What numbers don’t tell us Premium

Prisons are meant to facilitate rehabilitation but have become disempowering spaces with a mental health crisis

“More than half of those with mental illness were undertrials (58.4% were undertrials, while 41.3% were convicts)“  | Photo Credit: Getty Images/iStockphoto

The latest numbers are out. 9,180 prisoners with mental illness, 150 deaths by suicide, five prisoners with schizophrenia and epilepsy have died.

While we know the numbers, we do not know what is being considered as a mental illness and whether these numbers are limited to persons who are in the mental health ward, or does it also include those who are living in barracks but still on psychiatric medication. We also do not know when the onset of the illness was and what the different illnesses were or how long they have been in prison for. The National Crime Records Bureau’s (NCRB) Prison Statistics India Report is out for the year 2021. Perhaps it needs repeating, yet again that there is a mental health crisis in prisons.

We often hear that the aim of punishment (or at least one of its aims) is reform and rehabilitation. Yet when we look at the place where that punishment is served, we find conditions that, instead of promoting rehabilitation, ensure despair, hopelessness and helplessness. In any case, our prisons are not overcrowded with convicts, rather it is the undertrial population that makes up for over 70% of 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.

Lack of solutions

India’s National Mental Health Policy, 2014, considers prisoners a class of people vulnerable to mental ill-health. But while the NRCB gives us data confirming this categorisation, it does not take us much further towards crafting solutions, and leaves us none the wiser. Why do we have so many prisoners living with mental illness? Were all these prisoners living with a mental illness before incarceration, or did they have their first episode in prison? The system is not equipped to give us such crucial information.

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Understanding these numbers in a meaningful context is important because without that our default response to this crisis will continue to be that of treatment and conversations will get stuck at the poor healthcare infrastructure in prison.

To resolve the mental health crisis in prison, a purely medical approach will take us only so far. We need to take a more all-encompassing approach, move beyond treatment of individuals and towards identifying the social and underlying determinants of mental health in prisons. We need to look at mental health in prisons from a social and structural perspective as well. Otherwise, we 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, loss of autonomy. A certain amount of distress in the prison population is, therefore, bound to be present. However, firstly the conversation cannot simply end there; the distress must be addressed in a way which is not limited to medicating it away. Secondly, 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. Spaces which 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 it. The process is meant to be empathetic and caring. Instead, it is violent, harsh and ultimately leaves the prisoner no better off, if not worse off. That there are high rates of suicides and mental illness shouldn’t surprise us. It should, though, make us question the aim and effectiveness of our penal and social justice policy.

Maitreyi Misra heads Mental Health and Criminal Justice team at Project 39A, National Law University, Delhi. She is the lead author of Project 39A’s report Deathworthy: A Mental Health Perspective of the Death Penalty.