• Users Online: 141
  • Home
  • Print this page
  • Email this page
Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
REVIEW
Year : 2018  |  Volume : 34  |  Issue : 3  |  Page : 193-196

Prison mental health in India: Review


Schizophrenia Research Foundation, Anna Nagar West Extension, Chennai, Tamil Nadu, India

Date of Web Publication27-Sep-2018

Correspondence Address:
Dr. Vijaya Raghavan
Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai - 600 101, Tamil Nadu
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_9_18

Rights and Permissions
  Abstract 


Background: Awareness of mental health issues is on the rise among the general population and other disadvantaged populations such as homeless, migrants, and prisoners. Prisoners are a minority whose mental health needs are usually neglected. In comparison to the research done abroad, India has few studies published in this population, and hence, it becomes more important to focus on them to understand better. Materials and Methods: A Boolean search of articles published from January 2000 to December 2017 in electronic database of PubMed and Google Scholar was carried out, and original research studies done on mental health in prisoners were incorporated in the current review. Case reports and review articles were excluded from the current review. Results: A total of 12 research studies were included for the review and classified into prevalence of mental disorders and drug abuse in prisons, clinical features, and factors affecting mental health in prison. Conclusion: The number of studies in India is comparatively less than other countries. The prevalence of psychiatric disorders such as substance use, schizophrenia, depression, adjustment issues, and suicidal risk is considerably high. Hence, it is necessary to study the various factors predisposing prisoners to mental health issues and effective treatment options for better delivery of mental health among prisoners.

Keywords: Drug abuse, mental health, prison, psychiatric disorders


How to cite this article:
Rabiya S, Raghavan V. Prison mental health in India: Review. Indian J Soc Psychiatry 2018;34:193-6

How to cite this URL:
Rabiya S, Raghavan V. Prison mental health in India: Review. Indian J Soc Psychiatry [serial online] 2018 [cited 2018 Oct 17];34:193-6. Available from: http://www.indjsp.org/text.asp?2018/34/3/193/242358




  Introduction Top


India is the second largest populated country in the world with nearly 1.83 billion people. With only nearly 5000 psychiatrists catering for this significant population, there is a significant mental health gap in implementing effective treatment of mental disorders and promoting overall mental health of the population.[1] Moreover, the access to the mental health resources is much difficult to the vulnerable population such as migrant laborers, pregnant women, and refugees where the need is much higher than the general population. One such vulnerable population is the prisoners in the Indian prisons.

According to the 2013 statistics, more than 400,000 individuals were lodged in Indian prisons.[2] Contrary to the general belief, the prisoners form a heterogeneous group and come from diverse social and economically disadvantageous background. They are confined in prisons for long and short durations apart from those who get life-imprisonment. With poor facilities in the prison, lack of basic amenities, limited space, overcrowding of inmates, lack of healthy lifestyle, and absence or limited availability health-care services, the prisons can predispose the prisoners to various physical and mental disorders. In this scenario, prisoners with mental health problems may find it difficult to approach and receive mental health services, if any.

Recently, there has been increased awareness on the need of mental health services for prisoners. It is important to examine the evidence available from Indian research on prison mental health to understand the existing mental health issues in the prisons. The insight from these studies could help us design and implement robust strategies to identify and treat mental disorders and modify the prison environment to prevent mental disorders. Hence, the objective of this review is to provide an overview on prison mental health research in India. This review also aims at finding out the prevalence of mental disorders among prisoners and various psychological factors affecting mental health in prisoners and reviewing the interventions implemented to develop mental health in prisons.


  Materials and Methods Top


Search strategy

A comprehensive search was carried out using combinations of words such as “prison” or “jail” and “mental illness” or “mental health” or “psychiatric illness” and “India” in the electronic database of PubMed and Google Scholar with a time range of 2000–2017. Cross-references from the articles and gray literature were also screened.

Study selection

For this review, we included articles that were original research papers and excluded systematic reviews, case reports, and expert opinions. Only studies done in India from 2000 to 2017 were selected.

Organization

The research studies obtained were screened and segregated according to the inclusion and exclusion criteria. The selected studies were then categorized under subtopics such as prevalence of mental disorders and drug abuse in prisons, clinical features, and factors affecting mental health in prisons.


  Results Top


Of the 33 research studies, 12 studies satisfied the inclusion and exclusion criteria [Figure 1]. All the studies included in this review with their main findings, classified according to different themes, are given in [Table 1] and [Table 2].
Figure 1: Literature review search flowchart

Click here to view
Table 1: Prevalence of mental disorders among prisoners in Indian prisons

Click here to view
Table 2: Prevalence of substance use disorders among in Indian prisoners

Click here to view



  Discussion Top


Prevalence of mental disorders in prisons

The prevalence of various mental disorders present among prisoners is listed in [Table 1].[3],[4],[5],[6],[7] It is observed that schizophrenia is the most common disorder followed by depression and adjustment disorder found in prisoners. Various substance-use disorders such as cannabis, alcohol, and nicotine are also evidently prevalent [Table 2].[7],[8],[9],[10]

Suicide and self-harm behavior is another major concern in prisons. In a 10-year retrospective study by Bardale and Dixit, they observed that of 179 autopsies performed, nearly 14 cases were suicide by prisoners. 71.42% of them were in lock-ups while 28.57% were in prison.[11]

Although the research studies have found the prevalence of different disorders, one main drawback is the lack of using a common assessment tool. Using a common assessment for assessing the prevalence of disorders among the prisoners can help in better understanding and planning appropriate measures to deal with the mental health issues and for comparing between different sites. Furthermore, this will help assess the change in pattern of the mental disorders prevalent over a period of time.

Factors affecting mental health

In a study by Ayirolimeethal et al., men were suffering more from the psychiatric disorders than women and only 4% (men) had moderate-to-high risk of suicide whereas women were not found to be at risk.[5] In another study, the researchers found that majority of the prisoners were referred to the mental health facility by the prison officials (medical officer of prison/superintendent of prison) and not by the court, highlighting the role of officials in the early identification of mental disorders in the prisoners and in improving prisoners' mental health. Furthermore, nearly half of the males exhibited high suicidal risk during their hospital stay.[6]

In a study examining the relationship between emotional intelligence and criminal behavior using Mangal Emotional Intelligence Inventory (MEII), convicts scored significantly low on all domains of MEII which include intrapersonal awareness (own emotions), interpersonal awareness (others' emotions), intrapersonal management (own emotions), and interpersonal management (others' emotions) and aggregate emotional quotient.[12] This could lead to difficulties in regulating their emotions during times of hardship and crisis in prison. Another study investigating the relation between adjustment and mental health in prisoners found that they had poor adjustments in social and emotional areas leading to mental health issues.[13]

In an intervention study by Jhanjee et al., opioid substitution treatment with buprenorphine was provided to the prisoners and found it to be feasible and effective.[14]

Very few studies have systematically examined the clinical features and other variables associated with the prisoners with mental health issues. This is an important area of research as this throws light on the initial presentation of mental disorders in prisoners and their progression over time. Moreover, treatment aspects are not examined expect for one study.[14] Comorbid physical disorders could play an important role and need to be examined in this population.

Interventional studies for mental health in prisons

Apart from the psychiatric disorders and drug use, there are negative factors that can affect the mental health of prisoners such as overcrowding in prisons, exhaustion of prison facilities, different forms of violence, lack of privacy, feelings of isolation and uncertainty about future, lack of meaningful activities, and scarce health services.

One of the most widely implemented prison reforms for enhancing mental health in inmates was the practice of Vipassana, a meditation technique. In two major studies carried out in January 1994 and April 1994 on 120 and 150 individuals, respectively, in Tihar Jail,[15] it was observed that the psychiatric patients (about 23% of the total inmates) showed improvement in anxiety and depressive symptoms. Most of the individuals were found to display less hostility, felt less helpless, reported better well-being, and were hopeful about the future.

Sureka et al. investigated the effect of Sudarshan kriya and related practices on male prisoners with nonpsychotic psychiatric disorders for 6 weeks. Results showed significant improvement in functioning, anxiety, depressed mood, positive well-being, general health, self-control, vitality, and total positive general well-being.[16]

No study has investigated the various structural and administrative factors of the prisons that could have a potential role in influencing the mental health of the prisoners. Studies with innovative and feasible strategies or modifications in the prison set have to be conducted to examine their effectiveness and implementation for positive mental health among prisoners.


  Conclusion Top


This narrative review analyzed various studies conducted on mental health in prison in India and found that the number of studies from India is comparatively less than other countries. As most of the undertrials spend long periods of time in prisons awaiting their verdict, it effects their mental health functioning. It is high time the Indian judiciary system has a process in place which would reduce the time for the verdict. Moreover, the need for mental health services for the prisoners has been highlighted in various studies. This should prompt the establishment of dedicated mental health clinics within prisons for early detection and intervention. Majority of the studies highlighted the high prevalence of mental disorders in prisoners and the need for proper mental health services in prisons. Medical officers and other prison personnel, when trained in basic mental health, might play an important role in the early identification of mental health issues and referral for prompt treatment in mental health facility. Interventions such as having mental health doctors visiting them frequently or on-campus mental health professionals, fully operational mental health facilities, rehabilitation centers, swift flow in referring critically ill patients to a nearby hospital, and regularizing awareness sessions for the prisoners on the different health problems can lead to better mental health of the prisoners. Modification of the prison environment that nurtures a positive mental health among the prisoners could help in the prevention and early recovery from mental health disorders.

Acknowledgment

Postdoctoral support is by the Fogarty International Training Program in Chronic Noncommunicable Diseases and Disorders at the University of Florida, Grant # 1D43TW009120 (L. Cottler, PI) (VR). We thank S. Shiva Ganesh for gathering the data required for the review.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Patel V. The future of psychiatry in low- and middle-income countries. Psychol Med 2009;39:1759-62.  Back to cited text no. 1
    
2.
Bhaumik S, Mathew RJ. Health and beyond…strategies for a better India: Using the “prison window” to reach disadvantaged groups in primary care. J Family Med Prim Care 2015;4:315-8.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Goyal SK, Singh P, Gargi PD, Goyal S, Garg A. Psychiatric morbidity in prisoners. Indian J Psychiatry 2011;53:253-7.  Back to cited text no. 3
[PUBMED]  [Full text]  
4.
Kumar V, Daria U. Psychiatric morbidity in prisoners. Indian J Psychiatry 2013;55:366-70.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Ayirolimeethal A, Ragesh G, Ramanujam JM, George B. Psychiatric morbidity among prisoners. Indian J Psychiatry 2014;56:150-3.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Kumar D, Viswanath B, Sebestian A, Holla B, Konduru R, Chandrashekar CR, et al. Profile of male forensic psychiatric inpatients in South India. Int J Soc Psychiatry 2014;60:55-62.  Back to cited text no. 6
    
7.
Math SB, Murthy P, Parthasarathy R, Naveen Kumar C, Madhusudhan S. Mental Health and Substance use Problems in Prisons: Local Lessons for National Action. Bangalore: Publication, National Institute of Mental Health Neuro Sciences; 2011.  Back to cited text no. 7
    
8.
Torwane NA, Hongal S, Sahu RN, Saxena V, Chandrashekhar BR. Assessment of prevalence of tobacco consumption among psychiatric inmates residing in central Jail, Bhopal, Madhya Pradesh, India: A cross-sectional survey. Ind Psychiatry J 2013;22:161-4.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Tiwari RV, Megalamanegowdru J, Parakh A, Gupta A, Gowdruviswanathan S, Nagarajshetty PM, et al. Prisoners' perception of tobacco use and cessation in Chhatisgarh, India – The truth from behind the bars. Asian Pac J Cancer Prev 2014;15:413-7.  Back to cited text no. 9
    
10.
Rao R, Mandal P, Gupta R, Ramshankar P, Mishra A, Ambekar A, et al. Factors affecting drug use during incarceration: A cross-sectional study of opioid-dependent persons from India. J Subst Abuse Treat 2016;61:13-7.  Back to cited text no. 10
    
11.
Bardale RV, Dixit PG. Suicide behind bars: A 10-year retrospective study. Indian J Psychiatry 2015;57:81-4.  Back to cited text no. 11
[PUBMED]  [Full text]  
12.
Sharma N, Prakash O, Sengar KS, Chaudhury S, Singh AR. The relation between emotional intelligence and criminal behavior: A study among convicted criminals. Ind Psychiatry J 2015;24:54-8.  Back to cited text no. 12
[PUBMED]  [Full text]  
13.
Sinha S. Adjustment and mental health problem in prisoners. Ind Psychiatry J 2010;19:101-4.  Back to cited text no. 13
[PUBMED]  [Full text]  
14.
Jhanjee S, Pant S, Girdhar NK, Sethi H, Gunasekaran Rengaswamy R, Jain R, et al. Opioid substitution treatment in Tihar prisons, India: Process of implementation. Int J Drug Policy 2015;26:890-1.  Back to cited text no. 14
    
15.
Vipassana Research Institute. Available from: http://www.vridhamma.org/Psychological-effects-on-tihar-jail-inmates. [Last accessed on 2018 Apr 11].  Back to cited text no. 15
    
16.
Sureka P, Govil S, Dash D, Dash C, Kumar M, Singhal V, et al. Effect of Sudarshan Kriya on male prisoners with non psychotic psychiatric disorders: A randomized control trial. Asian J Psychiatr 2014;12:43-9.  Back to cited text no. 16
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed164    
    Printed8    
    Emailed0    
    PDF Downloaded40    
    Comments [Add]    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]