Impact of a Prison Therapeutic Diversion Unit on Mental and Behavioral Health Outcomes

Abstract

Introduction: Incarcerated individuals with mental health disorders are disproportionally sent to restrictive housing (i.e., solitary confinement), which is known to have deleterious impacts on mental health. In response, North Carolina's prison system developed Therapeutic Diversion Units, treatment-oriented units for incarcerated individuals with high mental health needs who cycle in and out of restrictive housing. This analysis compares the impact of restrictive housing and Therapeutic Diversion Units on infractions, mental health, and self-harm among incarcerated individuals.Methods: Data were 2016−2019 incarceration records from North Carolina prisons. Outcomes were rates of infractions, inpatient mental health admissions, and self-harm in restrictive housing and Therapeutic Diversion Units. Inverse probability of treatment weights was used to adjust for confounding, and Poisson regression with generalized estimating equations was used to estimate adjusted rate ratios. Analyses were conducted between January and December 2020. Results:The analytic sample was 3,480 people, of whom 463 enrolled in a Therapeutic Diversion Unit. Compared with Therapeutic Diversion Unit rates, the rate of infractions was 3 times as high in restrictive housing (adjusted rate ratio=2.99, 95% CI=2.31, 3.87), the inpatient mental health admissions rate was 3.5 times as high (adjusted rate ratio=3.57, 95% CI=1.97, 6.46), and the selfinjury incident rate was 3.5 times as high (adjusted rate ratio=3.46, 95% CI=2.11, 5.69).Conclusions: Therapeutic Diversion Unit use had strong impacts on infractions, mental health, and self-harm. Therapeutic Diversion Units provide a promising alternative to restrictive housing for individuals with mental health disorders.

Sustained impacts of North Carolina prison therapeutic diversion units on behavioral outcomes, mental health, self-injury, and restrictive housing readmission

“…Inpatient mental health admissions represent a severe mental healthrelated outcome. We previously found that current enrollment in TDUs was associated with a protective effect on inpatient mental health admissions, as compared to restrictive housing (Remch et al, 2021). However, findings from the current analyses indicate that following release from these environments, the hazard of inpatient mental health admissions was potentially elevated post-TDU compared to postrestrictive housing.…”

“…In prior analyses, we found that TDU enrollees demonstrated a considerably reduced rate of self-injury while enrolled in the program, as compared to their peers in restrictive housing (Remch et al, 2021). In this analysis, we found an increased rate of self-injury post-TDU compared to post-restrictive housing.…”

“…In an earlier analysis, comparing individuals in TDUs to TDU-eligible individuals in restrictive housing, we found strong associations between TDUs and reduced rates of infractions, inpatient mental health admissions, and self-harm outcomes (Remch et al, 2021). However, no studies have evaluated the sustained impacts of TDUs on these outcomes after individuals leave the program and return to the general prison population.…”

“…health needs as well as significant exposure to restrictive housing. The TDU program, designed to provide intensive intervention for these individuals and demonstrated in our previous research to be effective in improving behavioral and mental health outcomes during program enrollment (Remch et al, 2021) has the potential to provide enrollees with skills that could allow for sustained benefits beyond the duration of the program. Overall, we found mixed effects in terms of post-TDU outcomes.…”

Evaluation of a prison violence prevention program: impacts on violent and non-violent prison infractions

“…Men who met these criteria at the time of RDU enrollment contributed 417,343 person-days to the RDU-exposed group. Men who met these criteria while placed in RHCP, and who had not been previously enrolled in RDU or another restrictive housing diversion program (i.e., Therapeutic Diversion Units (TDUs, which have also previously been evaluated)) (Remch et al 2021 , 2022 ), contributed 480,479 person-days to the RHCP-exposed group. Men who contributed person-days to the RHCP-exposed group and later enrolled in the RDU could contribute person-time to both groups.…”