Summary of findings 9. Cognitive behavioural therapy + intensive case management versus standard care for both severe mental illness and substance misuse.

COMBINED COGNITIVE BEHAVIOUR THERAPY and INTENSIVE CASE MANAGEMENT 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: COMBINED COGNITIVE BEHAVIOUR THERAPY and INTENSIVE CASE MANAGEMENT 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	COMBINED COGNITIVE BEHAVIOUR THERAPY and INTENSIVE CASE MANAGEMENT
Leaving the study early: Loss to Treatment Follow‐up: mean 12 months	See comment	See comment	Not estimable	59 (1 study)	⊕⊝⊝⊝ very low1,2	Unable to use data ‐ (no breakdown by treatment arms)
Adverse event: Death	See comment	See comment	Not estimable	‐	See comment	The trial did not measure death.
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. Data were skewed and 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. Data were skewed and 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. Data were skewed and 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. Data were skewed and 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 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.