Understanding causes of mental ill-health among prisoners Alternatives to detention People with severe mental health conditions should never be held in prisons, and there is an absolute prohibition of detention on the basis of impairment.12 In cases where they are detained, accommodation should, at a minimum, be in facilities with appropriate specialised treatment, in units supervised by healthcare staff. [Mandela Rule 109 (3)] Those with less severe mental health conditions should be diverted away from the criminal justice system where appropriate. If diversion is not possible, sentencing alternatives should be considered, in consultation with mental health professionals. Prison should only be used as a pre-trial measure or sanction as a last resort, particularly given the negative impact it has on mental well-being. Prisoners arrive with existing mental health conditions Backgrounds Poor mental health is often associated with poverty, unemployment, violence, discrimination, stress, social exclusion, substance dependencies and physical ill-health. Troubled backgrounds contribute to both criminality and mental ill-health. It is common for people with mental health disorders to have received no treatment before arriving at prison.10 [UN Tokyo Rules, Rule 6] Imprisonment causes and exacerbates mental ill-health Imprisonment as a result of mental ill-health In some countries, people with mental health conditions who have not committed a crime, or who have committed a minor offence, are sent to prison rather than given appropriate care. Impact of imprisonment Sentence length, uncertainty about the future and a lack of mental stimulation can cause or contribute to mental ill-health amongst prisoners, as can reduced contact with support networks. Mental health is also impacted by the availability, or lack of, drugs in prisons. Mental health contributing to offending Offenders with mental health conditions also have a high rate of imprisonment. Some commit crimes as a result of their condition or because of poverty. They may be more likely to be arrested and convicted due to prejudices in the criminal justice system and may be less likely to be granted parole. Conditions of detention Prison overcrowding and poor conditions of detention contribute to mental ill-health, as do factors such as limited privacy and isolation, including solitary confinement. Poor physical health and lack of appropriate treatment is also closely related to mental ill-health. In many African countries it is possible to be arrested for being a ‘rogue’, ‘vagabond’ or an ‘idle and disorderly person’. In one reported case, a school teacher with a psychosocial disability missed his medication due to a local drug shortage and was walking down the road singing – he was arrested, charged with being ‘idle and disorderly’, and subsequently spent three months in prison.11 Mistreatment in detention People’s mental health can also be impacted by mistreatment inside prison, such as violence, including sexual violence, bullying and harassment, stigma, discrimination and dehumanisation by staff. 10 11