Examining mental health in the prison system

By KANISA GEORGE

Imagine being locked up, isolated and forced to conform to rules and instructions set by a master. Imagine being unable to breathe the fresh ocean air at Pigeon Point or be enthralled by the lush greenery of the Main Ridge or the Bamboo Cathedral.

It's something we seldom think of, but when we were all forced to stay indoors during the lockdown, most of us got a taste of what it might be like to have our liberty taken away.

According to the Inter-American Development Bank's Regional Comparative Report for the period of 2016-2019, Trinidad and Tobago had a rate of incarceration of about 258 people per 100,000 inhabitants compared to the global average of 145. The Survey of Individuals Deprived of Liberty report also found that while incarceration rates were high, they had little impact on the crime rate and came at an exponential cost to Caribbean governments. In fact, of the 17 Caribbean countries that spent the most on prison administration, TT ranked fourth on the list.

Beyond the obvious inferences drawn from these statistics, there is an undercurrent theme so widely disregarded that it comes as no surprise that TT, like our Caribbean counterparts, fall short on the issue of rehabilitation. To understand the shortcomings of our correctional regime, we must go a step further and examine the impact incarceration has on prisoners and the psychologically damaged individual that often remains. Consistent research shows that prisoners have higher rates of mental illnesses than the average person, and in some countries, there are more incarcerated people suffering from mental health problems in prison than in the psychiatric hospitals.

Admittedly, the concept of social control, which is defined as any structure, process, relationship, or act that contributes to social order, must be sufficiently dissected for any society to understand the role of its prison system and its impact on mental health. Although various regulatory models of social control exist, developing countries are a few steps behind, focusing all their attention on the custodial institution, with little to no emphasis on other models such as welfare agencies, halfway houses, and parole.

A research paper by Luke Birmingham titled, The Mental Health of Prisoners found that the prison environment and the rules and regimes governing daily life inside prisons can be seriously detrimental to mental health. According to his study, mental health problems are the most significant cause of morbidity in UK prisons, with over 90 per cent of prisoners suffering from a mental disorder. Not only is this a constant reality in countries throughout the world, it's further underscored by overall poor health care in the prisoner system and lack of support for persons affected by mental health.

Numerous studies reveal that imprisonment can have a damaging effect on the mental health of inmates and, very often, without the corresponding support necessary. Prisoners deal with various issues such as coping with the length of their sentences, separation from their loved ones, and various stressors associated with the prison environment.

The World Health Organization found that various factors are an inherent part of most prisons and can negatively affect mental health. Overcrowding, various forms of violence, enforced solitude or conversely, lack of privacy, lack of meaningful activity and isolation were cited as the main prison conditions that severely affect mental health. This results in delusions, paranoia, depression, sleep deprivation, and an increased risk for suicide and suicidal thoughts due to the cumulative effects of these factors.

Prisoners serving a sentence with knowledge of a precise end date can easily manage expectations and compartmentalise their experience, whereas those on remand face an entirely different demon. According to studies, people on remand are at a much higher risk of developing mental health issues as they grapple with the uncertainty of their confinement. They often feel abandoned by the legal system, become reticent and are susceptible to mental breaks.

Further, prisoners suffering from mental health issues are less likely to be diagnosed and often don't receive the appropriate treatment. And because mental health isn't always a top priority in our society, it can be argued that it's on the back burner in our prison system. By failing to confront these issues, are we merely kicking the can further down the road?

Edgar and Rickford found growing evidence suggesting that the unmet mental health needs of the prison population could lead to the decreased likelihood for prisons to prevent re-offending and that unchecked mental health issues have a direct effect on recidivism. What we need is an overhaul of the justice system, focusing on issues such as human rights, mental health and movement towards a system that takes on a modern approach to social control. If one thing is clear, we need to do more to understand the impact of imprisonment on mental health and re-offending. Only through candid discussions and a system committed to further social change can strategies for protection and proper care for inmates be achieved.