50% of young people in juvenile justice centres and 80% of incarcerated women require immediate mental health care

50% of young people entering juvenile justice centres and 80% of incarcerated women require immediate mental health care. In this context, the success of mental health care for individuals with disorders in the prison environment fundamentally depends on effective collaboration between the justice system, health services, and the community. This is one of the main resolutions of the I Conference on Mental Health in the Penitentiary Environment, held yesterday and today at the Parc Sanitari Sant Joan de Déu, under the title Building Bridges Toward Comprehensive Care.

Over two days, professionals from various fields have addressed issues such as dignifying the prison experience, community reintegration, suicide prevention, gender perspective, and intervention with adolescents. In all these cases, there is agreement on the need for a person-centred model that considers their life trajectory and social context.

In Catalonia, in 2024, 2,202 adolescents with behaviours requiring judicial intervention were recorded. 8% of the total young people admitted to Juvenile Justice Educational Centres required intensive intervention in therapeutic units, such as the one at Los Tileros Educational Centre, managed by Parc Sanitari Sant Joan de Déu. Although Organic Law 5/2000 (Organic Law Regulating the Criminal Responsibility of Minors – LORPM) provides specific measures for minors with mental disorders who commit criminal offenses, such as outpatient treatment in open settings and therapeutic internment in educational centres, the lack of specialized high-containment clinical resources hinders adequate care for transgressive adolescents with mental health issues in the community setting.

However, the judicial and mental health systems operate with different logics. While one side seeks to ensure compliance with the law and criminal responsibility, the other prioritizes clinical diagnosis and treatment of psychological conditions. Experts demand greater coordination to ensure fairer and more effective interventions. A recent 2023 study by the Centre for Legal Studies and Specialized Training on recidivism reveals that 7 out of 10 minors who have offended do not reoffend, highlighting accompaniment and social environment as key factors in prevention.

Gender perspective

Women represent a minority in the prison system (between 2% and 9% globally), but 80% of those who enter prison suffer from mental disorders and face quadruple stigma: personal, social, criminal, and penitentiary. This issue has made the specific needs of women, particularly regarding mental health and substance abuse, invisible and has perpetuated a system that does not adequately address gender, social, and emotional inequalities. Challenges are exacerbated in cases of maternity or disability.

Researchers Christina Quinlan from the Dublin Institute of Technology and Gemma Escuder from Parc Sanitari Sant Joan de Déu, experts in gender in the prison context, call for a system reform with a feminist perspective, trauma-informed, and sensitive to intersectionality.

A pioneering model with pending challenges

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

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

Despite advances, there are still difficulties in referring individuals with severe mental disorders who have committed crimes in a state of mental disturbance, without understanding the consequences of their actions, to community resources. According to Aitor Eneko Oliveras, head of Nursing Management in Penitentiary Mental Health at Parc Sanitari SJD, "60% of security measures are carried out in penitentiary psychiatric hospitals, perpetuating a model that prioritizes security over care," which becomes one of the main challenges for health policies, the penal model, and human rights.

Suicide, an emergency in prisons too

The suicide rate in Catalan prisons in 2024 is 8.1 per 10,000 inmates, eight to ten times higher than in the general community. The higher incidence of this issue is amplified by the special circumstances of deprivation of liberty, the concentration of additional risk factors among inmates, and the environmental conditions of incarceration. This is a first-level public health issue.

To address this, the Framework Program for Suicide Prevention in the prison system has been implemented, which includes different levels of intervention agreed upon and integrated into the individual’s relationship with the various entities involved, primarily control and surveillance teams, multidisciplinary treatment teams, and healthcare teams. Recently, a shock plan with ten measures has been introduced to strengthen coordination, increase prison staff training, expand preventive actions, implement accompaniment, and intensify monitoring of at-risk inmates, also incorporating a gender perspective.