Date: 20/09/2022

Relevance: GS-2: Issues relating to development and management of Social Sector/Services relating to Health

Key Phrases: The National Crime Records Bureau, Prison Statistics India Report, the mental health of prisoners, reform and rehabilitation, National Mental Health Policy 2014, all-encompassing approach, Mental Healthcare Act of 2017.

Why in News?

• The National Crime Records Bureau’s (NCRB) Prison Statistics India Report is out for the year 2021.
• 9,180 prisoners with mental illness, 150 deaths by suicide, and five prisoners with schizophrenia and epilepsy have died.

The mental health of prisoners:

• The aim of punishment (or at least one of its aims) is reform and rehabilitation.
• The place where that punishment is served, it is found that instead of promoting rehabilitation, ensures despair, hopelessness, and helplessness.
• In any case, the prisons are not overcrowded with convicts, rather it is the undertrial population that makes up for over 70% of the prison population.
• More than half of those with mental illness were undertrials (58.4% were undertrials, while 41.3% were convicts). However, the numbers could very well be higher.
• For instance, Project 39A’s report on mental health and the death penalty, deathworthy, revealed that over 60% of death row prisoners had a current episode of mental illness, but many of them had not been identified by the prison as needing treatment and care.
• Deathworthy also revealed that suicide had little to do with mental illness and a lot with absent social support, violence, distress, and despair.

Challenges that add to a significant impact on the mental health of prisoners:

• Poor facilities in the prison
• Lack of basic amenities
• Limited spaces
• Overcrowding of inmates
• Lack of healthy lifestyle
• Absence or limited availability of healthcare services
• Negligible social interaction
• Probable abuse, physical, verbal, and/or mental
• Discrimination and stigma
• Lack of privacy
• Lack of meaningful activity
• Insecurity about future prospects (work, relationships, etc) or being ostracized in the future after release.

Lack of solutions:

• India’s National Mental Health Policy, 2014, considers prisoners a class of people vulnerable to mental ill health.
• While the NRCB gives us data confirming this categorization, it does not take us much further towards crafting solutions, and leaves us none the wiser.
• Understanding these numbers in a meaningful context is important because without that the default response to this crisis will continue to be that of treatment and conversations will get stuck on the poor healthcare infrastructure in prison.

Need for a more all-encompassing approach:

• To resolve the mental health crisis in prison, a purely medical approach will take us only so far.
• There is a need to take a more all-encompassing approach, move beyond the treatment of individuals, and towards identifying the social and underlying determinants of mental health in prisons.
• There is a need to look at mental health in prisons from a social and structural perspective as well.
• Otherwise, it might end up with a heavily medicated prison population, but not a healthy one.

Aspects of incarceration:

• There are aspects of incarceration that cause distress — loss of liberty, loss of close contact with loved ones, and loss of autonomy.
• A certain amount of distress in the prison population is, therefore, bound to be present.
• The conversation cannot simply end there; the distress must be addressed in a way that is not limited to medicating it away.
• There are aspects of incarceration that are now assumed to be its common features, such as overcrowding and violence but are certainly not inherent to incarceration.
• It would be absurd to think a population subject to persistent violence (of different kinds) will be healthy.
• Anyone who has interacted with prisoners and prison officials will attest to the fact that each is suspicious of the other and the relationship (as skewed as it is) is based on mistrust and fear.

Effectiveness of our penal and social justice policy:

• Spaces that are meant to facilitate rehabilitation instead become spaces with further disempowerment and disenfranchisement.
• It is no coincidence that these are goals that are essential for a mentally healthy population.
• Reform, rehabilitation, or reintegration are meant to make prisoners confident in their lives, their choices, and their ability to take decisions and be responsible and accountable for them.
• The process is meant to be empathetic and caring.
• Instead, it is violent and harsh and ultimately leaves the prisoner no better off, if not worse off. There are high rates of suicides and mental illness.

What can be done?

• The Mental Healthcare Act of 2017 is an extensive piece of legislation that has provisions under section 31(2)which provides for mandatory training of all medical officers in prisons to provide basic and emergency mental healthcare.
• Also, section 103(6) of the Act, mandates each state’s government to set up mental health establishments in the medical wing of at least one prison in the state.
• The Act surely addresses the concerns of prison mental health; however, the ground reality is different and there is a significant lack of facilities and infrastructure in this regard.
• Implementation of these provisions of the Act at multiple levels is a tough task.
• Following are a few things that can be done:
  • Recognizing mental health concerns in prisons as a serious issue
  • Basic training of prison staff for identifying common mental disorders, including suicide prevention, and for their basic caregiving

Conclusion:

• There is an urgent need to implement the existing legal framework for dealing with mental healthcare in prisons.
• It has been repeatedly said that imprisonment does not bid farewell to fundamental rights.
• The probability is high that “a prisoner might emerge from the prison not only without job skills but also incapacitated for future work because of severe and lasting physical and mental health issues,” as proclaimed in the Surendra Singh Sandhu judgment.
• Addressing mental health issues in prison settings would increase the ability of inmates to adjust and integrate into community life after serving their sentence, thereby also reducing the likelihood of reoffence.

Source: The Hindu

Mains Question:

Q. "Prisons are meant to facilitate rehabilitation but have become disempowering spaces with a mental health crisis." Critically analyse the statement and suggest some measures to improve the mental health of prisoners.