental Health Journal, 42(4), 405–425. doi:10.1007/s10597-006-9055-6.
  16. 5Christy, A., Poythress, N. G., Boothroyd, R. A., Petrila, J., & Mehra, S. (2005). Evaluating the efficiency and community safety goals of the Broward county mental health court. Behavioral Sciences and the Law, 23, 227–243. doi:10.1002/bsl.647.Google Scholar
  17. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). New York: Psychology Press.Google Scholar
  18. 6Cosden, M., Ellens, J., Schnell, J., & Yamini-Diouf, Y. (2005). Efficiency of a mental health treatment court with assertive community treatment. Behavioral Sciences and the Law, 23, 199–214. doi:10.1002/bsl.638.Google Scholar
  19. Correctional Service of Canada (2009). Quick facts: Mental health strategy. Ottawa: Author. Retrieved December 31, 2009 from
  20. Douglas, K. S., & Skeem, J. L. (2005). Violence risk assessment: Getting specific about being dynamic. Psychology, Public Policy, and Law, 11, 347–383. doi:10.1037/1076-8971.11.3.347.CrossRefGoogle Scholar
  21. Draine, J., & Solomon, P. (1999). Describing and evaluating jail diversion services for persons with serious mental illness. Psychiatric Services, 50, 56–61.PubMedGoogle Scholar
  22. Fazel, S., & Danesh, J. (2002). Serious mental disorder in 23,000 prisoners: A systematic review of 62 surveys. The Lancet, 359, 545–550. doi:10.1016/S0140-6736(02)07740-1.CrossRefGoogle Scholar
  23. Fleiss, J. L., & Berlin, J. A. (2009). Effect sizes for dichotomous data. In H. Cooper, L. V. Hedges, & J. C. Valentine (Eds.), The handbook of research synthesis and meta-analysis (2nd ed., pp. 237–254). New York: Russell Sage Foundation.Google Scholar
  24. Hanson, R. K., Bourgon, G., Helmus, L., & Hodgson, S. (2009). The principles of effective correctional treatment also apply to sexual offenders: A meta-analysis. Criminal Justice and Behavior, 36(9), 865–891. doi:10.1177/0093854809338545.CrossRefGoogle Scholar
  25. Hanson, R. K., & Morton-Bourgon, K. E. (2005). The characteristics of persistent sexual offenders: A meta-analysis of recidivism studies. Journal of Consulting and Clinical Psychology, 73(6), 1154–1163. doi:10.1037/0022-006X.73.6.1154.PubMedCrossRefGoogle Scholar
  26. Hedges, L. V. (2010). Statistical considerations. In H. Cooper, L. V. Hedges, & J. C. Valentine (Eds.), The handbook of research synthesis and meta-analysis (2nd ed., pp. 221–236). New York: Russell Sage Foundation.Google Scholar
  27. Hedges, L. V., & Pigott, T. D. (2001). The power of statistical tests in meta-analysis. Psychological Methods, 6(3), 203–217. doi:10.1037//1082-989X.6.3.203.PubMedCrossRefGoogle Scholar
  28. Hedges, L. V., & Pigott, T. D. (2004). The power of statistical tests for moderators in meta-analysis. Psychological Methods, 9(4), 426–445. doi:10.1037/1082-989X.9.4.426.PubMedCrossRefGoogle Scholar
  29. Heilbrun, K., & Peters, L. (2000). Community-based treatment programmes. In S. Hodgins & R. Muller-Isberner (Eds.), Violence, crime and mentally disordered offenders (pp. 193–216). New York: Wiley.Google Scholar
  30. Hiday, V. A. (2006). Putting community risk in perspective: A look at correlations, causes and controls. International Journal of Law and Psychiatry, 29, 316–331. doi:10.1016/j.ijlp.2004.08.010.PubMedCrossRefGoogle Scholar
  31. Hodgins, S., & Janson, C. (2002). Criminality and violence among the mentally disordered. Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  32. 7Hoff, R. A., Baranosky, M. V., Buchanan, J., Zonana, H., & Rosenheck, R. A. (1999). The effects of a jail diversion program on incarceration: A retrospective cohort study. Journal of the American Academy of Psychiatry and the Law, 27(3), 377–386.Google Scholar
  33. James, D. J., & Glaze, L. E. (2006). Mental health problems of prison and jail inmates. Washington: U.S. Department of Justice.Google Scholar
  34. 8Khodayarifard, M., Pritz, A., & Khodayarifard, S. (2008). The impact of group and individual cognitive-behavioral intervention on the mental health state of male prisoners. International Journal of Psychotherapy, 12(2), 50–66.Google Scholar
  35. Kirby, M., & Keon, W. (2006). Out of the shadows at last: Transforming mental health, mental illness and addictions services in Canada. Final report of the Standing Senate Committee on Social Affairs, Science and Technology. Retrieved September 30, 2007, from
  36. Laishes, J. (2002). The 2002 mental health strategy for women offenders. Ottawa: Correctional Service of Canada. Retrieved online March 30, 2010, from
  37. Latimer, J., & Lawrence, A. (2006). The review board systems in Canada: An overview of the results from the mentally disordered accused data collection study. Ottawa: Department of Justice Canada.Google Scholar
  38. Lattimore, P. K., Broner, N., Sherman, R., Frisman, L., & Shafer, M. S. (2003). A comparison of prebooking and postbooking diversion programs for mentally ill substance-using individuals with justice involvement. Journal of Contemporary Criminal Justice, 19, 30–64. doi:10.1177/1043986202239741.CrossRefGoogle Scholar
  39. Link, B. G., Stueve, A., & Phelan, J. (1998). Psychotic symptoms and violent behaviors: probing the components of “threat/control-override” symptoms. Social Psychiatry and Psychiatric Epidemiology, 33, S55–S60. doi:10.1007/s001270050210.PubMedCrossRefGoogle Scholar
  40. Lösel, F., & Schmucker, M. (2005). The effectiveness of treatment for sexual offenders: A comprehensive meta-analysis. Journal of Experimental Criminology, 1, 117–146. doi:10.1007/s11292-004-6466-7.CrossRefGoogle Scholar
  41. 9McNiel, D. E., & Binder, R. L. (2007). Effectiveness of a mental health court in reducing criminal recidivism and violence. American Journal of Psychiatry, 164, 1395–1403. doi:10.1176/appi.ajp.2007.06101664.Google Scholar
  42. Messina, N., & Grella, C. (2006). Childhood trauma and women’s health outcomes in a California prison population. American Journal of Public Health, 96, 1842–1848. doi:10.2105/AJPH.2005.082016.PubMedCrossRefGoogle Scholar
  43. Monahan, J., Hoge, S. K., Lidz, C., Roth, L. H., Bennett, N., Gardner, W., et al. (1995). Coercion and commitment: Understanding Involuntary Mental Hospital Admission. International Journal of Law and Psychiatry, 18(3), 249–263. doi:10.1016/0160-2527(95)00010-F.PubMedCrossRefGoogle Scholar
  44. 10Moore, M. E., & Hiday, V. A. (2006). Mental health court outcomes: A comparison of re-arrest and re-arrest severity between mental health court and traditional court participants. Law and Human Behavior, 30, 659–674. doi:10.1007/s10979-006-9061-9.
  45. 11Morrissey, J. P., Cuddeback, G. S., Cuellar, A. E., & Steadman, H. J. (2007). The role of Medicaid enrolment and outpatient service use in jail recidivism among persons with severe mental illness. Psychiatric Services, 58(6), 794–801. doi:10.1176/ Scholar
  46. Motiuk, L. L. (2000). Contribution to safe reintegration: Outcome measurement. In L. Motiuk & R. Serin (Eds.), Compendium on effective correctional programming (Chapter 23). Ottawa, Canada: Correctional Service Canada.Google Scholar
  47. 12Muller-Isberner, J. R. (1996). Forensic psychiatric aftercare following hospital order treatment. International Journal of Law and Psychiatry, 19(1), 81–86. doi:10.1016/0160-2527(95)00023-2.Google Scholar
  48. Muller-Isberner, R., & Hodgins, S. (2000). Evidence-based treatment for mentally disordered offenders. In S. Hodgins & R. Muller-Isberner (Eds.), Violence, crime and mentally disordered offenders (pp. 7–38). New York: Wiley.Google Scholar
  49. Peters, J. L., Sutton, A. J., Jones, D. R., Abrams, K. R., & Rushton, L. (2007). Performance of the trim and fill method in the presence of publication bias and between-study heterogeneity. Statistics in Medicine, 26, 4544–4562. doi:10.1002/sim.2889.PubMedCrossRefGoogle Scholar
  50. Priebe, S., & McCabe, R. (2008). Therapeutic relationships in psychiatry: The basis of therapy or therapy in itself? International Review of Psychiatry, 20(6), 521–526. doi:10.1080/09540260802565257.PubMedCrossRefGoogle Scholar
  51. Priebe, S., McCabe, R., Bullenkamp, J., Hansson, L., Lauber, C., Martinez-Leal, R., et al. (2007). Structured patient–clinician communication and 1-year outcome in community mental healthcare. British Journal of Psychiatry, 191, 420–426. doi:10.1192/bjp.bp.107.036939.PubMedCrossRefGoogle Scholar
  52. Prins, S., & Draper, L. (2009). Improving outcomes for people with mental illnesses under community corrections supervision: A guide to research-informed policy and practice. New York: Council of State Governments Justice Center.Google Scholar
  53. 13Rice, M. E., Harris, G. T., & Cormier, C. A. (1992). An evaluation of a maximum security therapeutic community for psychopaths and other mentally disordered offenders. Law and Human Behavior, 16(4), 399–412. doi:10.1007/BF02352266.Google Scholar
  54. 14Rivas-Vazquez, R. A., Sarria, M., Rey, G., Rivas-Vazquez, A. A., Rodriguez, J., & Jardon, M. E. (2009). A relationship-based care model for jail diversion. Psychiatric Services, 60(6), 766–771. doi:10.1176/ Scholar
  55. Rosenthal, R. 1979. The “file drawer problem” and tolerance for null results. Psychological Bulletin, 86(3), 638–641. doi: 10.1037/0033-2909.86.3.638.
  56. 15Sacks, J. Y., Sacks, S., McKendrick, K., Banks, S., Schoeneberger, M., Hamilton, Z., et al. (2008). Prison therapeutic community treatment for female offenders: Profiles and preliminary findings for mental health and other variables (crime, substance use and HIV risk). Journal of Offender Rehabilitation, 46(3), 233–261. doi:10.1080/10509670802143680.Google Scholar
  57. 16Sacks, S., Sacks, J. Y., McKendrick, K., Banks, S., & Stommel, J. (2004). Modified TC for MICA offenders: Crime outcomes. Behavioral Sciences and the Law, 22, 477–501. doi:10.1002/bsl.599.
  58. Sánchez-Meca, J., Marín-Martínez, F., & Chácon-Moscoso, S. (2003). Effect-size indices for dichotomized outcomes in meta-analysis. Psychological Methods, 8(4), 448–467. doi:10.1037/1082-989X.8.4.448.PubMedCrossRefGoogle Scholar
  59. 17Shafer, M. S., Arthur, B., & Franczak, M. J. (2004). An analysis of post-booking jail diversion programming for persons with co-occurring disorders. Behavioral Sciences and the Law, 22, 771–785. doi:10.1002/bsl.603.Google Scholar
  60. 18Silver, S. B., Cohen, M. I., & Spodak, M. K. (1989). Follow-up after release of insanity acquittees, mentally disordered offenders, and convicted felons. Bulletin of the American Academy of Psychiatry and the Law, 17(4), 387–400.Google Scholar
  61. Skeem, J. L., Manchak, S., & Peterson, J. K. (2010). Correctional policy for offenders with mental illness: Creating a new paradigm for recidivism reduction. Law and Human Behavior. Advance online publication. doi:10.1007/s10989-010-9223-7.
  62. 19Solomon, P., & Draine, J. (1995). One-year outcomes of randomized trial of case management with seriously mentally ill clients leaving jail. Evaluation Review, 19, 256–273. doi:10.1177/0193841X9501900302.Google Scholar
  63. Steadman, H. (1992). Boundary spanners: A key component for the effective interactions of the justice and mental health systems. Law and Human Behavior, 16(1), 75–87. doi:10.1007/BF02351050.CrossRefGoogle Scholar
  64. Sterne, J. A. C., & Egger, M. (2001). Funnel plots for detecting bias in meta-analysis: Guidelines on choice of axis. Journal of Clinical Epidemiology, 54, 1046–1055. doi:10.1016/S0895-4356(01)00377-8.PubMedCrossRefGoogle Scholar
  65. 16Sullivan, C. J., Sacks, S., McKendrick, K., Banks, S., Sacks, J. Y., & Stommel, J. (2008). Modified therapeutic community treatment for offenders with co-occurring disorders. Journal of Offender Rehabilitation, 45(1), 227–247. doi:10.1300/J076v45n01_15.Google Scholar
  66. 20Taylor, N. (2005). An analysis of the effectiveness of Santa Clara county’s mentally ill offender crime reduction program (Doctoral Thesis, Pacific Graduate School of Psychology, Palo Alto). UMI Number: 3181686.Google Scholar
  67. 21Tellefsen, C., Cohen, M. I., Silver, S. B., & Dougherty, C. (1992). Predicting success on conditional release for insanity acquittees: Regionalized versus nonregionalized patients. Bulletin of the American Academy of Psychiatry and the Law, 20(1), 87–100.Google Scholar
  68. 22Theurer, G., & Lovell, D. (2008). Recidivism of offenders with mental illness released from prison to an intensive community treatment program. Journal of Offender Rehabilitation, 47(4), 385–406. doi:10.1080/10509670801995023.Google Scholar
  69. Valentine, J. C., Pigott, T. D., & Rothstein, H. R. (2010). How many studies do you need? A primer on statistical power for meta-analysis. Journal of Educational and Behavioral Statistics, 35(2), 215–247. doi:10.3102/1076998609346961.CrossRefGoogle Scholar
  70. Van Marle, H. J. C. (2007). Mental health care in prison: How to manage our care. International Journal of Prisoner Health, 3(2), 115–123. doi:10.1080/17449200701321530.CrossRefGoogle Scholar
  71. 23Van Stelle, K. R., & Moberg, D. P. (2004). Outcome data for MICA clients after participation in an institutional therapeutic community. Journal of Offender Rehabilitation, 39(1), 37–62. doi:10.1300/J076v39n01_03.
  72. 24Wilson, D., Tien, G., & Eaves, D. (1995). Increasing the community tenure of mentally disordered offenders: An assertive case management program. International Journal of Law and Psychiatry, 18(1), 61–69. doi:10.1016/0160-2527(94)00027-1.
  73. 25Zlotnick, C., Johnson, J., & Najavits, L. M. (2009). Randomized controlled pilot study of cognitive-behavioral therapy in a sample of incarcerated women with substance use disorder and PTSD. Behavior Therapy, 40, 325–336. doi:10.1016/j.beth.2008.09.004.

Copyright information

© American Psychology-Law Society/Division 41 of the American Psychological Association 2011

Authors and Affiliations

  • Michael S. Martin
    • 1
    • 2
  • Shannon K. Dorken
    • 2
  • Ashley D. Wamboldt
    • 2
  • Sarah E. Wootten
    • 2
  1. 1.Department of PsychologyCarleton UniversityOttawaCanada
  2. 2.Correctional Service Canada, Mental Health BranchOttawaCanada

Personalised recommendations