Inmates with mental health diagnoses perform better when given therapy, a new study finds
New research released from the N.C. Department of Public Safety finds that incarcerated individuals with mental health disorders have better outcomes when placed in a Therapeutic Diversion Unit than when they are placed in restrictive housing like solitary confinement.
The study was done on North Carolina prison populations and done in part by the N.C. DPS, which oversees the Division of Adult Corrections. Because of this, some researchers were optimistic it could lead to changes in policy for how inmates with mental health diagnoses are treated.
"For a very long time, there has been a pretty high reliance – not in all corrections facilities but in many corrections facilities – on using solitary confinement, or restrictive settings to manage a lot of different behavioral problems. So that is not new, that's been long standing, and there are quite serious concerns about that," said Shannon Lynch, an Idaho State University professor of clinical psychology who has studied mental health outcomes of incarcerated individuals. She was not involved in the North Carolina study.
There's a body of research that indicates just how adverse restrictive housing can be for people who suffer from a mental health disorder—depression, anxiety, psychiatric distress, even feelings of dehumanization and loss of identity.Dr. Gary Junker
About 37% of people in prison have a history of mental health problems, according to a 2017 report from the U.S. Department of Justice. The study analyzed 3,480 people, of which 463 enrolled in a Therapeutic Diversion Unit, or TDU. Study results, published in the American Journal of Preventative Medicine, indicate that offenders assigned to a TDU instead of restrictive housing were:
- 3 times less likely to commit a disciplinary infraction
- 5 times less likely to commit a severe infraction involving violence or contraband
- 3 times less likely to require inpatient mental health treatment
- 3 times less likely to threaten or commit self-injury
- 4 times less likely to commit self-injury
The results for self-injury, including suicide, are critical indicators of the impacts TDUs can have, said Dr. Gary Junker, a study co-author and director of health and wellness for the state prisons system. Prisons' own past research has indicated that nearly half of all self-harm or self-mutilation occurs in restrictive housing.
"There's a body of research that indicates just how adverse restrictive housing can be for people who suffer from a mental health disorder—depression, anxiety, psychiatric distress, even feelings of dehumanization and loss of identity," Junker said. "We now have data, which came from our own offender populations, to guide us as we determine best practices."
Still, it wasn't immediately clear that these study results would lead to widespread changes in how prisons use restrictive housing. Charles Mautz is the administrator of N.C. Prisons' Innovation Institute and co-author of the study. He said he was pleased with getting the study results into the hands of prisons policy makers.
"We really have been tasked with developing and finding good information and evidence-informed information so that our policy makers and our leadership can take that and move in that direction," Mautz said. "I think that's really what this study does. It provides very valuable information saying, 'Here's a series of differences, here's some impacts we are seeing.' And that's exactly what we've done."
Todd Ishee, N.C. commissioner of prisons, said corrections systems have long struggled with providing proper care to offenders who suffer from psychological disorders.
"You have to protect the safety of prison staff and the other offenders, so you must remove someone who represents a threat, at least temporarily, from the general population," Ishee said. "But at the same time, you don't want to put someone in restrictive housing for an action they've taken in a moment of crisis. It's better to give them the help they need."
One hurdle in moving away from restrictive housing to TDU is cost. It's simply more expensive to provide therapy than to place an inmate in solitary confinement. However, researchers like Lynch say looking narrowly just at those costs doesn't fully account for all the other costs that could be saved through a TDU.
For one, the study shows that inmates commit fewer infractions. That keeps everyone inside a prison safer, including the inmate and others as well as prison staff.
"So if we can decrease the rate of behavioral infractions for self and others, we're generally most likely increasing safety, and so it gives us a justification for allocating resources to that kind of housing. And that's important," says Lynch.
Also, fewer infractions could lead to less overall time in prison. Inmates with high infraction levels are far less likely to qualify for early release. The Division of Adult Correction and Juvenile Justice has an annual budget of about $1.6 billion. The average daily cost per inmate was $127 in the 2019-20 fiscal year.
"Having data that show that therapeutic environments, which are often a little more expensive, are helpful, is very important, says Lynch. "If they were in a more supportive environment and able to work on their mental health issues, they might actually be incarcerated for less time, which would also be less expensive."
The study was a collaboration among the N.C. Department of Public Safety—Prisons, UNC-Chapel Hill's Injury Prevention Research Center, and the N.C. Department of Health and Human Services' Division of Public Health.