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The new global analysis found those in prison had high rates of depression and post-traumatic stress disorder (PTSD), as well as substance use and alcohol use disorders. Infectious diseases were also common.
In a paper published in The Lancet Public Health journal, the authors compiled and reviewed previous major studies into prison health in more than 50 high, medium and low-income countries, which included data from more than two million people in prison.
The data indicated members of the prison population globally had a range of complex and often overlapping physical and mental health conditions, including:
- 11.4% had depression, as compared to 6-8% in the general population
- 9.8% had PTSD and 3.7% had a psychotic disorder (also at least double the rate in the general population)
- Nearly one in four (23.8%) had an alcohol use disorder and 38.9 per cent had a drug use disorder on entry to prison
- 17% had Hepatitis C with prevalence of Hepatitis B, HIV and tuberculosis in excess of community-based people, and significant rates of sexually transmitted infections (including gonorrhoea, chlamydia and syphilis).
The authors are calling for better health provision for prisoners, which they say will have longer term benefits for wider society.
Professor Seena Fazel, senior author and Professor of Forensic Psychiatry at the University of Oxford, said:
“Our findings indicate that incarcerated persons across the world consistently experience poor health across a wide range of mental and physical conditions. Yet, even in high-income settings, considerable variation exists in the quality and availability of prison health care.
“Given almost all people in prison will be released at some point, improving their health during imprisonment has the potential to improve the health of the communities to which they will return.
“For example, evidence-based treatment of mental illness and substance misuse will also contribute to public safety by decreasing rates of reoffending, which has economic benefits too.
“Many people in prison are young adults, and have complex physical and mental health needs, so this provides an important opportunity to address and treat them, which can positively impact public health, safety, and society as a whole.”
The authors say national governments should develop and implement strategies to meet the complex health needs of people in prisons.
Professor Fazel adds: “With mental health in particular, services need to be adequately resourced and linked with evidence-based interventions to address the high level of unmet need in prison populations. Adequately resourcing primary care is also key.”
Around 11 million people are in prison worldwide on any given day. The paper acknowledges the challenge of identifying the extent to which imprisonment can be both a cause and consequence of ill health, and the authors advocate for further research in this area.
The authors have also highlighted the drawbacks of the global study, given national differences in prison populations, justice policies and the way data is gathered and interpreted.