The impact of psychopathy on the forensic, treatment, and social outcomes of community mental health clients with a schizophrenia spectrum disorder and criminal offending history

© 2012 Dr. Lisa Anne ClarkeThe number of community-treated individuals with a schizophrenia spectrum disorder (SSD) and criminal offending history is increasing therefore responding to their needs is an important goal for community mental health clinicians. In order to do so, an understanding of the forensic, treatment, and social outcomes of these individuals, and the factors that contribute to those outcomes is vital. Psychopathy has been identified as a potential contributor to adverse outcomes in individuals with a SSD, however, studies to date have focused on forensic and general psychiatric inpatients as the population of interest and offending as the outcome of interest, thus providing no insight into the range of forensic, treatment, and social outcomes experienced by community mental health clients with a SSD and criminal offending history, and the impact that psychopathy has on these outcomes. The principal aim of this study therefore was to investigate the contribution of psychopathy to the forensic, treatment, and social outcomes of community mental health clients with a SSD and criminal offending history. Participants were 80 clients of a community mental health service with a SSD and criminal offending history, and 80 clients of the same service with a SSD but no criminal offending history, matched on age, sex, and primary psychiatric diagnosis. Psychopathy was measured using the Hare Psychopathy Checklist – Screening Version. There were two phases of data collection: Forensic, treatment, and social outcomes were assessed at a baseline date (for the cross-sectional part of the study) and annually for 3 years post-baseline (for the repeated-measures part of the study). Outcome data were obtained from clients’ medical records. Clients with a criminal offending history more closely matched the prototypical psychopath, and had significantly higher levels of the affective/interpersonal and behavioural/social deviance features of psychopathy than clients with no history of offending. The cross-sectional results revealed that clients with a history of offending had a number of significantly poorer forensic, treatment, and social outcomes compared to clients with no history of offending. The affective/interpersonal component of psychopathy was a unique and significant predictor of all outcomes examined. The repeated-measures results revealed that, over the 3-year follow-up period, there was a significant decrease in the number of community treatment orders applied and revoked, and the number of changes in living arrangement for the two groups combined. The affective/interpersonal component of psychopathy did not predict the rate of change in these outcomes. The repeated-measures part of the study also revealed that the time between the baseline date and the first crime was significantly shorter for clients with a criminal offending history than clients with no offending history. The affective/interpersonal component of psychopathy was a unique and significant predictor of both the time to first crime and first psychiatric hospitalisation after the baseline date. It was concluded that individuals with a SSD and offending history who live and receive treatment in the community have higher psychopathy levels and poorer outcomes than community treated individuals with a SSD and no offending history, and that the affective/interpersonal component of psychopathy is a unique and significant predictor of those adverse outcomes. The findings have important implications for the assessment, treatment, and management of community mental health clients with a SSD and offending history