Jennifer Eno Louden

Two subtypes of psychopathic violent offenders that parallel primary and secondary variants.

Although psychopathy usually is treated as a unitary construct, a seminal theory posits that there are 2 variants: Primary psychopathy is underpinned by an inherited affective deficit, whereas secondary psychopathy reflects an acquired affective disturbance. The authors investigated whether psychopathy phenotypically may be disaggregated into such types in a sample of 367 prison inmates convicted of violent crimes. Model-based cluster analysis of the Revised Psychopathy Checklist (PCL-R; R. D. Hare, 2003) and trait anxiety scores in the psychopathic subgroup (n = 123; PCL-R > or = 29) revealed 2 clusters. Relative to primary psychopaths, secondary psychopaths had greater trait anxiety, fewer psychopathic traits, and comparable levels of antisocial behavior. Across validation variables, secondary psychopaths manifested more borderline personality features, poorer interpersonal functioning (e.g., irritability, withdrawal, poor assertiveness), and more symptoms of major mental disorder than primary psychopaths. When compared with the nonpsychopathic subgroup (n = 243), the 2 psychopathic variants manifested a theoretically coherent pattern of differences. Implications for etiological research and violence prevention are discussed.

Assessing Relationship Quality in Mandated Community Treatment: Blending Care With Control

Traditional measures of the therapeutic alliance do not capture the dual roles inherent in relationships with involuntary clients. Providers not only care for, but also have control over, involuntary clients. In 2 studies of probationers mandated to psychiatric treatment (n=90; n=322), the authors developed and validated the revised Dual-Role Relationships Inventory (DRI-R). The authors found that (a) relationship quality in mandated treatment involves caring and fairness, trust, and an authoritative (not authoritarian) style, (b) the DRI-R assesses these domains of relationship quality, is internally consistent, and relates in a theoretically coherent pattern with ratings of within-session behavior and with measures of the therapeutic alliance, relationship satisfaction, symptoms, and treatment motivation, and (c) the quality of dual-role relationships predicts future compliance with the rules, as assessed by probation violations and revocation. The DRI-R covaries with multiple domains more strongly than a leading measure of the therapeutic alliance, suggesting that it better captures the nature and effect of relationship quality in mandated treatment.

Probation, Mental Health, and Mandated Treatment A National Survey

A large number of probationers with mental illness (PMIs) are under supervision in the United States. In this national survey, we compared the supervision approaches of a matched sample of 66 specialty mental health and 25 traditional probation agencies. The prototypic specialty agency has five key features that distinguish it from the traditional model: (a) exclusive mental health caseloads, (b) meaningfully reduced caseloads, (c) sustained officer training, (d) active integration of internal and external resources to meet PMIs’ needs, and (e) problem-solving strategies as the chief means for addressing treatment noncompliance. Probation supervisors perceived these specialty features as “very useful” and perceived specialty agencies as more effective than traditional ones for PMIs. However, the most important feature of the prototypic specialty agency may also be the most endangered: reduced caseloads. Implications for research and practice are presented.

Social Networks and Social Control of Probationers with Co-Occurring Mental and Substance Abuse Problems

Probationers with co-occurring mental and substance abuse problems (PCPs) are both subject to considerable social control, and at high risk of probation failure. In this study, we screened 601 probationers for symptoms, interviewed 82 identified PCPs about their relationships, and then followed these PCPs for eight months to record treatment nonadherence and other probation violations. First, PCPs’ social networks were small, heavily comprised of professionals and opposing forces who engaged in risky behavior, and saturated with pressure to adhere to treatment. Second, the size and composition of PCPs’ social networks were more relevant to rule compliance than social support and undermining. Third, the quality of PCPs’ relationships was key: satisfying relationships with clinicians and, to a lesser extent, officers and the core network related to low perceived coercion, high treatment adherence, and low risk of future violations. In particular, having a likable clinician who engaged in participatory decision-making reduced the risk of violations. Implications for contextually sensitive risk reduction efforts are discussed.

Offenders with mental illness have criminogenic needs, too: toward recidivism reduction.

Many programs for offenders with mental illness (OMIs) seem to assume that serious mental illness directly causes criminal justice involvement. To help evaluate this assumption, we assessed a matched sample of 221 parolees with and without mental illness and then followed them for over 1 year to track recidivism. First, compared with their relatively healthy counterparts, OMIs were equally likely to be rearrested, but were more likely to return to prison custody. Second, beyond risk factors unique to mental illness (e.g., acute symptoms; operationalized with part of the Historical-Clinical-Risk Management-20; Webster, Douglas, Eaves, & Hart, 1997), OMIs also had significantly more general risk factors for recidivism (e.g., antisocial pattern; operationalized with the Level of Service/Case Management Inventory; Andrews, Bonta, & Wormith, 2004) than offenders without mental illness. Third, these general risk factors significantly predicted recidivism, with no incremental utility added by risk factors unique to mental illness. Implications for broadening the policy model to explicitly target general risk factors for recidivism such as antisocial traits are discussed.

Does the three-factor model of psychopathy identify a problematic subgroup of young offenders?

The present study tests the utility of the personality-based three-factor model of psychopathy according to the Hare Psychopathy Checklist: Screening Version (PCL:SV). This model of psychopathy excludes aspects of criminal behavior as opposed to other models of psychopathy. The main research question was to what extent the three-factor model of psychopathy can identify a problematic subgroup of young offenders. The sample consisted of 148 incarcerated young male criminal offenders, between 15 and 25 years of age (mean=19.07, SD=2.11) who were recruited from a central detention center for young offenders in a northern German county. Model-based cluster analysis of the three psychopathy factors showed that three different clusters labeled: (i) Unemotional/Impulsive-Irresponsible, (ii) Low traits, and (iii) Psychopathic personality, had the best fit to the data. The psychopathic personality cluster with high scores on all three factors of the PCL:SV exhibited, as expected, a significantly higher prevalence of conduct disorder and substance use problems, but was not significantly different from the other clusters on past criminality and previous incarcerations. In conclusion, the results showed that the three-factor model of psychopathy can be useful in identifying a problematic subgroup of young offenders.

Two subtypes of psychopathic violent offenders that parallel primary and secondary variants. Correction to Skeem et al. (2007).

Although psychopathy usually is treated as a unitary construct, a seminal theory posits that there are 2 variants: Primary psychopathy is underpinned by an inherited affective deficit, whereas secondary psychopathy reflects an acquired affective disturbance. The authors investigated whether psychopathy phenotypically may be disaggregated into such types in a sample of 367 prison inmates convicted of violent crimes. Model-based cluster analysis of the Revised Psychopathy Checklist (PCL-R; R. D. Hare, 2003) and trait anxiety scores in the psychopathic subgroup (n = 123; PCL-R > or = 29) revealed 2 clusters. Relative to primary psychopaths, secondary psychopaths had greater trait anxiety, fewer psychopathic traits, and comparable levels of antisocial behavior. Across validation variables, secondary psychopaths manifested more borderline personality features, poorer interpersonal functioning (e.g., irritability, withdrawal, poor assertiveness), and more symptoms of major mental disorder than primary psychopaths. When compared with the nonpsychopathic subgroup (n = 243), the 2 psychopathic variants manifested a theoretically coherent pattern of differences. Implications for etiological research and violence prevention are discussed.

Slipping Through the Cracks: Is Mental Illness Appropriately Identified Among Latino Offenders?

Among U.S. offenders, both ethnic minorities and persons with mental illness are overrepresented. In communities, ethnic minorities are less likely than European Americans to receive mental health treatment, despite having similar need. Many barriers to treatment (e.g., financial and transportation) are removed in prisons; therefore, we sought to understand whether and how ethnicity relates to identification of mental illness (a proxy for treatment receipt) among prisoners. Due to the growth of the Latino population, we focused on Latino offenders. We examined records from two states with high proportions of Latino offenders to determine whether the likelihood of being identified with a mental illness differed by ethnicity. Offenders who had a mental disorder were disproportionately likely to be European American or African American and less likely to be Latino. We offer suggestions for future research on ethnic disparities in correctional mental health to promote best practices with vulnerable offenders.

Comparing the predictive utility of two screening tools for mental disorder among probationers.

To increase the likelihood that probationers with serious mental disorder can be identified by probation agencies, we tested the utility of two promising mental health screening tools, the K6 and the Brief Jail Mental Health Screen (BJMHS), in identifying probationers with DSM-IV Axis I mental disorders. In this study, 4,670 probationers completed the screening tools as part of routine intake procedures at a probation agency. We interviewed a subset of 149 probationers using a structured clinical interview to determine whether they met criteria for an Axis I anxiety, mood, or psychotic disorder at any point during their lifetimes. The BJMHS correctly identified 77% of probationers with mental disorder overall, and contrary to our hypotheses, the measure was as sensitive with women as it was with men. Adding items assessing posttraumatic stress disorder provided some incremental utility to the measure. The K6 demonstrated similar levels of sensitivity to the BJMHS when using a lower cutoff score informed by prior research with offenders. Contrary to prior research, we found that the BJMHS was sensitive to mental disorder among female probationers. We suggest that probation agencies implement either the BJMHS or the K6 as part of their intake procedures to identify probationers with serious mental disorder so the complex needs of this group can be better addressed.

Using the MAYSI-2 to identify mental disorder among Latino juvenile offenders

Many juvenile justice agencies have adopted the Massachusetts Youth Screening Inventory–Version 2 (MAYSI-2; Grisso & Barnum, 2006) to facilitate appropriate programming for young offenders with mental illness. Although Latinos are the fastest-growing ethnic group in the criminal justice system, there is scant research on the utility of the MAYSI-2 among Latino adolescents. The present study examined the utility of the MAYSI-2 in detecting diagnosable mental illness among 398 Latino and 60 European American adolescents in a juvenile justice agency. In addition to testing the scoring configuration used by the agency to identify adolescents in need of further attention, we tested 2 additional scoring configurations of the MAYSI-2. We found that the MAYSI-2 had similar utility at identifying serious mood and anxiety disorders for both ethnic groups, but was less sensitive to behavioral and substance use disorders among Latinos than it was among European Americans. In addition, the MAYSI-2 overall was less sensitive to mental illness among Latino boys compared with Latina girls. We discuss these findings within the context of best practices for identifying adolescents with mental illness in juvenile justice agencies.