Worldwide more than 10.35 million people are currently being held in penal institutions and the global prison population rate is increasing. Mental illness is especially prevalent in prison populations, by far exceeding the rate of mental disorders in the general population (Fazel et al, 2008). Prisoners are also a high-risk group for suicide and self-harm: suicide rates in prisons are up to ten times higher than those in the general population. A recent UNODC report suggests that suicide among prisoners seems more frequent in Europe compared to other regions, with suicide rates among prisoners accounting for over 13% of all deaths in prison. In Norway, inmate suicide rates are 8 times higher, and in Portugal rates rise up to 14 times higher than the general population rates of suicide.
While prison psycho-social treatment and healthcare have improved in the last decades, mental health care is minimal except for those with the severest problems. In fact, only a small proportion of all mental disorders prevalent in prison populations is diagnosed at all.
These mental health issues are exacerbated with age: over 20% of adults aged 60 and over suffer from a mental or neurological disorder (WHO, 2015). As the world’s population ages rapidly, so too the number of the elderly in jails and prisons is increasing at an exponential rate: at a rate 3 times that of the general prison population.
The graying prison population poses new and costly challenges that the correctional system is not adequately prepared to address. First, the stressful conditions of prison confinement are associated with an accelerated aging process, with prisoners’ health status generally considered to be equivalent to that of people 10 years older in the general population (Maschi et al., 2013). Further, these inmates present special health and mental health needs: compared to their counterparts in the community, they have a greater incidence of chronic disease, disability, and mental health issues (Fazel et al., 2002).
Studies also show that the prison environment is not suitable for many of the older, disabled and chronically ill men (Fletcher et al., 2013). The Committee on Legal Affairs and Human Rights published recently a report addressing barriers in access to adequate health care for “critically ill” detainees, including unavailability of trained and independent medical staff in prison settings.
MenACE project aims to increase the response to mental health disorders within prisons and the quality of palliative and end of life care services provided by enhancing the competences of management and frontline staff to address prisoners’ mental health needs and the special needs of older prisoners.