ACE’s and Arrest Rates among Individuals with SMI

Featured Article | Journal of the American Academy of Psychiatry and the Law | 2023, 51 (3) 329-336

Adverse Childhood Experiences and Arrest Rates among Individuals with Serious Mental Illnesses

Oluwatoyin Ashekun, MPH - Research Assistant at DeKalb Community Service Board, Decatur, GA

Adria Zern, MPH - Research Project Manager in the Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY

Stephanie Langlois - Research Assistant at DeKalb Community Service Board, Decatur, GA

Michael T. Compton, MD, MPH - Professor of Psychiatry in the Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, and Research Psychiatrist, New York State Psychiatric Institute, New York, NY

Adverse childhood experiences (ACEs) are linked to both poor mental health and adverse social outcomes, including arrest and incarceration. Furthermore, individuals with serious mental illnesses (SMI) are known to have high rates of childhood adversity and are overrepresented in all facets of the criminal justice system. Few studies have examined the associations between ACEs and arrests among individuals with SMI. We examined the impact of ACEs on arrest among individuals with SMI while controlling for age, gender, race, and educational attainment. In a combined sample from two separate studies in different settings (N =539), we hypothesized that ACE scores would be associated with prior arrest, as well as rate of arrests. The prevalence of prior arrest was very high (415, 77.3%) and was predicted by male gender, African American race, lower educational attainment, and mood disorder diagnosis. Arrest rate (number of arrests per decade, which thus accounted for age) was predicted by lower educational attainment and higher ACE score. Diverse clinical and policy implications include improving educational outcomes for individuals with SMI, reducing and addressing childhood maltreatment and other forms of childhood or adolescent adversity, and clinical approaches that help clients reduce the likelihood of arrest while addressing trauma histories.

adverse childhood experiences; arrests; child maltreatment; childhood adversity; incarceration; serious mental illnesses

This study investigates the relationship between adverse childhood experiences (ACEs) and arrests among individuals with serious mental illnesses (SMI). ACEs, comprising traumatic events during childhood, are prevalent and have enduring effects on health. Understanding this relationship is crucial for informing interventions and policies aimed at improving outcomes for individuals with SMI and reducing their risk of arrest.

Previous research has highlighted that ACEs are widespread and have lasting effects on health, especially mental health and substance abuse. These experiences significantly correlate with involvement in the criminal justice system, including arrests and drug use, particularly among those with SMI. Furthermore, a considerable proportion of incarcerated individuals have experienced childhood maltreatment, emphasizing the pressing need to address ACEs to improve mental health outcomes and decrease involvement in the criminal justice system.

This study pooled data from two independent studies. Study 1 involved patients nearing discharge from psychiatric inpatient settings, with longitudinal data collected between 2014 and 2018. Study 2 surveyed English-speaking outpatient clinic patients between April and October 2013. Both studies utilized standardized demographic forms and assessed ACEs using a standardized questionnaire covering ten categories of adversity. Arrest data were collected differently: Study 1 obtained participants' arrest records from the Georgia Crime Information Center, while Study 2 relied on self-reported data. 

The study found that a remarkably high proportion (77.3%) of the sample had been arrested at least once in their lifetime, indicating a substantial risk of criminal justice involvement among individuals with SMI. Additionally, the study highlighted the role of ACEs in increasing the likelihood of arrest among those with SMI, emphasizing the need for interventions to address ACEs and their detrimental effects. Moreover, the analysis identified education as a protective factor against both the likelihood of having ever been arrested and arrest rate, suggesting the importance of educational attainment in reducing criminogenic risk factors among individuals with SMI.

Furthermore, the study found significant associations between gender and race with the likelihood of having ever been arrested, with males and African Americans being more likely to have a history of arrest. However, among those who had been arrested, there were no significant differences in lifetime arrest rates by gender or race. These findings mirror existing disparities in the general population regarding race and arrest rates, highlighting the need for interventions to address systemic and structural inequalities contributing to over-representation in the criminal justice system.

Overall, the study underscores the complex interplay between ACEs, demographic factors, and criminal justice involvement among individuals with SMI, emphasizing the importance of targeted interventions to mitigate these risks and improve outcomes for this vulnerable population.

Prevention Programs: Forensic clinicians should prioritize programs aimed at preventing childhood adversity and enhancing protective factors. These could range from early childhood interventions fostering socioemotional development to school-based initiatives combating bullying, as well as parenting programs addressing abuse and neglect and mentoring interventions for adolescents and young adults.

Promotion of Protective Factors: Recognizing and promoting factors that mitigate the impact of childhood adversity can significantly reduce the likelihood of later involvement in the criminal justice system. By bolstering protective factors early in life, clinicians can help prevent future arrests among individuals with SMI.

Trauma-Focused Treatment: Treatment models should integrate an understanding of the strong correlation between childhood adversity and arrests. Trauma-focused approaches, particularly in juvenile justice and adult correctional settings, are essential for addressing underlying trauma and reducing the risk of further criminal behavior.

Collaboration and Advocacy: Forensic clinicians should advocate for collaboration between mental health services and the criminal justice system. This collaboration can facilitate early intervention, access to appropriate treatment, and diversion programs aimed at preventing incarceration and promoting rehabilitation for individuals with SMI.

“Several methodological limitations are noteworthy. The first pertains to the difference in our method of collecting arrest data between the two studies. Study 1 used state-wide administrative data, which would not have included any arrests occurring outside of Georgia (and many participants lived within an hour of one or more surrounding states). On the other hand, Study 2 relied on self-report, which, although it covered arrests in any state, could be limited by recall error or biases. Although we know of no literature validating self-report arrest data against administrative data, self-report of another stigmatized condition, substance use (in comparison to objective urine toxicology measures) has been shown to be largely reliable and valid. Furthermore, we entered the study site (and thus arrest ascertainment approach) into both regression models, and it was not a significant predictor in either model, which may help to validate the accuracy of the self-report measures used in Study 2. Second, both studies relied on the ACE questionnaire, which although very widely used, only captures a relatively small array of adverse childhood experiences. Other studies should inquire about many other aspects of adversity in childhood and adolescence. Third, there was also an inherent selection bias for participants with more serious courses of illness related to the Study 1 eligibility criterion of having two inpatient psychiatric hospitalizations. Thus, our results are most applicable to patients with a more serious course of illness, and other studies should extend to patients without inpatient hospitalization histories. Fourth, similar to the different approaches to ascertaining arrest data in the two studies, diagnoses were obtained via semi-structured research interview in Study 1, and by patient self-report in Study 2. Fifth, current or prior severity of illness was not included in the analysis. Finally, the data come from only two sites and thus findings may not be generalizable to other settings across the United States. This exploration of history of arrest and frequency of arrest could play an important role in improving understandings of criminogenic risk factors for individuals with SMI” (p. 334).