What comes to your mind when you are asked to imagine a prison? Unless you have visited one, or know someone who has been there, the main sources for your views are often media formats, such as movies and the news [1]. In the previous mental health article by Amit Singh, we discussed how the media contributes towards creating a stigma about mental health. This is also true in the case of prisons – movies based in prisons play a crucial part in informing our beliefs and actions [1]. What do prisons actually look like outside of the media? Prisons are often overcrowded – as of May 2020, 49% of UK prisons were overcrowded [2]. They usually also have problems with sanitation, enforced solitude, lack of privacy, furthermore there is no appropriate care for physical or mental health [3].
Prisoners and public opinion
The media often creates an image that most prisoners are criminals who have committed violent crimes [4]. In reality, the causes of imprisonment can range from violent crimes to computer hacking and fraud (often referred to as white-collar crimes). In the UK, 29% of prisoners are in prison due to violence towards another person, and 18% of prisoners are there because of sexual offences, which clearly indicates that the prison population charged with acts of violence is less than half [5].
In 2015 – 2016, 5.3% of all violent incidents in England and Wales were committed by people with severe mental illness.
There is also a common belief that a lot of prisoners have mental illnesses, making it important to identify if this is true or not. Different surveys found that 30-64% of the victims of violent crimes believed that the offender was under the influence of alcohol or drugs, however, only 1% of the victims believed that the offender had mental illness [6]. Additionally, another study found that in 2015-2016, 5.3% of all violent incidents in England and Wales were committed by people with severe mental illness [7]. Studies have found that it is not necessarily the mental health problems that lead to violence, but the major determinants are socio-demographic and economic factors [8]. This highlights that mental illnesses do not always lead to violence and imprisonment! Furthermore, substance abuse is another determinant of violence and this can be in the context of a concurrent mental health problem or not [9]. In this current context, substance abuse is classified separately from mental health disorders, however they can be highly linked and often occur together.
Let’s dig deeper into the prevalence of mental health problems in prisons. It has been discussed widely that mental health problems are more prevalent in prisons than in the general population. However, the numbers of different mental health problems range widely depending on studies. For example, a study in the US with 18,185 prisoners in 2004 showed that about 26% of the inmates were diagnosed with a mental health condition at some point during their lifetime [9]. This is similar to mental health problem prevalence in the general population (which is 1 in 4 in a year in the UK [10]. Nevertheless, it is thought that it is mainly more severe mental health problems that are highly prevalent in prisons, such as severe depression, psychosis and substance abuse [11]. For other mental illnesses the picture is not as clear. A lot of research studies use self-reported questionnaires, which means that people are given a sheet of paper with few questions and they have to rate how they are feeling/have felt (usually in the past two weeks). However, using only self-reported questionnaires, without a professional interview may give misleading results that show higher rates of mental health problems [11]. For example, studies that used researchers with clinical backgrounds who conducted clinical interviews had lower prevalence rates than studies that used self-reported measures [11]. Furthermore, a lot of questionnaires have not been adjusted to life in prison and are more relevant to the general population in comparison to individuals in prisons. This may also bias the results of these studies.
There are also higher numbers of suicides in prisons – suicides are 3-8 times more likely in prisons compared to the general population.
There are also higher numbers of suicides in prisons – suicides are 3-8 times more likely in prisons compared to the general population [11,12]. This is due to poor mental health services in prisons, and the unsupportive environment of prisons – individuals feel lonely and cut off from their family and friends. Individuals with mental health problems are at increased risk of suicide, self-harm, violence, and victimisation [9]. Also people with mental illness remain in prison longer than those without mental illness, despite being charged with the same offence [13]. This highlights that there is no appropriate care and support for those who have mental health issues. Next, let’s see if the prevalence of mental health problems is high in prisons because people come in with mental health problems or do those problems develop in prisons.
Mental health in prions: cause or result?
The answer is, both, however, there are not enough studies looking at that to draw conclusions. More research, especially longitudinal research (research that follows the same individuals for a long period of time) is required to get an insight how one’s mental health changes before, during and after imprisonment. It is not questionable that prisons are bad for mental health. Individuals may experience overcrowding, various forms of violence, enforced solitude or conversely, lack of privacy, lack of meaningful activity, isolation from social networks, insecurity about future prospects (work, relationships, etc.), and inadequate health services, especially mental health services [3]. Those are likely to worsen or trigger mental health problems. Additionally, individuals who have mental health problems prior to prison may not receive appropriate treatment during their time in prisons, resulting in worsening of their condition. However in some cases, their conditions may also get better [9]. Individuals coming from lower socioeconomic backgrounds or the BAME community, often find it more difficult to seek help for mental health problems. If there is some mental health support in the prisons, they may get the support they need to improve. Nevertheless, this does not diminish the fact that there is a significant need for mental health services where background does not matter – it is much more effective and less damaging to prevent mental illnesses rather than wait until they may lead to offences and place those individuals into prisons. Preventions are also more cost-effective for governments in the long run.
In some areas, usually those with inadequate mental health care, individuals may also be dumped in prisons instead of psychiatric hospitals [9]. This may be due to not having appropriate care centres for those with mental problems, or the care centres not being good enough, which leads to the belief that prisons are safer for them. This can be worsened by stigma and non-acceptance of mental health problems, and thus anyone who is a bit different and has committed a small offence is often regarded as someone who should go to prison.
Almost half the people in prisons have been violent towards another person, however often this violence is not linked to mental illnesses. The actual determinant of violence is most often one’s socioeconomic background, and substance abuse. The mental health problem prevalence is higher in prisons than in the general population, however there are not enough studies to determine if those individuals come in with mental health problems, and how many of those problems develop in the poor conditions of prisons. More research is required into longitudinal studies in prisons, as well as more programs that support individuals mental health in prisons. Prevention programs in lower socioeconomic areas to prevent those individuals being imprisoned would also play a key role in creating a much needed change.
References
[1] J. Bennett. The Good, the Bad and the Ugly: The Media in Prison Films. The Howard Journal of Criminal Justice 45(2): Apr 12, 2006.
[2] G. Sturge. UK Prison Population Statistics. UK Parliament: Jul 3, 2020.
[3] WHO & ICRC. Mental Health and Prisons. World Health Organization: 2005.
[4] J. M. Pollak & C. E. Kubrin. Crime in the News: How Crimes, Offenders and Victims are Portrayed in the Media. Journal of Criminal Justice and Popular Culture 14: 2007.
[5] Ministry of Justice. Crime in the News: How Crimes, Offenders and Victims are Portrayed in the Media. UK Government: Aug 13, 2020.
[6] Time to Change. Violence & mental health. Time to Change.
[7] G. Thornicroft. People with severe mental illness as the perpetrators and victims of violence: time for a new public health approach. The Lancet Public Health 5(2): Feb 1, 2020.
[8] H. Stuart. Violence and mental illness: an overview. World Psychiatry 2(2): Jun, 2003.
[9] J. M. Reingle Gonzales & N. M. Connell. Mental Health of Prisoners: Identifying Barriers to Mental Health Treatment and Medication Continuity. American Journal of Public Health 104(12): Dec 1, 2014.
[10] Mind. Mental health facts and statistics. Mind: 2017.
[11] S. Fazel, A. J. Hayes, K. Bartellas, et al. Mental health of prisoners: prevalence, adverse outcomes, and interventions. The Lancet Psychiatry 3 (9): Sep, 2016.
[12] Prison Reform trust. Mental health care in prisons. Prison Reform Trust.
[13] W. McPherson. Managing the Mental Health Population at the Broward Sheriff’s Office. Corrections Today 70(3): Jun, 2008.