We know that conditions behind bars—from overcrowding to poor nutrition to medical neglect—lead to adverse health outcomes for incarcerated people. But the impact of incarceration on health extends far beyond the millions of people behind bars—it affects families, corrections staff, entire communities, and public health at large. Mass incarceration is not just a criminal justice issue—it is a public health crisis.

Compared to the general population, incarcerated people experience higher rates of chronic medical conditions, such as asthma, hepatitis B, hepatitis C, and HIV/AIDS. Mental health conditions, including depression, anxiety, and substance use disorders, are also common. Incarceration often exacerbates these health conditions—or leads to new ones. For example, people who have been incarcerated are more likely to develop cardiovascular disease at younger ages and have worse outcomes compared to the general population. Research shows the stark impact of incarceration on how long one lives: each year spent in prison is associated with a two-year decline in life expectancy.

Corrections professionals also experience poor health outcomes because of harsh prison conditions. They have rates of post-traumatic stress disorder comparable to those of returning veterans of war and more than double the suicide rate of police officers. Low pay, long hours, insufficient training, and minimal emotional support make hiring and retaining staff a challenge, ultimately affecting the care and programming available within prisons.

The toll on families

The impact that incarceration has on public health is not contained within correctional facilities. First, people with loved ones behind bars face worsened health outcomes. In particular, the incarceration of a loved one has profound consequences for women’s health—both mental and physical. Women with partners who are incarcerated are more likely to experience hypertension, diabetes, heart attack, and stroke.

And the impact of having a parent who is incarcerated is also, unsurprisingly, wide-ranging. Research links parental incarceration with an increased risk of mental health conditions and substance use disorders, with potential long-term risks into adulthood. In fact, one study found that parental incarceration is more detrimental to children’s physical and behavioral health and well-being than divorce or the death of a parent.

Overall, having an incarcerated family member is linked to a decrease in life expectancy—by 2.6 years, according to one study, and by 4.6 years for people who have had three or more immediate family members held behind bars.

Community health, both physical and mental, suffers

Mass incarceration also impacts the health of communities broadly—a fact that was made brutally evident during the COVID-19 pandemic, as jails and prisons became breeding grounds for the virus.

“Substantial epidemiological research shows that mass incarceration raises contagion rates for infectious disease—both for people in jails, and for the community at large,” researchers Sandhya Kajeepeta and Seth J. Prins wrote in the Appeal. Evaluating data from 1987 to 2016, they found that increases in a county’s jail incarceration rate were associated with subsequent increases in county mortality rates.

Jails are revolving doors, with more than 7.6 million jail admissions each year. People may return to their communities after spending days, weeks, months, or years incarcerated, making it clear how the effects of inadequate health care in jails can extend far beyond, contributing to serious public health consequences for entire communities.

People living in communities with high rates of imprisonment are at higher risk of mental health conditions, such as anxiety and depression, and other health issues than those who do not. Incarceration degrades social ties and increases chronic stress, harming the health of entire neighborhoods. And across all of these studies, it’s evident that negative health outcomes disproportionately impact Black people—reflecting the disparities prevalent within the criminal legal system.

The impact of immigration detention

Conditions within immigration detention facilities mirror prison conditions in the United States more broadly, and the Trump administration’s mass detention and deportation plans only serve to make things worse for both people held in immigration detention and their loved ones. People have been warehoused in increasingly overcrowded detention facilities, sent to the detention camp at Guantanamo Bay, deported and imprisoned in El Salvador, and separated from loved ones—with dire mental and physical health consequences for both adults and children. Again, these policies are detrimental to the health and well-being of millions of people.

Research spanning decades makes it clear that what happens within jail cells and prison walls affects us all. A system ostensibly designed to keep us safe is actually harming incarcerated people, their families, corrections staff, entire communities, and the broader public. We are no safer or healthier for it.

Not only do we need to improve health care inside carceral facilities, but we also need to ensure continuity of care after people leave jail and prison. This means investing in robust public health services and community-based alternatives to incarceration, including accessible substance use treatment and comprehensive mental health care services. But ultimately, we need approaches to public safety that keep people out of jail and prison in the first place. Our collective well-being depends on it.

In Australia, the number of young people held in detention facilities increased by 8% (from 784 to 845) between the June quarter of 2023 and the June quarter of 2024.

But what if some of these young people were treated and helped, rather than incarcerated? A series of recently published studies examining mental health in the youth justice population suggests treatment would be more beneficial than punitive measures – some of which may even promote persistent offending.

Increased incarceration

New South Wales saw a 31% increase in young people in detention between 2023 and 2024.

Increases in youth detention numbers have also been reported in Queensland, the Australian Capital Territory, Tasmania and South Australia over the same period.

About 60% of young people in detention are First Nations youth.

Custody as a catalyst

Young people in the justice system have significantly higher rates of mental ill-health and adverse childhood experiences than their peers in the general population.

However, less clear is how involvement in the justice system, particularly custody, affects the severity and trajectory of these mental health issues over time.

Our team examined how exposure to the justice system affected mental health among young people in NSW. We analysed administrative health and justice data over two years post-supervision.

These data came from more than 1,500 justice-involved youth who participated in the Young People in Custody Health Survey in 2003, 2009 and 2015 and Young People on Community Orders Health Survey between 2003 and 2006.

We found young people who had spent time in custody faced markedly higher rates of subsequent psychiatric hospitalisation compared with those supervised in the community.

The risk of psychiatric hospitalisations was higher for those with multiple custody episodes. This demonstrates the significant negative impact of incarceration on the mental health of young people long after they are released.

We also examined how the impact of custody on psychiatric hospitalisations differed by age.

We found psychiatric hospitalisation rates were similar among youth aged 14–17 years who had been supervised in the community, compared with those aged 18 and older.

However, youth aged 14–17 who were placed in custody were hospitalised at significantly higher rates than their older peers aged 18 and above.

This suggests incarceration is particularly harmful for younger offenders.

How does this affect crime?

When we examined the long-term consequences of youth detention on subsequent offending, we found conviction during adolescence, especially before the age of 14, significantly increased the likelihood of later entering the adult prison system.

Those who were incarcerated during adolescence faced a fivefold increase in the risk of being incarcerated as an adult, compared with young people who’d never been in custody.

This suggests it may be beneficial to delay the involvement of young people in the justice system to help prevent repeat offending in the future.

Breaking the cycle

So what can be done to help?

In NSW, laws allow young people with mental health conditions to be diverted from judicial processes into treatment. Such laws for young people also exist in other states, although specific models vary.

While research shows those diverted into treatment have a lower risk of reoffending, less than half of eligible youth receive this option.

How do we help those who miss out? Our studies examined whether going to mental health services voluntarily (without a court order) could help reduce recidivism.

Among boys who had been in custody, we found they were 40% less likely to reoffend if they received mental health treatment after release than those who did not receive such treatment.

A similar, but larger, benefit was observed among boys supervised in the community. There, mental health treatment was associated with a 57% reduction in reoffending risk.

Evidence-based reform

Evidence shows punitive measures do not deter youth crime, but instead are likely to perpetuate cycles of offending into adulthood.

Policymakers should reimagine youth justice to protect young people and create real pathways to rehabilitation.

Raising the minimum age of criminal responsibility to delay the onset of formal contact with the justice system aligns with developmental science and prevents early criminalisation of young people.

Enhancing routine mental health screening in the justice system and expanding access to diversion programs is warranted.

Our findings on the benefits of routine mental health treatment highlight the potential for more integrated approaches. When combined with wraparound services for health and education, they could be even more effective.

As detaining a young person costs around $1 million annually, mental health treatment-based approaches make sound financial sense too.

Emaediong I. Akpanekpo, PhD Candidate, School of Population Health, UNSW Sydney and Tony Butler, Professor and Program Head, Justice Health Research Program, UNSW Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

According to the Prison Policy Initiative, 10.6 million people go to jail and 600,000 people enter prison in the United States each year. Many justice-involved individuals have pre-existing mental health issues. And some individuals who were considered mentally healthy before their arrest develop mental health symptoms once they are in prison.

Being in prison can take a serious toll on an individual’s psychological well-being. New conditions often develop, and pre-existing conditions may worsen. Sadly, many justice-involved individuals are released back into the community without ever receiving any treatment.

Keep reading to learn more about the potential psychological and emotional costs of being imprisoned and why this is not just a problem for individuals but for society as a whole.

Mental Health Concerns Among Incarcerated Individuals

According to a 2018 report by the National Academies of Sciences, Engineering, and Medicine, 44% of incarcerated individuals have been told by a mental health professional that they have a mental health condition. In state prisons, 73% of women and 55% of men have a mental health problem.

Substance abuse is also highly prevalent among incarcerated individuals. Quite often, mental health issues and substance abuse issues occur alongside one another.

Increased incarceration rates in the United States have disproportionately affected racial and ethnic minority populations. As of 2021, 38.5% of incarcerated individuals are Black, and 30% are Hispanic.

The American Psychological Association estimates that between 10% and 25% of incarcerated individuals have a “serious mental illness,” such as schizophrenia. According to the National Institute of Mental Health (NIMH), in the general population, it’s estimated that about 6% of individuals have a serious mental illness.

Many other incarcerated individuals may experience depressive disorders, anxiety disorders, or PTSD. For some, these issues may be pre-existing conditions. For others, the problems may have started after their incarcerations.

Quite often, disorders go unrecognized by people in prison and prison staff. The response of individuals with mental health issues to the prison system may seem like a “normal” reaction to an institutionalized setting; this assumption prevents any type of acknowledgement of the problem, letting people with mental health issues suffer in silence.

Black individuals are more likely to be incarcerated before trial, to fare worse in plea agreements that might have otherwise kept them out of prison, to receive the death penalty, and to be arrested and charged with drug crimes.

While some people feel that increasing the number of people behind bars keeps communities safer, the statistics don’t necessarily show a decrease in crime. The Sentencing Project suggests there is a weak relationship between increased incarceration and decreased crime.

The Toll Prison Takes on Psychological Well-Being

Incarceration takes a serious toll on mental health for several reasons:

Loss of Purpose

People can experience a loss of purpose when they’re locked up. Prisons are not obligated to pay their occupants a minimum wage for labor, and they can charge high fees for phone calls with families.

It can be difficult for a justice-involved person to contribute to their family’s financial or emotional needs. A perceived lack of purpose in life can take a serious toll on anyone’s psychological well-being.

Loss of Identity

When someone is incarcerated, they are no longer known for their profession, such as being a musician or a delivery driver. They also aren’t known for their skills, talents, or knowledge. The loss of a sense of self can be quite disorienting, confusing, and troublesome.

Separation From Loved Ones

They can no longer be with their friends and families. Missing their loved ones and not being part of their daily lives increases feelings of isolation and loneliness.

Additionally, they can’t be there for their loved ones, so they may worry about those they can’t support, such as an elderly family member. They may also experience a lot of grief over missing out on a child’s activities or not being able to be there for a partner.

Physical Environment Adds to Stress

Concrete walls, little natural light, and a lack of overall stimulation can take a serious toll on mental health. People in prison have few ways to relieve stress. And their sterile environment is likely to fuel boredom, which can be quite stressful in itself.

Research shows the environment even takes a toll on the prison staff. Frequent staff shortages can mean individuals don’t get out of their cells as often, which can add even more stress to their daily lives. This can create a cycle of stress that is tough to break.

Exposure to Violence

Incarcerated individuals are often exposed to violence while behind bars. They may witness fights breaking out at meal times or during recreation times. They may also witness acts of violence between guards and incarcerated peers, or they may become victims of aggression.

Research shows that exposure to violence while in prison creates emotional distress. In addition, exposure to violence has a direct impact on how well individuals adjust to life outside of prison after they’re released.

People who are exposed to greater acts of violence while they are incarcerated are more likely to have trouble settling back into the community.

Solitary Confinement

Whether individuals are placed in solitary confinement due to disciplinary issues or they’re segregated because of a safety issue, being locked up alone for 23 hours a day can take a serious toll on a person’s well-being.

For years, the American Civil Liberties Union (ACLU) and other organizations have sought to have solitary confinement banned as a human rights violation, but the practice is still fairly common in the U.S.

Researchers have found that the vast majority of individuals who are placed in solitary confinement have “serious mental illness.” These conditions may be why they exhibited behavioral issues in the first place. Solitary confinement can exacerbate symptoms.

But others are likely to develop mental health issues as a result of the extreme isolation. Studies show solitary confinement increases the risk of anxiety, insomnia, paranoia, aggression, and depression.

Lack of Treatment

Even when mental health concerns are known, disorders often go untreated. Most prisons lack the funds to offer adequate mental health treatment. Those who do offer services of some kind may be limited in the types of treatments they provide.

Additionally, services in prison may not be all that effective. It’s tough for individuals to open up to someone when they lack physical and psychological safety.

Many incarcerated people may not be given proper medication either, even if they were taking medication to help with a condition at the time they were admitted to prison.

Older research found that 26% of inmates were diagnosed with a mental health condition at some point during their lives. Only about 18% of them were taking medication for their condition when they became incarcerated. Of those who were taking medication, less than 50% were prescribed medication during their admission.

More recent research found that 38.4% of people living in prison received some type of behavioral treatment while only 7.1% received any type of treatment for substance use and mental health problems.

Although courts mandate adequate treatment for mental health care, treatment is usually reserved for diagnoses that are considered the most serious. Medications are often expensive, and quite often, to save costs, prescriptions are not made readily available.

Specialized treatment is rarely available in prisons. And generic groups or services may not be able to assist with specific conditions. Additionally, most prisons do not provide adequate access to treatment providers.

So, incarcerated individuals’ conditions often go unrecognized. Quite often, inmates are given simple screening questionnaires to complete at intake. They aren’t assessed by a mental health professional at all and likely never come into contact with one throughout their time in prison.

Consequences of Inadequate Treatment

The consequences of inadequate mental health care contribute greatly to the suffering of the affected individuals and their families. Untreated psychiatric conditions among the prison population even takes a toll on society financially, in the form of taxpayers’ money.

Untreated psychiatric conditions may increase the risk of recidivism. Justice-involved people who have serious mental health issues are 29.7% more likely to return to prison at least once.

A 2020 study looked at the rates of recidivism among individuals who were released from prison. Those who reported poor mental health in prison were more likely to recidivate than those who had average mental health during their sentence. The rates of recidivism were between 33% and 68% higher for people with poor in-prison mental health than for their peers.

State Hospital Closures

Since the 1970s, there has been a big push toward the deinstitutionalization of individuals with mental health issues. On the surface, closing “asylums” and institutions that housed people with severe psychiatric conditions seemed like a good idea. Many of the institutions were understaffed and unable to give patients the individual treatments they needed.

Closing the doors to psychiatric hospitals and other long-term institutions, however, has had serious consequences. The community mental health centers intended to replace long-term institutions quickly lost their government funding, leaving a gap in the social safety net. The lack of long-term treatment options contributed to a major increase in incarcerations.

Rather than reside in a state-run hospital, many individuals with mental health issues now spend much of their time in jail.

According to research conducted by The Treatment Advocacy Center, the number of individuals with “serious mental illness” is now 10 times higher in jails than in state psychiatric hospitals.

Takeaways

Anyone who is facing incarceration should consider revealing any pre-existing mental health conditions. Disclosing those issues may increase the likelihood of accessing treatment.

But bigger changes are needed at the systemic and legal levels. Better access to mental health services overall may prevent crime. Treating people during incarceration and providing access to ongoing treatment after they’re released may reduce recidivism rates.

For up to four hours at a time, William Buhl attentively monitors a person who is on suicide watch at Nash Correctional Institution — a medium custody prison in Nashville. Buhl sits at a table outside a cell with a direct view of his subject. He observes their behavior, records notes every 15 minutes and offers an open ear.

He’s there as a peer observer — a fellow incarcerated person who has been screened and trained to observe and engage with people in mental distress and on suicide watch.

It’s a duty Buhl and other peer observers said they don’t take lightly. The objective is to keep people alive and see them improve.

“Lives are important, and they’re valuable,” Buhl said. “Somebody out there loves us.”

Prison officials launched the Peer Observer Program as a suicide prevention strategy recommended by the department’s Suicide Prevention and Self-Directed Violence Workgroup. The group convened after a spike in suicides in 2018, when 11 people died in custody — up from six the year before.

Buhl became one of the North Carolina prison system’s first peer observers in November 2019 as part of the program’s pilot at Mountain View Correctional Institution, a medium security prison in Mitchell County.

He was motivated to take part because, about a year before, he lost a friend to suicide. Someone, he said, who was more like a brother.

(From left to right) Noah White, William Buhl and Brandon Blakeney serve as peer observers at Nash Correctional Institution. They spoke with NC Health News about their experiences serving in the role and the impact of the program. Credit: Rachel Crumpler / NC Health News

Buhl, who has been incarcerated for nearly 20 years, can better relate to the struggles in prison that may contribute to mental deterioration: separation from family, the toll of long sentences, and interpersonal conflicts within cell blocks. His shared lived experience often means the people he observes are more likely to open up to him.

“Another inmate will talk to another inmate quicker, a lot of time, than they will staff, especially when they realize that we’re wearing the same clothes they are,” Buhl said.

In 2024, peer observers worked 5,356 hours conducting suicide watches, according to Department of Adult Correction data provided to NC Health News.

Lewis Peiper, chief of behavioral health at the Department of Adult Correction who led the workgroup, said they learned about using peers to help monitor people on suicide watch from Gary Junker, the head of behavioral health at the time. Junker had helped implement a peer observer program at the federal prison in Butner when he worked there.

“They found that not only is there benefit to staff — for the staff not sitting on the watch — but it improved the experience of the watch for the people involved,” Peiper said. “Sometimes a person in a uniform within a prison population, they can be seen almost as an adversary … Having a peer, it can kind of just lower the tenor.”

A 2005 peer-reviewed evaluation paper on the federal peer observer program called it a “win-win solution.” The researchers found people spent less time on suicide watch when watched by another incarcerated person without compromising the standard of care. The researchers also found that observers themselves felt personal gain from being able to help.

Modeled after the federal program, Peiper said the use of peer observers in North Carolina prisons has so far been effective. A March 2022 cost-benefit analysis report by the North Carolina Division of Prisons’ Innovation Institute recommended expanding the program, which has slowly spread to 72 peer observers serving across five prisons.

“It’s simple, yet it works,” Peiper said. “It has an impact on the environment and the experience of suicide watches on the individuals and on the prison.

“There’s something powerful about when you bring folks in and have them trained into a role,” he said. “It’s a trusted role. It’s got guardrails on it for safety purposes, but they become great ambassadors for mental health. And they can have a reach well beyond what a licensed psychologist might be able to have on their own.”

What do peer observers do?

People in prison have disproportionately higher rates of mental illness than the general population, and they have higher rates of self-harm.

In 2024, 13 people in North Carolina prisons died by suicide — tying the record for most suicides in a year. In addition, 2,941 self-harm incidents occurred that required a self-injury risk assessment, according to department data provided to NC Health News. Of those, 32 percent included some type of action, such as cutting or burning oneself with scalding water, while the other 68 percent made written or verbal threats.

Peiper said the prison system’s policy is to place people deemed suicidal under “constant observation,” where they are placed in a cell with line-of-sight visibility for an observer and given items, such as a safety blanket, safety smock and vinyl-covered mattress — all tear-resistant.

Generally, a correctional officer provides the observation. It’s time-intensive to monitor someone closely 24/7 — and that’s made more difficult by chronic staff shortages at the Department of Adult Correction.

Department Secretary Leslie Cooley Dismukes told state lawmakers during her May 14 confirmation hearing that the correctional officer vacancy rate is near 40 percent, and the shortage is a “direct threat to public safety.”

At the five prisons that have peer observer programs, the majority of the observation is performed by these trained peers, which frees up staff time.

Although peer observation was not created as a solution to short staffing, Peiper said it’s a particularly valuable benefit when correctional staff are sorely needed in multiple locations at once. Peer observers do still require supervision, he noted, but not as much as people on suicide watch. Operating a peer observer program also requires additional behavioral health resources.

Christine Tartaro, a researcher at Stockton University in New Jersey who has studied correctional suicide for over 25 years and assessed the landscape of prison peer observer programs, said that prisons often struggle to have adequate resources for mental health care. It’s particularly a challenge to meet the need as the proportion of people with mental illness in prison increases — including in North Carolina, where about one-quarter of the total prison population (or about 8,000 people) has a mental health diagnosis that requires treatment.

Tartaro said it makes sense for prisons to use a resource they have in abundance: people who are incarcerated.

Incarcerated people interested in becoming peer observers are carefully screened and undergo interviews. In particular, Peiper said, they look for candidates who are working on their own individual rehabilitation and aren’t actively having their own mental health issues.

Once selected, peers undertake an initial four-hour training focused on understanding the job requirements, suicide prevention and strategies on how to handle situations that may present. They receive ongoing training and debriefings, as they serve in the role, to enhance their knowledge and skills as well as address any secondary trauma from what they might witness, he said.

When watching someone on suicide watch, peer observers can serve up to four hours in a 24-hour period.

“The observers are not there to be counselors, but they do have some basic conversations, and they’re taught in the training kind of how to be supportive but to not step into the role of being a counselor,” Peiper said.

Correctional officers still circulate regularly, and a behavioral health clinician meets with the incarcerated person daily to assess their mental health and whether they can return to their regular housing unit.

Tartaro cautioned that incarcerated peers should not be a substitute for mental health staff. Instead they should act as a supplementary set of eyes or source of social support.

“Allowing the incarcerated to supplement doesn’t all of a sudden mean that we back away and say, ‘Okay, well now the staff don’t need to do anything,’” Tartaro said.

Peer connection

Brandon Blakeney, who has been a peer observer since mid-2023 — first at Mountain View and now at Nash Correctional — still remembers his first observation. The man on suicide watch came to the door to talk to him and said he had never been on self-injurious behavior precautions before and was scared, having never felt so low.

“I got goosebumps a few times when the guy was discussing with me about his past history and the events that led up to him feeling like he wanted to end it,” Blakeney said. “I related to him because I have had some of those same experiences.

“Just hearing him discuss what was affecting him in such a way gave me a much deeper appreciation for all of the things that guys go through in prison,” Blakeney continued. “If you spent an hour in prison just as a fly on the wall, you’d see a lot of masking, a lot of, I guess, what we call ‘perpetrating the fraud’ because you’re not necessarily expressing who you really are or what you feel.

“When you’re in those vulnerable moments that are so rare, you just appreciate life,” he continued. “The impact of me being able to be there when someone is contemplating ending their life, I can’t measure it.”

Compared to having a staff member there, having a peer on suicide watch changes the dynamic, Blakeney said.

“He realizes that somebody’s actually paying attention to him that cares and wants to see if he’s okay,” Blakeney explained. “That changes people’s perspective, too, because there are a lot of guys in prison who don’t have any support — and just a friendly four hours does the world for people.”

During his four years working as a peer observer, Buhl said he’s seen how the presence of peers can help someone improve — though some take longer than others. For example, Buhl recalled one man on suicide watch that he and other peer observers watched for 30 days. When Buhl ran into him later in a medication line, the man came over and hugged and thanked him.

“That was reward enough for him to say he appreciated it,” Buhl said. “This was a guy that went through a lot of stuff, like 26 surgeries, over trying to harm himself. It said a whole lot to everyone on the team that he thought that much of us.”

Prison staff can also see how peers make a difference. Peiper said that Mountain View Correctional’s warden was initially skeptical about implementation of the peer observer program, but now is sold. For example, when Mountain View reopened in January after being closed for several months after Hurricane Helene tore through western North Carolina, Peiper said the staff there was intent on getting the peer observer program running again.

Impact beyond suicide watch

The impact of peer observers extends beyond suicide watch. Peer observers and prison staff alike told NC Health News that the role creates more openness around mental health in prison.

The peer observers are sought out daily by the prison population to discuss various issues.

“They point us out on the yard and then approach us,” Blakeney said. “We could be going to chow or just going from one place to the next, and somebody might pull up and say, ‘Hey man, I’d like to speak with you about something.’ It’s always an opportunity for a door to be open, is what being a peer observer is like.”

A guard tower at Nash Correctional Institution, a medium custody prison in Nashville. The prison can house up to 654 incarcerated men. Credit: Rachel Crumpler / NC Health News

The peer observers also find a sense of purpose from their role — for which they receive no pay.

“To me, it’s a very important program to be able to help another inmate and say, ‘Hey, I’m here for you,’” Buhl said. “I give up that rec time. I give up canteen time. I give up my time that I can watch a movie or spend time doing whatever to go back there to sit those four hours and push everything aside — because somebody needs help.”

Blakeney said serving as peer observers also helps the observers themselves. He said he joined the program at the “perfect moment” when things in his life outside of his control were “hardening his heart.”

Being a peer observer, he said, has made him a better person and father because he’s now in tune with more things beyond himself.

“You get to see the impact you can have on somebody that just needs somebody to be near them. Not even conversation — just your presence sometimes is enough,” Blakeney said. “It’s just one of those things that opened up my life.”

Involving peers Other prisons around the country have incorporated peers into their suicide prevention efforts. The Federal Bureau of Prisons and at least 15 state departments of correction have written policies around the use of incarerated people as components of their suicide prevention programs, according to a 2023 study in the Journal of Correctional Health Care. Robert Cramer, a UNC Charlotte researcher who studies suicide and has worked with the N.C. Department of Adult Correction on suicide prevention efforts, said that using peers is innovative and in line with a public health approach driven by the notion that anyone can help with suicide prevention. “A lot of public health programs are really oriented toward, how do you get laypersons to be able to, in some way, engage in supportive conversations and get the person in distress to help?” Cramer explained. Peiper said the Department of Adult Correction will keep empowering peers to support the mental health of those in its facilities, including with the launch of peer support specialist roles. The goal is to have the first group of incarcerated people in these jobs this fall, he said. “The ultimate goal is to have [peer observers] be integrated in a broader and statewide peer-supported model within behavioral health services across all of our facilities,” Peiper said.

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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.