How to treat depression in prison – and why it matters

Newswise — EAST LANSING, Mich. – Of the 4 million prisoners released each year, 23 percent have suffered from major depressive disorder and went without adequate mental health treatment while in jail. When released, they rejoin society in worse mental shape than when they were originally incarcerated – which could prevented with the right care. Until now, no research has investigated treatment of major depressive disorder for inmates; but a team lead by Michigan State University found a solution to address mental health care and cost in prisons.

The research, published in Journal of Consulting and Clinical Psychology, tested the effectiveness of interpersonal psychotherapy on inmates battling major depressive disorder, or MDD, as well as a strategy to bring affordable treatment into a prison setting.

“Whether or not people want to consider prisoners as ‘others,’ the truth is that 15 million people touch the criminal justice system each year in the United States,” said Jennifer Johnson, lead author and professor of public health in MSU’s College of Human Medicine. “Most of us have friends, family or neighbors who have been through this system. The fact we’ve waited until 2019 to tackle the issue of mental health means we’ve understudied and underserved huge population.”

About 2.3 million people are incarcerated every day and if they too suffer from depression, addiction or other disorders, they will not likely get the help they need. Prison-funding for mental health care is determined by state legislatures, which leaves them understaffed and under-resourced, Johnson explained.

To address the issues of both care and cost, Johnson and colleagues trained a team to treat 181 inmates through interpersonal psychotherapy, or IPT. The team included both master’s level health therapists working in the prisons, as well as bachelor’s level and re-entry counselors. This allowed the researchers to extend the reach of counselors and care without having to hire new mental health professionals.

Johnson explained that IPT is one of the most effective forms of therapy because it addresses specific life events – which consistently burden prison populations. She explained that traumatic and hapless experiences, such as assault, abuse, poverty and drug-related tragedies, are overwhelmingly present with those incarcerated.

“In IPT, you go back to a time in a person’s life when they began feeling a certain way and start to address what was going on at that time,” Johnson said. “IPT deals with relationships, feelings, changes and grief. Using this therapy, you’re helping people feel and express emptions, and problem-solve with them on ways to improve communications or improve relationships that address the original problem.” 

To keep costs down, counselors worked in a group-setting with inmates twice a week for 10 weeks. Inmates were individually assessed at the very beginning of the trial to set goals, after the trial ended and then three months later to see the lasting impact of therapy.

The inmates’ MDD was measured using the Hamilton Reading Scale for Depression, which assesses symptoms such as feeling gloomy or sad, losing interest in things one once enjoyed, feeling helpless, hopeless or suicidal, and rating insomnia, appetite, weight and energy.

“As compared to the usual treatment prisons offer, IPT reduced depressive symptoms, helped the inmates adjust to feelings of hopelessness, adjusted PTSD symptoms and was better at reducing symptoms of major depression,” Johnson said.

Using IPT proved a low-cost intervention as well. The cost per patient was $2,054, which was mostly driven by the cost of training supervisors, Johnson said. Without the cost of supervision, the cost per patient would be $575; the same treatment outside of prison would come to $1,750, she said. 

“This is the first large randomized study for major depression ever conducted for an incarcerated population, but found both an effective and cost-effective solution,” Johnson said. “This method could drastically improve the mental well-being of people while in prison – and when they re-enter the world.”

Moving forward, Johnson will continue researching ways to treat inmates by conducting the first large suicide prevention trial for people leaving the criminal justice system.

(Note for media: Please include a link to the original paper in online coverage: https://psycnet.apa.org/record/2019-05660-001?doi=1)

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