Description of the Problem
Long-term schizophrenia causes hallucinations, delusions, confused thoughts and words, thinking issues, and withdrawal. 1% of the population is affected, but jails and prisons have 3–5 times the rate. Because schizophrenia has both positive and negative symptoms, prisoners with it struggle with social skills and conversation (Yoon et al., 2020). Positive symptoms like delusions and hallucinations impede mental function. Bad symptoms like alogia, avolition, and flat affect isolate people. If they can’t communicate, schizophrenia patients may break the rules, be victims, or lack social support. This population also experiences unemployment, homelessness, drug abuse, and reincarceration due to poor social functioning.
Research-backed group therapy improves social and speaking abilities quickly and cheaply. It encourages positive behaviour through peer comments and interactions. Group therapy helps schizophrenia patients develop their social skills so they can communicate, advocate, and behave better. Enhancing conversational skills also builds self-confidence and self-esteem (Yoon et al., 2020). As conversation relies heavily on executive functions like focused attention, memory, organization and planning, group therapy can also strengthen cognitive capabilities. For incarcerated populations with limited resources, group therapy maximizes benefits by addressing the psychosocial needs of several individuals simultaneously.
Context and Affected Population
This study would be implemented at a county jail for adult male schizophrenia or schizoaffective disease inmates. Jails often lack mental health staff and activities for severely mentally ill inmates. Individuals with schizophrenia and related psychotic disorders are up to 4 times more prevalent in prisons than in the community. Estimates suggest up to 25% of inmates in some facilities have a recent history of mental health treatment, the majority for psychotic disorders (Forry et al., 2019). Jails often serve as frontline mental health providers for disadvantaged populations with limited community access to care.
Incarcerated adults with schizophrenia face considerable challenges beyond their mental health symptoms. They frequently have extensive trauma histories and comorbid conditions like substance use disorders. Most have limited education, vocational skills, and social support. After release, many struggle to obtain housing, healthcare, income stability and community integration. Without proper treatment and life skills, they are at high risk for recidivism (Forry et al., 2019). Group therapy initiated in the jail could establish a foundation for ongoing mental health care and prosocial development post-release. It utilizes direct peer interactions to shape conversational competence in a maladaptive social withdrawal environment.
Implications for Nursing Practice
According to Wilma et al. (2023), correctional nursing is a broad and busy field that helps people of all ages with their physical and mental health problems. Nurses are very important for checking out new prisoners, determining severe and long-term conditions, coordinating care, giving medications, teaching, and figuring out which situations must be dealt with first. As a prisoner with schizophrenia’s symptoms get better, nurses keep an eye on any side effects from medications and any psychological problems that may arise. They also facilitate communication between security staff and behavioural health providers. Implementing group therapy for social skills aligns with the nursing process of assessment, diagnosis, planning, intervention and evaluation.
Nurses would initiate the project through a needs assessment identifying conversational deficits as a priority issue. They then connect inmates meeting eligibility criteria with mental health professionals for group enrollment. Nurses would collaborate with group facilitators to maximize participation and track progress. They could also participate in groups as cofacilitators to provide clinical input and modelling (Wilma et al., 2023). Evaluating group therapy outcomes, nurses would identify positive effects on disciplinary incidents, medication adherence, and psychosocial functioning. They could share results with stakeholders to inform future programs and resource allocation. Nurses can play essential roles in this project as direct care providers, care coordinators, health instructors, and leaders in evidence-based practice.
Nurses can speak up for a stigmatized and disadvantaged group by going to group treatment. It aligns with nursing ethics to promote justice and reduce inequities for incarcerated individuals with mental illness. Social skills training facilitates community reintegration and prosocial functioning. It exemplifies compassionate, patient-centred care focused on rehabilitation and recovery. Group therapy also builds knowledge regarding therapeutic communication, cognitive deficits, and behavioural healthcare. It dramatically expands the nurse’s understanding of correctional psychiatry and working with complex, multi-need patients.
Priority for the Clinical Site
County Jail has identified poor social skills and conversational abilities among inmates with schizophrenia as a top area of concern. Security staff report these individuals often seem confused, talk to themselves, and disengage from social interactions. They struggle to follow directions or clearly express needs, resulting in disciplinary citations for noncompliance. Some fail to participate in education or vocational programming due to impaired verbal communication (Wilma et al., 2023). Deficits in social cognition and conversation isolate them from potential social support and prosocial modelling.
After release, their limited social functioning hinders successful community reintegration. Within the jail, a lack of social competence exacerbates anxiety, depression, and risk of self-harm or suicide. It also precludes the development of problem-solving abilities, conflict resolution skills, and constructive goal-setting- critical capabilities for preventing recidivism. Group therapy provides an evidence-based practice to efficiently address this treatment gap, fulfilling the organization’s mission to prepare inmates for reentry through rehabilitation. It also meets the need for mental health interventions that consider the jail’s tight time frames, high patient volumes, and security protocols.
With current staffing, the jail cannot meet psychosocial needs solely through individual therapy. Group therapy reaches more patients simultaneously, using peer interactions to facilitate learning. For individuals reluctant to engage initially, group sessions promote disclosure through vicarious learning and cohesion. Cognitive-behavioural curriculums build concrete conversational skills step-by-step. Homework and roleplaying reinforce learning between sessions with feedback from peers and clinicians. Overall, the group model matches the needs of the jail by being replicable across patient cohorts. It standardizes treatment yet maintains flexibility for personalization based on functioning level.
Organizational Structure
The 1500-bed County Jail is operated by the County Department of Corrections and supervised by a County Commissioners-appointed warden. The jail ensures detainees’ safety and promotes rehabilitation and reintegration. Health services like medical, dental, mental health, and drug treatment are contracted to Wellpath. Wellpath wants to make health care fairer and more accessible for people involved with the justice system by providing patient-centred, sensitive care. The healthcare unit is a separate department within the jail’s organizational structure. They need to work together with the security staff for movement, programs, disciplinary problems, and discharge. Internally, the warden, unit managers, and mental health director oversee staffing, budgets, policies, day-to-day operations and quality improvement. Externally, County funding, state laws, available community resources, inmate population size and acuity impact care coordination. The jail must balance custody requirements with therapeutic aims to effectively implement interventions like group therapy for inmates with schizophrenia.
Previous Attempts to Address the Problem
While County Jail offers some individual counselling and peer support groups, no evidence-based group therapies have been implemented to address social skills deficits in inmates with schizophrenia. Particular treatment is resource-intensive, while peer support groups need more structure and skill development. Group therapy led by mental health professionals can leverage peer interactions to provide targeted skill training efficiently. Cognitive-behavioural social skills training has demonstrated effectiveness in criminal justice settings (Yoon et al., 2020). This provides a solid foundation to address the organization’s needs.
References
Forry, J. B., Ashaba, S., & Rukundo, G. Z. (2019). Prevalence and associated factors of mental disorders among prisoners in Mbarara municipality, southwestern Uganda: a cross-sectional study. BMC Psychiatry, 19(1). https://doi.org/10.1186/s12888-019-2167-7
Wilma, W., Hamid, S., Hanny Handiyani, & Ede Surya Darmawan. (2023). Nursing services as perceived by inmates in correctional facilities in Jakarta, Indonesia: A qualitative study. Belitung Nursing Journal, 9(2), 184–191. https://doi.org/10.33546/bnj.2485
Yoon, I. A., Slade, K., & Fazel, S. (2020). Outcomes of psychological therapies for prisoners with mental health problems: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 85(8), 783–802. https://doi.org/10.1037/ccp0000214
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