|Year : 2018 | Volume
| Issue : 3 | Page : 193-196
Prison mental health in India: Review
Syed Rabiya, Vijaya Raghavan
Schizophrenia Research Foundation, Anna Nagar West Extension, Chennai, Tamil Nadu, India
|Date of Web Publication||27-Sep-2018|
Dr. Vijaya Raghavan
Schizophrenia Research Foundation, R/7A, North Main Road, Anna Nagar West Extension, Chennai - 600 101, Tamil Nadu
Source of Support: None, Conflict of Interest: None
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
| Introduction|| |
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. 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. 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|| |
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.
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.
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|| |
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].
|Table 1: Prevalence of mental disorders among prisoners in Indian prisons|
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|Table 2: Prevalence of substance use disorders among in Indian prisoners|
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| Discussion|| |
Prevalence of mental disorders in prisons
The prevalence of various mental disorders present among prisoners is listed in [Table 1].,,,, 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].,,,
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.
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. 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.
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. 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.
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.
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. 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, 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.
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|| |
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.
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
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]