People found not guilty by reason of insanity show a surprisingly mixed criminal risk profile

A recent study reveals that legal outcomes for people with severe mental health conditions are not solely determined by their psychiatric symptoms. Researchers found that standard criminal risk factors, such as antisocial attitudes and having friends involved in crime, strongly predict whether a psychiatric patient has been involved in the legal system.

In the past, intervention programs focused on treating psychiatric symptoms, but this approach failed to keep people out of jail. Experts now understand that most people with mental illness commit crimes due to general risk factors like antisocial behavior, substance abuse, family issues, and criminal attitudes. The research, published in Law and Human Behavior, compared three groups of psychiatric patients.

The first group consisted of 74 patients with a history of misdemeanor or felony convictions. The second group included 68 patients with no criminal history. The third group comprised 207 forensic patients found not guilty by reason of insanity in California state hospitals. The study used questionnaires to assess criminal tendencies, social support, and mental health.

Patients with a history of typical criminal involvement had the highest criminal risk factors, including the most criminal associates and strongest antisocial attitudes. They also reported the lowest levels of social support. The insanity acquittees were a mixed group, showing some criminal risk factors but not the same level of antisocial attitudes as the other group.

They had the lowest reported level of mental health distress. Overall, the findings show that criminal risk factors and social support metrics can distinguish between these patient groups, with insanity acquittees resembling those without criminal histories.