As a national expert in the development and testing of interventions for people with serious mental illness within the criminal justice system, Associate Professor Amy Blank Wilson focuses much of her work on closing the gap between research and treatment.
To this end, her studies within prisons often involve adapting interventions that rely on cognitive behavioral therapy (CBT) – a psychological treatment that aims to change an individual’s thinking patterns. Moreover, her previous research has demonstrated that these CBT-focused interventions can be successful in preventing a relapse of criminal behavior among people with serious mental illness in prison settings who are criminally at risk.
Although expanding the scientific evidence around correctionally based CBT has been rewarding for Wilson, she and some of her colleagues in the field have wondered aloud for years how they might take the successful intervention in a different direction. Fast-forward to March 2020. As the COVID-19 pandemic surged, Wilson and her research team knew their current work within North Carolina’s prison system would be put on hold.
For Wilson, the timing offered an opportunity to finally dig further into a question she and other scientific colleagues had long asked: “Why wait until someone’s in prison to give them treatment that could help them avoid prison?”
As principal investigator on a project supported by a $755,320 highly selective research grant from the National Institutes of Mental Health, Wilson will spend the next three years alongside her social work team tackling just that question. Their goal: to design and test a new CBT-focused intervention that, if successful, could make a larger impact by targeting individuals with serious mental illness before they ever become involved in the criminal justice system.
“Although these aren’t necessarily preventative services, we have thought that if we’re good enough at it, they could become preventative or at least intervention early,” Wilson said.
The project, which includes a partnership with UNC’s Center for Excellence in Community Mental Health (CECMH), involves a randomized control trial to test the preliminary effectiveness of the new intervention and to identify strategies to scale up and expand the intervention into community mental health settings across the country.
Working closely with Wilson is a social work team of co-investigators of national prominence with expertise in mental illness, intervention design, and psychological services: Robert Morgan, dean of the College of Health and Human Sciences at Southern Illinois University Carbondale and an international expert on correctional psychology and Natalie Bonfine, associate professor of psychiatry at Northeast Ohio Medical University and a long-time collaborator on this work.
Wilson is especially proud of the School of Social Work alumni who make up the team. Caroline Ginley, MSW ’09, has worked on previous studies with social work faculty and is serving as a co-investigator. Anna Parisi, Ph.D. ’21, a long-time practitioner who has collaborated with Wilson on a previous intervention, is serving as a consultant. Rounding out the team are additional experts from within the School, including Research Professor Kirsten Kainz, whose professional interests focus on intervention research and Project Manager Jamie Swaine, MSW ’05, who has collaborated with Wilson on previous research.
Intentionally gathering such a skilled team was vital in her decision to pursue a new intervention, Wilson said.
Previous research certainly has supported the exploration of alternative solutions to preventing people with serious mental illness from criminal justice involvement. In fact, studies have shown that about half of adults with serious mental illness who receive traditional mental health services within community settings are still likely to be arrested, jailed, or imprisoned during their lifetime.
Nevertheless, designing and testing a different kind of solution to help prevent people with mental illness from becoming entangled in the criminal justice system presented its own set of challenges, Wilson and her colleagues agreed. Most significantly, shifting a line of research within the middle of a solidly built scientific career was not only bold but bordering on unprecedented. After all, such a move would require a lot of time and resources, involve potentially no initial funding, and have limited chance of success.
“But our commitment to trying was strong,” Wilson recalled.
For Parisi, a post-doc at the Center on Mindfulness & Integrative Health Intervention Development at the University of Utah, that commitment was influenced in part by the social work field’s advancement in supporting smart decarceration. With more researchers focused on evidenced-based approaches to end mass incarceration, Parisi embraced the opportunity to help further that science and with Wilson’s encouragement, took the lead on developing the intervention prototype.
What resulted was an intervention that focuses on several treatment targets, including helping people strengthen their problem-solving skills in relationships with others and helping people manage emotions in stressful situations.
“The intervention also focuses on helping people manage all of their interrelated symptoms around mental health issues, such as substance use issues,” Wilson explained. “Ultimately, we’re giving adults with a serious mental illness the concrete skills needed to help them develop plans and strategies to deal with challenges before they become a crisis. And we’re giving them skills to manage risky thoughts in their relationships and interactions (with others). We all have them, and in some situations, people need help in how they manage their thoughts and who they spend their time with so that they reduce the risk of bad outcomes.”
Over the last year and with assistance from CECMH, the team conducted focus groups to ensure that the intervention can meet the needs of individuals with mental illness within their communities and the clinicians who serve them.
“This project represents an important step toward closing the research-to-practice gap by foregrounding the voices of community members in the process of intervention development and design,” Parisi added.
Over the next three years, the research team will develop their new intervention using deployment-focused intervention research methods and conduct a rigorous preliminary test of its effectiveness.
The potential to better understand the relationship, if any, between adults living with mental illness and the criminal justice system is an important one to explore, Swaine added.
“This project brings together an amazing team of experts in both mental health and criminal justice and really challenges them to begin to think about the relationship between mental illness and recidivism in a whole new way,” she said. “As a social worker, it’s been so exciting to see the role social workers have played in this project from intervention design to development to the research process. I think it really speaks to the far-reaching impact social workers can have when they use their expertise and experience to guide future practice that ultimately can impact larger systems.”