Let’s Talk: Mental Health in Prison Populations

Chitra Balakrishnan

February 25, 2020

The increasing dialogue and awareness surrounding mental health is gradually leading towards its de-stigmatization within universities, workplaces and homes [1]. With movies such as Still Alice, A Beautiful Mind and Silver Linings Playbook humanising individuals facing mental health difficulties, we see genuine attempts by the media to initiate conversation and awareness  regarding mental illness in society. Additionally, movies such as Joker, Split, Shutter Island and Girl, Interrupted, although not flawless in their depictions, shed light on the role of environmental factors in the development of mental health concerns and antisocial behaviours (i.e., actions that harm others or lack consideration for the basic rights of others). Individuals who commit crimes and also have mental health concerns are often cut off from society and locked up in prisons or correctional facilities, receiving little or no help [3]. This article seeks to convey a psychological perspective, with regard to mental health, on the individuals that enter the legal system.

Mental Illness Statistics of Youth Who are Incarcerated in British Columbia, Canada

Gretton and Clift studied the prevalence of mental health disorders and mental health needs among a sample of 140 males (12 – 20 years) and 65 females (13 – 18 years) who were incarcerated in British Columbia, Canada [1].

In order of most to least common, the authors identified the following mental health concerns among the sample of youth who were incarcerated:

  1. Alcohol and drug misuse (79.8% males and 80.7% females)
  2. Anger and irritability (55.5% male and 63.2% females)
  3. Somatic complaints (50.4% males 59.6% females)
  4. Symptoms of depression and anxiety (31.9% males and 54.4% females)
  5. Suicidal ideation (14.3% males and 29.8% females)

In order of most to least common, the top five most prevalent disorders* among the sample were the following: 

  1.  Substance use disorders (73.0% males and 87.8% females)
  2. Conduct disorder (72.9% males and 84.3% females)
  3. Oppositional defiant disorder (19.3% males and 40.4% females)
  4. Some type of anxiety disorder (17.5% males and 29.6% females)
  5. Attention-deficit/hyperactivity disorder (12.5% males and 22.0% females)

*Note: The diagnoses made by the authors were provisional, as comprehensive assessments were not carried out.

The main differences between males and females who were incarcerated included:

  • Females had a higher probability of experiencing substance dependence, suicidal ideation, sexual abuse, post-traumatic stress disorder, oppositional defiant disorder and symptoms of depression and anxiety compared males in the sample
  • Females in the sample were three times more likely, and males in the sample were five times more likely to have faced physical or sexual abuse, compared to a community sample

Mental health concerns among individuals who are incarcerated are pervasive and yet, not enough facilities and services are in place to address them. In the following section, we identify some barriers that impede access to appropriate resources. 

Challenges in Providing Mental Health Services in Prison Systems

Despite the increasing need for mental health services and professionals in prison systems, Canada is lacking in its efforts to provide these individuals with the support and treatment they require [2]. Simpson and colleagues reported two main challenges that are faced in Canadian prison systems when attempting to address these mental health needs:

  1. The prison systems in Canada are multi-jurisdictional with regard to health care provisions, meaning that each province implements their own health care systems and legislation. In particular, prison systems function with respect to the Mental Health Act of the province in which they are located, despite its governance being federal or provincial. The lack of one single body governing physical and mental health services to the entire country can lead to significant disparities in how individuals receive health care across different locations. 
  2. Even when those who enter into the prison system  are screened for mental disorders, they are often left untreated. There may also be personal factors, such as concerns about reputation and confidentiality, prior experience, and individual demographics, that dissuade individuals from accepting any available treatment. Simpson and colleagues mention that effective treatments help in reducing symptoms of distress, improving coping ability, and promoting healthy behavioural adjustment among incarcerated individuals [2]. However, systemic and individual barriers prevent those in the prison system from receiving the support they need. 

Presently, necessary mental health service responses need to be recognized and implemented to support individuals that face mental health concerns and have been incarcerated. Moreover, those who are incarcerated need to be made aware of the rights they hold when interacting with the legal and prison systems. Based on internationally recognized principles, these individuals have the right to receive health care that meets their needs [2]. Essential services for individuals who are incarcerated  include screening for mental disorders at reception, acute and non-acute treatment services, programs to meet their needs while in custody, preparation for release, and engagement with community mental health services on release. Through early assessment, the health care and prison systems may be able to provide more appropriate mental health services for those in need. As always, effort and funds need to be invested in to expanding areas of public policy and clinical needs. 



[1] Gretton, H. M., & Clift, R. J. W. (2011). The mental health needs of incarcerated youth in British Columbia, Canada. International Journal of Law and Psychiatry, 34(2), 109-115. doi:10.1016/j.ijlp.2011.02.004

[2] Simpson, I. F., McMaster, J. J., & Cohen, S. N. (2013). Challenges for Canada in meeting the needs of persons with serious mental illness in prison. Journal of the American Academy of Psychiatry and the Law Online, 41(4), 501-509.

[3] Simpson, S. (n.d.). Mental illness and the prison system. Retrieved from https://www.camh.ca/en/camh-news-and-stories/mental-illness-and-the-prison-system

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