Dedicated mental health services for inmates will enable detection and quick treatment.

A group of people that have been wholly forgotten are the imprisoned. Behind the metallic bars are silent screams of the voiceless terrors that haunt the people that inhabit it.

Missing Focus

Mental illness today is a global health challenge and the alarming rate of rising statistics is an absolute nightmare. It reveals that more than 80% of the population do not receive mental healthcare for myriad reasons ranging from stigma, inaccurate information, lack of awareness and costly services to name a few. An important area of discussion that probably has not been focused on as much as it should be is mental health among jail and prison inmates. Studies report that over 10 million people are imprisoned worldwide. The prevalence of all diagnosed mental illnesses is higher among prisoners as compared to the non-clinical population. Research shows that there is a lower rate of identification and treatment of psychiatric issues among prison inmates (Fazel et al, 2016).

While mental health concerns in India are by themselves a topic of whispers, that of prisoners are barely even acknowledged. Every year, thousands of prisoners in India die within the prison premises by suicide. They lack access to good food, doctors, a social structure, sense of purpose and the motivation to get better. Aren’t they in need of the best psychological assessments and treatments to truly rehabilitate them and make them better citizens and humans? What will it take for us to move from a punitive prison system to a rehabilitative system? More suicides? More reoffending? More false confessions? More societal injustice? It seems like we have already checked all of those boxes.

Little Change

With the amendment to the Mental Health Act in 2017, India seemed to be working towards acknowledging the importance of access to mental health and professional training. However, not much has changed in terms of quality of care or professional training. Many universities today offer courses in forensic and rehabilitative psychology. But the skills gained by these ‘trained’ individuals are limited to getting a job in the corporate, academic or private sector. Forensic psychologists learn how to handle deception detection machinery, and work as lab technicians.

However, there is no emphasis on training them to help rehabilitate prisoners. On the contrary, the focus is on finding ways and inventing unscientific machines to convict and punish them for a crime. The quality of professionals and existing systems within the forensic and investigative psychology sector is appalling, to say the least. The complex interplay between the structure perpetuating mental health problems, the inmates not reporting the problems, and the absolute lack of care and treatment for the reported or diagnosed problems creates an ever-vicious cycle of worsening mental health for prison inmates.

Research has shown that offenders who are not given their due and adequate treatment for mental illnesses stand at a much higher rate of reoffending (Bakker and Riley, 1996; Douglas and Webster, 1999). When cases of suicidal ideation go unreported and untreated, it significantly leads to a higher number of prison suicides (Skogstad et al, 2006). Prison inmates with mental illnesses are at a much higher risk of suicide, self-harm, violence and victimisation. The minority group, including women and older prison inmates, are likely to have different mental health challenges and their needs should be met accordingly (Fazel et al, 2016). The blanket approach for treatments for mental illnesses would not be effective in any setting.

What can we possibly do to fix this overarching problem? Clearly, there is a lot that needs to be done and must be done. Some of them are:

● Update educational materials and incorporate latest research in this field

● Train professionals using techniques that are established and well-researched as scientifically and practically applicable in the real-world

● Eliminate torture tactics (physical and psychological) within the law enforcement system

● Mandate training for existing law enforcement agents with humane techniques of investigations

● Hire psychologists who trained to work with prisoners in every prison in the country

● Frequent visits of mental health professionals to prisons and operational mental health facility

● Focus needs to be on rehabilitation, not punishment

● Regular awareness programmes that highlight the importance of overall health among inmates

● Justice departments and researchers must collaborate because a combined action from necessary officials will address the grave problem in a holistic manner and lead to practical solutions

Healthy Prison

It is high time we dedicated mental health services and functional facilities for the mental health of prison inmates so that detection and treatment of problems can be done at a faster pace. Many studies have indeed highlighted in much detail the high prevalence of mental disorders in prisoners and the urgent need for proper mental health services there (Rabiya & Raghavan, 2018). Adequate training of the prison personnel is vital in this scenario. It is crucial to understand that the environment in which people live has a huge impact on their cognitive, emotional and behavioural development.

A healthy prison environment is important for the nurturing of healthy mental health among prison inmates. Hence, it becomes crucial to understand the multiple interacting predisposing factors that play a part in the mental health issues of prisoners and also better treatment. A collective effort between mental health professionals and the judiciary is the need of the hour to deliver timely and appropriate treatment to those in need. There is a microscopic view prevalent when it comes to inmates: ‘they are prisoners’. Their identity as an individual blends into their offence and punishment. Embracing a macroscopic view towards them can help develop a better society. This involves providing access to good mental health and resources to find a different path in life, away from crime. The onus falls on all of us to rework our biases and prejudices so that we don’t hinder the fair process of treating people like people.