N.C. Prisons Study Better, Safer Outcomes: Diversion Program Offenders With Mental Illness

RALEIGH -- Press Release Sep 30, 2021 North Carolina Department of Public Safety

 New medical research from North Carolina’s prison system supports the use of alternative treatment for mentally ill offenders.

Published today in the American Journal of Preventive Medicine, the study evaluates therapeutic diversion units (TDUs), which are treatment-oriented prison housing for offenders with a mental illness. TDUs are staffed with behavioral health, nursing and custody professionals. They provide an alternative to restrictive housing.

The study examines data regarding North Carolina offenders who have both a diagnosed mental illness and a history of restrictive housing placement for their behaviors. Researchers found that offenders assigned to a TDU instead of restrictive housing were at least three times less likely to commit further infractions, harm themselves or require inpatient mental health treatment.

Todd Ishee, N.C. commissioner of prisons, said corrections systems have long struggled with providing proper care to offenders who suffer from psychological disorders.

“You have to protect the safety of prison staff and the other offenders, so you must remove someone who represents a threat, at least temporarily, from the general population,” Ishee said. “But at the same time, you don’t want to put someone in restrictive housing for an action they’ve taken in a moment of crisis. It’s better to give them the help they need.”

Previous studies have found that mentally ill offenders are 30-60 percent more likely to be assigned to restrictive housing. Charles Mautz, a co-author of the new study, said the data indicates TDUs are a viable, safe alternative for offenders with a mental illness when they otherwise might be assigned to restrictive housing.

“What we have is a rigorous, objective evaluation of particular outcomes from this one method of housing and providing programming, compared to another, for a similar population,” said Mautz, administrator of the state prison system’s in-house research unit, the Innovation Institute. “The key implication is that therapeutic diversion units can provide a therapeutically oriented alternative to restrictive housing that benefits this vulnerable group of offenders without posing an increased risk to safety.”

Study results indicate that offenders assigned to a TDU instead of restrictive housing were:

3 times less likely to commit a disciplinary infraction
5 times less likely to commit a severe infraction involving violence or contraband
3 times less likely to require inpatient mental health treatment
3 times less likely to threaten or commit self-injury
4 times less likely to commit self-injury.
The results for self-injury, including suicide, are critical indicators of the impacts TDUs can have, said Dr. Gary Junker, also a study co-author and director of health and wellness for the state prisons system. Prisons’ own past research has indicated that nearly half of all self-harm or self-mutilation occurs in restrictive housing.

“There’s a body of research that indicates just how adverse restrictive housing can be for people who suffer from a mental health disorder—depression, anxiety, psychiatric distress, even feelings of dehumanization and loss of identity,” Junker said. “We now have data, which came from our own offender populations, to guide us as we determine best practices.”

The study was a collaboration among the N.C. Department of Public Safety—Prisons, UNC-Chapel Hill’s Injury Prevention Research Center and the N.C. Department of Health and Human Services’ Division of Public Health. Researchers examined 2016-2019 data for almost 3,500 offenders with a mental illness. Of those, 463 had been assigned to a TDU, and the remainder to restrictive housing.

Tim Moose, N.C. DPS chief deputy secretary for the Division of Adult Correction and Juvenile Justice, said the study reflects a commitment both to innovation and to providing appropriate care to the offenders in state custody.

“I want to thank our partners at the UNC-CH Injury Prevention Research Center and at DHHS for their assistance and collaboration in this important study,” Moose said. “And most especially, thanks go to Dr. Junker and our mental health professionals, nurses and corrections staff working in our facilities, who since 2016 have been working to implement and refine the innovative TDU concept in prison locations as a means to both enhance safety and provide much-needed mental health treatment for the offender population, most of whom will transition back to live in our communities.”

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