New Research on Therapeutic Diversion Units in North Carolina Prisons

Updated: Dec 13, 2021

Research on the impact of restrictive housing and Therapeutic Diversion Units on infractions, mental health, and self-harm among incarcerated individuals was recently conducted in North Carolina’s prison system. Remch et al.’s article “Impact of a Prison Therapeutic Diversion Unit on Mental and Behavioral Health Outcomes”, which was published in September of 2021, examines the positive impact Therapeutic Diversion Units can have on incarcerated individuals with mental health disorders.

Remch et al. state that incarcerated individuals with mental health disorders are disproportionally sent to restrictive housing (i.e., solitary confinement, administrative or disciplinary segregation, and supermax), which is known to have negative impacts on mental health. In order to reduce the long-term use of restrictive housing for individuals with mental illness in NC prisons, the NC Department of Public Safety, Adult Correction and Juvenile Justice, Division of Prisons developed Therapeutic Diversion Units. Therapeutic Diversion Units, which were first implemented in 2016, are multidisciplinary treatment units designed to decrease incidents involving violence, self-harm, and behavioral problems and to enhance the care and custody of individuals with mental illness. Therapeutic Diversion Units are focused on helping participants develop effective emotional regulation and self-management skills, understand their symptom presentation and patterns, and prepare for re-entry into a less restrictive environment within the prison and ultimately into the community.

Remch et al. analyzed data from incarceration records from North Carolina prisons from 2016-2019, resulting in a sample size of 3,480 people of whom 463 were enrolled in a Therapeutic Diversion Unit. They found that compared to Therapeutic Diversion Units the rate of infractions was 3 times higher in restrictive housing, the inpatient mental health admissions rate was 3.5 times higher, and the self-injury incident rate was 3.5 times higher. Remch et al. conclude that Therapeutic Diversion Units provide a promising alternative to restrictive housing for individuals with mental health disorders. They stated their findings “support the limited but growing research suggesting that therapeutic-oriented alternatives to restrictive housing may improve the mental health of incarcerated individuals without posing a risk to the safe operation of correctional facilities.”

Read the full article here: Impact of a Prison Therapeutic Diversion Unit on Mental and Behavioral Health Outcomes - American Journal of Preventive Medicine (

Written by Crystal Poole, NC-CURE Intern