In the following article, the reader will find information about mental health in prisons, some of its implications and an example of a real case.
Mental health in prisons
Mental health in prisons is a very difficult subject to deal with since we can intuitively think of the difficult implications of the situation. In simple terms, it is about everything related to the management of mental health in prisons, health care for people who are in prison and at the same time suffer from a mental disorder, among other aspects.
People who are in charge of mental health in prisons should be well aware of the mental health policy regarding these people.
Mental health in prisons: some introductory data
As mentioned, it is relatively easy to imagine the negative consequences of prison confinement for mental health. We know that conditions are often not adequate, and it is not a normal state for a human being. Our lives, under normal conditions, are conducted with greater freedom and fewer restrictions than those that can be found in a prison.
According to studies conducted worldwide, mental health in prisons has the characteristic of being much poorer than in the general population. That is to say, if we take a sample of people who are in prison, and carry out measurement by means of instruments and/or interviews, we will find that these people have more alarming signs of mental health than we would find in the general population, with average citizens.
The following are some of the factors that influence the poor mental health of people in prison. In this way, we will begin to understand the consequences and implications of mental health in prisons:
- Overcrowding is one of the main factors that have negative consequences for mental health in prisons. People share a small space with many others, from which other consequences are also generated. There is no possibility of having an adequate, spacious personal space, as we are normally used to. No, prisons are overcrowded and this is something that happens in most countries around the world. Mental health in prisons, under these conditions, is a very big challenge for public health administrations.
- It is also common to find different types of violence generated among people inside prisons. It can be physical, verbal, and even sexual violence. It is not difficult to imagine the implications of this on mental health in prisons. Acts of violence are perfect prospects for becoming traumatic events that, if not properly managed, can trigger psychopathological symptoms.
- Forced solitude, on the other hand, is not a factor that plays in favor of inmates either. They must remain locked up and isolated most of the time, with no space to share with others, which is usually not safe all the time either.
- In addition to this, the lack of privacy also has negative consequences for mental health in prisons. We all need privacy at some time of the day, and especially for some activities. In prisons, sometimes there is not even a private space for bathing and this type of physiological needs. Sometimes inmates must take a shower while dozens of others are around. This type of exposure is not at all comfortable.
- There is another common feature of prisons, which is that they lack the possibility of meaningful activities. Much time is spent alone, brooding, isolated, and often without the activity of any kind. Some prisons strive to implement programs where inmates must engage in some manual or artistic activity, which will help them maintain some form of mental health while they are locked up.
- Mental health in prisons also means that people in prison are unsure about their future and their possibilities (in terms of personal relationships, finances, work, career, etc.). It is clear that these people are being held accountable for inappropriate action and that they should be penalized, but this does not detract from the conditions they face. While they are locked up, life outside the prison continues and they find themselves in a kind of space suspended in the time since most of the actions that were once possible and available to them are no longer possible.
- Mental health in prisons is very poor. Even the health services are generally insufficient and those who are in prison have very serious problems in accessing the treatment they need to regain their health status.
Given all the above, it has also been found that suicide rates are up to 10 times higher in prisons when compared to data from the general, non-prison population. As we see, these data indicate that the situation of mental health in prisons is very complicated.
In addition to the above, i.e. people in prison are more likely to suffer from mental health problems, they are also less likely to receive the treatments they need.
On a scale of social, government and public health care priorities, mental health in prisons is not in a privileged position.
Mental health in prisons: what about the staff?
From another perspective of the problem are those who work in prisons. Those who keep the security, the people in charge of general services, food, cleaning, among others. All of them are exposed to this highly stressful environment, which can also generate consequences.
Mental health in prisons also means that there are a number of people who earn their living by maintaining the minimum conditions necessary for the prisons to function properly. One need only imagines what a typical day in prison would be like.
Those who work there must interact with hundreds of people whose mental health is very vulnerable. The daily interaction must be very complicated since there are no optimal conditions for good mental health.
Some additional facts
According to the Prison Reform Trust, the following data is presented to give an idea of the mental health implications for those who are at some point in a detention center:
26% of women surveyed and 16% of men reported receiving for some mental health problems in the year prior to custody. In other words, a significant proportion of those incarcerated already had some form of the mental disorder prior to entering the prison.
On the other hand, 25% of the women and 15% of the men from whom the information was taken showed symptoms of a psychotic nature. This should be contrasted with data from the general population, where the rate is 4%. This is very alarming and may inform the impact of incarceration on mental health.
On the other hand, it has already been mentioned that the proportion of people causing harm to themselves is higher in prisons. About 70% of the people who have caused themselves harm in prison have been previously identified as having some kind of mental health problem, so it is not entirely surprising that they have done so. A risk factor had been previously identified.
Information is also provided on the proportion of prisoners who receive treatment for mental illness. It was found that about one in five people diagnosed with mental illness do not receive appropriate treatment while in prison.
This indicates a high number of untreated people with mental health problems whose symptoms may be exacerbated by their situation, which may put them in potential danger.
Finally, it indicates data that estimates the capacity of prisons to refer people who need them to the relevant services for their mental disorder. Thus, it was found that 40% of the prisons inspected in 2016 did not have the necessary training and preparation for prison officials to identify those inmates who needed to go to mental health services.
An example of a real case
We’ll call this person M, who was diagnosed with paranoid schizophrenia after he went to prison for almost killing a fellow soldier, where he was working. M relates the situation he experienced while in prison, during almost two years of imprisonment.
M is now in a specialized mental health center for those who have committed a crime and simultaneously suffer from a mental disorder. In these cases, the cause of the person’s action was the mental disorder, its symptoms, and not his own will.
M says she went months without antipsychotic medication, so she was continually having hallucinations, and her peers were aware of what was happening to her. Some of them were afraid of him because they saw him talking against the wall, with a person who was only in his head.
Others threatened him several times and assured him that if he continued to show his “strange” behavior, he would suffer the consequences. M did not have a private cell, and was always watched by his partner, feeling a lot of pressure and anxiety. He needed professional help.
It took about 23 months for him to start receiving the appropriate treatment, and to be seen regularly by a psychiatrist to adjust his medication and improve his symptom management.
What could be determined later, by the whole health team that was caring for him, is that as a result of all the time he spent with his active symptoms, his functionality deteriorated greatly and further treatment was even more difficult.
At first, M was not responding adequately to treatment, and his symptoms were very difficult to regulate.
As can be seen in this particular example, the consequences of not receiving the right treatment at the right time can have many negative consequences for the patients and also for the group of people around her.
The situation of mental health in prisons refers to the conditions in which people live when they are imprisoned and how this influences their mental health. It also refers to the opportunities prisoners should have to receive specialized mental health treatment when required. We mentioned some severe difficulties when it comes to providing proper mental health services to imprisoned people.
Frequently asked questions (FAQs) about mental health in prisons
- Mental Health in Prisons: Critical Perspectives on Treatment and Confinement (Palgrave Studies in Prisons and Penology)
- The Prevention of Suicide in Prison (Advances in Mental Health Research)
- Strangeways: A Prison Officer’s Story
- London’s prison mental health services: A review
- Mental health/illness and prisons as place: Frontline clinicians׳ perspectives of mental health work in a penal setting
- Mental health in prisons: great difficulties but are there opportunities?