Bi-Adaptive Model of Mental Illness and Criminalness

The bi-adaptive model provides a framework for intervening when the two areas of mental illness and criminalness occur in the same individual. The presence of multiple problem areas (comorbidity) increases negative outcomes. This has repeatedly been shown in the mental health field, as the level of problems at work, distressed close relationships, and generally poorer health outcomes result when more than one mental health disorder is present. In addition, advances in the treatment of co-occurring, or comorbid, disorders have suggested a unified treatment protocol or a combined/interdisciplinary approach.

Drawing upon the co-occurrence in psychiatry literature, a bi-adaptive model of mental illness and criminalness was developed. This model has implications for research, practice, and treatment. For example, through the proposed treatment matrix of intervention strategies, targeted content areas, and therapeutic processes, the bi-adaptive model outlines an integrated strategy to intervene with offenders with mental illness. This entry first explains the comorbidity framework and then discusses the similarities between the comorbidity framework and the bi-adaptive model, with a focus on offenders with mental illness.

The Comorbidity Framework. The comorbidity framework has been used to discuss the integration of mental illness and criminalness. The comorbidity framework serves as a heuristic, for technically two diagnoses are required for comorbidity and criminalness is not a recognized diagnosis. In contrast to the comorbidity framework, the bi-adaptive model is concerned little with whether the two areas occurred simultaneously or sequentially or whether one area is the cause of the other area—for example, whether criminalness is what contributes to the etiology of the mental disorder (although further etiology developments may inform and modify aspects of the bi-adaptive model).

Functional impairments in offenders with mental illness can lead to difficulties in carrying out basic probation tasks, such as paying fines. These functional impairments may contribute, indirectly, to the relationship between mental illness and recidivism. This is consistent with the literature, which highlight the role that the understanding of a mental illness can have in providing practical suggestions for managing recidivism risk. Some suggestions include supervision strategies to decrease anxiety, perceived threat, and negative affect.

Based on offender samples, the occurrence of a single disorder seems to be rare. Co-occurrence is far more common. In examining the prevalence of comorbidity among offenders, almost all offenders with mental illness diagnosed with common mental disorders (e.g., major depressive disorder, post-traumatic stress disorder, substance use disorder) also have a personality disorder (e.g., antisocial personality disorder, borderline personality disorder, obsessive-compulsive disorder). This was true regardless of the mode of assessment (interview vs. self-report). Similarly, the converse was also true. Those with a personality disorder reported one or more common mental disorders in the past, with 50% having an active mental disorder. When examining psychopathy, there was no evidence that psychopathy was associated with higher level of mental disorders. In summary, there is no single, unique pattern for offenders with mental illness.