Background: Despite the widespread need for mental health treatment in the prison population, resources in this setting are limited and most facilities are unable to provide adequate care. There is an urgent need for feasible, effective, and scalable mental health treatments for the prison setting.

Proposed Solution to the Problem: To develop effective and scalable mental health treatments for the prison setting, it is crucial to engage stakeholders to obtain input on how to overcome barriers that currently plague the correctional system. The project team proposes to expand a unique academic-community partnership based in Madison, Wisconsin to build stakeholder capacity for future research by leveraging the perspectives, experiences, and expertise of stakeholders with a lived history of incarceration as well as State of Wisconsin Department of Corrections (DOC) officials.

Objectives: The overall goal of this project is to build the capacity necessary to conduct transformative patient-centered outcomes research and comparative clinical effectiveness research (PCOR/CER) on mental health treatments for incarcerated people. The specific aims are: (1) establishing a sustainable collaboration between academic researchers and key stakeholders (people who have experienced mental illness while incarcerated and DOC officials); (2) educating stakeholders on the fundamentals of PCOR/CER; (3) engaging stakeholders to identify important outcomes and develop a research agenda; and (4) capturing stakeholder perspectives on barriers/facilitators to PCOR/CER in the prison setting.

Activities: The specific aims of this project will be achieved through two sets of meetings. One set of meetings—stakeholder advisory group meetings—will include academic researchers and stakeholder advisors. This set of meetings will occur approximately monthly throughout the project period. Based on the input and discussion from these meetings, the research team will create an initial draft of a research agenda for CER in the prison setting. The second set of meetings—focus group meetings—will include a broader group of formerly incarcerated stakeholders recruited through a community partner organization. This set of meetings will occur in the second year of the project. In these meetings, the research agenda and perspectives on barriers/facilitators obtained from the previous advisor meetings will be presented and discussed for feedback. The stakeholder advisory group will meet before and after each of the focus group meetings to plan the next focus group meeting and discuss feedback from the previous focus group meeting, respectively. The research agenda will be refined according to this feedback. 

Projected Outcomes and Outputs:

In the short-term, this project will produce a stakeholder advisory board and PCOR/CER research agenda for addressing the problem of mental health treatment in the prison setting along with a description of the barriers/facilitators to executing the research agenda.

In the medium-term (0-2 years post-project period), the agenda produced in this project will inform randomized controlled trials (RCTs) that will compare the effectiveness of different mental healthcare approaches relative to the status quo in the prison setting.

In the long-term (3+ years post-project period), results from these RCTs, which will be designed to collect the full range of outcome data needed for policymakers within DOC, will be used to implement more effective mental health treatment programs in the prison setting. These products and outcomes are significant because the chronic failure to adequately treat mental illness in the prison setting has had extremely negative consequences for the patients’ lives, financial costs to society, and public safety.

Patient and Stakeholder Engagement Plan: Stakeholders will be engaged through (1) monthly meetings in which stakeholder advisors help formulate a research agenda as well as discuss potential facilitators and barriers to research progress, and (2) focus group meetings in which a separate, broader group of stakeholders provide feedback on the agenda. In order to identify and engage additional stakeholders with lived experience of incarceration for the focus group meetings, the project team will work with a community partner (Nehemiah) and stakeholder advisors Aaron Hicks, Deborah Mejchar, and Karen Reece, PhD, who are connected with a large network of formerly incarcerated individuals through their respective organizations. These advisors will contact potential participants directly. 

Project Collaborators: Collaborators will include formerly incarcerated men and women who experienced mental health treatment needs while incarcerated; State of Wisconsin DOC officials including the Mental Health Director, Psychology Director, and Director of Research and Policy; and leaders of a community advocacy organization for formerly incarcerated individuals (Nehemiah).