The Brewing Mental Health Crisis In Indian Prisons

Bengaluru: Despite housing one of the world’s largest prison populations--a majority of them undertrials, and from marginalised communities--India has few comprehensive data on mental health conditions behind bars. The limited official data already point to a severe crisis, but experts and independent studies say the reality is far worse.

As per the last Prison Statistics India report published by the National Crime Records Bureau (NCRB), 119 prisoners died by suicide in 2022. That is a suicide rate of 20.8 per 100,000 prisoners, 67% higher than the national average among general population. An analysis of Prison Statistics India reports from 2014 to 2022 revealed:

• At least 9,084 of 573,220 prisoners in 2022--that is, 1.6% prisoners--reported mental illness. By 2023, this number rose to 16,503 prisoners, according to the Supreme Court’s Centre for Research and Planning.
• Suicide accounted for about 80% of unnatural deaths--779 out of 980--in prisons between 2017 and 2022.
• Two in three sanctioned posts for psychologists and psychiatrists in prisons were vacant in 2022--the highest since 2016. The year 2018 was the only year where more than 50% posts were filled.
• Only nine women psychologists and psychiatrists were employed in prisons in 2022, six of whom were in Tamil Nadu.

Experts told IndiaSpend that mental illness is more widespread among prisoners than NCRB data suggest. Inadequate evaluation, due to resource constraints and lack of training, also prevents effective monitoring, auditing, and assessment of the extent of mental health issues and care required.

Legal research think-tank Pacta’s July 2025 report also pointed out that the absence of updated data on mental illness and other disabilities in the Indian prison system acts as a barrier to meaningful reform.

Why govt data are underestimates

Several studies indicate that mental health issues in prisons far exceed official numbers. A 2021 handbook published by National Institute of Mental Health and Neurosciences (NIMHANS) to address mental health issues in prisoners during Covid-19 cited multiple studies conducted between 2011 and 2014, showing that the prevalence of mental illness in various state prisons ranged from 23.8% to 82%--at least 10 times higher than the official prison data for 2022.

Uttar Pradesh had the largest share of inmates with mental illness, at 23%. Kerala and Odisha followed, each accounting for 9% of prisoners with mental illness.

“The prevalence of mental illness is much higher than shown in NCRB prison data,” said Vijay Raghavan, professor at the Centre for Criminology and Justice, Tata Institute of Social Sciences, Mumbai.

“At least two-thirds of people in jails have anxiety, hopelessness, depression,” Sanjeev Jain, emeritus professor at the Department of Psychiatry, Molecular Genetics Laboratory at NIMHANS Bengaluru, told IndiaSpend. “But we do not know if it is due to the prison environment, or because psychiatric evaluation at the time of conviction is not done. There is no baseline data.

“Often, young prisoners come from disturbed personal lives, face social exclusion, and may not show clear signs of mental illness at the time of their brush with the law,” he added.

A 2011 study by NIMHANS found that Bengaluru Central Jail had only one psychiatrist for more than 5,000 inmates. It said according to the MINI criteria, 4,002 prisoners or 79.6% could be diagnosed with either a mental illness or substance use disorder.

Even after excluding substance abuse, more than one in four inmates had a diagnosable mental disorder. About 12.7% had a lifetime history of major depressive episodes, and 9.1% had a current episode--twice the rate seen in the general population.

The study also reported that two out of every 100 inmates had attempted suicide, and more than seven per 100 had deliberately self-harmed. It said, “Considering that only 2% of the prison population self-reported any mental illness, it can be understood that a systematic assessment improves identification of diagnosable mental disorder by 14 times.”

A Telangana prison official who wanted to remain anonymous also contested the state’s official figure of 2% of inmates with mental illness, which is the same as the national prison average. He told IndiaSpend that the actual number is likely much higher, with many inmates on medication and more severe cases referred to mental health institutions.

The official said that the state prison administration relies on volunteer counsellors from civil society organisations, and new entrants are often unwilling to share mental health issues due to mistrust, while only the more severe cases are identified and treated. “If the prison medical staff provided these services, it would ensure continuity and help build trust with inmates.”

The UN Standard Minimum Rules For The Treatment Of Prisoners, or the Nelson Mandela Rules (Rule 30), also recommend that prisoners must be screened for healthcare issues and needs, including psychological or other stress, at the time of their admission in jails.

1 mental health worker for every 23,000 prisoners

In 1,330 prisons across the country, holding over 570,000 inmates, only 25 psychiatrists or psychologists were employed in 2022--one for about 23,000 inmates.

In the same year, 25 of 36 states and Union Territories in India had not sanctioned a single post for psychologists or psychiatrists. Among them were Uttar Pradesh, Bihar and Madhya Pradesh--which house over 40% of the prison population and have occupancy rates above the national average.

In 30 member states of the European Union that reported figures to the Health in Prisons European Database, there were 1.4 psychiatrists for every 1,000 prisoners. In contrast, based on 2022 prison data, India had just 0.05 psychiatrists per 1,000 prisoners.

This also falls short of the 2016 Model Prison Manual issued by the Ministry of Home Affairs, which recommends at least one psychologist or counsellor for every 500 prisoners. But the manual only provides guidance and is not binding on the states that govern prisons.

The Mental Healthcare Act 2017, however, mandates that at a minimum, the state governments must train medical officers in public healthcare establishments and prisons “to provide basic and emergency mental healthcare”. It says that a mental health establishment must be set up in the medical wing of at least one prison in every state.

A June 2023 advisory issued by the National Human Rights Commission (NHRC) urged governments to fill existing vacancies and increase staff strength; train prison personnel in mental health, including refresher courses every three years; screen and monitor at-risk prisoners; and implement a Gatekeeper model, in which select inmates are trained to identify and refer those at risk.

Every jail is supposed to have a psychologist and psychiatrist, but these positions almost never get filled, said Jain of NIMHANS. Raghavan of TISS said if psychiatrist posts remain vacant, states should at least hire social workers or counsellors on contract to focus on preventive mental healthcare.

But most states don’t have any meaningful mental health screening or periodic assessments in prison, said Maitreyi Misra, Director, Mental Health and Criminal Justice, The Square Circle Clinic, NALSAR University of Law, Hyderabad. “There’s a health pro forma which is administered to prisoners at the time of their entry into prisons which has one generic question regarding mental health.”

Misra added that the prisons she had visited and had knowledge of had not implemented the NHRC guidelines. “The guidelines themselves are also not sufficient because they’re too vague and not sure how much of the guidelines are backed by evidence. Even where the guidelines may be implemented, I am not sure their effectiveness is being reviewed. We simply don’t have policies for effective suicide prevention.”

According to the Supreme Court’s Centre for Research and Planning report, prison departments responded in “affirmative that the initial health screening of the newly admitted prisoners includes mental health screening”. But there were variations in the way states screened. In most of Odisha’s jails, screening of new inmates is done by a clinical psychologist and psychiatric social worker, while in Gujarat, Puducherry, Jharkhand, Madhya Pradesh, Chhattisgarh, new inmates are “behaviourally examined” by the jail medical officer.

Kerala, Jammu & Kashmir and Manipur reported that although health screening was done for new jail admissions, there was no standard procedure of mental health screening of the newly admitted prisoner.

The report also showed health screening in most states is done by the medical officer. Except for Odisha, Telangana, Karnataka, Manipur and in a few jails in Nagaland, they were not given any training to provide basic and emergency mental healthcare, which was in contravention to Section 31(2) of Mental Healthcare Act, 2017

Record-keeping, peer networks in jails

The Model Prisons And Correctional Services Act, 2023 for managing prisons, which was shared with the state governments by the Union home ministry in May 2023, provides for the transfer of prisoners to mental healthcare institutions after the permission of the Mental Health Review Board.

But the India Justice Report 2025 noted that only six states and one UT--Assam, Haryana, Karnataka. Meghalaya, Nagaland, Odisha, and Ladakh--mandate prisons to maintain a record of mentally ill inmates.

With gaps in the state mental health system, some prisons have turned to peer networks. Initiatives such as Unnati in Telangana and Samarth in Gujarat prisons focus on bringing cognitive behavioural change in inmates through peer counselling.

Speaking to IndiaSpend, the Telangana prison official said that while a proper mental health evaluation process has not been established in the state, psychiatrists from district hospitals visit for weekly screening of prisoners and civil society organisations help train inmates and staff to identify those at risk. Despite that, some cues may not be visible.

IndiaSpend has reached out to the Ministry of Home Affairs for comments on its initiatives to address the mental health crisis in prisons, including data collection, monitoring, suicide prevention, and prisoner screening. We will update this story when we receive a response.

Of the 9,084 prisoners with mental illness reported in Prison Statistics India 2022, about 63%, were undertrials. While convicts see a higher prevalence of mental illness, the uncertainty and immediate stress on undertrials makes them particularly vulnerable. A World Health Organization report on Prisons and Health notes that detainees held on remand, particularly those subjected to restrictions such as solitary confinement, are more vulnerable.

Misra of The Square Circle Clinic said, “Despite the high proportion of undertrials in India, and research showing that undertrial prisoners, particularly new entrants, are much more likely to attempt suicide than those convicted, there are no policies or interventions to address the unique problems they face.”

Women prisoners have little to no basic infrastructure, support

Another vulnerable group in prisons are women. Although their numbers are much lower--23,772 women were behind bars in 2022--the jail conditions, especially for those with children, make them more susceptible to mental health issues, as IndiaSpend reported.

Vijay Raghavan of TISS told IndiaSpend that lower socio-economic status, abandonment, isolation, loss of access to children, and the loss of a social role in traditional societies severely impact imprisoned women’s mental health.

The 2016 Model Prison Manual recommends that at least one woman psychiatrist be appointed in every prison--meaning at least 34 women psychiatrists, one for each 34 women’s jails across 16 states. But only nine were employed nationwide in 2022, six of whom were in Tamil Nadu.

The United Nations Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders (Bangkok Rules) states that gender-specific healthcare services, at least equivalent to those available in the community, should be provided to women prisoners.

Mental health crisis plagues prisons worldwide

A 2024 study led by the University of Oxford--compiling, reviewing and analysing data and major studies from over 50 high, medium and low-income countries--found that prisons had “high rates of depression and post-traumatic stress disorder, or PTSD, as well as substance use and alcohol use disorders”.

The study noted that 11.4% of prisoners had depression, compared to 6-8% in the general population. Additionally, 9.8% had PTSD and 3.7% had a psychotic disorder--at least double the rate found in the general population.

In the United States, according to the 2021 Bureau of Justice Statistics data, more than 6,200 local jail inmates died by suicide between 2000 and 2019. Suicide deaths in jails increased by 13% over this 20-year period. More than three-quarters of those who died by suicide were “unconvicted and awaiting adjudication of their current charge”.

What is keeping the crisis brewing?

“Earlier, the civil system of medicine coordinated with the judicial and legal system, but now they are separate services,” said Jain of NIMHANS, explaining that “now a doctor who joins the jail service does not have to see others outside the system, unlike before. Medical college, civil hospital, community health staff are all separate leading to a lack of avenues of growth of medical professionals and inadequate incentives.”

Raghavan, who also heads Prayas, a TISS initiative focused on criminal justice, pointed to multiple stressors--lack of family support, socio-economic conditions, and routine prison operations like jhadti (inspection) or alarm bajna during emergencies such as escape attempts. “These can be extremely stressful.”

In addition, uncertainty and limited legal resources, particularly among those from marginalised groups, significantly impact inmates’ mental health, said Kaustubh Joag, co-director and senior research fellow at the Centre for Mental Health Law and Policy, Indian Law Society, Pune.

Joag, a psychiatrist who has assessed death row prisoners in distress, said that prisons often have “hierarchies which lead to discrimination and bullying, adding to the distress” and “suicidal ideation can exist even without depression, and may be triggered impulsively”.

Besides the need for sensitisation around mental health, Joag emphasised the importance of care beyond the biomedical approach. He said basic infrastructure is crucial for wellbeing, including sanitation, food, recreational facilities, and occupational activities.

The 2011 NIMHANS review of mental health in prisons said: “Prison health is often neglected and continues to be ignored despite accumulating objective evidence supporting the need for rational health policies in prisons…politicians, policy makers, bureaucrats and community leaders have ignored this area, citing various reasons such as ‘prisoners need not be treated’, ‘let them suffer’, insufficient funds, non-availability of trained manpower.”

If you are feeling suicidal or struggling with your mental health, help is at hand. Please reach out to a mental health professional or contact a helpline near you.

Ashwin Sreekumar, an intern at IndiaSpend, assisted with the data.

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