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Inmate Attitudes toward Treatment: Mental Health Service Utilization and Treatment Effects

by Lucas B. Shaw and Robert D. Morgan (2011). "Inmate Attitudes toward Treatment: Mental Health Service Utilization and Treatment Effects." Law and Human Behavior, 35(4): 249-261.

Offenders in the criminal justice and corrections systems are rarely asked about their attitudes or perspectives on the type, extent, or other dimensions of mental health services they have (or do not have) available to them. This is unfortunate because offender attitudes can in fact play an essential role in the development, delivery, and effectiveness of such services. In recent years,  Robert Morgan, along with various colleagues from the psychology department at Texas Tech University in Lubbock, has issued a series of research articles that have reported the advantages of acknowledging or enhancing offender attitudes toward mental health treatment: different offender groups have different concerns about treatment; and prisoners have self-preservation, procedural, self-reliance, and professional service provider concerns about the mental health services they seek.

Still, the impact of inmate attitudes on treatment outcome remains underexplored. Shaw and Morgan point out this is true even for such widely heralded interventions as those guided by common factor or Risk-Need-Responsivity (RNR) models. The underlying thrust of this study is "to understand how inmate attitudes toward treatment and mental health services impact post-treatment institutional behavior (specifically disciplinary behavior) and scores on a measure assessing risk for future criminal behavior."

For this study, Shaw and Morgan assessed 278 male inmates confined under the auspices of the Kansas Department of Corrections. Approximately two-thirds (N=186) of this sample received, at minimum, one individual or group mental health treatment session; the remaining third (N=92) had not received any treatment for five years. The type of treatment prisoners did receive was unspecified. The sample was ethnically diverse, housed at different classification levels, and largely single. Their average sentence length was just more than eight years. Demographically, both groups - the treatment and non-treatment groups - were similar. Prisoner attitudes were measured according to four scales: an Attitudes Toward Seeking Professional Psychological Help Scale (a 10-item measure that assesses satisfaction with specific services), a Thoughts About Psychotherapy Survey (an adapted set of 15 items that evaluate treatment seeking fears), an Expectations About Counseling Questionnaire (a 66-item measure that assesses client expectations about treatment), and a Self-Appraisal Questionnaire (a 72-item self-reported measure of risk for violence).

Three primary findings resulted from this study:

  • More mental health treatment sessions lead to more positive attitudes toward seeking mental health treatment;
  • More mental health treatment lead to more severe disciplinary infractions; and
  • Positive attitudes toward mental health help-seeking decreased the number and severity of disciplinary infractions.

Lucas and Morgan place these findings with the context that the prisoners receiving treatment may have been high-risk offenders, because treatment services such as those central to this sample of prisoners are typical given to more serious offenders.

The authors recommend four intervention guides:

  • Prison-based education program could offer more information about mental health services;
  • Prison educators can target incoming offenders during orientation about their attitudes toward mental health treatment (providing them with accurate information);
  • Early prison-based services can focus specifically on inmate attitudes toward treatment; and
  • Mental health and correctional staff members can target specific inmate treatment fears, such as concerns about stigma.

Lucas and Morgan conclude that "it is relevant for mental health professionals to assess treatment satisfaction to investigate the effectiveness of their services in prison."

For further information, contact Robert D. Morgan in the Department of Psychology, Texas Tech University, Lubbock, Texas, (e-mail)

Posted Fri, Aug 26 2011 2:25 PM by Tracey Vessels


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