Behind bars: Exploring mental health challenges in incarcerationNOVEMBER 3, 2023
Mental health and mental disorder are often viewed as two distinct states, yet the boundaries between them are not always clear-cut. The impact of addiction, the prevalence of co-occurring disorders, and the repercussions of incarceration on mental well-being all contribute to the intricate web of challenges individuals face.
"Mental health is not merely the absence of mental disorders; it encompasses a state of well-being that enables individuals to cope with life's stresses, realize their full potential, and contribute to their communities. Conversely, mental disorders are diagnosable conditions that disrupt emotions, cognition, and behaviors, causing distress and impairing functioning," said Ashwin Thind, Clinical Psychologist while delivering his talk 'Incarceration and the Mental Health Impact on Prisoners' at the Human Rights, Prison Health and Drug Policy Reform hybrid event by Clinical School Johor Bahru, Monash University Malaysia. Addiction as a chronic disease Addiction, as described by the National Institute of Drug Abuse (NIDA), is a chronic, relapsing brain disease characterized by compulsive drug seeking and use despite negative consequences. Ashwin emphasized that addiction leads to structural changes in the brain, making it a chronic but manageable condition, akin to diabetes and hypertension, with a relapse rate of 40-60%. Comparing relapse rates between substance use disorders and other chronic illnesses reveals the pervasive nature of addiction. While substance use disorders exhibit a relapse rate of 40-60%, hypertension and asthma patients face relapse rates ranging from 50-70%. Prevalence of co-occurring disorders The prevalence of co-occurring disorders further complicates the landscape of mental health and substance use. Approximately 45% of individuals with a substance use disorder also experience at least one mental disorder, as reported by the United Nations Office on Drugs and Crime (UNODC). The World Drug Report 2020 highlighted that 750 million people live with a mental disorder, while over 35.6 million individuals aged 15 and above who use substances may have a substance use disorder. The impact of incarceration on mental health cannot be understated. Surviving in a prison environment becomes a priority, leading to additional trauma, isolation, disconnection from family and society, loss of autonomy, and a sense of purposelessness. Post-incarceration syndrome, characterized by the absorption of institutional personality traits, contributes to the revolving door phenomenon, where individuals experience multiple incarcerations. Overcrowding in prisons, psychological distress, and the perpetuation of stigma further exacerbate the mental health challenges faced by incarcerated individuals. Incarceration and substance use Incarceration and substance use are deeply intertwined, with only 10% of people who use drugs developing an addiction, as reported by UNODC. In Malaysia, 60% of incarcerated individuals are serving time for non-violent minor drug offenses, highlighting the disproportionate impact of drug-related policies on the prison population. Misconceptions about people who use drugs, lack of treatment availability in prisons, and the perpetuation of stigma all hinder the recovery process and reduce help-seeking behavior. Recovery from mental health and substance use disorders is a multifaceted journey, encompassing four dimensions: health, home, purpose, and community. Additionally, the eight dimensions of wellness - emotional, financial, social, spiritual, occupational, physical, intellectual, and environmental - provide a comprehensive framework for achieving holistic well-being. Evidence-based approaches, including multidisciplinary interventions, pharmacotherapy, family therapies, and community-based treatments, offer pathways to recovery. Embracing a recovery-oriented, collaborative, and patient-centered approach that addresses mental disorders and substance use disorders simultaneously is crucial. Voluntary treatment has been shown to yield better outcomes, emphasizing the importance of empowering individuals in their recovery journey and improving their quality of life. |
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