Panel calls for improved psychiatric care in African prisons

Sub-Saharan African nations can improve behavioral healthcare in their prisons by implementing low-cost treatments known to be effective, an expert panel concludes in a new report.

“We don’t need to start testing new interventions,” said first author Dr. Helen Jack, assistant professor of medicine at the University of Washington School of Medicine. “We need to start thinking about how we implement what we already know works: screening people who are incarcerated for mental health and substance-use disorders and providing appropriate psychosocial care and medication to those in need of care.”

The report appeared April 15 in the journal The Lancet Psychiatry.

Many of the 1.3 million people incarcerated in African prisons have mental health conditions and substance-use disorders, but most sub-Saharan prisons currently have limited treatment resources, the report said.

The report represents the consensus of 97 participants with extensive experience in sub-Saharan African prison mental healthcare. The panel included providers and patients.

“Having involved people with lived experience was central to the process — from defining priorities to guiding dissemination — ensuring that our recommendations will have real-world relevance and impact,” said Charlene Sunkel, chief executive officer of Global Mental Health Peer Network, a patient-advocacy group based in South Africa.

After a 10-month process of developing consensus priorities, the experts identified 38 challenges that they recommend should guide investment in behavioral health in prisons in Sub-Saharan Africa.

The top five priority challenges identified were:

• The need to screen and diagnose people upon entry into prison.
• Need for alternatives to incarceration for youngsters and other vulnerable people, including those with mental health conditions.
• Need for attention to the unique needs of incarcerated women.
• Need for attention to the needs of people with severe mental health issues, such as psychosis, who are incarcerated.
• Need for adequate access to psychotropic medications in prisons.

Governments and nongovernmental agencies should begin by investing in the delivery of basic behavioral health services during incarceration, and ensuring that former prisoners continue to receive care in the community after release, the panel said.

Other priorities included involving people outside of the health workforce, such as prison officers, wardens and judicial system personnel, in supporting behavioral healthcare for incarcerated people, improving the often deplorable prison conditions, and updating policies and legislation to align with international human rights standards.

Dr. Adegboyega Ogunwale, chief consultant psychiatrist at the Neuropsychiatric Hospital in Nigeria, underscored the need to enlist existing prison healthcare personnel in these reform efforts.

“Given limited human resources in African prison settings, task-shifting of mental healthcare to trained nonspecialist healthcare personnel in prisons will improve mental health service efficiency,” he said.

Dr. Murugi Micheni, director of epidemiology and strategy at the National Syndemic Diseases Control Council in Kenya and a co-author of the paper, said developing mental health services in communities will make it possible to provide more effective care for many individuals with mental health problems who otherwise might go to prison.

“By investing in community-based care and rehabilitation, we can offer more appropriate responses that protect public safety, uphold human dignity, and promote better long-term outcomes for both individuals and society,” Micheni said.

Support for the project came from U.S. National Institute on Drug Abuse and National Institute of Mental Health (K23MH129420).

Written by Michael McCarthy.
 

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