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Background: Individuals with serious mental illness (SMI) have disproportionately high rates of criminal legal system involvement. For many, this becomes a repeated cycle of arrest and incarceration. Treatments that address symptoms of mental illness are a critical component of the continuum of services for people with SMI in the legal system; yet on their own, psychiatric treatments have not been successful at reducing criminal legal system involvement for this population. Research suggests that criminogenic risk factors, the major drivers of criminal legal system involvement, are disproportionately prevalent among individuals with SMI. However, promising criminogenic-focused interventions have only just begun to be adapted for individuals with SMI. The proposed study will examine the capacity of Forging New Paths (FNP), a novel criminogenic-focused group intervention developed for individuals with SMI, to engage its primary and secondary outcomes when delivered in community mental health settings. Methods: The proposed pilot study will engage a small-scale clinical trial comprising three cycles of FNP delivered in a community mental health center in a Southeastern state in the U.S. The anticipated total sample size is N = 72 and will consist of community-dwelling adults with SMI who have a moderate or higher criminogenic risk level and a history of criminal legal system contact. This study will examine the extent to which FNP is able to engage its primary (aggression and community tenure) and secondary (criminal attitudes and impulsivity) treatment outcomes. Discussion: FNP provides an important new service for community-based mental health settings to reduce criminal legal system involvement (and recidivism) among the individuals they serve with SMI. Clinical Trial Registration: NCT06290648. [ABSTRACT FROM AUTHOR]

Intellectual functioning impacts defendants' competence to stand trial, though research on this population remains limited. This study replicated and advanced prior work, focusing on defendants' demographic, clinical, cognitive, and criminal justice variables and their association with length of hospitalization and restoration determinations. Participants were 74 male and female criminal defendants in a midwestern state who were adjudicated incompetent to stand trial, had a diagnosis related to intellectual deficits, and completed competency restoration. Most defendants (83.7%) were restored to competency. Demographic factors were unrelated to restoration outcomes; violence of alleged offense predicted shorter hospitalization. Receiver Operating Characteristic Curve analyses determined an IQ score cut-off of 63.5 for which participants were of greater likelihood to be determined restored, providing guidance on the likelihood of restoration for defendants with intellectual disability related diagnoses. Specifically, this score can be used with clinical data to inform competency determinations for defendants with cognitive deficits. [ABSTRACT FROM AUTHOR]

Objective: The therapeutic working alliance is an important factor in producing treatment change and positive therapeutic outcomes for people with mental illness, yet little is known about the working alliance's role in treatment change in people with mental illness that is justice involved. In addition to treating the mental illness symptoms of justice-involved people with mental illness, addressing factors known to predict criminal behavior (including criminal thinking) could optimize posttreatment outcomes and reduce future justice involvement. This study examines the role of the working alliance in treatment change in a clinical treatment sample of 265 adult male and female justice-involved people with mental illness and substance use disorders completing probation sentences in a residential treatment facility. Method: Repeated measures moderation analyses were used to test participants' reported working alliance as a moderator of change from pre- to posttreatment scores of self-reported mental illness symptoms and criminal thinking. Results: The working alliance significantly moderated reductions in depression, anxiety, anger, and manic symptoms (R2 ranging from.03 to.09), and general, reactive, and current criminal thinking (R2 ranging from.04 to.11). Conclusions: These findings expand the literature on the relation between working alliance and changes in mental illness symptoms by testing this association in the understudied population of justice-involved people with mental illness; these results also suggest the working alliance is associated with changes in criminal thinking. Treatment providers working with justice-involved people with mental illness should assess and emphasize the development of a working alliance to maximize treatment change. What is the public health significance of this article?: These findings expand our understanding of the role of the working alliance in treatment change among a criminal justice-involved clinical sample with mental illness and substance use disorders. Clinicians should continue to focus on not only treatment needs but also treatment processes for people with mental illness, regardless of setting. [ABSTRACT FROM AUTHOR]