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Making prison mental health a priority: Addressing the challenges in sub-Saharan Africa

Dr Helen Jack

Assistant Professor at the University of Washington and Visiting Lecturer at the IoPPN

09 May 2025

Nearly three-quarters of the world’s incarcerated population are in low- and middle-income countries (LMICs). In Africa alone, more than 1.3 million people are incarcerated, many of whom experience mental health and substance use disorders. Despite this, prison mental health remains a neglected issue. It receives little attention from African governments or international donor organisations, and prison mental health is often absent from international mental health guidelines, including the World Health Organization’s mhGAP Intervention Guide.

Prisons across the region often lack even basic mental health services. Most incarcerated people receive little or no care, and in many cases, what care is available falls far short of acceptable standards. Although support for mental health care has gained public attention outside of prisons, research and funding for mental health research and interventions is still lacking in prisons.

To address this gap, our team of researchers from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, University of Washington and an Advisory Board of physicians, lawyers, researchers and people with lived experience from around sub-Saharan Africa, have been working to better understand the mental health landscape in prisons across the region.

In 2019, we conducted a systematic review of studies on mental health and substance use disorders in African prisons. Of the 80 studies reviewed, two-thirds focused on documenting the unsurprisingly high prevalence of these conditions, but only three studies investigated interventions. Since then, while many new prevalence studies have been published, there has been no new research on interventions, leaving a critical gap in both research and policy.

Due to poor assessment procedures and limited treatment availability in African carceral settings, opportunities for effective intervention in new/hidden cases of mental illness and substance use disorder are missed. This has implications for psychiatric morbidity as well as adverse outcomes such as suicidal behaviour and violence victimisation among offenders with mental and substance use disorders.– Dr Adegboyega Ogunwale, PhD student at King’s College London and Nigerian forensic psychiatrist

Given this gap in research and practice, where do we begin?

In a new study published in The Lancet Psychiatry in April 2025, we set out to identify the most pressing priorities to address mental health and substance use disorders in prisons across sub-Saharan Africa.

Using the Delphi method – a structured approach to build a consensus through multiple rounds of opinions and feedback – we consulted 97 participants working in 23 sub-Saharan African countries. These included doctors, researchers, lawyers and advocates, 47 per cent of whom had personal or caregiving experience with mental health conditions, substance use disorders or incarceration.

Over four rounds of consultation, the group identified 38 priority challenges to improve mental health in prisons. These could be grouped into several themes, including:

Improving prison infrastructure
Implementing basic mental health care (screening, diagnosis, medication and psychological treatments)
Strengthening the clinical and non-clinical workforce.

All 38 priorities can be found in our Lancet Psychiatry publication.

The priority challenges are important because they confirm that countries across sub-Saharan Africa are experiencing similar concrete system challenges. They highlight the importance of collaboration between different disciplines such as law and psychiatry to craft a workable plan to improve the current state of mental health provision in prison.– Dr Letitia Pienaar, Associate Professor of Law at University of South Africa and a Delphi Advisory Board member

What’s next?

Ms Charlene Sunkel, CEO of the Global Mental Health Peer Network (GMHPN) and Delphi Advisory Board Member, will host a webinar on Thursday 15 May at 15:00 BST to discuss the Delphi findings and next steps for improving prison mental health.

Speakers include:

Dr Adegboyega Ogunwale, PhD Student at the IoPPN
Sandra Ferreira, Global Network Manager at GMHPN
Dr Dainius Puras, Professor at Vilnius University and former UN Special Rapporteur on mental health rights
Dr Helen Jack, Physician and Assistant Professor at the University of Washington and Visiting Lecturer at the IoPPN.