Mental Wellbeing Behind the Bars: How Indian Prisons Struggle With Mental Health

Poor facilities in prisons & restricted healthcare access can lead to inmates suffering from bad mental health.

Image used for representation.

(Photo: FIT)

The World Health Organisation (WHO) often keeps reiterating that there is no health without mental health.

And to no one's surprise, mental health challenges are evidently more widespread in populations that are socially vulnerable in any way.

One such vulnerable population is that of prisoners.

Till a decade ago, there were more than 4,00,000 individuals lodged in Indian prisons.

Keeping aside debates on human rights and the legal underpinnings, prisons with their restrictive environment can give rise to potent physical and mental health challenges.

Not to mention, it depends on the duration of imprisonment, type of prison facilities, staff behavior, as well as training.

Poor facilities in the prison, overcrowding, restricted privacy, limited mobility, lack of basic amenities, human rights violations, sleep disturbances, and restricted healthcare access can increase the risks of suffering from poor mental health.

Stigma, Discrimination, Abuse: Data Shows Epidemic Of Poor Mental Health in Prisons

A study published in the Indian Journal of Social Psychiatry in 2018 showed that schizophrenia was the most common mental illness in prison inmates followed by depression, post-traumatic stress disorder (PTSD), and sleeplessness.

Cases of cannabis, alcohol, and tobacco addiction were high too. Suicide and self-harm behaviors are also common in prisons which get further compounded with the fact that monitoring and sensitivity to such issues are limited.

Unfortunately, with other priorities in place, mental health almost always gets a backbencher status with respect to funding and service provisions.

Other factors in prisons such as lack of awareness towards mental health, stigma, exhaustion of facilities, violence, social isolation, uncertainty about future, and lack of ‘usual’ schedule discourage the inmates from seeking help.

Mental health issues in prison can vary based on whether or not an individual has life-term imprisonment. Also on whether a person has been truly or wrongly convicted or had mental health conditions in the past.

Trauma reactions like PTSD, adjustment disorders, panic disorder, and long-term depression are common in those convicted due to violent crimes.

The Prison Statistics India 2019 data mentions that

• 1.5 percent of the total prison population possibly suffer from mental illnesses

• 50 percent of these people are undertrials.

There is also a severe dearth of correctional (including mental health professions) staff in Indian prisons.

The ratio of prisoner per mental healthcare staff ratio and prisoner per correctional staff ratio are 243:1 and 628:1 respectively.

Stigma, discrimination, human rights crisis, substance abuse, and lack of staff training were identified as the main factors for the rise in mental health issues in prisons.

But Indian Law Provides Safeguards For Inmates 

The recent Mental Healthcare Act 2017 has several welcome provisions in this regard. It defines a prisoner with a mental illness as “a person with mental illness who is an under-trial or convicted of an offence and detained in a jail or prison”.

Under this Act, the proposed Mental Health Review Board is expected to visit and inspect prisons for mental healthcare facilities. The Board can also enquire as to why a prisoner with mental illness has not been transferred to a mental health establishment.

The Act mandates the training of all medical officers in prisons to deliver emergency healthcare. But perhaps the most awaited move was the proposed mandatory setting up of a ‘mental health unit’ in the medical wing of at least one prison in every state/union territory.

Besides, the Indian Law has certain provisions for the mentally ill in prisons.

CRPC Sections 328, 329, and 330 state that “if the accused person is determined to be of unsound mind, then the adjudicating authority must allow for postponement of this trial.”

The mentally ill population in prisons have the legal right to receive treatment at a mental healthcare facility.

Also, those with mental illness may be released based on the surety of safe conduct and furnishing sufficient security. If bail is not possible, then the accused will be kept in safe custody.

Are These Laws Enough Though?

Prison life can be considered as the strictest form of surveillance and regularisation of human lives, hence leading to extreme stress.

There's a lot more than can be done for the inmates:

• The prison staff needs to be trained to detect early signs of mental illness in the inmates.

• Those at risk should be actively monitored.

• Dedicated treatment needs to be there including visit by mental health professionals.

• Admission in mental healthcare units or establishments is a must for severe mental health conditions including suicide risk.

The MHCA 2017 can be put to effective use with policy provisions.

• Prisons are to be regularly visited by the local Mental Health Review Board.

• External (preferably neutral) experts can monitor the mental healthcare services in prisons and suggest ways for improvement.

• The prison inmates are to be made aware of mental hygiene and de-stigmatisation of mental illness.

• Trained counsellors should be available in jails.

Finally, the prison environment, with all its restrictions and punitive angles, needs to bear a humane approach. Group activities including recreational and educational provisions can help restore quality of life of prisoners.

Studies conducted in Tihar Jail in 1994 showed that the practice of Vipassana, a form of meditation, reduced depressive symptoms in the inmates. Similarly, Yoga and Pranayama improve vitality and general health.

The age extremes and women prisoners are further vulnerable. Depression and anxiety disorders are more common in convicted ladies, while addiction problems and suicide risk are common in the youth.

Many of the older prisoners have memory complaints and possible dementia which hamper their daily activities and safety.

Dementia awareness among prison staff and inmates are minimal in our country and grossly neglected. Given the rapidly aging Indian population, dementia awareness, detection, and care assume special importance in our prisons.

Fostering positive mental health in prison environments can not only reduce the mental illness burden within the inmates but possibly help in psychological stability – thereby reducing further crimes and violence.

(Dr Debanjan Banerjee is Consultant Neuropsychiatrist, APOLLO Multispecialty Hospitals, Kolkata. This is an opinion piece. The views expressed above are the author’s own. The Quint neither endorses nor is responsible for them.)