Maintaining social capital in offenders with schizophrenia spectrum disorder—An explorative analysis of influential factors

Abstract

The importance of “social capital” in offender rehabilitation has been well established: Stable family and community relationships offer practical assistance in the resettlement process after being released from custody and can serve as motivation for building a new sense of self off the criminal past, thus reducing the risk of re-offending. This also applies to offenders with severe mental disorders. The aim of this study was to identify factors that promote or hinder the establishment or maintenance of social relationships upon release from a court-ordered inpatient treatment using a modern statistical method—machine learning (ML)—on a dataset of 369 offenders with schizophrenia spectrum disorder (SSD). With an AUC of 0.73, support vector machines (SVM) outperformed all the other ML algorithms. The following factors were identified as most important for the outcome in respect of a successful re-integration into society: Social integration and living situation prior to the hospitalization, a low risk of re-offending at time of discharge from the institution, insight in the wrongfulness of the offense as well as into the underlying psychiatric illness and need for treatment, addressing future perspectives in psychotherapy, the improvement of antisocial behavior during treatment as well as a detention period of less than 1 year emerged as the most predictive out of over 500 variables in distinguishing patients who had a social network after discharge from those who did not. Surprisingly, neither severity and type of offense nor severity of the psychiatric illness proved to affect whether the patient had social contacts upon discharge or not. The fact that the majority of determinants which promote the maintenance of social contacts can be influenced by therapeutic interventions emphasizes the importance of the rehabilitative approach in forensic-psychiatric therapy.

Correlates of Social Isolation in Forensic Psychiatric Patients with Schizophrenia Spectrum Disorders: An Explorative Analysis Using Machine Learning

“…Interestingly, items related to criminal history, e.g., the severity of the offence leading to the referenced forensic hospitalization or the number of previous convictions and incarcerations, did not emerge as highly influential in the model for discriminating between patients with and without social integration. This matches findings from one of the authors' previous publications exploring predictors of social integration after a court-mandated forensic psychiatric treatment: here, too, the variables most predictive of social isolation after discharge from inpatient treatment related to antisocial behavior and the patients' living conditions before the forensic psychiatric hospitalization, while the patients' criminal background, such as the number of previous incarcerations, played only a small role in the model [52]. This goes to show that the development and maintenance of social ties are not so much hindered by juridical problems but that other domains, especially psychopathology, are more dominant.…”

“…This sparks hope, as, in contrast to static items such as previous incarcerations, all of those items can be influenced therapeutically: through sufficient treatment of the underlying SSD, patients can be empowered to form and maintain social ties, while untreated symptoms aggravate social isolation. Nevertheless, a cautionary aspect remains when the results are put into context with the findings of a previous study by the authors mentioned above [52]: when the population was evaluated for predictors of social ties after discharge from courtmandated treatment, only 37.9% of all patients had some sort of social network upon their release. Upon their admission, the very same patient population had social ties in 29.4%, meaning that only roughly 10% of all patients could actually form and/or maintain a social network during their hospitalization even though their hindering symptoms were treated.…”

High Risk, High Dose?—Pharmacotherapeutic Prescription Patterns of Offender and Non-Offender Patients with Schizophrenia Spectrum Disorder

“…Schizophrenia spectrum disorders (SSD) are severe mental disorders with a heterogeneous combination of symptoms and a lifetime prevalence of around one percent [ 35 , 36 ]. Frequently, affected patients are unable to cope with the challenges of their day-to-day life, and experience impairment and disability in multiple domains, including the ability to maintain social relationships, sustain employment, and live independently [ 37 , 38 ]. Additionally, the diagnosis of SSD is associated with a substantially higher risk of violent behavior and committing a violent crime [ 5 , 9 , 39 , 40 ].…”