Mumbai: Only one psychiatrist for over 42,000 prisoners in state

Inmates at Nagpur Central Jail undergo a training to check blood pressure. Training existing prison staff and inmates in identifying signs of mental illnesses can ease the situation, said experts

On the occasion of World Mental Health Day today, mid-day looked into the condition of mental healthcare available to prisoners lodged in jails across Maharashtra. There are 42,577 prisoners in the state, but there is only one psychiatrist and two psychologists to attend to them. The state has also not implemented the Mental Healthcare Act, 2017, which mandates one mental health unit in at least one prison in each state. mid-day had on October 10 highlighted the latest statistics on basic medical care available in jails across the state, painting a worrying picture.

Worrisome statistics

Dr Soumitra Pathare, consultant psychiatrist and director of the Centre for Mental Health Law and Policy, Indian Law Society in Pune, who had provided technical assistance to the Ministry of Health and Family Welfare in drafting the Mental Healthcare Act, said, "The situation only highlights the deficiency and condition that prevails in the prisons of Maharashtra and across the country today. It is unfortunate that the Mental Healthcare Act, 2017 is yet to be fully implemented in Maharashtra." "It is the responsibility of the State to ensure their [prisoners'] safety and provide them with healthcare facility, including mental healthcare," said Dr Pathare.

"A recent NCRB statistic shows that as many as 9,180 inmates, of the total 5.5 lakh prisoners lodged in various prisons across the country, were suffering from mental illnesses, as on December 31, 2021. Among the 185 unnatural deaths of inmates reported across coutry, 150 inmates killed themselves, including 7 in Maharashtra prisons. These are worrisome numbers, and are but the tip of the iceberg. The actual number of those suffering may be multi-fold," Dr Pathare concluded.

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Need more specialists

"With a 17 per cent increase in suicides between 2019 and 2021 and one in seven Indians reporting mental illnesses, the state needs to address this issue soon. There is a big shortage of psychiatrists and psychologists in Maharashtra and across India. Incentivising these posts in prisons is the need of the hour as more than 80 per cent of mental health professionals are in private practice. Psychiatrists who are retired can also be roped in for this," said Dr Harish Shetty, psychiatrist at Dr L H Hiranandani Hospital. He added, "Increasing the seats for diploma in Psychological medicine and DNB is a good idea. Several posts in mental hospitals in the state are also not filled as there are no doctors available."

Right to healthcare

"While securing the right to health of prisoners, it is equally necessary to secure their mental health and wellbeing, as protected under Article 21 and 41 of the Constitution," said Advocate Floyd Gracias, Supreme Court counsel. "People serving sentences and undertrials would have an increased risk of mental health issues. While they may be accused or convicts, as the case may be, they are still people within the meaning of Article 21 and are therefore entitled to protection from deprivation of life and in its expanded definition, a holistic standard of living. Therefore, mental health is as important as physiological health in enhancing the quality of life of prisoners and undertrials," said Floyd.

Train existing prison staff

Dr Vijay Raghavan, professor at Centre for Criminology and Justice at TISS and Project Director, Prayas, said, "Overcrowding of existing prisons and shortage of human resources in state prisons are the two main areas of concern. The prison staff are overworked and stressed, and only those prisoners showing visible signs of mental illness such as attempting suicide, aggressive behaviour, etc are taken to mental health set ups. But those, including prison staff themselves, with underlying illnesses go unnoticed."

"In 2021, the Bombay High Court had taken suo motu PIL on COVID and prisons, wherein the chief justice had expressed concern about the vacant posts, including paramedical staff, within the prisons. The state government in their submission had assured to fill in the vacancy within three months, but not much seems to have changed," he said.

When asked about the way out, Dr Raghavan, who was a part of the retired Justice Dr S Radhakrishnan Committee appointed by Bombay High Court for prison reforms, said, "The state can train the existing prison staff and convicts in identifying visible signs of mental illness viz. anxiety, depression, to serious issues of aggressive behaviour, suicidal tendency, etc among prisoners and bringing them to the notice of jail administration so they can get treatment."

Provisions for prisoners in the Metal Healthcare Act

Section 103 of the Mental Healthcare Act, 2017 deals with prisoners with mental illness. It states, "The state government shall set up mental health establishment in the medical wing of at least one prison in each state and Union territory." "The medical officer of a prison or jail shall send a quarterly report to the board concerned or SMHA certifying therein that there are no prisoners with mental illness in the prison or jail," it reads. The Act also makes it mandatory for state and Central governments to table such reports in the state and Central legislations.