1) Mental health problems are highly prevalent among prisoner populations globally, with around 1 in 9 prisoners suffering from mental illnesses like depression. However, prisoners' mental health needs often go neglected. 2) Factors inside prisons like overcrowding, isolation from family/friends, and feelings of guilt can cause or exacerbate existing mental health conditions. Imprisonment inevitably deprives individuals of liberties and choices. 3) Addressing prisoners' mental health could yield benefits like decreasing recidivism and diverting the mentally ill away from prisons into treatment. However, challenges remain around stigma, limited resources, and the use of prisons as "dumping grounds" for the mentally ill.

1. Seminar on
Mental Health Problem among prisoners. A Neglected
Public Health Issue
Under cordial guidance of
Mr. Hari Parsad Kafle
Associate Professor
By
Shiksha Adhikari
At
School of health and allied science
Faculty of Health Science
Pokhara University, Nepal
2019
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2. Introduction
• The term mental health indicates the state where
individual realizes their potential, cope with normal
stresses of life with fruitful working.
• Prisoners are person who are deprived of liberty
against his or her will
• About one thirds of Blacks, Hisparmic or non white
ethnic groups women are confined in local jails and
state and federal prisons.
• Mental disorders and suicide are highly prevalent in
prisons.
Braithwaite RL, Treadwell HM, Arriola KR. Health disparities and incarcerated women: A population ignored.
American Public Health Association; 2005, Møller L, Gatherer A, Jürgens R, Stöver H, Nikogosian H. Health in
prisons: a WHO guide to the essentials in prison health: WHO Regional Office Europe; 2007.
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3. Contd…
• Globally there is a rapid increase in prison
population, and one out of nine inmates suffers from
mental disorders like depression
• Half of male inmates and up to three quarters of
female inmates reported symptoms of mental health
condition in prior year.
Reingle Gonzalez JM, Connell NM. Mental health of prisoners: Identifying barriers to mental health
treatment and medication continuity. American journal of public health. 2014;104(12):2328-33.
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4. Major mental health problems
among prisoners.
4%
10%
65%
4%
12%
42%
0%
10%
20%
30%
40%
50%
60%
70%
Psychotic illness Major depression Personality disorder
Male Female
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Møller L, Gatherer A, Jürgens R, Stöver H, Nikogosian H. Health in prisons: a WHO guide to the
essentials in prison health: WHO Regional Office Europe; 2007.

5. Prevalence among state and federal
prisons
10.92%
4.11%
1.96%
3.16%
4.76%
3.28%
19.20%
9.77%
4.65%
5.72%
7.13%
6.04%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
Depression Mania Schizophernia PTSD Anxiety Personality
disorders
Comparison of Mental health problem among Federal and State Prisons
Federal State
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6. Breakdown of death in Prisons.
25%
9%
1%
65%
Death rate
Suicide Not yet classified Homicide Other causes, including illness
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Fazel S, Hayes AJ, Bartellas K, Clerici M, Trestman R. Mental health of prisoners: prevalence, adverse
outcomes, and interventions. The Lancet Psychiatry. 2016;3(9):871-81.

7. Causes of mental health disorder in
prison
• People without mental disorders develop mental
problem during their imprisonment due to deprivation
they encounter in the prisons.
• Deprivation of liberty inevitably involves deprivation of
choices taken for granted in outside community.
• Communication with families and friends are limited
and are without privacy.
• Other factors like overcrowding, dirty, depressing
environment, poor food, depressing environment or
prisoners have guilt about offences they have
committed.
Møller L, Gatherer A, Jürgens R, Stöver H, Nikogosian H. Health in prisons: a WHO guide to the
essentials in prison health: WHO Regional Office Europe; 2007.
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8. Prevalence among different countries
• A total 2 in 5 (40%) Prison reported that they had
mental health condition at some stage in their life
where 65% are female and 36% are male
• Prevalence of psychosis in London prison
population are found to be more than 20 times then
of general community where 70% of population in
prisons had more than 1 mental health disorders.
The health of Australia’s prisoners 2018
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9. The WHO statement on prisons and
mental health: the Trencin Statement
‘Without urgent and comprehensive action, prisons
will move closer to becoming twenty-first century
asylums for the mentally ill, full of those who most
require treatment and care but who are held in
unsuitable places with limited help and treatment
available.’
Fraser A, Gatherer A, Hayton P. Mental health in prisons: great difficulties but are there
opportunities? Public health. 2009;123(6):410-4.
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10. Mental health, prisons and public
health: the future
• Place mental health at the top of their agenda for
research and action
• Those with mental disabilities need understanding, a
lessening of the stigma surrounding them, and access to
the particular service which is best able to help them.
• Politicians and policy makers committed to better health
and better justice, there is a need to send out a message
that good prisons can be good for public health
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11. • The public and the justice system must understand
that prison should not be a dumping ground for
people with mental illness, ‘as a first step towards
reducing the unnecessary, unjust and harmful
imprisonment of offenders with mental disabilities’.
• With the wider recognition that ‘mental health,
neglected for far too long, is crucial to the overall
well-being of individuals, societies and countries,
and must be universally regarded in a new light
Fraser A, Gatherer A, Hayton P. Mental health in prisons: great difficulties but are there opportunities?
Public health. 2009;123(6):410-4.
11

12. Mental health promotion in prisons: a
checklist
• Reception
• Introduction
• Clean environment
• A controlled environment
• Management and staff: support for prisoners
• Management and colleagues: support for staff
• Contact with families, friends and outside community
• Privacy and confidentiality
• Activities
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13. Benefits of responding to mental
health issues in prisons
• For prisoner
Improve the health and quality of life of both prisoners with
mental disorders and of the prison population as a whole.
For prison employees
A prison that is responsive to, and promotes the mental health of
prisoners, is more likely to be a workplace that promotes the
overall morale and mental health of prison staff
For the community
Addressing the mental health needs of prisoners can decrease
incidents of re-offending, reduce the number of people who return
to prison, help divert people with mental disorders away from
prison into treatment and rehabilitation
Møller L, Gatherer A, Jürgens R, Stöver H, Nikogosian H. Health in prisons: a WHO guide to the essentials in prison health: WHO
Regional Office Europe; 2007.
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14. Challenges in mental health and
prison
• Mental disorders occur at high rates in all countries
of the world.
• Prisons are bad for mental health
• Prisons are sometimes used as dumping grounds for
people with mental disorders
• People with mental disorders are exposed to stigma
and discrimination
• Effective treatment is possible but too often the
available resources are wasted
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15. Bibliographies
• Bartlett A, Hollins S. Challenges and mental health
needs of women in prison. The British Journal of
Psychiatry. 2018;212(3):134-6.
• Braithwaite RL, Treadwell HM, Arriola KR. Health
disparities and incarcerated women: A population
ignored. American Public Health Association; 2005.
• Møller L, Gatherer A, Jürgens R, Stöver H,
Nikogosian H. Health in prisons: a WHO guide to
the essentials in prison health: WHO Regional
Office Europe; 2007.
15

16. • Fazel S, Hayes AJ, Bartellas K, Clerici M, Trestman
R. Mental health of prisoners: prevalence, adverse
outcomes, and interventions. The Lancet Psychiatry.
2016;3(9):871-81.
• Greenberg GA, Rosenheck RA. Jail incarceration,
homelessness, and mental health: A national study.
Psychiatric services. 2008;59(2):170-7.
• Reingle Gonzalez JM, Connell NM. Mental health
of prisoners: Identifying barriers to mental health
treatment and medication continuity. American
journal of public health. 2014;104(12):2328-33.
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17. THANK YOU!
‘the failure to tackle widespread mental illness among
prisoners is storing up huge social and public health
problems for the future’
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