Interventions for drug-using offenders with co-occurring mental illness: : A systematic review and economic appraisal

Background: Drug-using offenders with co-occurring mental health problems are common in the criminal justice system. A combination of drug use and mental health problems makes people more likely to be arrested for criminal involvement after release compared to offenders without a mental health problem. Previous research has evaluated interventions aimed broadly at those with a drug problem but rarely with drug use and mental health problems. This systematic review considers the effectiveness of interventions for drug-using offenders with co-occurring mental health problems. Methods: We searched 14 electronic bibliographic databases up to May 2014 and five Internet resources. The review included randomised controlled trials designed to reduce, eliminate, or prevent relapse of drug use and/or criminal activity. Data were reported on drug and crime outcomes, the identification of mental health problems, diagnoses and resource information using the Drummond checklist. The systematic review used standard methodological procedures as prescribed by the Cochrane collaboration. Results: Eight trials with 2058 participants met the inclusion criteria. These evaluated: case management (RR, 1.05, 95 % CI 0.90 to 1.22, 235 participants), motivational interviewing and cognitive skills, (MD-7.42, 95 % CI-0.20.12 to 5.28, 162 participants) and interpersonal psychotherapy (RR 0.67, 95 % CI 0.3 to 1.5, 38 participants). None of these trials reported significant reductions in self-report drug misuse or crime. Four trials evaluating differing therapeutic community models showed reductions in re-incarceration (RR 0.28, 95 % CI 0.13 to 0.63, 139 participants) but not re-arrest (RR 1.65, 95 % CI 0.83 to 3.28, 370 participants) or self-report drug use (RR 0.73, 95 % CI 0.53 to 1.01, 370 participants). Mental health problems were identified across the eight trials and 17 different diagnoses were described. Two trials reported some resource information suggesting a cost-beneficial saving when comparing therapeutic communities to a prison alternative. Conclusions: Overall, the studies showed a high degree of variation, warranting a degree of caution in the interpretation of the magnitude of effect and direction of benefit for treatment outcomes. Specifically, tailored interventions are required to assess the effectiveness of interventions for drug-using offenders with co-occurring mental health problems

A systematic review of selected interventions to reduce juvenile re-offending. Technical Report.

What do we want to know? Persistent juvenile re-offending remains an area of concern for public policy, due to the social, economic and health impacts of such offending on victims and offenders. A large proportion of criminal offences are committed by repeat offenders. The broad purpose of this systematic review was to review the research evidence on a selected range of interventions to reduce re-offending by juveniles to try and identify more effective interventions. What did we find and what are the implications? When compared to standard diversion (caution and monitoring) there was consistent evidence of reductions in re-offending from the following intervention: Pre-sentencing diversion with personal skills training and reparation The intervention included: - personal skills training/ counselling about anger management, personal responsibility and decision making. - some form of reparation to the community/ victim of crime. - family involvement. When compared to standard residential placement there was consistent evidence of reductions in re-offending from the following intervention: • Community based family residential placement for female juvenile offenders The intervention included: - residential placement for six months to a year in small group supportive ‘family type’ environment. - personal skills training/counselling which is about anger management, personal responsibility and decision making. - monitoring and use of appropriate incentives and sanctions. Promising effects The following interventions were classified as having promising positive effects with limited or inconsistent evidence: • ‘Teen Courts’ compared to other diversion • Community based family residential placements compared to standard residential placements for male juvenile offenders Insufficient evidence There was insufficient evidence identified to assess the impact of the following interventions: • Secure incarceration compared to community sentence • Psycho-dynamic counselling compared to normal court interventions • Pre-sentence diversions compared to court community sentence • Multi-component diversion for persistent offenders (comparison not clear) • Multi-component diversion for mixed groups of offence severity (comparison not clear) • Supported transition from secure incarceration to community compared to no or limited support • Probation plus sports counselling compared to probation only • Violence re-education programme compared to court imposed community service What are the implications? The results suggest that those interventions where there is consistent evidence of beneficial effect could be priorities for possible implementation accompanied by rigorous evaluation in the UK context as the evidence on the effects of this intervention in this review all came from the USA. The ‘promising’ interventions could be considered priorities for further rigorous evaluation. How did we get these results? The review was undertaken in a number of stages. The first stage consisted of identifying all studies that met the review inclusion criteria published between 1998 and 2007. Descriptive information about these studies was collected and used as a ‘map’ of research in the field of interventions to reduce juvenile re-offending. At this point there were 94 studies included the map. A further round of coding was undertaken to help identify sub-groups of studies. The results of this coding were discussed with the steering group and a decision was made at that point to focus on a number of subgroups for the in-depth review. At this stage detailed data extraction was undertaken to assess the quality of the studies and facilitate synthesis of the findings of the selected studies in order to provide answers to the review questions

Interventions for female drug-using offenders (Review)

Kumar KM,

Study of Impact of COVID-19 on Mental Health and Wellbeing of Staff Working in a Forensic Mental Health Service

This study explored the impact of COVID-19 on the mental health and wellbeing and trust support of Tees Esk and Wear Valleys (TEWV) NHS forensic staff using an online google survey during the second wave of the pandemic. Survey respondents were a voluntary cross-sectional sample of 246 TEWV staff working in the forensic directorate staff; this included males (n = 60, 24.5%); with the majority of staff aged between 36–50 years (n = 99, 40.2%) and 50 years or older (n = 80, 32.5%). The results showed that staff working at home and on the front line were both affected by depression, stress and anxiety. Those most at risk were younger staff members. We concluded that the mental health and well-being of staff working should be a priority. It is important to consider targeted support that should be aimed at younger staff members to provide an open culture enabling for those who want support to have readily available signposted resources. Staff working in different settings may have experienced a different impact of COVID-19 on their mental health and wellbeing, and whilst some interventions might be successfully applied across the service, it would be beneficial to understand the unique needs of staff working in specific settings

The effect of a peer-led problem-support mentor intervention on self-harm and violence in prison : an interrupted time series analysis using routinely collected prison data

Background: Levels of mental disorder, self-harm and violent behaviour are higher in prisons than in the community. The purpose of this study was to determine whether a brief peer-led problem-support mentor intervention could reduce the incidence of self-harm and violence in an English prison. Methods: An existing intervention was adapted using a theory of change model and eligible prisoners were trained to become problem-support mentors. Delivery of the intervention took two forms: (i) promotion of the intervention to fellow prisoners, offering support and raising awareness of the intervention but not delivering the skills and (ii) delivery of the problem-solving therapy skills to selected individual prisoners. Training and intervention adherence was measured using mentor log books. We used an Interrupted Time Series (ITS) design utilizing prison data over a 31 month period. Three ITS models and sensitivity analyses were used to address the impact across the whole prison and in the two groups by intervention delivery. Outcomes included self-harm and violent behaviour. Routine data were collected at monthly intervals 16 months pre-, 10 months during and six months post-intervention. Qualitative data measured the acceptability, feasibility, impact and sustainability of the intervention. A matched case-control study followed people after release to assess the feasibility of formal evaluation of the impact on re-offending up to 16 months. Findings: Our causal map identified that mental health and wellbeing in the prison were associated with environmental and social factors. We found a significant reduction in the incidence of self-harm for those receiving the full problem-solving therapy skills. No significant reduction was found for incidence of violent behaviour. Interpretation: Universal prison-wide strategies should consider a series of multi-level interventions to address mental health and well-being in prisons

Pharmacological interventions for drug-using offenders : an update to a systematic review and meta-analysis

This updated systematic review assesses the effects of pharmacological interventions for drug-using offenders. Methods Systematic review protocols and conventions of the Cochrane Collaboration were followed to identify eligible studies. Studies were pooled in a meta-analysis to assess the impact of pharmacological interventions on drug use and criminal activity. An economic appraisal was conducted. Results The search strategies identified 22 studies containing 4372 participants. Meta-analyses revealed a small statistically significant mean difference favouring pharmacological interventions relative to psychological interventions in reducing drug use and criminal activity. When comparing the drugs to one another there were no significant differences between those included (methadone versus buprenorphine, naltrexone and cyclazocine). Conclusion Overall, the findings of this review suggest that methadone and naltrexone may have some impact on reducing drug use and reincarceration. Individual pharmacological drugs had differing (generally non-significant) effects. One study identified serious adverse events. Three studies reported cost and consequences information sufficient to conduct a full economic analysis but this was not comprehensive enough to be able to make judgements across all treatment options. Full economic analyses should be encouraged. The study findings were limited mainly to male adult offenders