Can We Make Mental Health Care Work in Prisons? A Peek into a Dutch Experiment!

Hey everyone! Let’s talk about something that’s often swept under the rug but is incredibly important: mental health in prisons. It’s a tough environment, and folks behind bars often struggle way more with their mental well-being than people on the outside. So, what if we could find a practical way to help them, even with all the challenges prisons present? Well, some clever folks in the Netherlands are trying to figure that out, and I’m here to give you the inside scoop on their plan!

The Unseen Struggle: Mental Health in Prisons

So, picture this: you’re in a remand prison, meaning you’re waiting for trial. It’s a stressful, uncertain time, right? It’s no surprise then that mental health problems like anxiety, depression, and even PTSD are super common among prisoners, especially in those initial weeks after arrival. We’re talking rates of psychotic illness around 3.7%, major depression at 11.4%, anxiety disorders hitting 30%, and PTSD at 9.8% – these are serious numbers, folks!

These issues don’t just make life miserable for the individuals; they can also lead to a lower quality of life, a higher risk of being victimized in prison, and more misconduct. And while the jury’s still out on a direct, always-there link between mental health and re-offending, some newer, solid studies suggest that, yeah, mental health problems can increase the chances of someone re-offending. It’s a vicious cycle.

Now, you might think, “Well, prisons are structured, so isn’t that a good place to tackle these problems?” And you’d be right, in theory. But there are some hefty roadblocks. For starters, spotting mental health issues isn’t always easy, especially the “quieter” ones like depression or anxiety. In the Netherlands, for example, psychiatric screening isn’t standardized when prisoners arrive. Often, it’s up to prison staff, who aren’t mental health experts, to notice if someone’s struggling. Plus, like many places, Dutch prisons are dealing with staff shortages, which puts even more pressure on everyone.

Then there are the barriers from the prisoners’ side. Some might not trust health specialists, fear being stigmatized, or feel they need to appear tough. They might not even know what help is available or get tangled in bureaucracy and long waiting lists. It’s a recipe for people not getting the help they desperately need.

A Glimmer of Hope: Introducing Problem Management Plus (PM+)

So, what’s the solution? Enter Problem Management Plus (PM+). This is an intervention developed by none other than the World Health Organization (WHO). How cool is that? The main idea behind PM+ is to teach people practical ways to manage their day-to-day problems, which in turn helps ease common mental health symptoms like anxiety and depression. Think of it as getting a toolkit based on Cognitive Behavioural Therapy (CBT) techniques.

The really neat part? PM+ is designed to be delivered by trained non-specialists, often called “PM+ helpers.” These could even be peer mentors – people who get what you’re going through because they’ve been there themselves or come from a similar background. It’s usually a five-session deal, and it’s been shown to work wonders in other vulnerable groups, like Syrian refugees and people in conflict zones. It’s brief, it’s affordable, and it doesn’t rely on having a bunch of psychologists on hand, which is a massive plus in a prison setting.

Putting PM+ to the Test: The PROSPER Study in Dutch Prisons

This brings us to the heart of the matter: a pilot study in the Netherlands called the PROSPER study. The big question these researchers are asking is: Is PM+ a good fit for Dutch remand prisons? Is it acceptable to the prisoners and feasible to actually run it there? They also want to figure out what might help or hinder rolling out PM+ on a larger scale in Dutch prisons later on.

It’s a single-blind pilot randomised controlled trial (RCT) – fancy words, I know! Basically, they’re comparing a group of remand prisoners who get PM+ alongside the usual care (PM+/CAU) with a group that just gets the usual care (CAU only). They’re aiming to get 60 Dutch-speaking prisoners, 18 or older, who are showing signs of psychological distress.

To be included, prisoners need to score 16 or higher on a distress scale (the K10). They’ll be recruited from two remand prisons, one for men and one for women. Of course, there are some exclusion criteria – like if someone is in a penitentiary psychiatric centre, poses a security risk, has an acute medical condition or imminent suicide risk, is already getting specialized mental health care, or has severe mental/cognitive impairments.

The researchers are looking at a bunch of things to see if the intervention is feasible:

• Recruitment success: How many people sign up?
• Intervention retention: How many people stick with the PM+ sessions?
• Protocol adherence: Are the PM+ helpers delivering the intervention as planned?
• Serious adverse events: Are there any negative outcomes?
• Stakeholders’ views: What do prisoners, helpers, prison staff, and even family members think?

Participants will be assessed for anxiety, depression, problems they identify themselves, suicide risk, self-harm behaviour, and PTSD symptoms at the beginning, right after the intervention, and then three months later. This isn’t about proving PM+ “cures” everything in this pilot – it’s more about seeing if the whole setup can work smoothly in a prison, paving the way for a bigger, more definitive study down the line.

Who’s Involved and How Will We Know if It Works?

Let’s talk about the “usual care” (CAU) in Dutch prisons. Prisoners can get referred to a mental health professional or ask for a consultation. These requests go through a psycho-medical meeting. But, and it’s a big but, Dutch prisons generally only provide *necessary* care; if something can wait until release, it often will. Plus, the ratio of medical staff to prisoners is pretty high compared to other similar countries – 1 staff member for every 318 prisoners! That’s a lot of people per staffer.

For this study, participants will be recruited from remand units. They can express interest through staff or contact researchers directly. They get all the info, have a week to think it over, and then give written consent. If they’re eligible, they do a baseline assessment, and then they’re randomly assigned to either the PM+ group or the CAU-only group. The PM+ sessions (two 60-minute sessions a week for this study, adapted from the usual five 90-minute weekly sessions) will be given by third-year bachelor’s or master’s students in psychology or criminology. These “PM+ helpers” get a 5-day training, which is a bit shorter than usual because they already have some background knowledge.

What about when people get released or transferred? The study tries to keep them involved! If released, PM+ sessions might go remote, and assessments can be online or face-to-face. If transferred, they’ll try to continue in the new prison. It’s all about being flexible.

To measure how things are going, they’re using a bunch of questionnaires:

• K10: To screen for psychological distress.
• MINI (suicidality module): To assess suicide risk.
• SCIL: To check for potential intellectual disabilities.
• LEC-5: To look at lifetime traumatic events.
• PHQ-9: For depression symptoms.
• GAD-7: For anxiety symptoms.
• PCL-5: For PTSD symptoms.
• SCOPE-2: To assess vulnerability to self-harm and suicide in prison.
• PSYCHLOPS: For self-identified problems.
• WHOQOL-BREF: To measure quality of life.
• CSRI (adapted): To track healthcare use.

Phew, that’s a lot of measures! But it’s all to get a really good picture of what’s happening and whether these tools are even usable in a prison context.

Digging Deeper: The Process Evaluation

After the main trial bit is done, there’s a process evaluation. This is where they really get into the nitty-gritty. They’ll analyze documents like notes from supervision meetings and records from the PM+ helpers. Plus, they’ll do semi-structured interviews with about 25 stakeholders. This includes:

1. The prisoners who took part in the RCT.
2. Their family members or friends.
3. The PM+ helpers, trainers, and supervisors.
4. Prison staff.

The interviews will explore everyone’s experiences with PM+, what they thought of the content, the format, how well participants stuck with it, and how the PM+ strategies applied to daily life. They’ll also be looking for barriers and facilitators to scaling up PM+ in the wider prison system. It’s all about learning lessons for the future.

Safety is a big deal, too. Researchers and PM+ helpers get training on interacting with folks with a criminal justice background. There are protocols for adverse events, and if a participant expresses suicidal thoughts, there’s a clear plan. For PM+ helpers, there’s weekly group supervision with experienced professionals to discuss cases, share tips, and also talk about how the work is affecting them. It’s a supportive setup.

Why This Matters: The Bigger Picture

So, why am I telling you all this? Because this PROSPER study is a pretty big deal. It’s one of the first to really look at the potential of these WHO-developed scalable interventions for mental health within Dutch prisons. The findings could massively help design a full-blown RCT to see just how effective and cost-effective PM+ is for remand prisoners. And beyond that, it could give other researchers valuable insights into doing rigorous research in correctional settings, which, let’s be honest, is a tricky area to study.

PM+ has some really cool features for the prison context. It’s evidence-based, scalable, brief, and works across different types of problems. Crucially, it doesn’t need highly specialized (and often scarce) psychologists to deliver it. Imagine prisoners themselves being trained as peer PM+ helpers! That could not only help more people but also give the peer helpers a boost in skills and self-confidence. We’ve seen that happen in other prison peer mentor schemes.

Ultimately, reducing mental health problems in prisons isn’t just about improving well-being (though that’s huge!). It’s also about potentially reducing re-offending. PM+ could be a fantastic middle-ground option for prisoners who are struggling but might be hesitant to see a psychologist or can’t access one. It could bridge the gap between no treatment and specialist treatment.

This study is an important first step. It’s about seeing if we can make a practical, accessible, and acceptable mental health support system work in a challenging environment. If it shows promise, it could be a game-changer for many lives. I, for one, will be keeping a keen eye on how it all unfolds! It’s a reminder that even in the toughest of places, there’s always room for hope and innovation when it comes to mental well-being.

Source: Springer