Summary of findings 8. Cognitive behavioural therapy + psychosocial rehabilitation versus standard care for both severe mental illness and substance misuse.

COGNITIVE BEHAVIOUR THERAPY and PSYCHOSOCIAL REHABILITATION compared to STANDARD CARE for both severe mental illness and substance misuse
Patient or population: people with both severe mental illness and substance misuse Settings: jail and community Intervention: COGNITIVE BEHAVIOUR THERAPY and PSYCHOSOCIAL REHABILITATION Comparison: STANDARD CARE
Outcomes	Illustrative comparative risks* (95% CI)		Relative effect (95% CI)	No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	STANDARD CARE	COGNITIVE BEHAVIOUR THERAPY and PSYCHOSOCIAL REHABILITATION
Leavint the study early: Loss to Treatment Follow‐up: mean 12 months	See comment	See comment	Not estimable	61 (1 study)	⊕⊝⊝⊝ very low1,2	Data were only reported per trial and not per randomised arm.
Adverse event: Death ‐ not measured	See comment	See comment	Not estimable	‐	See comment	The trial did not measure death as an outcome.
Substance use: Alcohol ‐ not measured	See comment	See comment	Not estimable	‐	See comment	This trial focused on criminal outcomes of jail and offences. Data were skewed and not compared between arms.
Substance use: Drug (non‐alcohol) ‐ not measured	See comment	See comment	Not estimable	‐	See comment	This trial focused on criminal outcomes of jail and offences. The data were skewed and was not compared between arms.
Mental state ‐ not measured	See comment	See comment	Not estimable	‐	See comment	This trial focused on criminal outcomes of jail and offences. The data were skewed and was not compared between arms.
Global State‐ not measured	See comment	See comment	Not estimable	‐	See comment	This trial focused on criminal outcomes of jail and offences. The data were skewed and was not compared between arms.
Quality of life/life satisfaction ‐ not measured	See comment	See comment	Not estimable	‐	See comment	This trial focused on criminal outcomes of jail and offences. The data were skewed and was not compared between arms.
*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio;
GRADE Working Group grades of evidence High quality: further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: we are very uncertain about the estimate.

¹ Risk of bias: Rated as VERY SERIOUS: Although the random generation is reported as computer‐generated the numbers in the arms vary and no report is made as to whether randomisation was done in a ratio fashion. Blinding was not done and performance bias may be unclear and detection bias is high risk as the assessors were not blinded. There is a high risk of selective reporting bias as few outcomes are reported per arm and mainly by site.
 ² Imprecision: Rated as VERY SERIOUS: The sample size is small and any estimate of effect (had it been reported per arm) is highly likely to be imprecise.