Mental health conditions and mental or neurological disorders remain disproportionately high among prison populations and data suggests they are rising.
Like in the community, the diagnosis and collection, analysis and dissemination of information on the prevalence of poor
mental health or mental health conditions in prisons is generally only undertaken in high-income countries. Nevertheless, the data and anecdotal evidence available point to a worsening global mental health crisis in prisons. Rates of mental health conditions and mental or neurological disorders remain disproportionately high among prison populations and are rising in some cases. A broad range of evidence demonstrates that a reliance on criminal justice systems to respond to substance use and mental illness is contributing to this rise.
For instance, in Ireland, 70% of people in prison live with a personality disorder, more than 40% of people in prison in Italy and 60% in the Netherlands suffer from at least one mental health disorder, and in England and Wales, 48% of men and 70% of women in prison experience mental health ‘problems.’ Furthermore, a recent study from British Columbia, Canada, found that admission numbers of people who have both mental health needs and substance use disorders has doubled over the past eight years.
The low priority afforded to mental healthcare in many prison systems is demonstrated by the lack of qualified mental health staff. In India, there is only one psychologist or psychiatrist for every 16,503 people in prison, with 21 states not having any prison psychiatrists or psychologists. Prisons located in fragile and conflict-affected settings, and also those located in remote and rural locations, have a particularly dire shortage – or absence altogether – of specialised mental health professionals (see New prisons, planning and location). A recent review of practices in eight European countries found that although prison officers play a decisive role in identifying and supporting people with mental illness in prisons, training on caring for people with mental disorders is rarely provided or is reduced to a bare minimum, leading to inadequate support for detained people who suffer from mental disorders.
New evidence points to the significant impact of COVID-19 restrictions in prisons on mental health.
The low levels of mental healthcare in prisons prior to the pandemic, particularly in low-income settings, have been exacerbated by it. The pandemic has brought both a drastic increase in the need for mental health support due to COVID-19-related measures in prisons, and a dip in mental health. An analysis of news articles from Liberia, Guinea and Sierra Leone, all countries affected by Ebola previously, found high effects of the pandemic on the mental health of people in prison and prison staff. Fear, confusion, and disconnect from reality were observed among people in prison – psychosocial impacts from the pandemic that were likened to ‘psychosis’.
New research on 10 countries has revealed the seriousness and wide range of mental health impacts from COVID-19-related measures, such as an increase in the frequency and intensity of sleep problems, anxiety and self-harming behaviour (see Contact with the outside world). Reports continue to evidence the significant impact on the mental health of people held in quarantine or isolation that constitutes solitary confinement in many cases, including children, young people and women. There was an increase in the number of reported incidents of suicidal behaviour in Puerto Rico’s juvenile detention facilities and in the largest women’s prison in Europe, HMP Bronzefield in England, where a 140% increase of self-harm in the past two years has been connected to a lack of visits from family members, especially children.
As the pandemic has progressed, new initiatives have been developed to provide mental healthcare services despite ongoing restrictions. Prison officers have been tasked with providing psychological support to meet the shortfall of specialised staff. In Greece, staff have been trained to screen mental health issues and address cases of self-harm and prevent suicide. In the Philippines, a pilot programme by the NGO, DIGNITY, built the capacity of prison staff to provide basic mental health services to people in prison through psycho-education techniques.
Civil society continues to play an important role in providing mental health support for detainees. In Uganda, PRI is facilitating mental health training, screening and support for people in prison. Justice Project Pakistan has developed mental health awareness toolkits, which aim to support staff in dealing with people in prison with mental illness. In Lebanon, the NGO Restart provides mental health services in prisons in the North of the country as mental healthcare is otherwise not available in detention facilities.