People in prison disproportionately experience poor mental health and mental health disorders compared to the general population, often linked to societal factors, poor screening and treatment in prison, and the negative effects of imprisonment on mental health and well-being. To date, information on mental health in prisons is generally only available in high-income countries with scarce data on prevalence, experience and treatment in most countries across Africa, Asia, and Latin America.
Where information is available, it confirms the high rates of poor mental health in prisons and challenges accessing treatment and support. In the US, 43% of people in state prisons report one or more diagnosed mental health condition, but only 26% have received any professional support for their mental health since entering prison. In Europe, WHO has found mental health disorders affect 32.8% of the prison population, making mental health the most prevalent health concern reported in prisons in 2020. Among the 36 countries surveyed by WHO, 26 provide access in all prisons to mental health counsellors, including peer support and external providers for both mental health disorders and other well-being needs. Another regional survey by the Council of Europe and CEP found the prevalence of mental health disorders in prisons ranged hugely, from 0-80%. While about 90% of countries surveyed have a national level mental health policy for prisons, only 74% (31 countries) provide mental health awareness training for prison staff.
More than 1 in 3 people in prison showed symptoms of ‘severe anxiety disorder’ indicating high levels of posttraumatic stress, and two-thirds said that access to mental health support had worsened rather than improved during the lockdown.
New research continues to show the specific mental health needs of women in prison. In England, analysis of hospital data revealed more than 20% of admissions to hospital by older women in prison had a diagnosis of depression recorded, compared to less than 8% of their male counterparts. In Catalonia, Spain, 51% of women in prison in 2020 suffered from anxiety, compared to 37% of men in prison and 16.5% of the total general population. Women also showed far greater prevalence of personality disorder and depression than men in prison, although men had a higher rate of schizophrenia. Research by the Scottish Government also identified higher prevalence of mental health conditions and self-harm among women relative to men in prison, except for alcohol use disorder and depression.
The impact of the COVID-19 pandemic and associated measures in prisons continues to be revealed, with new research exposing the worsening mental health crisis in prisons. A study in England and Wales, where 85% of those surveyed were confined to cells for 23 hours a day during lockdown, found more than 1 in 3 people in prison showed symptoms of ‘severe anxiety disorder’ indicating high levels of posttraumatic stress, and two-thirds said that access to mental health support had worsened rather than improved during the lockdown. In March 2023, the prisons inspector reported that despite the lifting of pandemic restrictions, on weekends when staffing is lowest, 60% of men and 66% of women still spend less than two hours a day unlocked from their cells (compared to 42% and 36%, respectively, on weekdays).
Inadequate mental health staffing in prisons continues to be a common barrier to meeting the complex needs of prison populations. In New Zealand, as of January 2023, 21 out of 76 psychology and medium intensity rehabilitation programmes in prisons have been delayed or stopped due to staff shortages. While WHO found similar numbers of psychiatrists in prisons in Europe as in the community (1.3 and 1.4 per 1,000 respectively), it highlighted the need for a higher ratio of psychiatrists to people in prison, given the greater mental health needs of that population.
The lack of specialised staff and available treatment for people in prison with mental health conditions often leads to ill-treatment.
The lack of mental healthcare staff in prisons is far greater in countries with lower resources. In many places, gaps are filled by community health services that visit the prison at regular intervals like in Burundi where a local neuropsychiatric centre sends a specialist team twice a month to provide mental healthcare to Mpimba Prison. However, some of the challenges identified with this model include limited time for consultations, lack of training for prison healthcare staff in follow-up mechanisms and a lack of psychological screening on admission to prison.
The lack of specialised staff and available treatment for people in prison with mental health conditions often leads to ill-treatment. National Preventive Mechanisms (NPMs) have recently reported on prison staff resorting to isolating people experiencing mental health crises until they can receive care or for long periods of time. In Italy it was found that despite previous recommendations from the monitoring body, one prison was still using seclusion rooms in 2021 for people with evident mental health conditions, sometimes in indecent conditions. In the US, an investigation in the state of Pennsylvania revealed nearly 1 in 3 ‘use of force’ incidents analysed in county jails involved a person who was having a mental health crisis or who had a known mental illness. In many cases, prison staff had used weapons like stun guns and pepper spray, even though the person’s severe psychiatric conditions meant they may have been unable to follow orders or even understand what was going on.