The awareness about mental health of individuals has risen tremendously since the 1960s and the 1970s. With increased research in areas of psychology and with institutions regularly adopting new policies which give the mental health of an individual as much consideration as his/her physical health, societal attitude in this regard has been progressing at an exponential rate. However, there are certain individuals, who lose out on the benefits of modern practices and beliefs of society regarding mental health. A majority of such individuals are those who are held in prisons. This paper aims to discuss the mental health of prisoners in Indian prisons, the reasons behind the decline in the mental health of Indian prisoners, and the way in which such prisoners are dealt with according to the laws of India.
Prisoners in India and Mental Health
Due to them spending most of their sentence behind bars, prisoners are socially isolated. They are separated from their community, family, friends and are put into an alien environment, which brings feelings of loneliness, despair, and hopelessness. Moreover, the low standards of maintenance in Indian prisons have resulted in prisoners having to live in severely unsanitary conditions, with abysmal infrastructure, for not only mental health care, but also for basic physical ailments. A prolonged adaptation to such conditions and such frustrations and depravations of life leads to various psychological disorders in prisoners. Confinement of prisoners leads to disorders like Post Traumatic Stress Disorder and other related issues like decreased self-confidence and self-esteem. Due to these reasons, it has been observed that inmates tend to suffer from mental illnesses three times more than civilians.
The World Health Organisation defines ‘health’ as a “complete state of physical, mental and social well-being, and not merely the absence of disease or infirmity”. Though there have been several infrastructural reforms in Indian prisons, a lot remains to be done in looking after the well-being of the prison inmates’ mental health. The rudimentary level of care provided to prisoners’ mental health has led to Indian prisons becoming dumping grounds for prisoners who suffer from mental ailments. The prevailing conditions in Indian prisons, like the unhygienic conditions of prison cells, inedible food, and lack of administrative control over the treatment meted towards prisoners and even amongst inmates themselves, creates a severe impact on their mental condition. Many are also beaten and raped by their fellows in prisons.
Furthermore, there is a lack of fresh air and water in prisons, and they are heavily overcrowded. This constant lack of privacy and meaningful activity further leads to prisoners’ mental conditions. Their situation further deteriorates because they have to face a lot of social stigmas and are victims of marginalization due to them being criminals. They also have to bear the consequences of inadequate awareness amongst jail authorities about mental health and treatment. Instead of receiving treatment in order to alleviate their mental condition, prisoners are kept in isolation with little or no attention being paid to their mental health issues.
Many of the prisoners who are kept in jails are charged with committing petty offences. A lot of them suffer from substance addiction like addiction to alcohol, cigarettes, drugs, and other intoxicating substances. So, even though such inmates should have been sent to rehabilitation centres to help them overcome their addiction issues and the accompanying mental health problems, they are locked in prison cells, where loneliness and social isolation aggravate their existing problems.
The Bangalore Prison Mental Health Study
The National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, conducted a study in collaboration with the Government of Karnataka and the Karnataka State Legal Services Authority on prison inmates kept at the Central Jail, Bangalore. The study shows how dangerous it is to leave inmates’ mental ailments go unnoticed and how many more reforms are required. Firstly, the Central Jail’s capacity was 2100, but the study was conducted upon 5200 prisoners, which clearly shows the prevalence of prison overcrowding.
Secondly, it was observed that those prisoners who were suffering from any form of addiction to an intoxicating substance had increased the consumption of the same after their entry into the prison. Thirdly, the study also revealed that many prisoners were suffering from mental health ailments like depression and loneliness. A certain number of prisoners even had suicidal tendencies, and the prevalent conditions present in the prisons had driven quite a number of them to try and take their lives.
Some of the statistics gathered from the report regarding the above claims are that 79.6% of the Central Jail prisoners were reported to be suffering from depression or substance abuse. The undertrial prisoners who resided in the Central Jail, who used to smoke an average of 9 cigarettes a day, were found to have increased their cigarette consumption to 34. Convicted prisoners were also found to have increased smoking from 11 cigarettes a day to 45 cigarettes a day. Around 51.5% of the prisoners were addicted to alcohol, and out of these group of prisoners, 86% were found to be suffering from alcohol consumption disorder, which is caused due to harmful patterns of alcohol consumption. When a test for drug identification was conducted upon around 720 prisoners, it was found that about 1/3rd of the prisoners tested positive for one or more than one drug. Most of these inmates tested positive for substances like cannabis, cocaine, opioids, amphetamines, barbiturates, and benzodiazepines. It was also found that inmates who had been staying in the prison for a certain time period had increased their consumption of drugs by 2.5% compared to the new entrants’ consumption of drugs.
This shows how a prolonged stay in such a correctional facility, without the needed medical attention, can cause so much damage to the lives of the inmates. Unfortunately, 71% of the inmates also declared that they would not be able to give up their addiction to intoxicating substances without external help.
In another survey conducted on the prisoners in the District Jail of Dhanbad, Jharkhand, it was revealed that the prisoners were experiencing depression, loneliness, anxiety, and inability to live life or face life’s challenges. They were also facing issues with emotional and social adjustment. All these developments had an adverse impact on their mental health.
The next part of the paper will explore the various laws that deal with the treatment of prisoners and their various mental health issues and related ailments.
The Legal Framework
The first legislation that comes under discussion is the Mental Healthcare Act of 2017. The Mental Healthcare Act is an exhaustive piece of legislation that contains several important provisions that deal with prisoners’ mental health. Section 31(2) of the Mental Healthcare Act provides for compulsory training of medical officers in prisons, in primary and emergency mental healthcare. Furthermore, Section 103(6) of the Mental Healthcare Act mandates that every State Government has to establish a Mental Health Establishment in the medical wing of at least one prison in the state.
It must be appreciated that the Legislature has taken cognizance of the issue of the mental health of prisoners, but the ground realities portray a completely different picture. It shows the extreme gap that exists between the legislations and their implementation by the authorities. One such instance that shows the lack of complete implementation is the status of resident psychiatrists in Mumbai’s Yerawada Jail. According to Section 103(6) of the Mental Healthcare Act, State Governments should facilitate the establishment of Mental Healthcare Establishments in the medical wing of at least one State prison. While such an establishment does exist in the Yerawada Jail in Mumbai, but there is a lack of resident doctors in the establishment. According to Dr. Sandeep Mahamuni, a visiting psychiatrist at the Yerawada Jail, several jail prisoners have been diagnosed with mental ailments such as depression, anxiety, and schizophrenia. Some prisoners have suicidal tendencies and tend to cause harm to themselves. However, due to the lack of residential doctors in the mental health wing of the jail, immediate attention cannot be provided to such prisoners, and they are admitted into hospitals in Pune, where they receive their medical treatment.
Some State prisons also have policies regarding mental health that are grossly inadequate to deal with a situation, if the same arises. For example, the Chhattisgarh Jail Department’s “Prisoner welfare and rehabilitation policy” consists of only one mental health provision. India has not been able to adapt to the progressive rehabilitation methods that are used in American and European prison systems, in which attention is given to peer support and training, and in which the mentally unfit prisoners are segregated from the mentally stable prisoners, in order to narrow down the scope of treatment that is to be imparted.
The subsequent legislation to be examined is the Criminal Procedure Code (CrPC), that contains certain provisions dealing with the treatment of the accused dealing with mental health issues. Sections 328 and 329 of the CrPC provide for the accused to be provided with bail if he/she is found to be a lunatic during the time of the inquiry or during the trial. Also, in case the aforementioned circumstance occurs, Section 330 and Section 331 of the CrPC give the judge the power to order for the detention of the accused in safe custody and continue the trial only when the accused has regained his normal mental state. Many other provisions in the Code also deal with procedures that deal with the accused’s appearance in the court/Magistrate and how a person who is not mentally stable should be released when possible.
Loopholes in the Law and the Way Forward
Despite these provisions, there still remain loopholes in the law, which can create several issues for prisoners. The provisions dealing with granting a bail to the accused when the latter is not of in sound mental state, leave the discretion of deciding the same with the judges. The language that has been used in such provisions is – “opinion of the Magistrate or the Court”, “sufficient security”, and “opinion of the Magistrate”. The usage of such terms can create problems for the accused who undergoes the trial since any decision taken by the judge can have severe and long-lasting consequences for the accused. These consequences can prove to be too severe and devastating if the accused has a mental ailment that the judge could have misjudged. The decision of the Magistrate should be justified only when “there is a sufficient cause to believe it and not when there is subjective satisfaction alone.” In the case of Amit Kumar Dey v. The State of Tripura, even though the medical experts who had examined the accused had confirmed that the accused was not of sound mental state, the Additional Sessions Judge had refused to grant bail to him. Thankfully, this case was appealed to the High Court, which decided that the decision that was taken by the trial judge should have based on sound evidence, and this gave the accused a chance to have a free and fair trial.
Another provision of the CrPC that is problematic is Section 54 of the CrPC. This provision makes the medical examination of the arrested person by a medical officer compulsory. The officer, while examining the arrested person, is only required to make a report about the physical injuries sustained by the latter, but there is nothing in the provision which mandates the medical officer to prepare a report regarding the mental state of the arrested person. A report regarding the same could give better insight into the reason of the arrested individual behind committing the crime. It could also help the police deal with the accused in a better manner if they know about his/her mental condition since the treatment that an arrested individual receives in a police station can have an extremely severe impact on their mental health.
It has also been found that people who suffer from mental illnesses have faced exclusion when lawyers represent them in courts. This creates a further problem for the accused to get access to justice. The NALSA has taken cognizance of this matter and hopefully will arrive at a solution that improves the system of free legal aid and access to justice in our country.
Despite the shortcomings in our legislations, there have been positive steps that have been taken to ensure the welfare of the inmates. The doctors in the All India Institute of Medical Sciences (AIIMS), Delhi, and the Delhi Prison Administration have drafted the first guidelines on mental health issues faced by prisoners in Jail. These guidelines are known as ‘Psychological First Aid’. These guidelines have primarily been drafted by Dr. Nand Kumar, a psychiatry professor at AIIMS.
It can be concluded that despite the several reforms that have been undertaken to make the conditions in prisons better, there is still a need for reforms in the area of the care of mental health the prison inmates and undertrials. Mental health is an extremely sensitive part of an individual and so special care must be taken to ensure that a person’s mental health remains in ‘normal’ condition throughout the time he/she is serving his sentence/undergoing trial. The Government should also take cognizance of the reforms required in the law and ensure their on-ground implementation, so that we can move forward in the task of ensuring inclusivity and proper treatment for those who suffer from such ailments. Hon’ble Justice Rajiv Sharma of the Uttarakhand High Court had once remarked that “A prisoner may 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.” Therefore, the State should continue to move forward in making developments for the benefit of such prisoners who deal with mental health issues.
[Mehul Jain is a second-year law student at the National University of Juridical Sciences, Kolkata.]
 Dr. Vijaya Raghavan et al., ‘Prison Mental Health in India: Review’, Indian J. Soc Psychiatry (2018).  Suresh Bada Math, et al., Minds Imprisoned: Mental Health Care in Prisons (2011).  Id.  The World Health Organisation, Constitution of the WHO, available at https://www.who.int/about/who-we-are/constitution (Last visited on January 11th, 2021).  Dr Sanjay Kumar Saha, et al., 'A Study on Mental Health Morbidities with Socio-Demographic Correlates If Any, Among the Inmates at Bankura Prisons, West Bengal', 2D Sch. J. App. Med. Sci (2014).  Id.  Suresh Bada Math, et al., Minds Imprisoned: Mental Health Care in Prisons (2011).  Id.  Id.  Suresh Bada Math, et al., Mental Health and Substance Use Problems in Prisons. The Bangalore Prison Mental Health Study: Local Lessons for National Action (2011).  Id.  Id.  Id.  Id.  Id.  Id.  Id.  Sudhinta Sinha, Adjustment and mental health problem in prisoners, Industrial psychiatry journal (2010)  The Mental Healthcare Act, 2017.  The Mental Healthcare Act, 2017, § 31(2).  The Mental Healthcare Act, 2017, § 103(6).  Upneet Lalli, Attitude to prison reforms: An empirical survey, Indian Journal of Criminology (2018-19).  Outlook India, Mental Health sufferers in Maharashtra’s Jails, September 24, 2018, available at https://magazine.outlookindia.com/story/mental-health-suffers-in-maharashtras-jails/300608 (Last visited on 14th September, 2020).  Jail Department Chhattisgarh, Prisoners welfare and rehabilitation policy, available at http://jail.cg.gov.in/rehabpol.htm#point2 (Last visited on 14th September, 2020).  The Proof of Guilt Blog, Mental Health of Indian Prisoners: An analysis of Key Provisions, Guidelines and Judicial Decisions, November 18, 2019, available at https://theproofofguilt.blogspot.com/2019/11/guest-post-mental-health-of-indian.html (Last visited on 23rd January, 2021).  The Code of Criminal Procedure, 1973.  The Code of Criminal Procedure, 1973, § 328.  The Code of Criminal Procedure, 1973, § 329.  The Code of Criminal Procedure, 1973, § 330.  The Code of Criminal Procedure, 1973, § 331.  The Code of Criminal Procedure, 1973, § 330(2).  The Proof of Guilt Blog, Mental Health of Indian Prisoners: An analysis of Key Provisions, Guidelines and Judicial Decisions, November 18, 2019, available at https://theproofofguilt.blogspot.com/2019/11/guest-post-mental-health-of-indian.html (Last visited on 23rd January, 2021).  Dr. Partap Singh & Anr. v. Director of Enforcement Foreign Exchange Regulation & Ors.1985 AIR 989.  Amit Kumar Dey v. The State of Tripura, (2014) 2 TLR 581.  The Code of Criminal Procedure, 1973, § 54.  NALSA (Legal Services to the Mentally Ill and Mentally Disabled Persons) Scheme, 2015.  India Today, New Guidelines to tackle mental health of inmates, April 16, 2019, available at https://www.indiatoday.in/mail-today/story/doctors-draft-first-guidelines-on-mental-health-issues-for-inmates-in-jail-1502754-2019-04-16 (Last visited on 14th September, 2020).  Surendra Singh Sandhu v. State of Uttarakhand & Ors., 2017 (1) N.C.C. 754.