Chronic Mental Illness in Prisons: Global Scenario

Mental Health and Prison

Mental disorders occur at high rates in all countries of the world. An estimated 450 million people worldwide suffer from mental or behavioural disorders (World Health Report, 2001). These disorders are especially prevalent in prison populations (Brinded, 2001; Brugha, 2005; Holley, Arboleda, & Love, 1995).The disproportionately high rate of mental disorders in prisons is related to several factors: the widespread misconception that all people with mental disorders are a danger to the public; the general intolerance of many societies to difficult or disturbing behavior, the failure to promote treatment, care and rehabilitation, and above all, the lack of, or poor access to, mental health services in many countries. Many of these disorders may be present before admission to prison, and may be further exacerbated by the stress of imprisonment. However, mental disorders may also develop during imprisonment itself as a consequence of prevailing conditions and also possibly due to torture or other human rights violations. Prisons are bad for mental health. There are factors in many prisons that have negative effects on mental health, including: overcrowding, various forms of violence, enforced solitude or conversely, lack of privacy, lack of meaningful activity, isolation from social networks, insecurity about future prospects (work, relationships etc), and inadequate health services, especially mental health services, in prisons. The increased risk of suicide in prisons (often related to depression) is, unfortunately, one common manifestation of the cumulative effects of these factors. Prisons are sometimes used as dumping grounds for people with mental disorders. In some countries, people with severe mental disorders are inappropriately locked up in prisons simply because of the lack of mental health services. People with substance abuse disorders or people who, at least in part due to a mental disorder, have committed minor offences are often sent to prison rather than treated for their disorder. These disorders therefore continue to go unnoticed, undiagnosed and untreated.

It has been known that psychiatric disorders are highly prevalent among prisoners (Coid, 1984). Many people with identifiable psychiatric illness do conflict with the law, often by no fault of their own but because of symptoms of their psychiatric illness and end up in jails. Such symptoms include impaired judgment, lack of impulse control, suspiciousness, disinhibition, paranoia, inability to trust others, delusions and hallucinations. It is quite likely that act of incarceration may well exacerbate underlying psychiatric conditions. The effect of such incarceration may well be so severe as to precipitate mental abnormality in vulnerable individuals (Coid, 1984). Different levels of stress during incarceration give rise to different incidence of psychiatric morbidity among remand prisoners (Anderson et al., 2000).