Implementing a brief treatment program for justice-involved people with mental illness in jail: A mixed-methods feasibility trial

Research suggests that people with mental illness involved in the criminal legal system’s (PMI-CL) future legal involvement can be reduced by treating psychiatric symptoms and criminal risk (Morgan et al., 2012; Skeem et al., 2011). Jail, the entry point to the criminal legal system, presents an optimal opportunity to provide such treatment; however, despite the over-representation of people with mental illness in jails, there is a lack of treatment programming (Bronson & Berzofsky, 2017). Changing Lives and Changing Outcomes (CLCO) was developed to meet the need for integrated services by treating PMI-CL’s mental illness and criminal risk. The aim of the proposed study is to conduct a mixed-methods implementation trial of a 9-session CLCO treatment module for PMI-CL currently incarcerated in the Lubbock (Texas) County Detention Center with a diagnosed serious mental illness. This study tested the feasibility and acceptability of the module’s implementation in the jail, per quantitative indicators, qualitative feedback from PMI-CL treatment recipients, and jail administrators. This project also examined the feasibility, acceptability, and effectiveness of the intervention in producing post-treatment reductions in severity of psychiatric symptoms, criminal thinking, antisocial attitudes, number of disciplinary infractions, and improvements in psychological well-being and illness management among PMI-CL. The treatment recipient sample consistent of 75 PMI-CL recruited for participation who completed pre-treatment testing, of whom 33 began treatment, 22 completed treatment, and 20 completed post-treatment testing. After treatment, 29 treatment recipients provided quantitative and qualitative focus group discussion data on their perceptions of the implementation’s feasibility and acceptability. Six jail administrators also provided quantitative data on their perceptions of treatment implementation, using two, four-item measures assessing feasibility (Feasibility of Intervention Measure), and acceptability (Acceptability of Intervention Measure), respectively. Quantitative analyses were conducted by two coders using inductive thematic template analysis; seven global themes relating to treatment recipients’ perceptions of the assets and hindrances to feasibility and acceptability were developed and are presented with supporting quotations alongside quantitative results. Consistent with a-priori hypotheses, quantitative results indicate treatment recipients and jail administrators found the intervention feasible and acceptable. Specifically, 97% of treatment recipients endorsed the program’s feasibility, and 100% endorsed its acceptability. Jail administrators’ mean scores on the Feasibility of Intervention Measure (M = 4.13, SD = 0.45) , and Acceptability of Intervention Measure (M = 4.33, SD = 0.56) were above four, indicating feasibility and acceptability of the current implementation. However, some quantitative indicators of feasibility suggest the current intervention may benefit from modification to facilitate future implementation. Also consistent with a-priori hypotheses, treatment recipients demonstrated statistically significant reductions from pre-to-post treatment reductions in a psychiatric distress with a medium effect size (dRM = .51), increases in general well-being with a medium effect (dRM = -.70), and self-management of their mental illness with a medium effect (dRM = -.73). Although not statistically significant, participants’ reactive criminal thinking scores also decreased across treatment, approaching a medium effect (dRM = .45). This project contributes to the limited but extant literature that treatment providers can effectively provide brief group psychotherapy to people with mental illness involved in the legal system—and specifically, people in jail. The current results provide promising preliminary evidence that such interventions can be implemented to the benefit of treatment recipients’ reduced criminal risk, and improved mental health and overall well-being, at a critical junction in their criminal justice involvement.

Embargo status: Restricted until 09/2024. To request the author grant access, click on the PDF link to the left.