Adults with severe mental illness (SMI) who come into contact with the criminal justice system experience high rates of trauma exposure and posttraumatic stress disorder (PTSD). For individuals with SMI, symptoms of PTSD are associated with exacerbated psychiatric symptoms, higher risk of homelessness and—for those with a history of arrest—increased risk of recidivism. The goal of the present study was to assess the effectiveness of evidence-based psychotherapies (EBPs) for trauma-related distress in treating individuals with SMI who have been diverted from jail to receive community-based treatment services. Participants were 97 individuals with SMI referred to the trauma-informed segment of the St. Louis City Jail Diversion Program between 2011–2015. Seventy-two participants began treatment and received Cognitive Processing Therapy (CPT; 53%), Cognitive-Behavioral Therapy (CBT; 39%), and Motivational Interviewing (MI; 8%). Treatment completers (56%) did not differ from noncompleters on any baseline characteristics. Hierarchical Linear Modeling showed significant decreases in symptoms of PTSD and depression throughout the course of treatment for both completers and noncompleters. The addition of emergency/stressor sessions into EBP protocols was associated with greater likelihood of therapy completion. Findings indicate a need for further research that examines barriers to treatment completion for persons with SMI and posttraumatic distress. Results also provide novel evidence for the effectiveness of EBPs for trauma-related distress when delivered in an outpatient setting to individuals with SMI who have come into contact with the justice system.
Feingold, Z. R., Fox, A. B., & Galovski, T. E.
Psychological Services, 15(4), 2018