Date Published: January 23, 2018
Publisher: Springer US
Author(s): G. Hopkin, S. Evans-Lacko, A. Forrester, J. Shaw, G. Thornicroft.
Prisoners have high rates of mental illness and the transition from prison to the community is a problematic time for the provision of mental health services and a range of negative outcomes have been identified in this period. A systematic review was conducted to identify interventions for prisoners with diagnosed mental health conditions that targeted this transition period. Fourteen papers from 13 research studies were included. The interventions identified in this review were targeted at different stages of release from prison and their content differed, ranging from Medicaid enrolment schemes to assertive community treatment. It was found that insurance coverage, and contact with mental health and other services can be improved by interventions in this period but the impact on reoffending and reincarceration is complex and interventions may lead to increased return to prison. There is a developing evidence base that suggests targeting this period can improve contact with community mental health and other health services but further high quality evidence with comparable outcomes is needed to provide more definitive conclusions. The impact of programmes on return to prison should be evaluated further to establish the effect of interventions on clinical outcomes and to clarify the role of interventions on reincarceration.
It is well established that prisoners have high rates of mental health problems compared to the general population (Fazel and Danesh 2002; Fazel and Seewald 2012). Prison mental health services are increasingly being developed to identify and treat those with diagnosed mental health conditions during their time in custody. However, the transition from prison to the community is stressful for prisoners with mental health problems and their families and a range of negative outcomes have been identified in this period.
This systematic review found 14 articles relating to 13 studies of interventions aimed at the transition from prison to the community for individuals with mental health problems. The results of these studies suggest that interventions aimed at the transition from prison to the community can improve health insurance coverage and increase contacts with mental health and other health services and this approach should be pursued more widely. However, this systematic review reveals some concerning trends regarding return to custody after involvement with interventions aimed at transition and the impact of interventions on reoffending is not clear. The primary outcome of the majority of the included studies was based on forensic outcomes, such as lowering recidivism rates, and whilst this is an important area, a key rationale for interventions aimed at this period is to prevent severe negative health outcomes of prisoners with mental illness after release (Baillargeon et al. 2010; Lize et al. 2015). Despite this rationale, only one study evaluated the impact of interventions on behavioural and clinical outcomes and no studies examined all-cause or drug related mortality, or suicide and more emphasis is needed to establish whether interventions do have an effect on these important outcomes.
There is an emerging body of evidence that interventions for prisoners with mental illness aimed at the transition from prison to the community can improve health insurance coverage and contact with mental health and other health services. The evidence for a reduction in reoffending is equivocal with small improvements and non-significant results found but there is also a concerning trend that these interventions could increase reincarceration through increased monitoring. Further high quality trials are needed to examine these outcomes in more detail and there should be efforts to design and report trials to allow more comprehensive comparison. The majority of existing studies are based in the US and more trials are also needed across the world to ensure the findings are replicable in differing prison and health systems.