Back to top Open menu arrow
Download PDF Reprints

The Journal of
Clinical Psychiatry
Members only

Original Research Focus on Psychosis March 30, 2026

Correlates and Predictors of Criminal Legal Involvement in People With First-Episode Psychosis

; ;

J Clin Psychiatry 2026;87(2):25m15991

Abstract

Objective: Because limited research has evaluated criminal legal involvement (CLI) during a first episode of psychosis (FEP), we explored rates, correlates, and predictors of CLI among people with FEP.

Methods: We conducted a secondary analysis on the Recovery After an Initial Schizophrenia Episode-Early Treatment Program (RAISE-ETP) study, a cluster randomized controlled trial conducted from 2010 to 2012 with people experiencing FEP in the US. We explored rates of recent CLI prior to baseline and over the 2-year follow-up and evaluated predictors of CLI at baseline and over the follow-up period (N = 381).

Results: At baseline, 11% of the sample reported CLI within the past month, which was significantly associated with lower education, longer duration of untreated psychosis, lifetime alcohol or any drug use disorder (other than cannabis), and more severe excitement factor symptoms on the Positive and Negative Syndrome Scale (PANSS). Over the 2-year follow-up, 13.6% of the sample reported CLI which, controlling for baseline CLI, was predicted by longer duration of untreated psychosis, schizophrenia diagnosis, lifetime alcohol or any other drug use disorder, alcohol or cannabis use in the 30 days prior to baseline, and more severe positive and excitement symptoms on the PANSS at baseline. Those with CLI at baseline were nearly 3 times more likely to have subsequent CLI over the follow-up. Baseline CLI was associated with dropping out of treatment due to incarceration.

Conclusion: The findings suggest that CLI in people with FEP could be reduced by earlier detection and more effective treatment of psychotic symptoms, substance use, and criminogenic risk factors.

Trial Registration: Data used in this secondary analysis are from ClinicalTrials.gov identifier: NCT01321177.

J Clin Psychiatry 2026;87(2):25m15991

Author affiliations are listed at the end of this article.

Members Only Content

This full article is available exclusively to Professional tier members. Subscribe now to unlock the HTML version and gain unlimited access to our entire library plus all PDFs. If you're already a subscriber, please log in below to continue reading.

Subscribe Now

Already a member? Log in

  1. Yee N, Matheson S, Korobanova D, et al. A meta-analysis of the relationship between psychosis and any type of criminal offending, in both men and women. Schizophr Res. 2020;220:16–24. PubMed CrossRef
  2. Fazel S, Yu R. Psychotic disorders and repeat offending: systematic review and meta-analysis. Schizophr Bull. 2011;37(4):800–810. PubMed CrossRef
  3. Bales WD, Nadel M, Reed C, et al. Recidivism and inmate mental illness. Int J. 2017;6:41. CrossRef
  4. Cloyes KG, Wong B, Latimer S, et al. Time to prison return for offenders with serious mental illness released from prison: a survival analysis. Crim Justice Behav. 2010;37(2):175–187. CrossRef
  5. Wang L, Bertram W. New data on formerly incarcerated people’s employment reveal labor market injustices. Prison Policy Initiative; 2022.
  6. Herbert CW, Morenoff JD, Harding DJ. Homelessness and housing insecurity among former prisoners. RSF. 2015;1(2):44–79. PubMed CrossRef
  7. Morgan ER, Rivara FP, Ta M, et al. Incarceration and subsequent risk of suicide: a statewide cohort study. Suicide Life Threat Behav. 2022;52(3):467–477. PubMed CrossRef
  8. Daza S, Palloni A, Jones J. The consequences of incarceration for mortality in the United States. Demography. 2020;57(2):577–598. PubMed CrossRef
  9. Massoglia M, Pridemore WA. Incarceration and health. Annu Rev Sociol. 2015;41:291–310. PubMed CrossRef
  10. Ramaswamy M, Manz C, Kouyoumdjian F, et al. Cancer equity for those impacted by mass incarceration. J Natl Cancer Inst. 2023;115(10):1128–1131. PubMed CrossRef
  11. Van Dorn R, Volavka J, Johnson N. Mental disorder and violence: is there a relationship beyond substance use? Soc Psychiatry Psychiatric Epidemiol. 2012;47(3):487–503. PubMed CrossRef
  12. Whiting D, Gulati G, Geddes JR, et al. Association of schizophrenia spectrum disorders and violence perpetration in adults and adolescents from 15 countries: a systematic review and meta-analysis. JAMA psychiatry. 2022;79(2):120–132. PubMed CrossRef
  13. Youn S, Guadagno BL, Byrne LK, et al. Systematic review and meta-analysis: rates of violence during first-episode psychosis (FEP). Schizophr Bull. 2024;50(4):757–770. PubMed CrossRef
  14. Bhui K, Ullrich S, Coid JW. Which pathways to psychiatric care lead to earlier treatment and a shorter duration of first-episode psychosis? BMC Psychiatry. 2014;14:72. PubMed CrossRef
  15. Chien VH, Compton MT. The impact of mode of onset of psychosis on pathways to care in a hospitalized, predominantly African-American, first-episode sample. Early Interv Psychiatry. 2008;2(2):73–79. PubMed CrossRef
  16. Ferrara M, Guloksuz S, Mathis WS, et al. First help-seeking attempt before and after psychosis onset: measures of delay and aversive pathways to care. Soc Psychiatry Psychiatr Epidemiol. 2021;56(8):1359–1369. PubMed CrossRef
  17. Penttilä M, Jääskeläinen E, Hirvonen N, et al. Duration of untreated psychosis as predictor of long-term outcome in schizophrenia: systematic review and meta-analysis. Br J Psychiatry. 2014;205(2):88–94. PubMed CrossRef
  18. Catalan A, Salazar de Pablo G, Aymerich C, et al. Short Versus Long duration of untreated psychosis in people with first-episode psychosis: a systematic review and meta-analysis of baseline status and Follow-Up outcomes. Schizophr Bull. 2024;51(5):1206–1230. PubMed CrossRef
  19. Large MM, Nielssen O. Violence in first-episode psychosis: a systematic review and meta-analysis. Schizophr Res. 2011;125(2–3):209–220. PubMed CrossRef
  20. Prince JD, Akincigil A, Bromet E. Incarceration rates of persons with first-admission psychosis. Psychiatr Serv. 2007;58(9):1173–1180. PubMed CrossRef
  21. Rolin SA, Marino LA, Pope LG, et al. Recent violence and legal involvement among young adults with early psychosis enrolled in Coordinated Specialty Care. Early Interv Psychiatry. 2019;13(4):832–840. PubMed CrossRef
  22. Webster KD, Gunter TD, Vohs JL, et al. Early phase psychosis and criminal conviction in United States adults. Early Interv Psychiatry. 2024;18(6):425–430. PubMed CrossRef
  23. Sariaslan A, Leucht S, Zetterqvist J, et al. Associations between individual antipsychotics and the risk of arrests and convictions of violent and other crime: a nationwide within-individual study of 74 925 persons. Psychol Med. 2021;52(16):1–9. PubMed CrossRef
  24. Langeveld J, Bjørkly S, Auestad B, et al. Treatment and violent behavior in persons with first-episode psychosis during a 10-year prospective follow-up study. Schizophr Res. 2014;156(2–3):272–276. PubMed CrossRef
  25. Randall JR, Chateau D, Smith M, et al. An early intervention for psychosis and its effect on criminal accusations and suicidal behaviour using a matched-cohort design. Schizophr Res. 2016;176(2-3):307–311. PubMed CrossRef
  26. Stevens H, Agerbo E, Dean K, et al. Reduction of crime in first-onset psychosis: a secondary analysis of the OPUS randomized trial. J Clin Psychiatry. 2013;74(5):e439–e444. PubMed CrossRef
  27. Whiting D, Lennox BR, Fazel S. Violent outcomes in first-episode psychosis: a clinical cohort study. Early Interv Psychiatry. 2020;14(3):379–382. PubMed CrossRef
  28. Bo S, Abu-Akel A, Kongerslev M, et al. Predictors of criminal offending in a clinical sample of patients diagnosed with schizophrenia: a 6-year follow-up study. Personality Disord Theor Res Treat. 2021;12(3):216–227. PubMed CrossRef
  29. Greenberg G, Rosenheck RA, Erickson SK, et al. Criminal justice system involvement among people with schizophrenia. Community Ment Health J. 2011;47(6):727–736. PubMed CrossRef
  30. Robertson AG, Swanson JW, Frisman LK, et al. Patterns of justice involvement among adults with schizophrenia and bipolar disorder: key risk factors. Psychiatr Serv. 2014;65(7):931–938. PubMed CrossRef
  31. Kane JM, Schooler NR, Marcy P, et al. The RAISE Early Treatment Program for first-episode psychosis: background, rationale, and study design. J Clin Psychiatry. 2015;76(3):240–246. PubMed CrossRef
  32. Kane JM, Robinson DG, Schooler NR, et al. Comprehensive versus usual community care for first-episode psychosis: 2-year outcomes from the NIMH RAISE Early Treatment Program. Am J Psychiatry. 2016;173(4):362–372. PubMed CrossRef
  33. Mueser KT, Penn DL, Addington J, et al. The NAVIGATE Program for first-episode psychosis: rationale, overview, and description of psychosocial components. Psychiatr Serv. 2015;66(7):680–690. doi:10.1176/appi.ps.201400413. PubMed CrossRef
  34. Golberstein E, Busch SH, Sint K, et al. Insurance status and continuity for young adults with first-episode psychosis. Psychiatr Serv. 2021;72(10):1160–1167. PubMed CrossRef
  35. Norman RM, Malla AK. Duration of untreated psychosis: a critical examination of the concept and its importance. Psychol Med. 2001;31(3):381–400. PubMed CrossRef
  36. Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13(2):261–276. PubMed CrossRef
  37. Emsley R, Rabinowitz J, Torreman M, et al. The factor structure for the Positive and Negative Syndrome Scale (PANSS) in recent-onset psychosis. Schizophr Res. 2003;61(1):47–57. PubMed CrossRef
  38. Addington D, Addington J, Maticka-Tyndale E. Assessing depression in schizophrenia: the Calgary Depression Scale. Br J Psychiatry Suppl. 1993(22):39–44. PubMed CrossRef
  39. Heinrichs DW, Hanlon TE, Carpenter WT Jr. The Quality of Life Scale: an instrument for rating the schizophrenic deficit syndrome. Schizophr Bull. 1984;10(3):388–398. PubMed CrossRef
  40. Ramsay CE, Goulding SM, Broussard B, et al. Prevalence and psychosocial correlates of prior incarcerations in an urban, predominantly African-American sample of hospitalized patients with first-episode psychosis. J Am Acad Psychiatry L. 2011;39(1):57–64. PubMed
  41. Marion-Veyron R, Lambert M, Cotton SM, et al. History of offending behavior in first episode psychosis patients: a marker of specific clinical needs and a call for early detection strategies among young offenders. Schizophr Res. 2015;161(2-3):163–168. PubMed CrossRef
  42. Ramsay Wan C, Broussard B, Haggard P, et al. Criminal justice settings as possible sites for early detection of psychotic disorders and reducing treatment delay. Psychiatr Serv. 2014;65(6):758–764. PubMed CrossRef
  43. Howes OD, Whitehurst T, Shatalina E, et al. The clinical significance of duration of untreated psychosis: an umbrella review and random-effects meta-analysis. World Psychiatry. 2021;20(1):75–95. PubMed CrossRef
  44. Salazar de Pablo G, Guinart D, Armendariz A, et al. Duration of untreated psychosis and outcomes in first-episode psychosis: systematic review and meta-analysis of early detection and intervention strategies. Schizophr Bull. 2024;50(4):771–783. PubMed CrossRef
  45. Weiss A, Chaudhry S, Atiya W, et al. Reducing duration of untreated psychosis: strengthening the case for early detection campaigns. Psychiatr Serv. 2025;76(6):598–601. PubMed CrossRef
  46. Malla A. Reducing duration of untreated psychosis: the neglected dimension of early intervention services. Am J Psychiatr. 2022;179(4):259–261. PubMed CrossRef
  47. Woodberry KA, Bernier E, Elacqua KM, et al. Screening for early emerging mental experiences: feasibility of psychosis screening in integrated care settings. Psychiatr Serv. 2025.
  48. Ford E. First-episode psychosis in the criminal justice system: identifying a critical intercept for early intervention. Harv Rev Psychiatry. 2015;23(3):167–175. PubMed CrossRef
  49. Pope LG, Warnock A, Perry TH, et al. Information sharing across mental health service providers and criminal legal system stakeholders: perspectives of people with serious mental illnesses and their family members. Soc Sci Med. 2022;307:115178. PubMed CrossRef
  50. Wasser T, Pollard J, Fisk D, et al. First-episode psychosis and the criminal justice System: using a sequential intercept framework to highlight risks and opportunities. Psychiatr Serv. 2017;68(10):994–996. PubMed CrossRef
  51. Pope LG, Pottinger S. First-Episode Psychosis: Considerations for the Criminal Justice System. Vera Institute of Justice; 2022. Accessed March 10, 2026. https://www.nri-inc.org/media/1475/dh-first-episode-psychosis-considerationscriminal-justice-rev3_0.pdf.
  52. Lundin NB, Blouin AM, Cowan HR, et al. Identification of psychosis risk and diagnosis of first-episode psychosis: advice for clinicians. Psychol Res Behav Manag. 2024;17:1365–1383. PubMed CrossRef
  53. Compton MT, Pope LG, de Bibiana JT, et al. Changes in knowledge, behavioural expectations, self-efficacy, and stigma after an educational campaign about early psychosis for jail correction officers. Early Interv Psychiatry. 2023;17(8):798–806. PubMed CrossRef
  54. Duncan A, Wertheimer J. Survey responses suggest few U.S. jails use screenings and assessments for behavioral health diversion. In: The Pew Charitable Trust; 2025.
  55. Patrick ME, Kloska DD, Mehus CJ, et al. Key subgroup differences in age-related change from 18 to 55 in alcohol and marijuana use: U.S. national data. J Stud Alcohol Drugs. 2021;82(1):93–102. PubMed CrossRef
  56. Wright AC, Browne J, Cather C, et al. Relationship between patterns of cannabis use and functional and symptomatic trajectories in first-episode psychosis. Eur Arch Psychiatr Clin Neurosci. 2023;273(4):765–778. PubMed CrossRef
  57. Webster KD, Gunter TD, Vohs JL, et al. Criminal offending and incarceration in United States adults with early phase psychosis and comorbid substance use disorder. Early Interv Psychiatry. 2025;19(2):e70005. PubMed CrossRef
  58. Valuri GM, Morgan F, Jablensky A, et al. Impact of substance use and other risk factor exposures on conviction rates by people with a psychotic illness and other mental disorders. Soc Psychiatry Psychiatr Epidemiol. 2020;55(4):517–525. PubMed CrossRef
  59. Wilson AB, Draine J, Hadley T, et al. Examining the impact of mental illness and substance use on recidivism in a county jail. Int J L Psychiatry. 2011;34(4):264–268. PubMed CrossRef
  60. Starzer MSK, Hansen HG, Hjorthøj C, et al. Predictors of mortality following a schizophrenia spectrum diagnosis: evidence from the 20-year follow-up of the OPUS randomized controlled trial. Schizophr Bull. 2023;49(5):1256–1268. PubMed CrossRef
  61. Substance Abuse and Mental Health Services Administration. First-Episode Psychosis and Co-Occurring Substance Use Disorders. 2019.
  62. Lamberti JS, Katsetos V, Jacobowitz DB, et al. Psychosis, Mania and criminal recidivism: associations and implications for prevention. Harv Rev Psychiatry. 2020;28(3):179–202. PubMed CrossRef
  63. Prins SJ, Skeem JL, Mauro C, et al. Criminogenic factors, psychotic symptoms, and incident arrests among people with serious mental illnesses under intensive outpatient treatment. L Hum Behav. 2015;39(2):177–188. PubMed CrossRef
  64. Witt K, van Dorn R, Fazel S. Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies [published correction appears in PLoS One. 2013;8(9). doi:10.1371/annotation/f4abfc20-5a38-4dec-aa46-7d28018bbe38]. PLoS One. 2013;8(2):e55942. PubMed CrossRef
  65. Doyle R, Behan C, O’Keeffe D, et al. Clozapine use in a cohort of first-episode psychosis. J Clin Psychopharmacol. 2017;37(5):512–517. PubMed CrossRef
  66. Pechuán E, Toll A, Bergé D, et al. Clozapine use in the first two years after first-episode psychosis in a real-world clinical sample. Span J Psychiatry Ment Health. 2025;18(2):125–132. PubMed CrossRef
  67. Grover S. Clozapine use in schizophrenia: are we underutilizing? J SAARC Psychiatric Fed. 2023;1(2):69–71. CrossRef
  68. Agid O, Remington G, Fung C, et al. Real-world utilization patterns of long-acting injectable antipsychotics in Canada: a retrospective study. Can J Psychiatry. 2022;67(3):226–234. PubMed CrossRef
  69. Liu Y, Patterson ME, Sahil S, et al. Inpatient prescribing patterns of long-acting injectables and their oral or short-acting injectable equivalent formulations. Front Pharmacol. 2023;14:1140969. PubMed CrossRef
  70. Okoli CT, Abufarsakh B, Wang T, et al. Assessing the impact of long-acting injectable compared to oral antipsychotic medications on readmission to a state psychiatric hospital. J Psychiatr Ment Health Nurs. 2024;31(6):1155–1163. PubMed CrossRef
  71. Andrews DA, Bonta J, Hoge RD. Classification for effective rehabilitation: rediscovering psychology. Crim Justice Behav. 1990;17(1):19–52. CrossRef
  72. Bonta J, Andrews DA. The Psychology of Criminal Conduct. Routledge; 2023.
  73. Bonta J, Blais B, Wilson HA. The prediction of risk for mentally disordered offenders: A quantitative synthesis 2013-01. Public Safety Canada; 2013.
  74. Bonta J, Law M, Hanson K. The prediction of criminal and violent recidivism among mentally disordered offenders: a meta-analysis. Psychol Bull. 1998;123(2):123–142. PubMed CrossRef
  75. Huber CG, Hochstrasser L, Meister K, et al. Evidence for an agitated-aggressive syndrome in early-onset psychosis correlated with antisocial personality disorder, forensic history, and substance use disorder. Schizophr Res. 2016;175(1-3):198–203. PubMed CrossRef
  76. Du A, Kennedy L, Addington J, et al. Victimization and engagement with the legal system among individuals at clinical high risk (CHR) for psychosis. Schizophrenia Res. 2025;284:7–15. PubMed CrossRef
  77. Parisi A, Wilson AB, Villodas M, et al. A systematic review of interventions targeting criminogenic risk factors among persons with serious mental illness. Psychiatr Serv. 2022;73(8):897–909. PubMed CrossRef
  78. Youn S, Guadagno BL, Byrne LK, et al. Systematic review and meta-analysis: rates of violence during first-episode psychosis (FEP). Schizophr Bull. 2024;50(4):757–770. PubMed CrossRef

About the Authors

Buy PDF for $40

Please sign in or purchase this PDF for $40.

Cover features March 2026 issue highlighting articles on psychiatric drugs, peer interventions for perinatal depression, and metformin.

Vol 87 • 2026 • Number 1

Read the Current Issue

Original Research

Innovation in Psychiatric Drug Development: A Quantitative Analysis of FDA-Approved Psychiatric Drugs, 2012–2024

Meta-Analysis

Effectiveness of Peer-Administered Interventions for Perinatal Depression or Anxiety

Original Research

Effect of Adjuvant Metformin on Adherence to and Persistence of Treatment With SGAs in Nondiabetic Patients

Editorial

Thank You to the JCP Community

Editorial

Psychotherapy: Integral to Clinical Psychiatry

Original Research

Trends in Benzodiazepine Prescribing to Adults in the United States
View current Issue

Consensus Report on XT Use in Practice

Read the full report
Figure: Graphic promoting Consensus Report on Xanomeline-Trospium; colorful net design shown with JCP logo in lower left.

Subscribe to read
more articles

Subscribe