(Nov. 22, 2016) Individuals released from prison are known to have high rates of violent reoffending. From 2005 through 2010, more than one-third of released US prisoners were convicted of a new crime within two years of discharge. Mental health conditions are overrepresented in these populations.
To assess whether dispensing psychotropic medications to released prisoners could reduce that risk of reoffending, a binational team of researchers analyzed the records of more than 22,000 inmates released from Swedish prisons from July 1, 2005, to December, 31, 2010. Although Sweden has lower rates of incarceration and violence than the United States, the authors said key prisoner characteristics, including the prevalence of mental illness, are similar to those of the United States and other high-income countries.
Violent Reoffending Dropped with Drugs
During a median follow-up of 4.6 years, 18.1% of the released prisoners committed new violent offenses, including homicide, assault, robbery, arson and others. However, rates of violent reoffending were substantially lower during periods when antipsychotics, psychostimulants for disorders such as ADHD and drugs for addictive disorder were being dispensed compared with periods when they were not.*
The magnitude of the reduction was "possibly stronger" than the effect of psychosocial programs in prison, the authors said. Among individuals taking the antipsychotic drugs most associated with schizophrenia and bipolar disorder, medication treatment lowered the risk of violent re-offending by nearly 40%. The association was even stronger among individuals given psychostimulants and addiction medications.
The impact of medication on violent reoffending risk differed with diagnosis. Antipsychotics were not linked to lower rates of violent reoffending in individuals with co-occurring substance use disorders. However, drugs for substance addictions were associated with substantially less violent reoffending by released offenders with co-occurring bipolar or schizophrenia-spectrum disorders.
In the paper, Zheng Chang and colleagues said they examined the association between medications and reoffending risk because prison programs to reduce reoffending typically focus on psychosocial therapies, which have been found to produce "weak to moderate" success. Because mental health conditions are overrepresented in prison populations and reoffenders, the authors wrote, "treatment with appropriate psychotropic medications offers an alternative strategy to reduce reoffending."
Facilitating 'Safe Release'
"With planned reductions in prison populations in many countries, evidence to facilitate the safe release of large numbers of prisoners has become a research and policy priority," the authors said.
In a related editorial in the same issue, Jeffrey Swanson, PhD, wrote, "Revolving in and out of prisons and jails is no way to recover from a devastating disease like schizophrenia." Swanson questioned whether "the study may reflect as much about Sweden" - which he describes as a "salubrious social environment" - as it does about the effects of the medications.
The Chang study adds to a significant body of research previously developed in Sweden, where the National Patient Register has been collecting and reporting national health statistics for more than 100 years. Using the database, another Swedish/British research team reported in 2014 that mentally ill individuals were substantially less likely to commit violent crimes when taking psychiatric medication.
Doris A. Fuller
Chief of Research and Public Affairs
References:
- Chang, Z., et al. (1 November 2016). Association between prescription of major psychotropic medications and violent reoffending after prison release. Journal of the American Medical Association.
- Fuller, D.A. (29 March 2016). What we can learn from Sweden. Treatment Advocacy Center.
- Fazel, S., et al. (7 May 2014). Antipsychotics, mood stabilisers, and risk of violent crime. The Lancet.
Next Week: Stanley Medical Research Institute: Thinking Outside the SMI Box
Research Weekly is a summary published as a public service of the Treatment Advocacy Center and does not necessarily reflect the findings or positions of the organization or its staff. Full access to research summarized may require a fee or paid subscription to the publications.
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