Individual and environmental contributors to psychological distress during imprisonment

Published date01 May 2024
AuthorLouis Favril,Esther F.J.C. van Ginneken
Date01 May 2024
Subject MatterArticles
Individual and environmental
contributors to psychological
distress during imprisonment
Louis Favril
Ghent University, Belgium
Esther F.J.C. van Ginneken
Leiden University, the Netherlands
People in prison bear a higher burden of psychiatric morbidity compared with the general popu-
lation. This study examined the extent to which individual and environmental factors contribute to
poor mental health during imprisonment. Participants comprised 1296 randomly selected adults in
15 Belgian prisons. Psychological distress was more common in women than men and peaked dur-
ing the early stages of imprisonment. In addition to having a history of mental disorder, low levels
of perceived autonomy, safety, and social support were independently associated with experien-
cing distress. These f‌indings underscore the importance of considering the prison environment
in policies to improve the mental health of incarcerated individuals.
Prison, mental health, importation, deprivation
Mental disorders are a leading contributor to the global burden of disease (Ferrari et al.,
2022) and disproportionately affect people who come into contact with the criminal
justice system (Hensel et al., 2020). Epidemiological evidence consistently indicates a sub-
stantially higher prevalence of mental disorders and psychological distress among people in
prison compared with the general adult population (e.g., Baranyi et al., 2019; Bronson and
Berzofsky, 2017; Butler et al., 2006; Fovet et al., 2020). One in seven prisoners worldwide
has a severe mental illness (Fazel and Seewald, 2012), with data suggesting an increase in
their mental health needs over the past decade (Browne et al., 2023; Butler et al., 2022).
Corresponding author:
Louis Favril, Ghent University, Universiteitstraat 4, 9000 Ghent, Belgium.
European Journal of Criminology
2024, Vol. 21(3) 350369
© The Author(s) 2023
Article reuse guidelines:
DOI: 10.1177/14773708231201726
Although women only comprise a small proportion (7%) of the global prison population
(Fair and Walmsley, 2022), research shows that female prisoners bear a higher burden of
psychiatric morbidity compared with their male peers (Binswanger et al., 2010; Browne
et al., 2023; Svendsen et al., 2023; Tyler et al., 2019). This high prevalence is a cause for
concern since men and women who experience poor mental health in prison are at increased
risk of a conf‌luence of adverse outcomes including violence, victimisation, and self-harm
while in custody (Favril et al., 2020b; Fazel et al., 2016) as well as reoffending and prema-
ture mortality after release into the community (Chang et al., 2015; Forsyth et al., 2018).
Consequently, addressing the mental health needs of people in prison is likely to contribute
to improvements in both public health and safety, which in turn will confer economic ben-
ef‌its for society at large (Favril and Dirkzwager, 2019; WHO, 2019). Knowledge on the
determinants of mental health during imprisonment is key to inform service provision
and correctional policy.
In contrast to the hundreds of prevalence studies that have been conducted to date (Fazel
et al., 2016), comparatively little is known about what individual and environmental factors
may contribute to poor mental health in prisoners. The extent to w hich mental health during
imprisonment is inf‌luenced by prisonersbackground characteristics or by aspects of the
prison environment has been a matter of long-standing debate, which is essentially rooted
within two main paradigms (Armour, 2012; Favril, 2021; Fedock, 2017).
On the one hand, the importation model posits that background characteristics and
past experiences of people who enter prison determine their subsequent adaptation to
imprisonment (Irwin and Cressey, 1962). Incarcerated individuals disproportionately
come from disadvantaged backgrounds, whose life trajectories are commonly charac-
terised by social exclusion, poverty, unstable housing, low educational attainment, and
abuse (Friestad, 2010; Kouyoumdjian et al., 2016; Stewart et al., 2018). These drivers
of criminal justice involvement overlap to a large degree with the social determinants
of mental health (Caruso, 2017; Marmot, 2018; WHO, 2022). Indeed, the boundary
between prison and the outside community appears to be particularly permeable to
people who suffer from poor mental health (Moore et al., 2019; Stevens et al., 2015).
From this perspective, then, the high prevalence of mental health conditions in prisoners
is a ref‌lection of the complex health needs and pre-existing morbidity that they import
into prison typically set against a backdrop of social disadvantage. Supporting this
premise, research indicates that socioeconomic disadvantage, traumatic life events, and
pre-prison morbidity are associated with mental health symptoms during imprisonment
(Baidawi, 2016; Bowler et al., 2018; Dean and Korobanova, 2018; Edgemon and
Clay-Warner, 2019; Goncalves et al., 2016; Liebling and Ludlow, 2016). These vulner-
ability factors not only increase the likelihood of offending and subsequent incarceration
but might also predispose people to experiencing poor mental health once incarcerated.
On the other hand, the deprivation model emphasises that adaptation to life in prison is
shaped by the institutional context and related pains of imprisonment(Sykes, 1958).
Specif‌ically, this model argues that poor mental health during imprisonment is mainly
a consequence of the depriving and stressful environment in which people are detained.
In support of this model, evidence shows that certain characteristics of the prison envir-
onment negatively affect prisonersmental health, including a lack of purposeful activity,
poor social support, low levels of autonomy and safety, in-prison victimisation, and
Favril and van Ginneken 351

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