50% of youth in juvenile justice centers and 80% of incarcerated women require immediate mental health care

50% of young people entering juvenile justice centers and 80% of incarcerated women require immediate mental health care. And in this context, thesuccess in attentionto people with mental disorders in the prison environment depends fundamentally on theeffective collaboration between the justice system, health services and the community. This is one of the main resolutions of the 1st Conference on Mental Health in the Penitentiary, which took place yesterday and today at the Sant Joan de Déu Health Park, under the title Building bridges towards comprehensive care.

For two days, professionals from various fields addressed issues such as the dignification of prison stays, community reintegration, suicide prevention, the gender perspective and intervention with adolescents. In all these cases they have agreed on the need for a model centered on the person, which considers their life trajectory and their social context.

In Catalonia, in 2024, 2,202 adolescents were registered with behaviors that required intervention from the judicial system. 8% of the total number of young people who entered Juvenile Justice Educational Centers required intensive intervention in therapeutic units such as the Els Til·lers Educational Center, managed by the Sant Joan de Déu Health Park. Although Organic Law 5/2000 (Organic Law Regulating the Criminal Responsibility of Minors –LORPM–) provides for specific measures for minors with mental disorders who commit criminal offenses, such as outpatient treatment in an open environment and thetherapeutic inpatient In educational centers, the lack of specialized resources with high clinical content makes it difficult to provide adequate care for delinquent adolescents with mental health problems in the community environment.

However, the judicial system and the mental health system operate with different logics. While one seeks to ensure compliance with the norm and criminal liability, the other prioritizes clinical diagnosis and treatment of mental suffering. Experts are calling for greater coordination to ensure fairer and more effective interventions. A recent study of the Center for Legal Studies and Specialized Training on recidivism for the year 2023 reveals that 7 out of 10 minors who have committed crimes are not repeat offenders and highlights support and the social environment as key factors in prevention.

Gender perspective

Women represent a minority within the prison system (between 2% and 9% worldwide), but 80% of those who enter prison suffer from mental disorders and a quadruple stigma: personal, social, criminal and penitentiary. This fact has made invisible the specific needs of women, especially regarding mental health and drug addictions, and has perpetuated a system that does not adequately address gender, social and emotional inequalities. And the difficulties are aggravated in cases of maternity or disability.

Researchers Christina Quinlan, from the Technological University of Dublin, and Gemma Escuder, from the Sant Joan de Déu Health Park, gender experts in the penitentiary field, call for a reform of the system with a feminist perspective, informed by trauma and sensitive to intersectionality.

A pioneering model with pending challenges

In Catalonia, 40% of the 8,000 inmates required specialized care in mental health and addictions during 2024. The close link between mental health and the prison and judicial environment is characterized by notable heterogeneity in the organization of care, the provision of health services and the regulatory frameworks that determine the treatment and trajectory of people with mental disorders in prison.

The Catalan system, a pioneer in the State, has psychiatric units in the Brians 1 and Brians 2 centers, as well as specific programs resulting from the collaboration between the Departments of Justice and Health and the Mental Health and Addictions Master Plan. The Sant Joan de Déu Health Park is the main provider of these services in the province of Barcelona.

Despite advances, there are still difficulties in referring people with serious mental disorders who have committed crimes in contexts of psychological alteration, without understanding the consequences of their behavior, to community resources. According to Aitor Eneko Olivé, head of management of Penitentiary Mental Health Nursing at the SJD Health Park, "60% of security measures are complied with in penitentiary psychiatric hospitals, perpetuating a model that prioritizes security over care" and this becomes one of the challenges main work of the health policies, the penal model and human rights.

Suicide, an emergency also in prison

The suicide rate in Catalan prisons in 2024 is 8.1 per 10,000 inmates, between eight and ten times higher than that of the community. The greater incidence of this problem is amplified by the special circumstances of deprivation of liberty, the concentration of added risk factors in inmates and the environmental conditions that internment implies. This is a top-level public health problem.

To address this, the Suicide Prevention Framework Program has been deployed in the prison environment, which includes different levels of intervention agreed upon and integrated into the person's relationship with the different groups with which they are related, which are, fundamentally, control and surveillance teams, multidisciplinary treatment teams and healthcare teams. Recently, a shock plan has been incorporated with ten measures aimed at strengthening coordination, increasing the training of prison professionals, expanding preventive actions, implementing support and intensifying the monitoring of inmates at risk, which also includes the gender perspective.