Prison-Based Interventions for Early Adults with Mental Health Needs: A Systematic Review
| Author | Terence L. Johnson,Ashley Givens,Kimberly Moeller |
| Published date | 01 April 2021 |
| Date | 01 April 2021 |
| DOI | http://doi.org/10.1177/0306624X20952395 |
| Subject Matter | Articles |
research-article2020
Article
International Journal of
Offender Therapy and
Prison-Based Interventions
Comparative Criminology
2021, Vol. 65(5) 613 –630
for Early Adults with Mental
© The Author(s) 2020
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Health Needs: A Systematic
https://doi.org/10.1177/0306624X20952395
DOI: 10.1177/0306624X20952395
journals.sagepub.com/home/ijo
Review
Ashley Givens1 , Kimberly Moeller2,
and Terence L. Johnson3
Abstract
Rates of mental health needs of incarcerated young adults (15–35 year olds) are
concerning, however, mental health interventions targeting this population are under
studied. This article systematically reviews published, peer-reviewed research in nine
databases pertaining to mental health interventions for incarcerated young adults.
Only original studies conducted in the United States and determined to be valid
though NIH assessment tools were included in this analysis. The review includes 19
original studies testing 14 intervention programs exploring mental health outcomes
such as depression, PTSD, self-harm, and bipolar symptoms. Overall, findings
were mixed about the impact of reviewed programs. The variety of interventions,
outcomes, study settings, and implementation procedures complicates the ability to
determine the impact of mental health programming in carceral settings. This review
also reveals the lack of depth and replication of research in this area. Findings suggest
additional efforts are needed to establish efficacy and best practices when treating
mental health needs among this population.
Keywords
mental health, intervention, incarceration, young adult, systematic review, prison,
program, juvenile, literature review
1School of Social Work, University of Missouri, Columbia, MO, USA
2Research & Information Services Division, University of Missouri, Columbia, MO, USA
3School of Social Work, University of North Carolina, Chapel Hill, NC, USA
Corresponding Author:
Ashley Givens, University of Missouri-Columbia, 710 Clark Hall, Columbia, MO 65211, USA.
Email: givensa@missouri.edu
614
International Journal of Offender Therapy and Comparative Criminology 65(5)
Mental Health in Criminal Justice Settings
The high rate of incarcerated populations with mental health concerns in the United
States is undeniable, although the rates reported are often dated, and frequently vary.
Estimates of mental health diagnoses range anywhere from ⅓ to ½ of all inmates
(Fisher et al., 2006; James et al., 2006; Lynch et al., 2014; Steadman et al., 2009).
Depression alone accounts for 30% of local prison, 24% of state prison, and 16% of
federal prison populations (James et al., 2006). Determining the prevalence of mental
health concerns is challenging due to the nature of defining mental health (i.e., diag-
nosis, symptomatology) and by methodology of gathering data (i.e., case files, self-
reporting), yet regardless of the study, the correlation between inmates and mental
health concerns remains high (Martin et al., 2016). This high frequency of inmates
with mental health conditions is mirrored in juvenile criminal justice populations.
Youth with official diagnoses for mental illness are three times more likely to be
involved with the juvenile justice system (Erickson, 2012), with a prevalence of up to
⅔ detained youth having at least one mental health diagnosis (Schubert & Mulvey,
2014). Although this high prevalence is commonly agreed upon, estimates of preva-
lence are relatively dated (Atkins et al., 1999; Dixon et al., 2004; Duclos et al., 1998;
McCabe et al., 2002; Teplin et al., 2002; Wasserman et al., 2004, 2005) and the same
dated studies are repeatedly referenced (Riley et al., 2017).
Despite the high rates of justice involved youth, evaluation and subsequent treat-
ment is limited (Abram et al., 2013; Boothby & Clements, 2000; Hockenberry, 2016;
Kolodziejczak & Sinclair, 2018). Assessment in criminal justice processing and set-
tings is not standardized (Erickson, 2012; Schubert & Mulvey, 2014; Wasserman
et al., 2004) and when assessment is conducted, it is frequently done by non-profes-
sionals (Boothby & Clements, 2000; Kolodziejczak & Sinclair, 2018; Martin et al.,
2016). Once again, this trend is mirrored with incarcerated youth. The 2014 Juvenile
Residential Facility Census found that, out of the facilities that chose to respond to
questions relating to mental health, less than 60% evaluated all youth for mental health
needs and it was unknown how many of the evaluated youth received referrals for
treatment (Hockenberry, 2016).
Once evaluated, many incarcerated youth still do not receive necessary mental health
services (Abram et al., 2013). Various studies show a lack of services and treatment
options across the country. A correctional facility in southern California found that only
6% of youth were referred to mental health services (Rogers et al., 2001), while a study
of juvenile courts in Tennessee determined that fewer than 4% of offending youth were
referred, regardless of diagnosis (Breda, 2003). Similarly, the Northwestern Juvenile
Project determined that only 15% of youth with officially diagnosed psychiatric disor-
ders received treatment while in detention (Abram et al., 2013). When provided, psychi-
atric medications are commonly the sole form of treatment available in correctional
facilities (Abramsky et al., 2003; Elsner, 2006). Shortage of funding and psychologists
means that when psychologists are present, they often serve hundreds of clients (Boothby
& Clements, 2000; Kolodziejczak & Sinclair, 2018), and many treatments and interven-
tions are provided by non-professionals (Martin et al., 2016). Access to treatment is also
Givens et al.
615
influenced by human bias—multiple studies between 1995 and 2014 determined that the
race of youth influenced provision of services, despite greater incarceration of minority
youth (Spinney et al., 2016; Vaughn et al., 2008).
Mental Health Interventions in Criminal Justice Settings
The first rigorous study of severe mental illness (SMI) in criminal justice settings was
conducted by Dr. Linda Teplin in 1990 (Teplin, 1990). Her findings resulted in a rise
of criminal justice interventions, based on the assumption that persons with SMI
lacked access to mental health services, and that connection of incarcerated popula-
tions to treatment would prevent further criminal justice involvement (Epperson et al.,
2011, 2014; Erickson, 2012; Fisher et al., 2006). When surveyed, only 22.3% of state
prison, 14.9% of federal prison, and 22.6% of jail inmates with mental health concerns
reported receiving any treatment in the year prior to their arrest (James et al., 2006).
Unsurprisingly however, incarceration alone is ineffective in altering mental health
behaviors, and may instead worsen symptoms and prognosis (Erickson, 2012).
The initial series of interventions, known as “first generation” interventions
(Epperson et al., 2011, 2014) were designed with the intent to address mental health
concerns, and as a result, reduce recidivism. Interventions included Cognitive Behavior
Therapy (Berzins & Trestman, 2004; Black et al., 2008; Rohde et al., 2004; Yoon et al.,
2017), group therapies (Glowa-Kollisch et al., 2014; Johnson & Zlotnick, 2008; Lynch
et al., 2012; Olafson et al., 2018; Ovaert et al., 2003; Swopes et al., 2017), individual
therapies (Kamath et al., 2013; Pardini et al., 2014), education (Marrow et al., 2012),
activities like exercise (MacMahon & Gross, 1988), and various combinations of thera-
pies, activities, and education (Glowa-Kollisch et al., 2016). Interventions tend to focus
on three main outcomes: decreasing self-reported symptoms, decreasing physical
symptoms, and increasing education and skills. The majority of interventions are geared
toward impacting self-reported symptoms, such as depression, anxiety, PTSD, suicidal-
ity, and mood (Johnson & Zlotnick, 2008; Kamath et al., 2013; Lynch et al., 2012;
MacMahon & Gross, 1988; Olafson et al., 2018; Ovaert et al., 2003; Pardini et al.,
2014; Swopes et al., 2017; Zlotnick et al., 2003). Physical symptoms, such as aggres-
sion, self-harm, severity of substance abuse, and time on suicide watch, are another
common form of assessing these interventions (Berzins & Trestman, 2004; Black et al.,
2008; Glowa-Kollisch et al., 2014, 2016). Programs that provided inmates with skills to
manage mental health concerns, such as coping styles and problem-solving skills, relied
on self-reported outcomes of both symptomology and skill development, like mindful-
ness and optimism (Marrow et al., 2012; Rohde et al., 2004; Yoon et al., 2017).
Issues and Implications of Mental Health Interventions in
Criminal Justice Settings
As mentioned previously, treatment for mental health concerns is limited for incarcer-
ated populations. When interventions are provided however, there are numerous addi-
tional challenges. Estimating prevalence is difficult due to variations in considering
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International Journal of Offender Therapy and Comparative Criminology 65(5)
official diagnosis versus symptoms, and relying on self-reporting comes with similar
difficulties. Screening for interventions is often done by non-professionals (Martin
et al., 2016), and differences in culture create a wide range of self-reported responses
relating to mental health (Kolodziejczak...
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