and easy access to drugs. They may have nowhere to stay and no
way to earn a living legally.
“Even if they have support, they are faced with the same
risk factors they had coming in,” says Nancy Wolff, PhD, an
economist at Rutgers University who has studied trauma and
addiction among incarcerated men and women. “And now they
have one more: a felony label attached to them.”
Many inmates face additional difficulties that go beyond
criminal behavior. Both mental health and substance use
disorders are widespread in the nation’s jails and prisons, and
often co-occur, as Peters and colleagues describe in a recent
editorial (Psychiatric Rehabilitation Journal, 2015).
More than two-thirds of jail detainees and half of prison
inmates have a substance use disorder, Peters and colleagues
note, compared with 9 percent of the general population.
Rates of serious mental illness, including major depression and
bipolar disorder, are three to four times higher in prisons, and
four to six times higher in jails, than in the general population.
“The correctional system has become our de facto mental
health system,” says June Tangney, PhD, a clinical psychologist
at George Mason University who studies interventions for jail
inmates. “It is one of our silent shames.”
Yet a minority of people with mental health and substance
abuse disorders receive adequate treatment while in jail or
prison, Tangney and Peters say. Treatment that does take place
might not be intensive enough or last long enough to make a
significant difference. “We have people in crisis and often ready
for change, and really severely limited resources for treatment of
any kind,” Tangney says.
When inmates do receive treatment during their
incarceration, it’s often difficult to maintain those services once
they are released. “If individuals can’t connect with mental
health services on the outside, we lose a lot of the health gain
that correctional settings were able to provide,” Wolff says.
On the other hand, mental illness is not the only factor
Risk and need
worth paying attention to. “There has been a lot of attention
paid over the past decade or so to offenders with mental illness,
and there are a lot of misconceptions about that group,” says
Jennifer Eno Louden, PhD, a psychologist who studies criminal
justice and mental health at the University of Texas at El Paso.
“There’s a sense that these folks are extremely high risk, which
isn’t necessarily true, but also that mental health treatment is
the only service they need,” she says. “Mental health is only part
of the picture. We have to focus on their other needs as well.”
Though social scientists call them “needs,” these factors also
include personality traits, social relationships and situations
that increase the risk of criminal behavior, such as impulsivity,
poor family support and lack of employment. “Those are the
things we need to invest in if we’re going to have a fighting
chance,” Dvoskin says.
To best target criminogenic needs, the Risk-Need-Responsivity
(RNR) Model has emerged over the last few decades as the
leading tool for changing criminal behavior. The model was
developed largely from work by the late psychologist Donald A.
Andrews, PhD, of Carleton University in Ottawa, and colleagues.
The RNR Model’s first principle — risk — is to identify
offenders at the highest risk of recidivism, and provide them
with the most intensive services. Low-risk offenders should
receive little or no treatment. The second principle — need
— is to assess inmates for the eight broad criminogenic needs
associated with crime and violence. The third principle is to
respond to the specific needs identified for a given offender.
An offender with an impulsive personality and criminal
attitudes might be best served by a cognitive-behavioral therapy
program to change attitudes and behaviors, for instance, while
someone with an alcohol use disorder would be better served by
The RNR Model ensures that offenders with the greatest risk
will receive the intensive services that have the best chance of
helping them. It also benefits low-risk offenders by staying out
of their way, says Jennifer L. Skeem, PhD, a clinical psychologist
at the University of California, Berkeley. Providing services to
people who don’t really need them can be harmful, she says.
It’s not helpful if a former inmate has to leave work to attend
appointments, or to sit in the waiting room of a community
mental health center with higher-risk counterparts. “Over-
Social scientists have identified eight broad
“criminogenic needs” that are strongly
associated with crime and violence:
• Antisocial behavior
• Criminal attitudes and values
• Criminal friends and associates
• Dysfunctional family relationships
• Poor investment in school or work
• Lack of legitimate leisure activities
• Substance abuse