THE TREATMENT OF MENTALLY DISORDERED OFFENDERS

However narrowly defined, mentally disordered offenders (MDOs) are het erogeneous in demographics, diagnoses, offense characteristics, risk, and clinical needs. Treatment planning for MDOs should begin with an a ssessment of risk of future violent behavior in the community and risk of violence toward self or others inside an institution. Purposes of treatment among MDOs include treatments both to reduce risk of future violence and to alleviate the mental disorder. Relevant outcome measur es include criminal and violent behavior, psychiatric symptomatology, admission to correctional or psychiatric facility, and quality of life . Clinical problems include aggression and problems of institutional m anagement, criminal propensity, life skills deficits, substance abuse, active psychotic symptoms, social withdrawal, and depression. Because evidence relating them to risk of future violence is highest for the first 4 problems, it is argued that inpatient treatments should especi ally target them. Whenever risk levels and legal circumstances permit, community treatment is to be preferred. Sex offenders are discussed a s a group for whom specialized services are indicated. Relapse prevent ion and program development evaluation are recommended methods for gui ding treatment planning at both individual and system levels. Obstacle s to implementation of empirically based treatments are discussed, as are suggestions for overcoming such obstacles. Finally, promising dire ctions for future research are suggested.