Mental health care for detainees failing worldwide

A substantial majority of prisoners around the world experience psychological problems, yet authorities do little to address this issue. A new volume edited by Piet Hein van Kempen and Maartje Krabbe from Radboud University highlights for the first time how the situation has dramatic consequences worldwide and promotes human rights violations.

Estimates vary, but research shows that 40% to 90% of detainees in penal institutions worldwide suffer from mental illness. That percentage is extremely high when compared to the prevalence among the general population, where ‘only’ 18% to 29% experience psychological problems. According to Assistant Professor of Jurisprudence Maartje Krabbe, it is high time that this topic be addressed on a global level. In Mental Health and Criminal Justice, Krabbe and colleagues examine the precarious situation of prisoners worldwide.

Krabbe: “The numbers are so disproportionately high that mental health should be a dominant factor in our criminal justice system by now. And yet this is far from true: my analysis shows that the system fails this group on all fronts. There is often too little budget, inadequate mental health care and limited staff training.”

High recidivism rates

The result is that the mental state of many of these prisoners deteriorates in prison, which makes their reintegration more difficult. Krabbe: “Recidivism among former detainees with mental health problems is relatively high worldwide. That is not only unsafe but expensive. Research shows that the costs of habitual repeat offending are often much higher than the costs of providing treatment and support to a prisoner with mental health problems.”

Moreover, Krabbe points out, the current system violates global treaties and UN rules. “Prisoners have their freedom taken away, but that doesn’t mean they have no rights as psychiatric patients. In principle, this group is entitled to treatment of the same quality as people outside prison receive. On a global scale, however, this requirement is very rarely met. Many people do not receive the treatment to which they are entitled. That makes their reintegration more difficult because they are kept in an inappropriate system.”

Solutions

In their edited volume, Krabbe and colleagues address various aspects of the issue. Among these, they address which international rules are supposed to protect prisoners in theory but fail in practice. They also look at the specific situations in countries such as the Netherlands, Germany, Japan, the United States and Brazil. This reveals that fundamental errors are made in almost every country. The fact that suspects with psychological problems are less resilient during the criminal process leads to many wrongful convictions and – in the United States – even to the wrongful imposition of the death penalty."

"Chile, Hungary and the United States, among others, report that prisoners with mental health problems are more likely to be mistreated by prison officials because they cannot keep up in the system. Greece, Hungary and Portugal report that prisoners with mental health problems are often incarcerated for much longer than necessary, for example because there is no other place for them. The WHO reports that in many countries prisons are ‘dumping grounds’ for people with mental health problems, including those who have not committed any crime. In Japan, it is so difficult to prove that someone is of unsound mind that many suspects with mental health problems end up in prison regardless.

The researchers also point out that there are many solutions to these problems. “International organisations and previous publications make it clear what can be done,” says Krabbe. “But all those solutions require both policy and money. The focus should be on providing a good place for defendants and prisoners with psychological problems, one with adequate treatment and expert staff. That will reduce the costs of reintegration in the long term, but it is also above all more humane, in line with human rights and contributing to a safe society.”

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Law, Health & Healthcare