All posts by markcherrie

Mental health problems are common among prisoners in low-income and middle-income countries

In a major international review, we found very high rates of psychiatric and substance use disorders among prisoners in low-income and middle-income countries. The results from the systematic review and meta-analysis published in Lancet Global Health showed that the prevalence of psychosis, depression, and drug and alcohol use disorders is much higher in this marginalised population in comparison to the community, pointing to unmet needs and calling for action in research and policy.

Mental health and substance use problems are common among individuals involved in the criminal justice system. Incarcerated men and women often come from disadvantaged socioeconomic and family background, and frequently have a life history of victimisation and substance use, making them more vulnerable to mental health problems. While in prison, they often remain undiagnosed and untreated. Prisoners with unmet mental health needs have higher mortality, especially by suicide, and greater risk of recidivism and reoffending after release in the community, leading to multiple imprisonments.

Although 70% of the worldwide prison population are residing in low-income and middle-income countries (LMIC), almost all scientific evidence is coming from studies conducted in high-income countries. It is an important limitation as recommendations from a mostly Western context might not be applicable or generalizable to poorly resourced settings. Prison conditions in LMICs are usually very harsh, characterised by overcrowding, poor nutrition, and sanitation, and limited or complete lack of access to basic health care. To provide evidence for future research and policy making, we conducted a systematic review and meta-analysis on prison prevalence studies in LMICs.

After screening 6000 titles and abstracts from 17 electronic global databases, we identified 23 relevant publications based on 14,527 prisoners from 13 different LMICs. Considering a one year time interval, approximately 6.2% of the prisoners had psychosis, 16.0% major depression, 3.8% alcohol use disorders, and 5.1% drug use disorders. To illustrate the immense burden of mental health problems, we quantified the difference between the prevalence among prisoners in each sample and in the sex-matched general populations of the respective countries. Prevalence rates among prisoners were 16 times higher for psychosis, 6 times higher for major depression and illicit drug use disorder prevalence, and twice as high for alcohol use disorders, indicating a significant public health concern and large unmet health care needs in this marginalised group. Moreover, rates in prison populations of LMICs might be even higher than in high-income countries.

Based on our findings, we presented several implications and recommendations for research and policy.

  1. While a review from 2012 on prison mental health in high-income countries identified over 100 samples, we were able to find only 23 studies from a much larger and diverse group of countries. There is a need further evidence from LMICs to adequately plan interventions for prisoners with mental disorders, especially from regions underrepresented in research such as Central and East Asia, and Central America.
  2. Because correctional facilities in LMICs often lack basic health care, the implementation of cost-effective interventions and scalable treatments for individuals with mental health problems is crucial.
  3. Imprisonment could present an opportunity to treat people with mental health and substance use problems who otherwise would be difficult to reach for health services. National governments in LMICs should move the responsibility for prison health care from prison administrations to the national health services.
  4. Since human right violations, and physical and psychological abuse are more common in resource-poor correctional settings, increasing mental health literacy among staff and protecting the rights and health of people with mental illnesses should be a priority for penal justice policies.

The invited comment on our paper gives a valuable and very practical recommendation on how to improve mental health services in correctional facilities. Training prison health workers by mental health professionals using the WHO’s Intervention Guide for mental disorders (mhGAP-IG), could be a cost-effective and valuable programme for addressing the treatment gap among prisoners in LMICs and coming closer to the Sustainable Development Goals declared by the United Nations.

By Gergo Baranyi, PhD Student in Human Geography and Marie Sklodowska-Curie Early Stage Researcher, The University of Edinburgh

Hard Times: Mental Health under Austerity event

How important for mental health are the changing social, economic and environmental conditions in the places where we live? Our research, funded by ESRC, addresses this question through a new and innovative study of mental health of people living in different parts of Scotland. We are focussing especially on the period since 2007 when economic recession and austerity have impacted to a varying extent across the country. This event will use interactive data visualisations to present our research findings, showing how audience polling techniques allow the participants to select topics of special interest for them, to help determine in ‘real time’ the focus of the results presented. This will be combined with an opportunity for group discussion and exchange of ideas among diverse participants, many of whom will be involved in mental health care and promotion of better mental health. We will be sharing new evidence and discussing the implications for policy and practice in different parts of Scotland. The event is also intended to help shape the future research agenda.

FREE to attend. Registration via Eventbrite. Refreshments provided.


The Melting Pot, 5 Rose Street, Edinburgh, EH2 2PR

Update 21/12/18

We had a really productive day on the 7th of November, thanks to the helpful and encouraging input from all the attendees. Please feel free to download and share the Powerpoint slides. We have collated the information gathered using Mentimeter and transcribed the written notes. The report which features a discussion on how these findings relate to the wider project is now available to download.



How does the availability of green space throughout life affect cognitive ageing?

New research has found that a greater provision of parks in childhood and adulthood may help to slow down cognitive decline in later life. Published in Social, Science and Medicine, the CRESH team demonstrated how the availability of public parks throughout life affected cognitive ageing.

Cognitive ageing describes how our mental skills change over time. As we get older our mental skills, used for activities such as following directions or reading a map, deteriorate, which can lead to a reduction in quality of life and general health. Everyone experiences these declines differently and to a certain degree this is due to the places where you have lived. Features of the urban environment such as parks can provide opportunities for social interaction and physical activity, which can build resilience to change, a concept called ‘cognitive reserve’.

We considered whether there were critical times during life (e.g. childhood or older age) when the availability of local parks mattered most. We used data collected from a cohort of people all born in 1936 (the Lothian Birth Cohort 1936). We asked the participants to provide information on their addresses throughout their lives. Using some historical data we then worked out the amount of parks near to where they lived at each stage of life. We had two key findings.

We found a link between park availability in childhood and adulthood and cognitive test scores. Greater provision in both childhood and adulthood predicted better change in cognitive test scores between age 70 and 76. The argument for a link between the experiences of green spaces in childhood and adulthood has previously been described as the ‘childhood factor’. The ‘childhood factor’ describes how our experiences of green spaces in childhood shape our attitudes and patterns of use in adulthood, and possibly our health in later life. What we have found is that the ‘childhood factor’ may be the key to unlocking the potential benefit of green spaces on how we age.

We also found that this benefit might be felt most by certain groups of people. In addition to the lifestyle factors mentioned earlier, there are demographic, genetic and socioeconomic determinants of cognitive ageing. We found that women, those without an APOE e4 allele (a genetic risk factor for dementia) and those in a lower socioeconomic group benefited the most (in terms of cognitive ageing) from having good access to a park. Finding stronger relationships amongst lower socioeconomic groups may be explained by greater time spent in parks closer to home which would act to boost the potential benefits that come with better availability. This finding is similar to some earlier work by the CRESH team which found that environments can be ‘equigenic’ – or assist in reducing health inequalities.

The findings from this new work suggest that not only can greener places improve cognitive ageing and reduce inequalities but that the influence of access to high quality green spaces in childhood through to adulthood – particularly access to parks – can have life-long benefits.