The Ministry of Home Affairs’ advisory on mental health issues of prison inmates and staff in June came in the wake of increasing anxiety, stress and depression triggered by the Covid-19. Measures taken to curb the infection have severely affected the mental health of the prison population. For instance, resentment due to suspension of family visits and delayed court production of undertrials sparked riots in a Kolkata prison last year.
Ordinarily too, prison inmates are twice as likely to die of suicide than the general Indian population, as reported by the Commonwealth Human Rights Initiative (CHRI). The World Health Organization and the International Red Cross have also noted that circumstances like inadequate healthcare facilities, overcrowding, physical and sexual violence increase the possibility of prisoners to mental health issues. Prisons in India have a shortfall of medical staff by 41 per cent, while in 35 of 36 states/UTs, prison occupancy exceeds 50 per cent of inmates, according to the Tata Trusts’ India Justice Report (2020) released this year. Kumar and Daria (2013) have reiterated that the prevalence of psychiatric disorders is much higher in prisoners due to these conditions. Moreover, due to lack of recognition of the broad spectrum of mental illness within the criminal justice system, “prisons inevitably become homes for a greater number of mentally ill prisoners of various degrees”.
The recommendations in the advisory broadly include constant monitoring of prisoners with suicidal tendencies, buddy systems, psychological first aid (look, listen and link), organising awareness classes and stress management workshops. However, if proactive action is not taken to rectify the already existing apathetic and negligent conditions, these guidelines would only be restricted to being a piece of paper.
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Judiciary does the work, govts don’t
First, the advisory has proposed the availability of mechanisms to identify the prisoners with mental health issues and to facilitate prisoners with psychological issues to approach concerned authorities. Such mechanisms already exist but remain dysfunctional. Under Mental Healthcare Act (MHCA), 2017, the medical officer of the prison has an obligation to send quarterly reports to Mental Health Review Boards (MHRBs) about the status of prisoners with mental illness. MHRBs have been given the power to visit jails and ensure that prisoners with mental illnesses are transferred to mental health establishments. However, in an RTI reply dated 12 October 2020, the Ministry of Health and Family Welfare said only three states (Tripura, Uttarakhand, and Himachal Pradesh) have constituted MHRBs. Various petitions have been filed after which the High Courts of Delhi, Karnataka, and Kerala took cognizance and sought responses from their respective state governments regarding the constitution of MHRBs. In the absence of these authorities, it is unclear how this recommendation would be properly implemented.
Second, telepsychiatry video consultations, risk assessment of Covid-positive prisoners with mental illness twice a day; and in-person or teleconsultations at least once a day for elderly Covid-positive prisoners with mental illness have been suggested. The document also recommends the presence of at least one doctor, a physician, a psychiatrist, a dermatologist, a gynaecologist, a surgeon, two nurses and four counsellors for every 500 inmates. One psychologist/counsellor should be there for every 500 inmates as per the Model Prison Manual, 2016. Section 103(6) of the MHCA also mandates the constitution of mental health establishment in at least one prison in each state. However, due to the lack of mental health professionals or mental health establishments in prisons, this round the clock medical service becomes difficult.
Twenty-one states excluding Jammu & Kashmir do not have any psychiatrists or psychologists in prisons. Nationally, there is only one psychologist/psychiatrist for every 16,503 prisoners. Consequently, suicides accounted for 70 per cent of unnatural deaths in prisons. Uttar Pradesh, with zero mental health professionals, witnessed the highest number of suicides and mentally ill prisoners.
The latest Prison Statistics of India (2019) reported that only 7,394 inmates suffered from mental illness. Although officially, it is only 1.5 per cent of the total prisoner population in the country, the actual number must be higher as inadequate prison conditions predispose inmates to poor mental health. Last year, Karnataka reported that 33 per cent of its prisoners suffered from various types of mental disorders. If only one state had over 4,900 prisoners with mental illness, then the national number would be much higher than 7,394. A 2011 study published in the Indian Journal of Psychiatry suggested that 23.8 per cent out of the 500 surveyed prisoners suffered from psychiatric illness.
In 2019, a PIL was also filed in the Madras High Court for the establishment of a medical wing in the Central Prison to provide mental healthcare facilities exclusively. Dr Rabia and Dr Raghavan, in the Indian Journal of Social Psychiatry (2018), have further emphasised the necessity of constituting dedicated mental health clinics in prisons for early detection and intervention. They suggested frequent visits by mental health doctors and swift transfer of prisoners to psychiatric facilities. Recruitment of psychiatrists, psychologists and psychiatric nurses, therefore, needs to be done on a priority basis for the betterment of these conditions.
Third, it has been suggested in the guidelines that prisoners should be connected with their families through video-conferencing facilities. Physical distancing during the pandemic has given way to this alternative. However, as per the India Justice Report, only 808 of the total 1,350 jails had video conferencing to facilitate family e-visits. According to an article in the Scroll.in, only 10 out of 36 states and UTs have video-conferencing facilities in all their jails. States like Mizoram, Nagaland, and Sikkim don’t have this facility in any of their jails. The lack of technology has become a stumbling block here.
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Implement the existing prison rules first
The right to mental health has been recognised through judicial pronouncements and legislative frameworks. Yet, there remains utter disregard by the authorities. In X v. State of Maharashtra (2019), the Supreme Court recognised that every prisoner with mental illness has a right to live with dignity. The court also upheld the right of prisoners on death row to meet mental health professionals under Articles 14 and 21 of the Constitution in the Re-Inhuman Conditions case. Great emphasis has been laid on providing psychological counselling to prisoners to prevent or ensure early detection of mental illness. The High Courts have also reiterated that prisoners cannot be deprived of treatment for mental illness, such as in the Vaman Narain Ghiya case, and emphasised the treatment and rehabilitation of prisoners with mental illnesses.
These judgments align with the UN’s Mandela Rules and Model Prison Manual, which highlight the State’s responsibility in ensuring the mental health of prisoners through cultural, educational and recreational activities. The Rights of Persons with Mental Illness Rules, 2018, also provides a comprehensive standard for mental healthcare services in prisons, including mental status examinations at the time of entry to prison and questionnaire screening for substance abuse. However, these safeguards remain woefully inadequate due to their non-implementation.
There is an urgent need to implement the existing legal framework for dealing with mental healthcare in prisons. It has been repeatedly said that imprisonment does not bid farewell to fundamental rights. But the probability is high that “a prisoner might emerge from the prison not only without job skills but also incapacitated for future work because of severe and lasting physical and mental health issues,” as proclaimed in the Surendra Singh Sandhu judgment. Addressing mental health issues in prison settings would increase the ability of inmates to adjust and integrate into community life after serving their sentence, thereby also reducing the likelihood of reoffence.
Ritika Goyal is a law student at National University of Study and Research in Law (NUSRL), Ranchi. Views are personal.
(Edited by Srinjoy Dey)