2023-07-12 07:57:02
Prisons are an opportunity to care for the mental health of prisoners. However, many experts denounce inequalities and inefficiency in access to mental health care in these centers
With the aim of analyzing mental health care in Spanish prisons, the Spanish Society of Legal Psychiatry (SEPL) and the Spanish Society of Penitentiary Health (SESP) have prepared the ‘White Paper on health care for people with severe mental disorders (TMG) in prisons in Spain ‘.
The report reflects that in 2023 prison health care shares the same shortage of primary care physicians and psychiatrists than the national public health system.
The objective of this study is highlight the challenges and needs unsatisfied, make recommendations and propose feasible solutions that, from the perspective of experts, serve to improve the mental health of people who enter prison.
Mental health figures in prisons
Although the actual prevalence of people with SMI in the Spanish prison environment is not precisely known, the data provided by the report estimate at least that between 4 and 5 out of every 100 inmates have a severe mental disorder.
The figures show that of the total number of inmates assessed in psychiatric consultation, at least lhalf are diagnosed with a severe mental disorder.
Furthermore, according to Dr. Joaquin Anton Basanta, president of the Spanish Society of Penitentiary Health, less than 70% of internal people with a SMI have not had any follow-up of his mental health before his entry into prison.
“The prison environment is an opportunity to care for their mental health and stabilize the symptoms of their disorder,” says the doctor.
Specialized care in psychiatry is carried out in the 95% of prisons through psychiatrists.
However, most of these professionals act only as interlocutors treatment and follow-up being the sole responsibility of the prison doctor.
61% of the prisons in which the public services provide health care do so partially, varying from once a week to once a month.
Basanta regrets that “in 2020, the ratio of prison doctors in the Central Administration stood at 5.2 doctors per 1,000 prisoners.”
“In addition, this ratio tends to decrease due to the reduction in medical personnel due to a lack of incentives, the aging of the workforce and retirement without generational replacement,” explains the doctor.
Inequality in the mental health treatment of prisoners
Only three autonomous communities have prison health services integrated into the health system.
Only Catalonia, the Basque Country and the Comunidad Foral de Navarra have transferred prison health powers in 2023.
However, Andalusia and the Valencian Community are the Autonomous Communities with the highest number of people with high mental health care needs in their prisons.
In the Autonomous Communities without prison health powers, the provision of health services in prisons depends directly on the General Secretariat of Penitentiary Institutionsa non-health entity that functions as a parallel health system y poorly connected to the regional health system.
Dr. Alfredo Calcedo-Barba, former president of the Spanish Society of Legal Psychiatry, affirms that “the prison administration is not the most suitable to provide and manage health care for people in court.”
Calcedo-Barba points out that this situation creates differences and inequalities in the specialized mental health treatment of people in prison.
“The models of Catalonia, Navarra and the Basque Country serve as a reference and previous experience to plan and adjust the good practices adopted”, underlines the expert.
The report also analyzes in detail the international differences.
Infographic of the White Paper on health care for people with severe mental disorders in prisons in Spain.
Profile of people with SMI in prisons
People with a SMI who go to prison are generally young males (between 18 and 30 years old), without financial resources nor stable residence and with psychotic disorders. In addition, they are usually repeat offenders.
Women entering a prison with a TMG represent 7.5% of the total of the
Internal persons in Spain.
During prison admission, it is common for their mental health to deteriorate with pictures of anxiety, depression and disorders related to phobias.
In the case of minors who enter prison with a TMG, their conflicting behavior and their difficulty of adaptation to the prison.
The report highlights in particular how most vulnerable subgroups: women, unaccompanied foreign minors and people with attention deficit hyperactivity disorder.
Doctor Joaquín Antón Basanta and Doctor Alfredo Calcedo-Barba at the presentation of the White Paper on Health Care for People with Serious Mental Disorders in Penitentiary Centers in Spain.
High needs for mental health care in prisons
Joaquín Antón Basanta and Alfredo Calcedo-Barba agree that inmates have high mental health care needs that the ordinary penitentiary centers of the CCAAs are not capable of assuming.
The white paper reflects that most of the mental care needs of prisoners are taken on by prison doctors not specialized in psychiatry.
From a psychiatric point of view, dual pathology (associating a mental disorder with a disorder
for substance abuse) and psychotic disorders son the most common diagnoses.” , says Calcedo-Barba.
In addition, the doctor explains that substance use makes it difficult and delays the diagnosis of a dual pathology in the prison environment. The diagnosis of a psychotic disorder it is more complex and is done later.
Some significant and relevant data from the White Paper, presented by the SEPL and the SESPare the figures that show that people suffering from schizophrenia or other psychoses have the twice as likely to be jailed than patients with other diagnoses, and people with a psychiatric disorder who come out of prison have up to ten times more likely to be jaileds again.
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