Improve Prisoner Mental Health with Mindfulness
By John M. de Castro, Ph.D.
“Through meditation, prisoners come to recognize their conditioning as their own and take responsibility for it, and ultimately step outside of it so their thoughts and actions can come from a space of freedom. For some it’s like a light bulb going off, for others it takes time. But they all get it eventually. You see, most of them have been in and out of jail many times. They know through personal experience that just because the jail door opens, it doesn’t mean their life is going to change. They understand that this issue of real freedom is not about being locked up or not.” – Fleet Maull
Around 2 ¼ million people are incarcerated in the United States. Even though prisons are euphemistically labelled correctional facilities very little correction actually occurs. This is supported by the rates of recidivism. About three quarters of prisoners who are released commit crimes and are sent back to prison within 5-years. The lack of actual treatment for the prisoners leaves them ill equipped to engage positively in society either inside or outside of prison. Hence, there is a need for effective treatment programs that help the prisoners while in prison and prepares them for life outside the prison.
About half of the prison population have diagnosed mental health problems, most of which are untreated. Hence, there is a need for therapeutic programs to treat these problems in prisoners. Contemplative practices are well suited to this environment. Mindfulness training teaches skills that may be very important for prisoners. In particular, it puts the practitioner in touch with their own bodies and feelings. It improves present moment awareness and helps to overcome rumination about the past and negative thinking about the future. It’s been shown to be useful in the treatment of the effects of trauma and attention deficit disorder. It also relieves stress and improves overall health and well-being. Finally, mindfulness training has been shown to be effective in treating depression, anxiety, and anger. It has also been shown to help overcome trauma in male prisoners.
In today’s Research News article “Outcomes of Psychological Therapies for Prisoners With Mental Health Problems: A Systematic Review and Meta-Analysis.” See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5518650/, Yoon and colleagues review and summarize the published research literature on the effectiveness of various therapies for the treatment of mental health problems in prisoners. They included randomized controlled trials that employed a variety of different therapies, including “Cognitive behavioral therapy, dialectical behavior therapy, Mindfulness-based Therapy, and other group treatments such as Music Therapy and Art Therapy,” but excluded trials which solely used drug treatments. The trials examined depressed mood, anxiety, trauma symptoms, overall psychopathology, somatization, and hostility/anger.
They found 37 published reports of randomized controlled trials. These trials reported positive improvements in the prisoners’ mental health with moderate effect sizes. These included improvements in depression anxiety, trauma symptoms, overall psychopathology, and hostility/anger. Cognitive Behavioral Therapy (CBT) and Mindfulness-based Therapies were the most effective therapies. It did not matter if they were administered in a group or individual format. Unfortunately, the small number of studies, 6, that reported 3 and 6-month follow up data reported that the effects did not last and were no longer significant at follow-up.
These are important findings that clearly support the application of cognitive and mindfulness-based therapies for the treatment of prisoner mental health problems. The lack of lasting effectiveness, though, is a problem. This may suggest that the practices learned in the treatments are not continued after the formal sessions end. There is clearly a need for more study and experimentation to develop more long-lasting protocols. Regardless, mindfulness training would appear to be a potentially safe and effective treatment for the mental health problems of prisoners. It has to be kept in mind that mindfulness training not only helps the prisoners while incarcerated, it also helps after release, and this reduces recidivism. This by itself means that mindfulness treatments are not only a humane use of prison resources, but are also cost-effective.
So, improve prisoner mental health with mindfulness.
“The data demonstrate a stark change in the prisoners themselves and their interactions with others. Before the training most prisoners felt hopeless. They engaged in aggressive behaviour and exhibited a strong sense of “us” versus “them”. Following the training, prisoners reported that they could lead their lives more mindfully, had found fresh purpose and that their lives now had meaning – even for those who expected to spend the rest of their days behind bars.” – Inmaculada Adarves-Yorno
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Yoon, I. A., Slade, K., & Fazel, S. (2017). Outcomes of Psychological Therapies for Prisoners With Mental Health Problems: A Systematic Review and Meta-Analysis. Journal of Consulting and Clinical Psychology, 85(8), 783–802. http://doi.org/10.1037/ccp0000214
Abstract
Objective: Prisoners worldwide have substantial mental health needs, but the efficacy of psychological therapy in prisons is unknown. We aimed to systematically review psychological therapies with mental health outcomes in prisoners and qualitatively summarize difficulties in conducting randomized clinical trials (RCTs). Method: We systematically identified RCTs of psychological therapies with mental health outcomes in prisoners (37 studies). Effect sizes were calculated and meta-analyzed. Eligible studies were assessed for quality. Subgroup and metaregression analyses were conducted to examine sources of between-study heterogeneity. Thematic analysis reviewed difficulties in conducting prison RCTs. Results:In 37 identified studies, psychological therapies showed a medium effect size (0.50, 95% CI [0.34, 0.66]) with high levels of heterogeneity with the most evidence for CBT and mindfulness-based trials. Studies that used no treatment (0.77, 95% CI [0.50, 1.03]) or waitlist controls (0.71, 95% CI [0.43, 1.00]) had larger effect sizes than those that had treatment-as-usual or other psychological therapies as controls (0.21, 95% CI [0.01, 0.41]). Effects were not sustained on follow-up at 3 and 6 months. No differences were found between group and individual therapy, or different treatment types. The use of a fidelity measure was associated with lower effect sizes. Qualitative analysis identified difficulties with follow-up and institutional constraints on scheduling and implementation of trials. Conclusions: CBT and mindfulness-based therapies are modestly effective in prisoners for depression and anxiety outcomes. In prisons with existing psychological therapies, more evidence is required before additional therapies can be recommended.