Many assessments of mental illness (e.g., symptom checklists, diagnostic oriented symptom assessment) and criminal risk (e.g., level of criminal risk, criminal thinking) exist independently; however, the SMI is the first measure to simultaneously assess both symptoms of mental illness and criminal risk in one measure. Using a multifaceted approach to improved mental health functioning, reduced criminal risk, and reductions in psychiatric and criminal recidivism, specific constructs were identified as influential to the justice involved person with mental illness functioning (i.e., symptoms of mental illness, substance abuse, resilience, social support and occupational functioning, problem-solving skills, antisocial attitudes, antisocial associates). Items were then generated by the test developers to assess these target areas. This article provides an overview of the Services Matching Instrument (SMI), exploring the need for this tool, detailing its features, and discussing related study findings and future research areas.
Why the SMI Is Needed
Individuals with mental illness are overrepresented in the criminal justice system. Specifically, persons with mental illness are up to 3 times more likely to end up incarcerated than they are to end up receiving mental health services. Research has demonstrated that individuals with mental illness who are criminal justice involved share similar psychiatric symptoms with those with mental illness who are not criminal justice involved and share criminal risk factors with those who are incarcerated but not mentally ill. Thus, it stands to reason, when treating persons with mental illness within the criminal justice system, it is important to consider both the individual’s co-occurring mental illness and criminogenic risk factors. Effective treatment of persons with mental illness within the criminal justice system begins with the assessment of these constructs, so professionals can gain a better understanding of the individual’s specific treatment needs, decreasing the potential of reoffending.
A Closer Look at the SMI
The SMI consists of 94 theoretically derived items with a true or false response style. The 94 items produce eight theoretically derived clinical scales including psychiatric symptomology, criminal history, antisocial attitudes and associates, social networking, substance abuse, negative affect, social functioning, and traumatic history.
The psychiatric symptomology scale is an 18-item scale that asks about the presence of delusions, hallucinations (auditory and visual), and the individual’s psychiatric history. These questions are aimed at assessing for the possibility of a psychotic disorder or related severe mental illness that may contribute to the risk of psychiatric recidivism. The criminal history scale is an 11-item scale that assesses for the occurrence of common criminal activities and behaviors. The theoretical underpinning of this scale supports the idea that the best predictor of future behavior is past behavior. The antisocial attitudes and associates scale is a 9-item scale that targets the individual’s belief system, including his or her values and cognitions that disregard the rights of others and support a criminal lifestyle, and assesses the individual’s social support network of criminal and noncriminal others. The social networking scale is composed of 9 items that focus on the individual’s interpersonal functioning and ability to form and maintain healthy (i.e., prosocial) relationships. The substance abuse scale is a 9-item scale that assesses for the presence of alcohol- and drug-related disorders. The negative affect scale is a 15-item scale that assesses for the presence of persistent negative emotion and related depressive symptoms. The social functioning scale is a 12-item scale that evaluates the individual’s ability to perform expected duties and contribute to society in a positive manner. Finally, the traumatic history scale is a 7-item scale that provides information about the individual’s exposure to trauma to inform treatment (to allow for trauma-informed services), as well as a possible important target of treatment. The final four questions of the SMI form the infrequency scale that provides information about test-taking attitudes and screens for potential overreporting or exaggeration of symptoms and experiences.
It is hoped that this measure can provide clinicians with one self-report measure to determine clinical service needs to more efficiently match offenders with mental health and rehabilitation services. For example, if the SMI identified antisocial attitudes and associates as a potential problem area, the offender would be matched with appropriate services targeted at reducing criminal thinking and forming prosocial friendships.
Study Findings and Future Research
Initial research has focused on providing support for the internal consistency, test–retest reliability, and factor structure of the measure. With respect to internal consistency (i.e., how well the items on a scale measure the same trait), α values ranged from .767 to .937, suggesting strong cohesion of items within each subscale. The SMI also demonstrated a significant test–retest reliability (i.e., test of trait stability over time) over a 2-week time period (r = .908), an important issue given the purpose of this measure is to link offenders with clinical services. Research to date is promising, but ongoing and future research will focus on providing support for the validity (i.e., the degree to which a measure is testing what clinicians think it is) of the measure and confirming the proposed factor structure.
Given the overpresentation of people with mental illness in the criminal justice system, but also the number of individuals in the mental health system that have criminal justice involvement, it is anticipated that this measure will be of clinical utility during all phases of assessment. For example, this measure can help identify areas of treatment need during initial mental health or criminal justice screenings or during the assessment intake when an individual is admitted to a new institution or program. The SMI may also be administrated pretreatment and posttreatment to assess treatment change. Importantly, it is intended that the SMI will be helpful to mental health and criminal justice professionals working in correctional agencies (jail, prison, probation, parole), forensic mental health units, and general psychiatric facilities to more efficiently assess and subsequently guide clinical decision-making and case management strategies.
References:
- Abramsky, S., & Fellner, J. (2003). Ill-equipped: U.S. prisons & offenders with mental illness. Human Rights Watch. New York
- Gendreau, P., Little, T., & Goggin, C. (1996). A metaanalysis of the predictors of adult offender recidivism: What works! Criminology, 34, 575–607. doi:10.1111/j.1745912 -5.1996.tb -01220.x
- Morgan, R. D., Fisher, W. H., Duan, N., Mandracchia, J. T., & Murray, D. (2010). Prevalence of criminal thinking among state prison inmates with serious mental illness. Law & Human Behavior, 34, 324–336. doi:10.1007/s10979-009-9182-z
- Morgan, R. D., Flora, D. B., Kroner, D. G., Mills, J. F., Varghese, F., & Steffan, J. S. (2012). Treating offenders with mental illness: A research synthesis. Law and Human Behavior, 36(1), 37–50. doi:10.1037/h0093964