Mental Health and Healthcare Provision in Zambian Correctional Facilities

Abstract

Objective: The aim was to determine the prevalence of Axis- I disorders, mental health problems and mental health care service provisions in Zambian correctional facilities

Study sample: 240 inmates were interviewed using the Mini International Neuro-psychiatric interview (MINI), the Warwick-Edinburgh Mental Well-being scale (WEMWBS) and demographic questionnaire

Research Design: This was a cross-section point prevalence

Control or comparison condition: Inmates were statistically compared to each other based on the correctional facility security levels.

Results: The prevalence for current Axis- I disorders was 46.2%. Combined (current and past) prevalence was 63.3%. Major depressive episode current was the most prevalent 47 (19.6%), Psychotic disorder current 38 (15.8%), Psychotic disorder lifetime 18 (7.5%), Major depressive episode past 17 (7%), substance dependency current and Posttraumatic disorder at 14 (5.8%), Manic episode current 5 (2.1%) and the rest below 2% respectively. Total number of inmates with suicide risks was 49 out of 240 (20.4%). Out of 49, 20 (40.8%) had high- risk suicidality levels, 8(16.3%) had moderate suicidality risk- levels and 21(42.9%) had low suicidality risk- levels. Medium had the highest prevalence rate of inmates at risk of suicide 31(63.3%). Out of 31, 17(54.8%) had low risk, 6(19.4%) moderate and 8(25.8%) high-risk levels respectively.  The second highest was maximum 18(20%): out of 18, 4 (22.2%) had low risk, 2(11.1%) had moderate and 12(66.7%) high- risk levels. Maximum had the highest number of inmates who were found with high-risk 12(66.7%) of suicidal ideations and attempts followed by medium 8 (25.8%) and minimum did not register any inmates with suicide risks. There was a positive and significant relationship between suicidality risk levels and the type of correctional facility. Inmates in maximum correctional facility were more likely to have suicidal ideations and attempts than their counterparts in both.

 There was high current substance dependency in medium correctional facility with 11% distribution compared to maximum correctional facility 3%. Current substance abuse was 2% for both maximum and medium respectively. Only 1% in medium had current alcohol abuse and dependency. The prevalence of substance abuse represents the count of substance abuse and not the number of inmates because some inmates abused one or more substances.

Mental Well-being

 Minimum (50.7) ,Medium (63.2) and Maximum (37.4) respectively

Conclusion: Socio-epidemiological assessment found a high prevalence of Axis- I disorders and mental health problems compared to the general population. The low prevalence of substance abuse was largely due to the inmates’ limited access to substance in the correctional facilities. There was total absence of mental health care services in all the three correctional facilities.