Monday, July 15, 2024

Economic Evaluation of Mental Health Interventions in Prisons: A Critical Gap

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The relationship between incarceration and deteriorating mental health is well-documented, with significant implications for individuals, correctional facilities, and wider society. This underscores the necessity for effective mental health interventions. However, the challenge lies in balancing clinical efficacy with cost-effectiveness, especially given the limited budget allocated to prison healthcare services. A recent systematic review aimed to address this by evaluating the economic viability of mental health strategies for adult prisoners. The findings revealed a stark deficiency in cost-effectiveness data, emphasizing an urgent need for comprehensive economic evaluations in this domain.

Systematic Literature Search

A thorough literature search was performed across multiple medical and economic databases, focusing on full economic evaluations that compare the costs and consequences of at least two mental health interventions for incarcerated adults. Despite the extensive search, only a single publication met all the eligibility criteria, highlighting the significant gaps in available evidence. This lack of data poses a challenge for policymakers and healthcare providers aiming to implement cost-efficient mental health programs in prisons.

Implications for Future Research

The absence of robust economic evaluations in the existing literature suggests that future research must prioritize incorporating these analyses from the outset. This involves not only assessing the direct costs of interventions but also considering broader healthcare resource utilization. Additionally, employing generic outcome measures such as quality-adjusted life years (QALYs) could facilitate comparisons across various health conditions and align with predetermined cost-effectiveness thresholds.

From a market access perspective, the dearth of cost-effectiveness data restricts the ability to justify the allocation of resources for mental health interventions in prisons. This creates a barrier for new interventions to gain traction within the correctional healthcare market, potentially stalling advancements in prisoner mental health care.

Key Inferences and Recommendations

The study’s findings underscore several critical inferences for advancing research and policy:

  • There’s a pressing need for integrated economic evaluations in mental health intervention research within prison settings.
  • Future studies should aim to capture both direct and indirect costs to provide a comprehensive cost-effectiveness analysis.
  • Utilizing generic outcome measures like QALYs can enhance cross-disease comparisons and inform resource allocation decisions.
  • Addressing these research gaps can facilitate improved market access for effective mental health interventions in prisons.

In conclusion, bridging the gap in cost-effectiveness evidence is crucial for the development and implementation of effective mental health interventions in prisons. Such efforts are vital for optimizing resource allocation and improving the mental well-being of incarcerated individuals.

Original Article:

J Forens Psychiatry Psychol. 2024 May 10;35(4):622-628. doi: 10.1080/14789949.2024.2350515. eCollection 2024.


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The link between imprisonment and adverse mental health is well established and linked to both recidivism and prison misconduct, with negative consequences for prisoners, the prison system and society. To help minimise these impacts, appropriate mental health interventions are required. However, owing to finite resources to deliver healthcare in prisons, interventions must be both clinically and cost-effective. A systematic literature search was conducted using various medical and economic databases. The search aimed to identify full economic evaluations (comparing costs and consequences of two or more interventions) of mental health interventions for adult prisoners during incarceration. Results were intended to identify evidence gaps and highlight areas for future research. Only one publication met all eligibility requirements, with several limitations identified. This finding highlighted a clear lack of cost-effectiveness evidence for use by decision makers within the prison setting. This emphasises the need for future research to incorporate economic evaluation during the early stages of research design. Research should aim to incorporate both intervention costs and wider healthcare resource use, which may be affected, and generic outcomes, such as quality-adjusted life years (QALYs), which enable comparison across various disease areas and against pre-determined thresholds.

PMID:38983758 | PMC:PMC11232945 | DOI:10.1080/14789949.2024.2350515

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