A systematic review and meta-analysis of the effect of community treatment orders on aggression or criminal behaviour in people with a mental illness
Abstract Aims There has been concern about violent acts and other criminal behaviour by people with a possible history of mental health problems. We therefore assessed the effects of community treatment orders (CTOs) on self-, third-party-, and agency-reported criminal behaviour when compared to vol...
Saved in:
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2025-01-01
|
| Series: | Epidemiology and Psychiatric Sciences |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2045796025000058/type/journal_article |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850192658806341632 |
|---|---|
| author | S. Kisely C. Bull N. Gill |
| author_facet | S. Kisely C. Bull N. Gill |
| author_sort | S. Kisely |
| collection | DOAJ |
| description | Abstract
Aims
There has been concern about violent acts and other criminal behaviour by people with a possible history of mental health problems. We therefore assessed the effects of community treatment orders (CTOs) on self-, third-party-, and agency-reported criminal behaviour when compared to voluntary treatment.
Methods
A systematic search of PubMed/Medline, Embase, PsycINFO and criminal justice bibliographic databases for observational or randomised controlled trials (RCTs) comparing CTO cases with controls receiving voluntary psychiatric treatment. Relevant outcomes were reports of violence and aggression or contacts with the criminal justice system such as arrests and court appearances.
Results
Thirteen papers from 11 studies met inclusion criteria. Nine papers came from the United States and four from Australia. Two papers were of RCTs. Results for all outcomes were non-significant, the effect size declining as study design improved from non-randomised data on self-reported criminal behaviour, through third party criminal justice records and finally to RCTs. Similarly, there was no significant finding in the subgroup analysis of serious criminal behaviour.
Conclusions
On the limited available evidence, CTOs may not address aggression or criminal behaviour in people with mental illness. This is possibly because the risk of violence is increased by comorbid or nonclinical variables, which are beyond the scope of CTOs. These include substance use, a history of victimisation or maltreatment, and the wider environment. The management of risk should therefore focus on the whole person and their community through social and public health interventions, not solely legislative control.
|
| format | Article |
| id | doaj-art-84d2d2fafc744bccae5bd304159ac2e1 |
| institution | OA Journals |
| issn | 2045-7960 2045-7979 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Epidemiology and Psychiatric Sciences |
| spelling | doaj-art-84d2d2fafc744bccae5bd304159ac2e12025-08-20T02:14:28ZengCambridge University PressEpidemiology and Psychiatric Sciences2045-79602045-79792025-01-013410.1017/S2045796025000058A systematic review and meta-analysis of the effect of community treatment orders on aggression or criminal behaviour in people with a mental illnessS. Kisely0https://orcid.org/0000-0003-4021-2924C. Bull1https://orcid.org/0000-0003-4064-652XN. Gill2The University of Queensland School of Medicine, Brisbane, QLD, Australia Metro South Addiction and Mental Health Services, Metro South Health Service, Woolloongabba, QLD, Australia Griffith Criminology Institute (GCI), Griffith University, Brisbane, QLD, Australia Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, CanadaThe University of Queensland School of Medicine, Brisbane, QLD, Australia Queensland Centre for Mental Health Research, The University of Queensland, Brisbane, QLD, AustraliaSchool of Medicine and Dentistry, Griffith University, Brisbane, QLD, Australia Mental Health Policy Unit, Health Research Institute, University of Canberra, Canberra, ACT, Australia Mental Health and Specialist Services, Gold Coast Health, Southport, QLD, AustraliaAbstract Aims There has been concern about violent acts and other criminal behaviour by people with a possible history of mental health problems. We therefore assessed the effects of community treatment orders (CTOs) on self-, third-party-, and agency-reported criminal behaviour when compared to voluntary treatment. Methods A systematic search of PubMed/Medline, Embase, PsycINFO and criminal justice bibliographic databases for observational or randomised controlled trials (RCTs) comparing CTO cases with controls receiving voluntary psychiatric treatment. Relevant outcomes were reports of violence and aggression or contacts with the criminal justice system such as arrests and court appearances. Results Thirteen papers from 11 studies met inclusion criteria. Nine papers came from the United States and four from Australia. Two papers were of RCTs. Results for all outcomes were non-significant, the effect size declining as study design improved from non-randomised data on self-reported criminal behaviour, through third party criminal justice records and finally to RCTs. Similarly, there was no significant finding in the subgroup analysis of serious criminal behaviour. Conclusions On the limited available evidence, CTOs may not address aggression or criminal behaviour in people with mental illness. This is possibly because the risk of violence is increased by comorbid or nonclinical variables, which are beyond the scope of CTOs. These include substance use, a history of victimisation or maltreatment, and the wider environment. The management of risk should therefore focus on the whole person and their community through social and public health interventions, not solely legislative control. https://www.cambridge.org/core/product/identifier/S2045796025000058/type/journal_articleaggressioncommunity treatment orderscompulsory community treatmentcriminal justice contactsoutpatient commitment |
| spellingShingle | S. Kisely C. Bull N. Gill A systematic review and meta-analysis of the effect of community treatment orders on aggression or criminal behaviour in people with a mental illness Epidemiology and Psychiatric Sciences aggression community treatment orders compulsory community treatment criminal justice contacts outpatient commitment |
| title | A systematic review and meta-analysis of the effect of community treatment orders on aggression or criminal behaviour in people with a mental illness |
| title_full | A systematic review and meta-analysis of the effect of community treatment orders on aggression or criminal behaviour in people with a mental illness |
| title_fullStr | A systematic review and meta-analysis of the effect of community treatment orders on aggression or criminal behaviour in people with a mental illness |
| title_full_unstemmed | A systematic review and meta-analysis of the effect of community treatment orders on aggression or criminal behaviour in people with a mental illness |
| title_short | A systematic review and meta-analysis of the effect of community treatment orders on aggression or criminal behaviour in people with a mental illness |
| title_sort | systematic review and meta analysis of the effect of community treatment orders on aggression or criminal behaviour in people with a mental illness |
| topic | aggression community treatment orders compulsory community treatment criminal justice contacts outpatient commitment |
| url | https://www.cambridge.org/core/product/identifier/S2045796025000058/type/journal_article |
| work_keys_str_mv | AT skisely asystematicreviewandmetaanalysisoftheeffectofcommunitytreatmentordersonaggressionorcriminalbehaviourinpeoplewithamentalillness AT cbull asystematicreviewandmetaanalysisoftheeffectofcommunitytreatmentordersonaggressionorcriminalbehaviourinpeoplewithamentalillness AT ngill asystematicreviewandmetaanalysisoftheeffectofcommunitytreatmentordersonaggressionorcriminalbehaviourinpeoplewithamentalillness AT skisely systematicreviewandmetaanalysisoftheeffectofcommunitytreatmentordersonaggressionorcriminalbehaviourinpeoplewithamentalillness AT cbull systematicreviewandmetaanalysisoftheeffectofcommunitytreatmentordersonaggressionorcriminalbehaviourinpeoplewithamentalillness AT ngill systematicreviewandmetaanalysisoftheeffectofcommunitytreatmentordersonaggressionorcriminalbehaviourinpeoplewithamentalillness |