Do community mental health teams caring for severely mentally ill patients adjust treatments and services based on patients’ antisocial or criminal behaviours?

Abstract

While the frequency of meetings with CMHTs increased with the severity of antisocial behaviours, no specific treatments were provided to patients with SMI engaging in antisocial behaviours.

A systematic review and meta‐regression analysis of aggression during the First Episode of Psychosis

“…Unfortunately, the studies we identified here lacked information regarding such aetiological heterogeneity, and whether specific interventions were provided to reduce aggression. However, the limited literature in this area suggests that patients with severe mental illness (SMI), engaging in antisocial behaviour, do not receive specific treatments to target their antisocial behaviour .…”

“…Indeed, high rates of aggressive behaviour have been reported both within community and inpatient mental health settings. Further, recent reviews have highlighted concerns that current treatments for psychosis are not successful in reducing associated aggressive behaviours; an observation supported by empirical findings . Nevertheless, there are no reviews which systematically compare rates of aggression during FEP prior to, and following, service contact.…”

Schizophrenia and violence: realities and recommendations

“…In spite of the civil liberties issues raised by AOT, recent studies conclude that it reduces suicide attempts and physical harm to self, abuse of alcohol or drugs, physical harm to others, damaged or destroyed property, threatened physical harm to others, arrests, and gun violence (Gilbert et al, 2010;Phelan, Sinkewicz, Castille, Huz, & Link, 2010;Swartz & Swanson, 2004). In contrast, treatment programs such as Assertive Community Teams (ACT) and Intensive Care Management (ICM) teams do not reduce incarceration rates (Hodgins et al, 2009). However, when care focuses simultaneously on psychosis and antisocial behavior, as is the case with Forensic Assertive Community Teams (FACT), reductions in antisocial behaviors are evident (Hodgins et al, 2009).…”

“…In contrast, treatment programs such as Assertive Community Teams (ACT) and Intensive Care Management (ICM) teams do not reduce incarceration rates (Hodgins et al, 2009). However, when care focuses simultaneously on psychosis and antisocial behavior, as is the case with Forensic Assertive Community Teams (FACT), reductions in antisocial behaviors are evident (Hodgins et al, 2009). FACT teams, which focus on reducing antisocial behavior, may be able to reduce rehospitalization, arrests, and time in jail, as well as lower rates of both symptoms and aggressive behavior (Cuddeback, Morrissey, & Cusack, 2008;Hodgins et al, 2007b), although more research on their effectiveness is needed.…”

“…For example, 77.4% of caregiver relatives of people with a psychotic disorder reported being the victim of, or witnessing, significant aggression (verbal, physical, self-directed, or sexual) by the identified patient, and 52% of these victims reported incident-related symptoms of PTSD (Loughland et al, 2009). Moreover, most mental health service providers do not assess for or manage risk of violence, or provide treatments for violence reduction (Hodgins et al, 2009), leading to suboptimal treatment and persistence of unnecessarily elevated violence risk. Compounding the problem, many patients are placed in forensic psychiatric settings, jails, or prisons, where there are significant barriers to obtaining adequate mental health care (Reingle Gonzalez & Connell, 2014).…”