Purpose of the Review: The prevalence of mental and substance use disorders is three to five times higher than that of the general population. Psychosocial interventions are effective in identifying and managing mental health and substance use disorders. This article aims to review the randomized control studies which have used nonpharmacological interventions alone or in combination with pharmacological interventions for managing mental and substance use disorders in prison/correctional settings. Collection and Analysis of Data: Studies included were randomized control trials and pilot randomized studies that assessed the impact of psychosocial interventions for prisoners with mental disorders and substance use disorders. A comprehensive search for articles was done by the primary author (Sreekanth Nair Thekkumkara) in the following databases: PubMed, ProQuest, PsychArticles, and Google Scholar (search engine), for the period June 1, 2000, to December 31, 2020. Results and Conclusions: The 21 studies included in the review had a sample size of 34 to 759. The settings of all the interventions were the prison and different types of psychosocial interventions were provided across the studies. The average duration of intervention ranged between 10 min and 120 min with the frequency of one to six sessions per week for 1 to 36 months. All the 21 Randomized Control Trials (RCTs) were nonIndian studies. Overall, the results of the included studies showed significant improvement postintervention (motivational intervention, interpersonal therapy, cognitive behavior therapy, positive psychology intervention, music therapy, and acceptance and commitment therapy) on primary outcome measures such as symptom severity of depression, anxiety, and substance abuse prisoners. Positive effects were observed on secondary outcome measures such as motivation, aggression, follow up rates, and recidivism. A limited number of studies have focused on evaluating psychosocial interventions in prison settings. Most of the interventions were tested in prisoners with substance use disorder alone or in those with dual diagnoses and in high-income countries.
Background The prevalence of mental health problems and substance use disorders is high in prisons. There is a need to develop effective and sustainable models in prison to address their mental health demands. Aim The study aimed to develop and validate a peer support programme (PSP) for prisoners with common mental and substance use disorders (SUD). Method The PSP was developed by reviewing the literature and expert interviews and validated by seven experts. Result The expert interview brought out a total of 10 themes. The final components included in the content of the peer support interventions were information about mental health issues, identification of the cases, basic counseling skills, psycho-education, early warning signs and symptoms, managing substance use by motivational interviewing, and suicidal gatekeeping. Conclusion This study describes the development of a comprehensive PSP, and it needs to be tested to examine its feasibility and effectiveness in addressing mental health problems in prison settings.
Background The prevalence of mental disorders and substance use among prisoners is high. Convicted prisoners of ‘good behaviour’ can be part of a peer support system in prisons. Aim To evaluate the feasibility of a peer support programme for prisoners with common mental disorders and substance use in prison. Method The study used a mixed method research design, with a quasi‐experimental approach (single group pre‐post without control). It was conducted in two phases: Phase I. Thirty‐five peers/convicted prisoners were recruited through advertisements on the prisoners' community radio station. Volunteers with good behaviour reports were given training over 5 days to recognise mental and substance use disorders and provide basic peer support in prison; their attitudes and knowledge were tested before and after the training. Phase II. Feasibility of the peer support programme was tested by (i) recording the number of cases identified and referred, (ii) pre‐ and post‐evaluation of well‐being, coping, and symptom severity of those supported and (iii) evaluating qualitatively the experience of the peer supporters and service users. Results Thirty‐five peer supporters identified 49 cases over 3 months. These cases showed significant improvement in well‐being (Z −1.962; p < 0.050) and reduction in symptom severity (Z −1.913; 0.056). There was a significant improvement in the peers supporters' self‐esteem from pre‐ to post‐training (t −3.31; p < 0.002), improvement in their benevolence (t −4.37; p < 0.001) and a significant reduction in their negative attitudes to mental illness (Z −3.518; p < 0.001). A thematic model of peer support encompassed self‐experienced benefits for the peer supporter, wider recognition of peer supporters in the prison, challenges to this kind of support, experience of training and visions for future work. Conclusion The peer support programme was experienced positively by the peer‐supporters and supported. Common mental disorders, substance use and suicidality were recognised and appropriately referred. A full‐scale evaluation of this promising programme is warranted.
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