Specialized mental health units (MHUs) in correctional facilities may be critical to managing the high rates of serious mental illness in incarcerated populations, but there has been very little research on these programs.

Now, researchers from Harvard Medical School and McLean Hospital in Massachusetts have conducted the first comprehensive compilation and description of MHUs in U.S. correctional facilities. And while there was a dearth of data, MHUs were seen as reducing violence and injury (including assaults, self-injurious behavior, suicide attempts) and in some cases, reducign the recidivism rate for parolees with mental illness.

It is estimated by researchers that as many as 1 in 3 inmates now incarcerated may be affected by mental illness. For serious mental illness — defined by the National Institutes of Mental Health as a disorder that leaves someone seriously functionally impaired, interfering or limiting activities of life like holding a job — as many as 20 percent of inmates in jails and 15 percent of inmates in state prisons may be affected.

In fact, many patients, especially those with psychotic disorders, don’t receive their first psychiatric treatment until after they are incarcerated.

“The incarceration of mentally ill patients, who are often imprisoned due to issues related to untreated mental illness, is a major public health issue,” the authors write.

“Our gathering and collating the published and publicly available information on these 317 units will help bridge the gap in the literature on MHUs and help facilitate the development of additional MHUs.”

A preliminary review of health and criminal justice databases found “scant data”: Just 11 peer-reviewed articles were identified. To bridge the gap, clinical psychology Ph.D. student Talia Cohen, Rakesh Karmacharya, M.D., Ph.D., and colleagues at McLean Hospital performed a methodical, in-depth Google search of publicly available sources, including government websites, newspaper articles, and legal reports that led to the identification of 317 MHUs across the U.S.

Researchers looked at unit characteristics, services provided, and outcomes achieved by MHUs in correctional facilities. Although the available data varied, the authors analyzed the characteristics of the identified U.S. MHUs:

  • about 80 percent of units were located in prisons, rather than jails or other settings. About three-fourths served male inmates only;
  • about half of units offered groups or programs to inmates, one-third provided individual therapy, and less than one-fourth provided both group and individual services;
  • just over half of MHUs had dedicated mental health staff, while about one-fourth provided mental health training to correctional officers;
  • some units were developed in partnership with other government agencies, nonprofit organizations, or universities. Funding for MHUs came from a variety of sources, most often state budgets or legislation;
  • information on the outcomes of mental health care was available for 38 MHUs, most of which reported reductions in violence and injuries.

“The reports from these units show promising results for the benefits of implementing MHUs but also demonstrate the urgent need to conduct implementation and effectiveness trials for them,” the researchers write.

Based on their experience, the authors make recommendations for creating a successful therapeutic environment at MHUs. They believe that units should be small, serving no more than 40 inmates. For the MHUs identified in the review, average unit size was 73 beds.

In addition, MHUs should offer groups and programming plus individual therapy, should have a trained and dedicated clinical staff, and should provide mental health training to correctional officers, the researchers say. Only 12 (3.8%)of the MHUs identified in the review met all of these criteria.

While acknowledging the limitations of the evidence in their wide-ranging review, including the use of largely non-peer-reviewed sources, the research team hopes the study will offer useful descriptive information on MHUs in the U.S.

“Future research should collect systematized data from correctional facilities with MHUs in order to get a more comprehensive picture of the programs and to evaluate the effectiveness and feasibility of these treatment units,” the authors concluded.

The findings are published in the Harvard Review of Psychiatry.

Source: Wolters Kluwer Health