‘Gatekeeper Model’ to Prevent Suicides in Prisons

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Recently, the NIMHANS issued detailed guidelines to deal with mental health challenges of inmates and staff.

About

• In a bid to prevent suicides triggered by mental health issues in prisons across the country, the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, has recommended the “Gatekeeper Model”.
• NIMHANS is acting on the request of the Ministry of Home Affairs (MHA).

Gatekeeper Model

• Gatekeepers:
  • Gatekeepers are existing people who are in close contact with the prisoners and can provide help for the prisoners. 
  • They could be other convicted prisoners, prison staff who will be able to identify and support prisoners needing psychological help. 
  • People having a psychological problem or at risk of suicide can access the gatekeeper, who can bridge the gap between them and the professional services. This is of particular benefit in at-risk suicidal prisoners.
• Objective:
  • In this model, selected inmates, trained to identify prisoners at risk of suicide, would refer them to treatment or supportive services. 
• Case Study:
  • Referring to the Bangalore Prison Mental Health Study, the advisory pointed to the prevalence of mental illness and substance use disorder in about 80% of the prison population.

Buddy system

• The concept of a ‘Buddy System’ — social support through trained prisoners called “buddies” or “listeners” — was found to have a good impact on the well-being of suicidal prisoners. 
• Periodic telephone conversations with friends and family would also foster support
• e-Mulakat:
  • It is a part of implementation of ePrisons initiatives which had several modules, including e-Mulakat.
  • It is an online platform enabling relatives/friends/ advocates of prisoners to book prior appointments for interviewing prisoners through the National Prisons Information Portal. 
  • This was in addition to the video/voice call facility through mobile phones/telephone booths.

Mental Health Issues in Prisoners

• Increased risk of self harm
• Curtailed provision of health services due to logistic barriers
• Suspension of trials and delay in court hearings
• Uncertainty about the course of the trial
• Reduced contact with loved ones due to restrictions
• lack of physical distancing
• Identification of mental illness in prisoners

Actions Taken by the Government

• Telemedicine Guidelines:
  • During the COVID-19 pandemic, patients are discouraged from travelling and visiting a hospital unless it is an emergency or for treatment for COVID-19 illness. This includes patients in prisons as well. 
  • In this background, the Ministry of Health and Family Welfare, along with
  • NITI Aayog released the “telemedicine guidelines” in the country and have provided a statutory status for the practice of telemedicine. 
  • This had led to the development of “Telepsychiatry Operational Guidelines 2020” that can be referred to while implementing the telepsychiatry services in the respective establishments. 
• Mental health care Act 2017:
  • It specifically deals with Minimum standards and procedures for mental health care services in prisons
  • Some of the provisions are:
    • Screening of all inmates during the time of entry to prison including the following:
      • Mandatory physical and mental status examination
      • Questionnaire screening for substance use
      • Urine testing for common drugs of abuse
      • Periodic random urine drug testing
    • Identification of persons with serious mental illness and proper treatment and follow-up for this
    • group.
    • Ensuring the availability of minimum psychiatric medication in the prison to facilitate prompt
    • treatment (Antipsychotic medication, antidepressant medication, anxiolytic medication, mood
    • stabilizers, anticonvulsant medication, etc).
    • Availability of psycho-social interventions for prisoners with a range of mental health problems.
    • Protocols for dealing with prisoners with suicidal risk, with behavioural problems and crises related to mental illnesses as well as to prison life.
  • Various other provisions are also being worked upon to better the mental health conditions of inmates and staff of Prison.

Suggestions to reduce Mental Health Issues

• At prison level:
  • Mental health awareness for prisoners: Administrators/supervisors should PROMOTE awareness about Mental Health andStress through organizing awareness classes, stress management workshops, etc
  • Communication: Ensuring to keep up to date with the State Government guidelines. Keeping the prisoners informed about COVID-19 and following safety measures to prevent infection. Allowing prisoners to communicate with their family and friends at regular intervals over the telephone.
  • Support during times of distress: Staff should be alert to signs of prisoners undergoing an emotional crisis and in need of extra support – following, for example, disturbing news from their families related to COVID 19 and management should ensure that such support is provided.
• At individual level:
  • Self- Care: Self-care includes those activities to promote our emotional, physical, relational, and spiritual/religious wellness
  • Exercise

Sources: TH