Abstract
BackgroundLevels of mental disorder, self-harm and violent behaviour are higher in prisons than in the community. The purpose of this study was to determine whether a brief peer-led problem-support mentor intervention could reduce the incidence of self-harm and violence in an English prison.MethodsAn existing intervention was adapted using a theory of change model and eligible prisoners were trained to become problem-support mentors. Delivery of the intervention took two forms: (i) promotion of the intervention to fellow prisoners, offering support and raising awareness of the intervention but not delivering the skills and (ii) delivery of the problem-solving therapy skills to selected individual prisoners. Training and intervention adherence was measured using mentor log books. We used an Interrupted Time Series (ITS) design utilizing prison data over a 31 month period. Three ITS models and sensitivity analyses were used to address the impact across the whole prison and in the two groups by intervention delivery. Outcomes included self-harm and violent behaviour. Routine data were collected at monthly intervals 16 months pre-, 10 months during and six months post-intervention. Qualitative data measured the acceptability, feasibility, impact and sustainability of the intervention. A matched case-control study followed people after release to assess the feasibility of formal evaluation of the impact on re-offending up to 16 months.FindingsOur causal map identified that mental health and wellbeing in the prison were associated with environmental and social factors. We found a significant reduction in the incidence of self-harm for those receiving the full problem-solving therapy skills. No significant reduction was found for incidence of violent behaviour.InterpretationUniversal prison-wide strategies should consider a series of multi-level interventions to address mental health and well-being in prisons.FundingResearch Champions Fund and the Economic and Social Research Council Impact Acceleration Account Fund, University of York, UK.
Highlights
The mental health of people incarcerated in prison is recognised as a worldwide public health concern [1]
Interpersonal violence is the 13th leading cause of disability life adjusted years in 25À49 year olds globally, and the societal costs of mental health problems extend beyond prison, and those diagnosed with a mental health problem while in prison are more likely to reoffend in comparison to their counterparts [12]
The Theory of Change (ToC) model supported the idea that the mental health and well-being of prisoners was affected by environmental, social and cultural aspects of the prison
Summary
The mental health of people incarcerated in prison is recognised as a worldwide public health concern [1]. People residing in prison experience higher levels of mental health problems, self-harm and anti-social violent behaviour than in the general population [2,3,4,5]. Self-harm and violent behaviour are higher in prisons than in the community. The purpose of this study was to determine whether a brief peer-led problem-support mentor intervention could reduce the incidence of self-harm and violence in an English prison. Methods: An existing intervention was adapted using a theory of change model and eligible prisoners were trained to become problem-support mentors. We found a significant reduction in the incidence of self-harm for those receiving the full problem-solving therapy skills. Interpretation: Universal prison-wide strategies should consider a series of multi-level interventions to address mental health and well-being in prisons.
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