A recent study by the World Health Organisation (WHO) presented that 7.5% of Indians suffer from some Mental Health Conditions. However, India has less than 4,000 medical practioners to tackle this problem. The prevalence of mental health issues and the amount of people who actually get treated, also known as the Treatment Gap, is more than 70 per cent. These statistics clearly reflect the poor conditions of Mental Healthcare in India. But when the general public is out through so much, one can only imagine the situations of the one’s from the weak classes. Mental Health in India is surely a luxury. But the price gets higher and higher when one looks into the lower to lower vulnerable sections of people with no people to look after or pity. But who are these people? They can include the transgender community, the refugees, the migrant labourers or the least liked section of them all, the Prisoners.
It is an established fact that prison conditions are poor in India. According to the reports published in April i.e. the Prison Statistics India 2016, by the National Crime Records Bureau (NCRB), around the end of 2016, 68% of the prisoners were actually under trials. This clearly shows how poor the legal system of our country is and how unnecessarily under trials are put in to these prisons. This represents how maximum prisoners are put to prisons due to faulty arrest and ineffective legal aid system. Another thing to find out is the under use of Section 436A of the Code of Criminal Procedure. According to this section, any under trial prisoner is eligible to be released if he serves half of the tenure of the total tenure of prison he would face if the crime accused on him was proved. In 2016 for instance, only 929 prisoners were released from prison when in reality, 1557 under trial prisoners matched the eligibility. This can be accounted to the fact that most of the prison officials are unaware of such provisions. This was found out through a research by Amnesty India where it was found out that most of the prison officials were unaware of this section and were therefore unwilling to apply it.
Prisoners constitute of a large class of people, unlike what the general notion remains. As we are aware, prisoners consist of the accused and the convicted. These people come from various different classes of the society, from different states of India and are forced to live together. They are already at a vulnerable part of their lives, and are pushed forward to more than they can expect. But what is forgotten is also the fact that they come from different stages or levels of mental health. They may be disturbed from previous life experiences, or may be struggling from guilt of conviction. They may also be unable to accept this new change of life and/or are sent to a shock state. Prisoners also suffer through a lot mentally, and just like any other citizen, have their ‘Right to Mental Health Care’. It was observed by a study that from 2015 to 2016, the percentage of suicide had increased with a percentage of 28% among Prisoners. By a report by the NCRB, it was found out that for every 21,650 prisoners, there was only one mental health professional. Only six states and a union territory had psychologist or psychiatrist with states like Odisha, Madhya Pradesh and Uttar Pradesh, that have the greatest number of prisoners with mental health problem had none. These data are enough to spark a conversation about the problem of mental health care of prisoners in India. The dialogue for their rights can only begin when an elaborate study regarding their conditions are put out, and the general public gets a hang of their problems.
To identify the present mental health condition of the prisoner
To analyse the laws protecting the mental health of prisoners.
To identify the common problem in relation to the mental health of the prisoner
To analyse other countries mental health system
What are the different laws in relation to the mental health of prisoners?
What is the present mental health condition of prison population in India?
What are the changes that are needed to improve the mental health of the prisoners?
Why is it important to ensure the mental health of prisoners?
How do other countries support the mental health of their prisoners?
The research methodology used for this paper is Non-doctrinal or empirical form of research. Primary sources i.e. Data collected through various surveys are being analysed. Heavy emphasis is put on the researches that have been made by various Psychiatric Commissions for better understanding about general mental health. References have been made to other documents for the data regarding other countries. Case studies have also been conducted.
Table: Prevalence of Psychiatric Disorders in Prisoners
Disorders %Psychiatric Disorders 33Schizophrenia3.4Bipolar Affective Disorder2.5Delusional Disorder0.8Depressive Disorders16.1Generalized Anxiety Disorders6.0Obsessive Compulsive Disorders2.5Drug Abuse/Dependence 58.8Somatoform Disorders 1.7
The above-mentioned table presents the major psychiatric disorders prisoners face of and the amount it has affected the class. The study shows the prevalence of Drug Abuse or substance abuse as the most spread mental illness with more than 50% of the affected people suffering from it. In fact, it is said that the data could higher as some prisoners were hesitant in pointing this problem out. Similar data had been found in surveys done in other Indian as well as western scenarios for the same.
Mental Disorders are in fact higher in prisoners as compare to the general population. Studies have found out that 33% of Prisoners have some mental disorder. This comes after the expulsion of Drug or Substance Abuse. Depressive disorders also form a big part of the Problem.
A lot of times, prisoners already suffer from some kind of mental health issue. These could include weakened judgement skills, absence of impulsive control, suspicion, the absence of inhibitions, bizarre ideas, trust issue with people in general, hallucination and delusion. Few of them, as much as 3.4% in our data, suffer from Schizophrenia. Other times, they start suffering from such issues, after getting admitted.
The Constitution is the guarantor of its citizens right. Out of the thirty-two fundamental rights, the right that holds supreme importance, the most vital for a democracy, is Article 21 which provides us with Right to Life and Personal Liberty. The Supreme Court has held that right to life includes the right to live with human dignity. And this, along with the Directive Principle of State Policy established the right to protection of health as a Fundamental Right, ought to be held by the government.
Due to this, there have been various instances where it has been witnessed, that, when a government hospital does not provide on-time health care facility, it is a violation of the person’s fundamental right.
Major cases highlighting the importance of Right to Health include cases like CESC Ltd. v. Subhash Chandra Bose. In this case the Supreme Court stated that Right to Health did not only mean the absence of sickness. The court felt that medical facilities do not only provide a person against various kinds of sickness but also ensures a stable manpower to the country’s budget. The Supreme Court felt that leading a health life, or getting provided for it was a type of Social Security. The court finally stated that Right to health is the basic right of a workmen.
Another case highlighting the importance of health care is the case of Mahendra Pratap Singh v. Orissa State. This case highlighted that people are entitled to adequate healthcare. The case mainly focused on the fact that every person has the right to basic health care, if not a fancy hospital, a Primary Health Centre. It was stated by the courts that achievements can only be unlocked by people if they live a healthy life. The lack of healthy life means the lack of achieving these dreams.
A person’s mental health, is also an inseparable part of their healthy being. A person not treated for having a mental issue is as much a violated of his right as a person with physical ailment. A prisoner, is as much a citizen of India, as a general person is. Violating his mental health is a violation of his Fundamental Right. Therefore, it is necessary for the government to make provisions for his right.
Factors affecting the Condition
But before looking in for actions, we should look into the reasons behind the poor mental health conditions of the prisoners. To examine this issue, we should begin with the prison conditions to which these people are exposed to.
Prison overcrowding is a big issue for India. Prison overcrowding basically means that the number of prisoners in the prisons are more than the actual capacity. According to The Week, the capacity of holding prisoners in India was 3.78 lakhs when the actual amount was 4.19 lakhs in 2017. Due to this overcrowding, prisoners start facing suffocation. This suffocation leads to many health problems, but on the mental per say it creates mental instability for them. New prisoners face a lot of problem in adjustment. They leave their homes, and are therefore already in a vulnerable state. In these times, when they are forced to live in small spaces with people who they are not acquainted with, it causes a lot of stress emotionally and mentally. They are unable to concentrate or do normal activities like fellow people. They lose sleep, which also affects them mentally. Anxiety, depressive feelings, losing interests, excessive amount of stress and strain and the inability to enjoy life comes in picture.
Another major issue, which is also a vicious cycle is the treatment of fellow inmates. When kept in an enclosed space, one has two options. The first is to isolate oneself from the fellow mates. This can cause social isolation and lead to personality disorders. The other option is to join in a group. These groups are not fun, social groups. These refer to the gangs that are made up. These groups cause detrimental effects to a new comer. The gangs do not treat fellow prisoners well, which means that they suffer due to the bad behaviour or join them to also start creating problems for the fellow inmates. Hence, a vicious cycle is created. Something to protect oneself, but at the cost of others.
Some issues that prisoners face in the isolation could be the isolation itself. Humans are social animals, but our social skills are limited to people of our choices. When a person is stuck up in an overcrowded place, with people he would associate with be less than 50%, his social life would take a toll on him. Prisoners also face lack of privacy, uncertainty about their future and lack of meaningful activities they would want to perform. This reduces their productivity for prison work.
Present Government Support
Currently, there is not much support by the government to deal with Mentally Ill prisoner. The most common method this is used to deal with such patients is- the court declares them mentally unsound and sends them to a mental asylum. However, what happens on-paper or theory is different from the reality. Usually, after the court declares a person unfit for trial due to his mental illness, no such decision is made. The person continues to live in such mental illness in the Judicial custody of the police. Years later, when the court finally addresses the issue, the most typical answer is to send the prisoner to an asylum. This order also does not really apply as the now the jail authorities take time in taking action. In this barbaric process, the prisoner suffers. A case study, on such an action is given below.
The court delved into poor mental health of prisoners, was the case of Chiranjit Singh and National Human Rights Commission v. State and ors.where the prisoner suffered for 20 years. The prisoner, Chiranjeet, who was an accused of murdering Ashok Malhotra, was a 55-years-old man, suffering from Schizophrenia. He was put in Judicial Custody, however, no steps towards the case took place as he was not of sound mind. After a period of fifteen years, the court finally decided of granting him a bail. However, since he did not appear for the bail hearing on the affixed date, the court mercilessly cancelled his bail. Again, for four and a half months, he weakened in the Jail. Thankfully, in 2002, his case caught the attention of the National Human Rights Commission. From here, his journeyed took a better turn.
Several arrangements were made with even the Hindustan Times joining in. A writ of mandamus, against the Tihar Jail authorities, to transfer him to a suitable mental asylum and make necessary arrangements regarding his treatment were made. He was shifted to the Institute of Human Behaviour and Allied Science in Delhi. It was analysed, that the primary reason for the problems that triggered his deteriorating mental conditions was the poor environment and the sight of the jail. His criminal charges were quashed. However, the damages made to his mental conditions were permanent.
However, this case plays a significant role to this paper, as the National Human Rights Commission, had provided with guidelines for cases involving people mentally ill housed in jails. The guidelines have been explained as follows:
In order to ensure mental health and for early detection, effective psychiatric and psychological counselling must be provided. In order for this, prison authorities must collaborate with local medical institutions and NGOs.
Jails must have facilities for treatment of any mental disorders. Sub- jails should take inmates with mental disorders to psychiatric facilities. All jails must be affiliated to mental health institutions.
Every jail should have qualified psychiatrist, psychologist and psychiatric social worker.
Any person with mental disorder who is not accused with any crime shouldn't be kept in prison, such person must be taken to a psychiatric centre for further examination.
If an undertrial becomes mentally Ill in the prison, the state has affirmative responsibility to provide effective mental care. The person must be placed under observation.
When any convict has been admitted to a mental hospital after the completion of his sentence must be registered as a free person.
Any undertrial who is mentally ill must be placed in a prison which are attached to hospitals. Each such undertrial must be examined by a psychiatrist who will send a periodic report to the magistrate through superintendent of prison.
All those in jail with mental Illness must be kept together separately.
If any person is declared guilty and has recovered from a mental illness. Such prisoner can no longer be kept in a mental hospital, however he must remain in prison and periodically examined by a psychiatrist.
Any undertrial whose trial has been suspended due to mental illness, report must be sent to relevant judges as well magistrates on quarterly bases.
It is the duty of the state to make sure that every person it imprisons shall not be affected by any mental ailment. Therefore, every prison or jail should have the following:
Open areas in touch with environment, lawns, kitchen and flower gardens, Daily activities in the cell should include stress-relieving exercise like games, sports and meditation
Staff who are understanding and gentle with them:
Any officer at duty should not use any type of force on the prisoners except in case of self-defence, attempt to escape, resistance etc.
Special training to the officers shall be provided to deal with prisoners with aggressive nature.
An effective system for the redressal of grievance
Every criminal admitted shall be explained the norms relating to his behaviour in the prison. This shall explain the prisoner his rights and duties in the prison.
If a prison is illiterate, such information as mentioned above shall be explained to him orally.
Every prisoner shall be allowed, without any restriction, to complaint to the judicial authority or any such authority he deems fit.
Every complaint shall be dealt with promptly unless it is clearly frolicsome or matter less.
Members from the civil society are welcomed to see if any wrong discharge of power or corruption is taking place and can take steps against it.
Whenever it comes to the notice of the Trial Court, that the prisoner is mentally unsound, it is their duty to follow the procedure as prescribed in Chapter 25 of the Criminal Code of Procedure, 1973 and should make sure that a strict application of the Mental Health Act, 1987 takes place. Periodic Reports of the progress of the mental health of the prisoner should be sent to the Trail Court Judge.
Short-term capsule courses should be conducted in Delhi Judicial Academy so that judicial officers can be sensitized regarding mental health cases and so that officers can start following the Mental Health Act, 1987.
A report should be made to the Registrar of High Court to be put up to the Chief Justice for an appropriate action when the trial of a mentally ill accused has completed 50% of the jail-time he would have faced if conviction took place. The National Human Rights Commission should also be informed.
State Government should improve the Legal Aid Services.
The state should also take up the responsibility of all such prisoners who have completed their prison term, have improved their mental illness, but are yet unable to handle themselves completely.
Prisoners who do not have a family background or have a rough family should not be sent back to such homes, but should rather, be housed at such community-based areas. A small semi-independent community should be set up for them to live.
However, in cases where family support is present, the prisoners should be sent there as it will help better in their development.
The other situation, where the prisoner suffers from a mental condition after getting admitted to a prison or when his mental condition deteriorates in the prison, is even worse. In such situations, the metal issue is recognised even late as they are already in the prison, and the prison authorities have no time to recognise the problem. Finally, even when it does get recognised, the common solution is sending them to solitary confinement. A very lucky few get to see the ward of a hospital. The understanding of this situation shall be better with the reading of the case below.
Baba Khan was in prison for Drug Trafficking. He was a serious patient of Schizophrenia. He was considered a delusional man, and with the help of the state government, after nine years in the jail, was sent to the local hospital. However, over there he was accused of killing two people and sent back to the jail and put to isolation. When he was sent to the court for his trials for the murder, the court stated he was mentally unfit for a court hearing. According to the due process of law, he was supposed to be sent to an asylum. However, this did not happen. After 18 years, with massive effort, he was released. However, due to the poor condition of his life, he passed away 15 months after his release.
What we should focus on, in his case is the poor treatment he was given. The authorities first took eighteen years to identify his problem. Later, they removed him from the hospital because of the claims of him murdering two patients. What is to be recognised here is that the authorities had no proof to prove their claims. Also, after he was brought back to jail, they put him into solitary confinement, which is a big trigger for Schizophrenia.
Mental Healthcare in other Countries
UNITED STATES OF AMERICA
It is known that the number of people, mentally ill, in the prisons of America are thrice the amount of mentally ill people in the hospitals. This might be the reason that Mental Healthcare facilities provided to the prisoners of United States is commendable. Reported data shows that every one prisoner out of eight received mental healthcare. When a person is admitted to the prison, a screening takes place which establishes whether a prisoner will be sent to a general cell or a specialised confinement based on their health. Maximum prison authorities here appoint at least one psychiatrist and one psychologist. 25 of 50 states in America have laws relating to detention of mentally ill prisoners and their Supreme Court of America up holds the right of mental health of prisoners. There have been many landmark cases too, that have highlighted the importance of mental health care of prisoners in the country. These include Estelle v. Gamble and Helling v. McKinney. In a landmark judgement, Washington v. Harper, it was stated that even though prisoners have a right to reject treatment, the state can however, still conduct an antipsychotic treatment without a judicial procedure if the process is
“reasonably related to legitimate penological interest”.
The condition of the prisoners of United Kingdom are not very different from India. First, we need to understand the legal provisions for mentally ill prisoners in the kingdom. According to the government guidelines of England and Wales, a mentally unwell prisoner is supposed to be shifted from prison to asylum, immediately, within 14 days from the court’s order. However, in the real scene, this is not the truth. It has been recorded by the Guardian that more than 66% of the cases take more than 14 days for response while 7.1% cases took longer.
However, when this situation is compared with India, the laws and the time taken to implement them are much quicker.
Australia’s mentally ill patients are increasing in number gradually. In 2007, it was found that out of 25,000 prisoners, 5000 were suffering from some mental ailment. Mentally ill patients are kept in Supermaximum Prisons. These prisons are distinct from a regular prison. They have spacious rooms, however, do live in isolation, unless and until allowed for a period of 8-hours per day. However, the Supreme Court considers these prisons to be so difficult to stay at, that a person with good mental health may also start deteriorating here.
Though there is focus on different treatment of prisoners, the isolation element is so strong that it causes troubles.
The highest-populated state is improving its Mental health care for prisoners every day. China, though still not completed reaching the satisfaction point, has good provisions for their mental health care systems. The country is busy training their prison authorities with psychological programs so that it helps in early detection as well as understanding of the mental problems faced by their prisoners.
Along with this, every prison in China, also has a mental health treatment room and specific required equipment. They believe in doing so as trained authorities will help in calming down inmates and handling them easier. It is their correction program. The prison authorities have a National Psychologist Certification and conduct classes with prisoners regularly. Treatmenst like music therapy and mental analysis are also conducted. Special rooms decorated with green plants are made for the consultation sessions to happen. Prisoners are also made to perform plays every year so that they are, as well as other watching it are aware of their own mental conditions.
It is quite evident from the understanding of the present mental healthcare system that the present system is not adequate. Analysing through the Mental Health Care systems for prisoners in different countries, the National Human Rights Commission guidelines and the general understanding, it can easily be said that the system has to be reformed. No firm legislations are available for their protection except when the courts order mentally unstable prisoners to be sent, which also takes place at a slow rate. The guidelines provided by the National Human Rights Commission could be the stepping stones towards this reform. These guidelines cover all the arenas required at the current state. The Legislation should pass these regulations in the form of an Act so that it becomes binding on the Prison Authorities, all around India. This shall ensure that the fundamental right of mental health care is not violated amongst prisoners.
The paper throws light on the poor mental health care conditions of prisoners in India. It has been noticed that very little research on their conditions have been taken in India. Prisoners face through mental illness, both before and after entering to prisons. They suffer majorly from substance abuse and depression. Prisoners get affected by these issues after entering the prisons too. There mental health is affected due to various factors present in the prisons and system. Moreover, to deal with such situations, the number of psychologists and psychiatrists are also low. This only worsens the problems of the prisoners. When we look for concrete legislations to deal with these problems, there are no existing ones. Hence, it is necessary to make legislations for the same. For the same, it has been suggested that the guidelines of the National Human Rights Commission, as stated in the Chiranjeet Singh Case be followed.
Desai, M., & Mahabal, K. B. (2007). Health Care Case Law in India. Centre for Enquiry into Health and Allied Themes. Retrieved from https://www.escr-net.org/sites/default/files/Desai and Mahabal_0.pdf
Ogloff, J., Davis, M., Rivers, G., & Ross, S. (2007). The identification of Mental Disorders in the Criminal Justice System. Australian Institute of Criminology. Retrieved from https://aic.gov.au/publications/tandi/tandi334
Prisons Statistics India 2015. (2016). National Crime Record Bureau .
Psychiatric Morbidity in Prisoners. (2013). Indian J Psychiatry
3rd year Student
Symbiosis Law School Hyderabad
(Symbiosis International Pune)