Analysis of early intervention services on adult judicial outcomes

New onset psychotic disorders can increase entanglements with the criminal justice system. The resulting convictions and incarcerations can increase risk for suicide, delay access to care, and irrevocably impair employment and other opportunities for already vulnerable young adults1. Specialty team-based services for first-episode psychosis (FES) are effective across a range of outcomes, but little is known about their impact on criminality. We report a secondary analysis, for criminal justice outcomes, of a pragmatic randomized controlled trial of an FES (STEP) vs. usual treatment (UT) 4. FES can reduce criminality. The low overall prevalence of convictions in this sample was reassuring, but limited detection of group differences. Nevertheless, allocation to STEP reduced subsequent and first-time convictions, and below levels in a larger European trial. Putative mechanisms include STEP’s improvement of vocational functioning, which is associated with reduced youth criminality; and reduction of psychiatric hospitalizations which disrupt work and school functioning, but may also signal reductions in episodes of behavioral dysregulation, that can result in arrests. However, these speculations need to be tested against more granular information about the circumstances of each arrest. Such replication, and with a larger sample and more comprehensive (e.g. adding juvenile, jail diversion and department of corrections) databases, is urgently needed to inform service design and policy.