Mental health problems prevalent among SA's female inmates

Mental illness among female inmates in SA is rife but the psychological services provided by the government are inadequate and failing to meet the mental healthcare needs of these inmates.

This is according to a study conducted by the Commission for Gender Equality in 2017 which found that mental health problems are prevalent in female Correctional Centres and that female inmates face challenges with regards to accessing the relevant mental health services.

The findings also indicate that the specific mental health needs of female inmates are not taken into consideration by the department of correctional services.

“Furthermore‚ the fact that there are not enough mental health professionals within the correctional centres is another challenge‚ as the situation delays mental health intervention for those inmates who need urgent attention. It is also evident that training and development with respect to the provision of mental health services is not prioritised by the department‚” the study found.

The commission tabled its report titled Raising Issues of Mental Health Care for Female Inmates in South Africa dated July 2018 in Parliament on Monday.

The report is based on a study conducted in three female correctional centres - Johannesburg Female Correctional Centre‚ Pollsmoor Female Correctional Centre and Bizzah Makhate Female Correctional Centre in Kroonstad.

The commission explained that its study was based on the qualitative approach‚ as the focus was on people’s lived experiences within their original comfort spaces. The participants who were targeted for in-depth interviews included social workers‚ psychologists‚ psychiatrists‚ nurses‚ doctors‚ correctional centre managers and officials in the national department of correctional services health directorate.

The team also conducted focus group discussions with wardens and female inmates separately at each of the centres studied.

It found that training and capacity building of centre officials was fragmented‚ with training prioritised only at one of the three centres‚ while the training needs of professionals in the other two appeared to be neglected.

The World Health Organisation estimates that about 40% of all deaths in South African prisons are due to suicide‚ making suicide the primary cause of unnatural death among prisoners. In 2017‚ of the 52 reported deaths by the Department of Correctional Services‚ 24 deaths were caused by suicides (15 suicide hangings‚ 7 medication overdoses‚ 2 poisonous substances)‚ reads the report.

The commission's study found that mental health problems were prevalent among female inmates and that depression was a commonly diagnosed mental illness. It also revealed that inmates that were mothers could not cope with being separated from their children‚ particularly if the inmate was the primary caregiver prior to incarceration.

“The mothers were constantly concerned about the welfare of their children and the concern grew worse in cases where children were moved to the care of unreliable relatives and friends‚” it said.

Isolation from families was cited as another factor that led to depression. The women felt that they were missing out on important family milestones and being denied the opportunity to attend funerals of close family and friends also contributed to the problem‚ it found.

Other family problems included divorce‚ separation and spousal problems‚ with the women believing that their imprisonment was the primary reason for the breakdown in relationships.

The study found that another factor that was linked to depression in female correctional centres was the actual imprisonment.

In its report‚ the commission said informants revealed that the mere fact of being convicted as a criminal affected the mental well-being of female inmates as they would experience extreme shock and shame as a result of being perceived as delinquents by their families and communities.

“It was clear that the shame emanating from the status of being an incarcerated woman stemmed from the widespread gender stereotypes that predominantly associate criminal behaviour with men‚ thus making it taboo for a woman to bear the status of being a convicted criminal.”

Substance abuse and addiction was a significant finding in Pollsmoor Centre in the Western Cape. Although the abuse of substances is generally more pronounced among men than women‚ informants revealed that a number of female inmates had a history of substance abuse and were mainly using drugs to escape from the daily realities of poverty and other socio-economic challenges.

Some of the inmates also revealed to researchers that substance abuse was one of their coping strategies and were thus disgruntled that they could not even access cigarettes‚ since the use of tobacco was banned from the centre.

Informants also reported that many of the female inmates had experienced several traumatic events in their lifetime‚ such as growing up in dysfunctional families‚ living in extreme poverty‚ witnessing violence‚ and suffering intimate partner violence and sexual abuse.

“In fact‚ the clinical psychologist from the Pollsmoor Centre revealed that the majority of cases that were presented to her were associated with childhood trauma that was never diagnosed or dealt with accordingly.

“She reported that many of the inmates had no access to psychological services in their communities prior to incarceration‚ hence most of their mental health problems were only dealt with during their time in prison‚” the research found.

It also found that each centre had a clinical psychologist based on site but the availability of psychologists did not necessarily translate into actual accessibility of psychological services for inmates. This situation was worse for inmates in Johannesburg and Bizzah Makhate centres‚ who reported that they were not even aware of the presence of clinical psychologists at the centres.

Inmates from Pollsmoor‚ on the other hand‚ could access the onsite psychologist‚ and found her services to be helpful.

Due to overcrowding‚ however‚ the system was congested‚ which resulted in long waiting periods and inability by inmates to report severe depression and suicidal thoughts as they happened.

Johannesburg and Pollsmoor Centres were allocated three and one psychologists respectively‚ while the psychologist at Bizzah Makhate had to rotate across 14 centres in the management area.

This effectively meant that three psychologists at the Johannesburg Centre were expected to render services to a centre population of 698 inmates (at the time the study was conducted); while one psychologist was expected to attend to 637 inmates at Pollsmoor and 189 inmates Centres at Bizzah Makhate Centre‚ as well as inmates from 13 other centres.

The commission found that this proportion of psychologists per inmate population compromised the quality of services rendered to inmates. Psychologists struggled to have follow-up sessions and immediately attend to emergency cases.

The commission recommended that the department of correctional services' social workers based at its centres should create links between families of the inmates and community based social workers who offer services related to the welfare of children and families as part of the inmates’ psychosocial interventions.

The commission also recommends that the department improve mental health services in correctional centres by increasing the number of designated Mental Health Professionals within each centre‚ so as to increase inmates’ interactions with them.

There is also an urgent need for the training of the correctional service officials to promote efficiency when dealing with the mental health needs of the female inmates.