JMIR Publications

ABSTRACT

Background:

Indigenous Australians in custody experience rates of poor mental health and wellbeing that are much greater than the general community and these needs are not adequately addressed. Digital mental health strategies offer innovative opportunities to address the problem, but little is known about their feasibility or impact in this population.

Objective:

This study aimed to conduct a pilot trial evaluating the impact of adding the Stay Strong app (SSA) to mental health and wellbeing services for Indigenous people in custody. The trial compared Immediate and 3-month Delayed use of the app by the health service, assessing its effects on wellbeing, empowerment and psychological distress at 3 and 6 months post-Baseline.

Methods:

Indigenous participants were recruited from three high-security Australian prisons from January 2017 to September 2019. The outcome measures assessed wellbeing (Warwick-Edinburgh Mental Wellbeing Scale, WWS), empowerment (Growth and Empowerment Measure, GEM, giving Total, EE14 and 12S scores) and psychological distress (Kessler Psychological Distress Scale, K10). Intention-to-treat effects on these outcomes were analysed using Linear Mixed Models.

Results:

Substantial challenges in obtaining ethical and institutional approval for the trial were encountered, as were difficulties in timely recruitment and retention, due to staff shortages, release of participants from prison prior to follow-up assessments and an inability to follow up participants post-release. A total of 132 prisoners (Age M = 33, SD = 8 years) were randomized into either an Immediate (N = 82) or Delayed treatment group (N = 52), However, only 56 (42%) could be assessed at 3 months and 37 (28%) at 6 months, raising questions concerning the representativeness of results. Linear improvements over time were seen on all outcomes (GEM Total d = 0.99, EES14 d = 0.94, 12S d = 0.87, WWS d = 0.76, K10 d = 0.49) , but no differential effects for Group were found.

Conclusions:

We believe this to be Australia’s first evaluation of a digital mental health app in prison and the first among Indigenous people in custody. While the study demonstrated that the use of a wellbeing app within a prison was feasible, staff shortages led to delayed recruitment and a consequent low retention, and significant beneficial effects of the app’s use within a forensic mental health service were not seen. Additional staff resources and a longer intervention may be needed to allow a demonstration of satisfactory retention and impact in future research. Clinical Trial: This trial is not registered