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This paper highlights the forgotten mental health crisis inside Indian prisons. While thousands of inmates suffer from psychological distress, ranging from trauma to depression to violent outbursts, there is no formal system for psychotherapy in most jails. This silence is not just a public health failure; it violates the Indian Constitution, especially Article 21, which guarantees the right to life and dignity. The paper argues that denying psychotherapy to prisoners is a form of institutional violence, and it contradicts both national laws like the Mental Healthcare Act, 2017 and international agreements such as the United Nations Nelson Mandela Rules. Using real-life examples, legal precedents and government reports, the study shows that prisoners are being psychologically punished rather than reformed. The paper calls for urgent reforms, starting with mental health screening at admission, tele-therapy partnerships with institutions like the National Institute of Mental Health and Neurosciences (NIMHANS) and the recognition of therapy as a basic legal right in the prison system. This work fills a major research gap by framing psychotherapy in prisons not as a welfare option but as a constitutional and human rights obligation, an argument rarely made in Indian academic or policy literature.
This article explores the intersection of carceral geographies and climate (in)justice in Brazil, home to one of the world’s largest incarcerated populations. Drawing on ethnographic fieldwork, interviews and an analysis of reports from monitoring organisations examining facilities across the country, we ask how thermal conditions are part of a national project of inflicting suffering within the prison system. Conductive building materials, a lack or excess of water and ventilation, as well as overcrowding, exacerbate exposure to scorching heat or bone-chilling cold, subjecting prisoners’ bodies to extreme temperatures. We argue that this constitutes a form of thermal violence, in which heat and cold are weaponised to harm and punish.
Prison has long been recognized as a racialized institution in America, where race determines myriad aspects of life—from where individuals sleep to those with whom they live, eat, and socialize during incarceration. However, there is little evidence on how to effectively remediate prisons’ deep racial divisions—a question that is imperative given that interracial animus in prisons can be both a result and a determinant of racial conflict and violence. In this study, we argue that higher education in prison has significant potential to improve racial attitudes and foster racial integration by providing a “contrasting context” for interracial interaction in the classroom within an otherwise racially segregated institution. Using administrative data on college-level course completion, an original longitudinal survey of prison college students, and in-depth qualitative interviews with prison college alumni, we show evidence of shifts in racial attitudes and self-reported behavior as students move through their college career. Our results demonstrate the potential for prison higher education to shift race-based norms and offer a framework through which to analyze prison education that prioritizes outcomes of interest beyond recidivism.
Former prisoners are a vulnerable population, and suicide rates among this group are high, particularly following release from prison.
Aims
To explore former prisoners’ engagement with mental health services before death by suicide, and to examine the demographics, clinical history and clinical care of this patient group and compare them with patients who died by suicide who had not been to prison.
Method
The clinical, sociodemographic and care characteristics of patients in contact with mental health services who died by suicide in the UK were examined in a national clinical survey between 1 January 2001 and 31 December 2021, and comparisons were made between former prisoners and patients with no history of being in prison.
Results
Of the 33 381 (median age 46 years, range 10–100; 65.6% male) patients who died by suicide in the UK and had been in contact with mental health services in the 12 months before death, 3335 (11%) were ex-prisoners (male n = 2988, 90%; female n = 347, 10%). Compared with other patients, ex-prisoner patients had higher frequencies of personality disorder, schizophrenia and delusional disorders, as well as childhood abuse. Ex-prisoner patients were more likely to be male, to be aged between 45 and 65 years (median age 39, range 17–89), to live in deprived areas and to have a history of substance misuse. We found no differences in ethnicity.
Conclusions
Mental health services need to focus particularly on patients with a history of being in prison who are experiencing economic adversity and offer substance-use-related interventions to ensure continued patient engagement. The link with deprivation is striking at a time at which rising costs of living are resulting in more health inequalities.
This article explores Eugene V. Debs’s experiences at the Moundsville prison and the federal penitentiary in Atlanta (1919–1921). It looks at his relationships with other inmates and his supporters outside of prison and examines the effects prison life had on Debs and his ideology. Most importantly, it closely examines his only book-length work: his prison memoir, Walls and Bars. It explores Debs’s critique of the prison system, the jailing of drug addicts, and the interconnectedness of capitalism and the penitentiary system.
Mental illness affects an estimated 500 million people globally, with 85% living in low- and medium-income countries (LMICs). Research has shown that people with mental illness are over-represented in the criminal justice system compared with the general population. There is limited information available on institutional attitudes towards mental illness in LMICs.
Aims
This study aimed to examine mental health literacy (MHL) and mental health stigma (MHS) among Zimbabwe Prisons and Correctional Service (ZPCS) officers.
Method
A cross-sectional study using an online survey was conducted among ZPCS officers (N = 163) between August and December 2022. Data were collected using the Mental Health Literacy Scale (MHLS) and Attitudes Towards Mentally Ill Offenders (ATMIO). The primary hypothesis was that increased MHL is inversely related to MHS in this group.
Results
A significant inverse correlation was found between MHL and MHS (r = 0.36, P < 0.001). A regression analysis controlling for age and sex showed that MHLS is a statistically significant component in this model, indicating that MHL is associated with reduced MHS (P < 0.001).
Conclusions
In this group, increased MHL is associated with decreased MHS. This suggests that interventions to increase MHL should be further evaluated in these settings.
Abdol-Hossain Taymourtash, Reza Shah’s first minister of court, was universally recognized as the most powerful man in Iran after the shah himself. He was the lieutenant, ran the government for him. He played a key role at the shah’s side in selecting cabinet ministers and the deputies to be elected to parliament. He helped shape and realize Reza Shah’s vision for the revival and modernization of Iran. Yet in 1933, royal favor was suddenly withdrawn, and Taymourtash was arrested and imprisoned where, in all probability Reza Shah had him put to death. This article focuses on the always fraught relationship between a powerful autocrat and his loyal and efficacious lieutenant, and on the dilemma of those who wish to serve their countries and end up doing so at the cost of serving as the agents of a dictatorship.
Globally, people in prison often come from the most deprived sections of society due to adverse political, economic, environmental, social and lifestyle factors. This group experiences chronic and complex mental and physical health conditions at higher rates than the general population, including mental health conditions, chronic non-communicable and communicable conditions and acquired brain injury. They also have higher rates of tobacco smoking, high-risk alcohol consumption, illicit drug use and injecting drug use. As many as 90 per cent of people in custody have a diagnosis of either a mental health condition or addiction. Often, people in prison have under-utilised health care in the community and, for many, the first interaction with health services occurs during incarceration. Therefore, incarceration may provide an opportunity to access treatment to improve health and for appropriate health care to be initiated.
Chapter 6 focuses on the men who were caught in the act of trying to start the intended rebellion. They were all free people of African descent, yet some among them also invited enslaved people to join the rebellion. Thus, relations between enslaved and free people are at the center of this chapter. The ways in which these people talked about freedom and bondage with one another presents a picture in which it is impossible to say that the conspiracy was definitively anti- or pro-slavery. There were some men who took abolition of slavery quite seriously, and there were others who had no interest in the matter whatsoever. Those who fit the latter group were connected to a shadowy group of elite white men who had been planning their own rebellion. Evidence of these white men’s participation in a conspiracy showed up frequently during a significant number of different men’s interrogations. The High Court chose to ignore or dismiss all such claims, clearing the way for them to transform the collective insurgencies of 1798 into a so-called Pardo conspiracy, free from confusion, free from uneven relations, and unconnected to the aims of elite white men.
In this chapter, COBRA members enter into a confrontation with police, who accuse them of being trophee hunters and vigilantes. This happens in the aftermath of a sting on a man who was later given a long prison sentence.
This epilogue describes the author’s final interview with Severino, a former gang member and one of the principal interlocutors of the project. It describes his circumstances following his exit from the gang and the prospects for his future.
A description is provided of the current situation in Aotearoa New Zealand with regard to compulsory treatment of people with schizophrenia. This is placed within the context of homelessness in New Zealand and the provision of services to the incarcerated mentally ill. There are high rates of homelessness and incarceration and services are struggling to meet their needs. This is particularly a problem for the indigenous population. The current Mental Health Act allows for compulsory treatment of people who as a result of schizophrenia are seriously impaired in their capacity to care for themselves, and this will include people where there is a nexus between homelessness and their illness. The Mental Health Act is being reformed, with a new act likely to emphasize autonomy and capacity to a greater degree. Finally, the author considers the learnings from 5 years working within the Fixated Threat Assessment Centre, which provides a unique perspective on these issues.
A disproportionate number of women in prison have mental health problems and they are nine times more likely to die from suicide than women in the general population. They have insufficient access to help both inside where the focus has largely been on men, and outside where they often lack suitable help and support on release. For many women, improsionment is a tragedy that damages them, their families and the next generation, some of whom are born in prison, where giving birth can be particularly traumatic and potentially lethal. And men cannot be forgotten by women who are in prison, because many of them are in prison because of the actions of a man. However, it is crucial not to assume that ‘trauma’ explains all of their problems, particularly some kinds of violent behaviour. We need to keep many more women out of prison and try to help women much earlier along their life paths, long before they go to prison. Mental health care provides too little, too late. We must challenge our own stigmatising attitudes towards women in prison, support those NGOs who work tirelessly with women in the criminal justice system and advocate much more powerfully for women in prison.
This article summarises the BJPsych Bulletin 2024 special edition on mental health in criminal justice and correctional settings. The edition considers issues across a range of settings, including police custody, the courts and prisons, as well as considering wider international questions and systems within the field. In this edition, we assert the right of the individual to healthcare services that should be available, accessible, acceptable and of good quality. Psychiatry must play a significant role in shaping this debate as it moves forward.
This chapter seeks to provide clinicians with a better understanding of prisons and overcome many of the myths and misconceptions, with the objective of making the environment more attractive and interesting for future psychiatrists. In addition to a wide need and a rich variety of conditions, the psychiatrist in prison must contend with barriers to care such as working without a mental health act and, when a patient needs to be transferred and treated outside of prison, navigating complicated pathways to care. Mental disorder is prevalent in all prison systems. Pathways into prison may be related to general factors, specific factors such as delusions and comorbidities and complications of mental illness such as homelessness and breakdown of relationships, as well as service provision issues. The prevailing policy has been to divert prisoners in need of hospital care out of prisons. Court diversion models can focus on any point in the pathway from community to the criminal justice system. In prison, specialist mental health services are needed to address the high levels of morbidity due to self-harm, drug use, suicide and self-harm, hunger strikes and many other manifestations of developmental problems and traumatic experiences.
Emotional and behavioural disturbances accompanying neurocognitive disorders may sometimes lead to a criminal offence. Our knowledge of this specific forensic subpopulation is lagging behind the knowledge on, and attention for, ‘classic’ psychiatric disorders in forensic populations.
Aims
To gain knowledge on the prevalence and characteristics of individuals with neurocognitive disorders in the forensic population.
Method
This retrospective database study uses an anonymised data-set of the National Database of penitentiary psychiatric centres (PPC) (N = 8391), which collects data on all patients admitted to one of the four PPCs (mental health clinics within the prison system) in The Netherlands since May 2013. Inclusion criterion for this study was the presence of a Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) or Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) diagnostic code belonging to the category of neurocognitive disorders.
Results
A DSM-IV-TR or DSM-5 diagnostic code of a neurocognitive disorder was classified in 254 out of 8391 unique individuals, resulting in a prevalence of 3.0% in the total PPC population. The most prevalent diagnosis was unspecified neurocognitive disorder (59.1%). The neurocognitive disorder group significantly differed from a random control group from the database (n = 762) on demographic, clinical and criminological variables.
Conclusions
The prevalence of neurocognitive disorders in this real-world clinical sample is remarkably lower than in two earlier studies in similar populations. Also remarkable is the relatively high prevalence of an unspecified neurocognitive disorder. These findings lead us to hypothesise that neurocognitive disorders may be underdiagnosed in this population. Forensic psychiatric settings should evaluate whether they have sufficient expertise available in neuropsychological assessment.
Medical assistance in dying (MAiD) (which includes euthanasia and assisted suicide) is available in an increasing number of countries. In Belgium, The Netherlands and Switzerland (and was due to be implemented in Canada from 2024) eligibility includes mental suffering in the absence of any physical disorder. There are particular ethical and legal issues when considering MAiD for those involuntarily detained in prisons and hospitals. We describe four recent cases that illustrate these complexities, and highlight issues of equivalence of healthcare and self-determination against concerns about the criteria for determining eligibility of those with non-terminal conditions as well as the objections raised by victims and families and the demands for justice.
In solitude, as with any human experience, choice is an important driver. We know that humans, in general, like having some decision-making capability, or at least the perception of it. Positive time spent in solitude stems from the desire to be with ourselves, and we talk about how to exercise choice to be more comfortable and stronger in solitude. Simply wanting to avoid other people does not unlock its benefits and opportunities. The fact that you choose to devote your morning walk, drive to work, or shower time to solitude is what matters in building an enduring practice of everyday solitude. In this chapter, we also consider involuntary solitude, like prisoners in solitary confinement and pandemic lockdowns. This chapter also looks at what it means to have a "preference for solitude," the importance of understanding motivation in why we’re choosing time alone, and what it means to have the right framing and expectations for solitude.
The United States Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization made it drastically harder for women to access abortions. The Dobbs decision has had a disproportionate impact on women who are incarcerated or on some form of community supervision such as probation or parole. This Note analyzes a potential right to an abortion for women involved in the criminal justice system, even those living in states that have banned or deeply restricted abortion access after the Dobbs decision. In doing so, this Note looks for different constitutional avenues to protect incarcerated women’s right to an abortion, including under the Eighth Amendment to the U.S. Constitution.