Improving the Wellbeing of Female Prisoners via Psychological Skills Training: A Feasibility Study

• DOI: 10.1177/0306624X20928029
• Published date: 01 November 2020
• Date: 01 November 2020
• Subject Matter: Articles

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International Journal of
Improving the
Offender Therapy and
Comparative Criminology
Wellbeing of
2020, Vol. 64(15) 1571–1586
! The Author(s) 2020
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DOI: 10.1177/0306624X20928029
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Skills Training:
A Feasibility Study
Laura Lo1
, Matthew Iasiello1,2,
Marissa Carey1 and
Joseph van Agteren1
Abstract
Prisoners display significantly higher rates of mental disorders and lower mental
wellbeing than the general population. The integration of positive psychological
interventions in offender supervision has received recent advocacy. The aim of the
current pre-post pilot study was to determine the short-term effects of group-based
resilience training on mental health outcomes for female offenders and explore
intervention acceptability. Offenders (n ¼ 24) self-selected to partake in a multi-
component psychological skill program based on positive psychology, cognitive–
behavioural therapy, and mindfulness-based activities. The training was taught in
nine sessions of 1.5 hr each. Baseline and follow-up measurements of mental well-
being and psychological distress were collected and focus groups conducted to
investigate participants’ experiences, acceptability, and appropriateness of the train-
ing. Moderate to large effect sizes indicating significant improvements were observed
for wellbeing, g ¼ 0.75 and distress, g ¼ 0.56. Training was well received by partic-
ipants and staff and was delivered feasibly within the prison context. The results are
1Wellbeing and Resilience Centre, Lifelong Health Theme, South Australian Health and Medical Research
Institute, Adelaide, Australia
2College of Nursing and Health Science, Flinders University, Adelaide, Australia
Corresponding Author:
Laura Lo, Wellbeing and Resilience Centre, South Australian Health and Medical Research Institute, North
Terrace, Adelaide, South Australia 5000, Australia.
Email: laura.lo@sahmri.com

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International Journal of Offender Therapy and Comparative Criminology 64(15)
encouraging, and a future well-powered study using a rigorous controlled design is
warranted.
Keywords
female prisoners, positive mental health, positive psychology intervention, psycho-
logical skills training, resilience intervention, wellbeing and resilience program
Introduction
At any given time, there are more than 10 million imprisoned individuals world-
wide, with another 30 million who circulate in and out of prison each year (Fazel
et al., 2016). Among the prison population across the world and in Australia,
females are the fastest growing population (Casey et al., 2015; Jeffries &
Newbold, 2016). In Australia alone, statistics show an average increase of
10% in female prisoners from the 2017–2018 period (Australian Bureau of
Statistics, 2018), with increases as high as 46% in South Australia
(Department of Correctional Services, 2017).
The prison population often shows high levels of psychological distress and
high rates of psychiatric disorders, as well as low levels of mental and physical
wellbeing (Fazel et al., 2016; Maxwell et al., 2013; Sharma, 2012; Williams et al.,
2014). These high rates are fuelled by a complex combination of risk factors
such as social disadvantage, domestic violence, substance abuse and discrimina-
tion (Keleher & Armstrong, 2005), and the negative aspects associated with
being incarcerated, including fear, trauma, anxiety, and violence (Liebling &
Maruna, 2013). A systematic review of more than 100 studies and 33,000 prison-
ers found the 6-month prevalence of psychotic illnesses to be 1 in 7 prisoners
(Fazel & Seewald, 2012), although rates varied depending on the study. For
instance, one Australian study found the 12-month prevalence of any psychiatric
illness to be 80% for prisoners compared to 31% in the general population
(T. Butler, Andrews, et al., 2006). In extreme cases, some countries have more
individuals with mental illnesses in prison than there are in psychiatric hospitals
(Fazel et al., 2016). In Australia, the impact of mental disorder is greatest for
female prisoners and prisoners of Aboriginal and Torres Strait Islander descent,
who are at higher risk of suffering from mental illnesses compared to the general
(male) population (Bartels & Gaffney, 2011; Fazel et al., 2016; Mak & Chan,
2018; Maxwell et al., 2013). This trend has also been observed in other minority
and indigenous populations around the world (Norris, 2019).
These high rates of psychiatric problems in the prison population are accom-
panied by low levels of mental wellbeing and reduced physical health
(Liebling & Maruna, 2013). So much so, that by the age of 50–55 years, prison-
ers are often considered geriatric due to their complex health needs, which are

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either chronic in nature or long term (Williams et al., 2014). Even after
release, prisoners with previously reported or current mental illness are more
likely to experience poor health outcomes, crime, and substance abuse
(Cutcher et al., 2014).
As most prison sentences are temporary, the poor health and mental well-
being of prisoners will add to the existing health burden of the general popula-
tion once reintegrated. In 2014, the median sentence period for prisoners was 1.8
years (Australian Bureau of Statistics, 2014; Australian Institute of Health and
Welfare Canberra, 2015), and in 2017, 70% of female prisoners on remand in
South Australia were released with an average custody period of 47 days
(Department of Correctional Services, 2017). Although incapacitation, deter-
rence, punishment, and retribution are all goals of incarceration, it is vital to
have effective prison practices in place to help rehabilitate prisoners as they
eventually return to the community (Baillargeon et al., 2009). Improving the
mental health and wellbeing of offenders, an evidently vulnerable group, is
therefore a societal imperative.
The lack of resources within government departments is a common barrier to
the provision of extensive rehabilitation services for prisoners, particularly relat-
ed to mental health care (Borzycki, 2005). It is therefore important to find
solutions which are cost-effective and deliver tangible benefits to offenders.
The use of psychological group interventions that integrate positive psycholog-
ical principles in offender supervision and recidivism prevention strategies have
received recent advocacy (Gredecki & Turner, 2009; Tomar, 2013; Woldgabreal
et al., 2014). The integration of strengths-focused techniques within psycholog-
ical interventions are integral to influencing lasting improvements to mental
wellbeing (Tomar, 2013) as simply focusing on addressing deficits and distress
is insufficient. Strength-based interventions focus on the promotion of adaptive
aspects of mental health such as positive affect, mindfulness, and resilience,
resulting in increased subjective wellbeing and improved health outcomes
(Howell et al., 2007).
The limited evidence on the application of psychological group interventions
that use positive psychological principles and related constructs such as mind-
fulness within prison populations has shown promising results. A study inte-
grating positive psychology interventions and cognitive behavioural therapy
indicated a significant decrease in female prisoner’s psychological distress and
increase in psychological wellbeing (Mak & Chan, 2018). A small-scale pilot
study found promising results for mindfulness-based programs levels of stress
for incarcerated women (Ferszt et al., 2015). These results complement an earlier
systematic review that found that practicing mindfulness in a correctional set-
ting leads to improvements in negative affect, substance use, hostility, relaxation
capacity, self-esteem, and optimism (Shonin et al., 2013).
These early but positive findings point to the potential benefit of teaching basic
psychological skills such as mindfulness and positive psychological principles to

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International Journal of Offender Therapy and Comparative Criminology 64(15)
prisoners. As the number of female prisoners is rising, more research is required to
investigate novel approaches that aid in rehabilitation and help prepare for rein-
tegration into the community (Walmsley, 2006). While emerging research shows
promise, implementing a positive psychological group training within the prison
setting may face several challenges that are less apparent within the general pop-
ulation, including logistical constraints and potential issues in comprehension of
the material. The current pilot study therefore aimed to add to the existing evi-
dence by testing a group-based resilience training for female offenders in
Australia. The primary focus of this study was to explore preliminary short-
term effectiveness on mental health outcomes, specifically psychological distress
and subjective wellbeing. A secondary focus was to explore the suitability and
acceptability of the intervention in this unique population group.
Method
Participants and Setting
Participants were female prisoners within a women’s prison in Adelaide, South
Australia. Participants self-selected and stemmed from three groups, which were
designed by the correctional staff to be most appropriate for the setting. Groups
were (a) offenders in the pre-release centre, (b) long-term sentenced offenders,
and (c) offenders of Aboriginal or Torres Strait islander descent (hereafter:
Aboriginal). The “pre-release” group comprised of...