Literature Review
Fazel & Danesh (2002) say mentally ill prisoners mainly suffer from depression, antisocial personality disorder, and psychotic illnesses. Other common disorders that affect them include anxiety disorders, post-traumatic stress disorders, and attention deficit hyperactive disorders (among other types of symptoms) (Fazel & Danesh, 2002). Many studies that have investigated the plight of mentally ill offenders in prison agree that such special populations have unique needs, such as special medication and close monitoring (McDonald & Teitelbaum, 2013). The same studies also agree that most mentally ill offenders have been in and out of prison and mental health facilities (McDonald & Teitelbaum, 2013). The same prisoners do not have jobs or homes. Furthermore, most of them engage in substance abuse (or have a history of drug abuse). Since many jurisdictions lack specialised courts to try such offenders, Amnesty International (2008) says mentally ill offenders lack the opportunity to get a “fair” hearing. Therefore, authorities treat them like other criminals. However, since such populations require specialised care, they pose unique management challenges to prison authorities.
Many studies that have evaluated the challenges of managing mentally ill offenders in prisons have mainly focused on prisons in western countries (Knight & Stephens, 2009; NHS, 2014). Therefore, few empirical researches explain the management of mentally ill offenders in developing countries. For example, few researchers, such as Kaggwa (2012) and Obioha (2011), say that Nigerian prisons and African prisons (at large) have unique challenges that affect the management of mentally ill prisoners. In a 2013 African regional workshop on prison health and management, PRAWA (2013) affirmed that,
“In Africa and the world at large, prisons face numerous challenges including, but not limited to, over-population, long awaiting trial periods, and challenges in the management of special needs offenders. To solve these problems, it is necessary for all states to work together to ensure the achievement of proper and efficient management of prisons” (p. 1).
The African Commission on Human Rights has also affirmed the above statement by saying most African prisons are poorly resourced, highly congested and lack adequate health and sanitary facilities for managing not only mentally ill prisoners, but the larger prison population as well (Amnesty International, 2008). The organisation further says the prisons lack adequate recreational, vocational, and rehabilitation facilities to cater for their prison populations (Amnesty International, 2008). The restricted contacts that most prisoners have with the outside world, and the inefficiencies in the justice system (delay of trial), also complicate these problems (Orakwe, 2005). A close interrogation of the above reports makes it easy to understand why Nigerian prisons have been criticised not only for their poor administration and lack of resources, but also for their poor treatment of mentally ill prisoners (Asokhia & Agbonluae, 2013). A punitive culture that exists in Nigerian prisons, insufficient resourcing, and human resource issues contextualise this issue.
Punitive Culture
The purpose of any prison is to rehabilitate offenders. However, Nigerian prisons subscribe to a punitive culture that inflicts pain and suffering on prisoners. Obioha (2011) says this culture has introduced a new model of governance in Nigerian prisons where prison warders subject inmates to strict controls and monitoring. The World Health Organisation (2000) says this culture brutalises the human body and spirit because it leaves little room for mental growth and development. Knight & Stephens (2009) support this claim by saying that although some prisoners learn to cope with the strict rules, the rules have a damaging effect on their well-being. This is especially true for mentally ill prisoners because Obioha (2011) says the punitive culture creates hopelessness among the prisoners, thereby negating the purpose of rehabilitating mentally ill offenders. Again, Knight & Stephens (2009) support this claim by saying mentally ill prisoners do not have the psychological capability of coping with the extensive rules and punitive culture that exists in such prisons. However, they acknowledge the role of personality and type of illness on the ability of such prisoners to cope with the punitive culture in prisons (Knight & Stephens, 2009). Comparatively, Adetula & Adetula (2010) says the nature of the sentencing (particularly, the length of the sentencing) and the availability of health resources in the prison affects the ability of mentally ill prisoners to cope in correctional facilities.
Studies that have investigated the effects of punitive cultures in prisons show that they make the prisoners worse than they were when they came into the correctional facilities (Obioha, 2011). For example, Knight & Stephens (2009) say the health of mentally ill prisoners worsens when they are subjected to the punitive culture that exists in prisons. Obioha (2011) supports this fact because he says Nigerian prisons have a negative effect on mentally ill prisoners and ordinary prisoners alike. In fact, studies show that the punitive culture of Nigerian prisons “hardens” most prisoners, thereby increasing their possibility of committing more crimes when released (Knight & Stephens, 2009). Therefore, it is common for authorities to arrest freed prisoners because of repeated crime. These findings are not unique to Nigeria because Obioha (2011) says other prisons around the world also experience the same problem. For example, Obioha (2011) says the Canadian justice and police systems breed and enhance criminal behaviour by supporting a punitive culture in their prison and justice systems. This observation emerged after researchers affirmed a direct correlation between the length of time that the ex-convicts stayed in prisons and their rate of recidivism (Adetula & Adetula, 2010).
Concerning this fact, the researchers say, punitive cultures in prison exacerbate mental health problems, thereby inhibiting the recovery and rehabilitation of mental health prisoners (Binswanger & Stern, 2007).
Knight & Stephens (2009) report the findings of the Chief Inspectorate of prison facilities in Britain who recommends that mentally ill prisoners should be placed in psychiatric wards, within the prison facilities. However, like many developing countries, Nigeria lacks these specialised wards to manage mentally ill prisoners (Kaggwa, 2012). Relative to this observation, Knight & Stephens (2009) say the punitive culture that exists in many Nigerian prisons is a counter-therapeutic regime that undermines the emphasis on welfare and care for mentally ill prisoners. Particularly, the principles of punishment, security, and control defeat the purpose of caring for mentally ill prisoners in a supportive environment (Kaggwa, 2012). This analogy affirms the existence of an ideological clash between the prison culture and health service ideologies (Silber, 1974). The health service ideology assumes that mentally ill prisoners (although convicted criminals) should enjoy their right to health care, as a human right (Silber, 1974). Therefore, their convictions do not supersede their human rights. However, the prison service ideology does not respect this fact because it prioritises security concerns above mental health concerns (Obioha, 2011). For example, during prison lockdowns, security concerns become the main priority of prison officials. In such circumstances, prison authorities overrule any health activities that could be going on at the time, thereby inhibiting the potential success of any treatment that the mentally ill prisoners may be undertaking. Knight & Stephens (2009) say the rate of non-attendance of mentally ill prisoners in health sessions is about 35% because security controls in prison facilities limit the ability of prisoners to gain access to such health services.
The competition between prison and health ideologies has created a bigger problem for mentally ill prisoners because the World Health Organisation (2000) says health practitioners have trouble working in prison environments. Therefore, they prefer to withdraw their services altogether. Through this ideology clash, Asokhia & Agbonluae (2013) argue that the punitive culture that exists in Nigerian prisons denies mentally ill prisoners the right to health care services. By extension, Amnesty International (2008) says this punitive culture infringes on their human rights as well.
Insufficient Resourcing
Like many prisons in Africa, Nigerian prisons face an acute problem of insufficient resourcing (Kaggwa, 2012). This problem affects mentally ill prisoners by denying them the right to receive specialised care, and the opportunity to spend time in a rehabilitative environment. In fact, because of the lack of sufficient resources to rehabilitate offenders, Asokhia & Agbonluae (2013) say Nigerian prisons are a veritable avenue for human resource wastage. Particularly, the lack of rehabilitative facilities in such institutions creates room for idleness (Konrad & Daigle, 2007). In this environment, old ideas concerning prisoner mistreatment flourish and new concepts of rehabilitation disappear (Obioha, 2011). For example, in such environments, prisoners do not have an opportunity to develop a trade, or skill, which would make them productive (Daniels, 2006). Asokhia & Agbonluae (2013) elaborate that some Nigerian prisons have some facilities for rehabilitation, but they are either unusable, or inappropriate, for mentally ill prisoners to use. For example, NPS (2011) says many Nigerian prisoners lack educational facilities to improve their learning skills. This challenge affects ordinary prisoners as well (Obioha, 2011). Since mentally ill prisoners are a minority population in these prisons, their needs are more likely to be lower in the priority list of prison services. Based on this analysis, Ashia & Agbonluae (2013) say Nigerian prisons are “dens of idle minds,” which do not provide a supportive environment for mentally ill prisoners to thrive.
NHS (2014) says the idleness in Nigerian prisons is unhealthy for mentally ill prisoners because they need sufficient social support and resources to keep them busy. For example, mentally ill prisoners who suffer from depression may find the “idle” environment more depressing (NHS 2014). Since such prisoners may easily lose interest in engaging in social activities, or seeing the purpose of life, they need an environment that cheers them and makes them re-think their views of life (Daniels, 2006). Clearly, Nigerian prisons do not provide this environment. In fact, Obioha (2011) says, “The Nigerian prison environment, regarding amenities, is dull” (p. 98). Other researchers consider these prisons as “hell on earth” (Obioha, 2011), while observers say the prisons are dehumanising (Amnesty International, 2008).
The lack of resources in Nigerian prisons has made life unbearable for prisoners. Kaggwa (2012) says this hopelessness creates a culture of fragility in the prisons, where violence and exploitation are acceptable. The lack of facilities has made it physically unhealthy for mentally ill prisoners to live because the housing structure is “uncivilised” and prisoners lack basic living facilities, such as clean beddings (Obioha, 2011). For example, NPS (2011) says most prisoners in Nigeria sleep on the cold floor.
Overcrowding in the prison facilities also worsens the living conditions of the prisoners because many Nigerian prisons accommodate more people than the infrastructure can support (Kaggwa, 2012). This situation stretches existing infrastructure limits, thereby making it physically impossible to sustain a “decent” life for mentally ill prisoners, and the larger prison population as well. Studies that date back to the pre-colonial era highlighted these challenges (Kaggwa, 2012). In fact, Obioha (2011) says overcrowding has been a recurring administrative issue that prison authorities have failed to solve. Besides providing an unsupportive environment for mentally ill prisoners, the poor living conditions in Nigerian prisons have led to the outbreak of diseases and infections in the facilities (Abanihe & Isamah, 2010). For example, in 1987, overcrowding led to the outbreak of Bilharzia and skin scabies in Kano prison – Nigeria (Obioha, 2011).
The lack of resources in Nigerian prisons has also contributed to the acute medical problems concerning insufficient staffing and insufficient medical supplies in these facilities (NPS, 2011). Indeed, the lack of resources has made it difficult for such prison facilities to pay medical workers, or supply enough drugs, for mentally ill prisoners to get proper care. Obioha (2011) says even when sick prisoners need specialised care away from the prisons; there are no cars to transport them. Overall, Nigerian prisons suffer from inadequate financing that makes it difficult for prison staff to offer specialised care.
Human Resource Challenges
Tapscott (2006) believes that competent employees (prison staff) are important in managing effective rehabilitative institutions. Based on this understanding, many researchers agree that the recruitment of competent and helpful staff is akin to effective management of prisoners (Abanihe & Isamah, 2010). Above all, many researchers agree that African prisons face a serious problem of poor administration (that contributes to the human resource challenges) (Obioha, 2011; Kaggwa, 2012; NPS, 2011). Indeed, many prison facilities lack effective leaders that can instil confidence and motivation among their staff. Since most correctional institutions are hierarchical, leaders play a vital role in influencing the institutional culture that prevails in an organisation. This culture also plays a vital role in influencing how prison warders treat prisoners in the correctional facilities. Tapscott (2006) says Nigerian prisons lack the proper leadership acumen that could introduce significant changes to the management of mentally ill prisoners. For example, he says the high level of corruption that characterises public service in the West African country has permeated through the prison service and affected the provision of services to special populations (Tapscott, 2006). The lack of integrity among the prison wardens has therefore led to the weakening of institutional structures that could have supported the protection of minority rights in these facilities (Amnesty International, 2008). To affirm this fact, Tapscott (2006) says, “Conversely, where leadership is ineffectual, or corrupt, this weakness pervades all strata of the prison management, diminishes the prospects for initiative and increases the likelihood of mismanagement and the mistreatment of offenders” (p. 77).
The leadership crisis in Nigerian prisons touches the core of human resource issues in the correctional facilities. However, it does not highlight the deeper management issues that affect the treatment of mentally ill prisoners. In other words, because of the lack of a visionary and effective leadership in the prison service, there is a lot of insensitivity regarding the treatment of mentally ill prisoners and other groups of specialised prisoners in correctional facilities (Nigerian Prisons Service Manual, 2011). Therefore, the lack of specialised personnel, who understand the unique needs of these minority groups, is prevalent in these prisons (Tapscott, 2006). Few prison warders understand the specialised needs of mentally ill prisoners. However, the few officers that understand these needs do not understand how to manage them (Tapscott, 2006). Therefore, the lack of information regarding the special needs of mentally ill prisoners affects the quality of care that the prisoners get in the correctional facilities (Nigerian Prisons Service Manual, 2011).
Other parts of the world acknowledge the importance of having specialised healthcare workers to cater for the needs of special prison populations, such as children, pregnant women, and mentally ill prisoners (Anasseril, 2007). For example, Watson, Stimpson & Hostick (2004) say that UK prison authorities employ specialised nurses to cater for mentally ill prisoners. However, most of these nurses are unprofessional because they are correctional officers who have undergone short training courses to learn how to manage mentally ill prisoners (Anasseril, 2007). Since they are mainly prison staff, the Nursing and Midwifery Council does not register them as nurses (Watson et al., 2004). The failed recognition of nursing roles has led to the emergence of role conflicts between nursing and correctional services (Watson et al., 2004).
Specialised nurses have also experienced the same conflict because they trained nurses who complement the work of correctional officers (Appelbaum & Hickey, 2001). However, the role conflict mainly exists when the specialised workers work in the prison service and not in the nursing profession. Watson et al. (2004) affirm this conflict by saying, “It has been reported that there is a conflict between the divergent aims of correctional officers and nurses because of different underlying assumptions of providing health care on the one hand and correction on the other” (p. 120). Although UK prisons have a better record of providing specialised healthcare services (compared to Nigerian prisons), several professional institutions have recommended different strategies for improving mental health services in the prisons (Watson et al., 2004). For example, the UK Royal College of Nursing recommends that the level of training and education for specialised workers needs to increase (to achieve a higher level of certification for the workers) (Watson et al., 2004). This way, the quality of health care services provided to the mentally ill prisoners may improve.
Tanimu (2010) says African prisons do not pay close attention to the need for providing specialised care to mentally ill prisoners because their structures share close links with the police service. A 2003 study on African prisons showed that the prison service was a subsector of security-related government bodies, such as the ministry of interior and the ministry of home affairs (Tapscott, 2006). The study also found that the ministry of Justice was responsible for prison services in 12 African countries surveyed (Tapscott, 2006). The link between the prison service and security-related ministries explains why a punitive culture exists in the prison service (Tapscott, 2006). Moreover, in a country that most people still grapple with serious social and economic challenges, Nigeria does not consider the proper management of mentally ill prisoners as a national priority (Abanihe & Isamah, 2010).
Tapscott (2006) says the human resource challenges that characterise prison services are worse in African countries (compared to developed countries) because African prisons lack specialised health services to manage mentally ill prisoners and enough personnel to manage the wider prison population. For example, staff shortage is a common phenomenon in Nigeria and other African countries (Tanimu, 2010). Many researchers affirm this shortage by comparing the number of available staff and the number of prisoners they manage (Tapscott, 2006). Since overcrowding in African prisons is a common issue, prisoner needs outnumber the services provided by prison warders (Abanihe & Isamah, 2010). Therefore, staff shortages compromise the management of prisoners in the correctional facilities and affect the quality of services offered by the prison staff. For example, NHS (2014) says staff shortages in prisons cause an increase in stress and anxiety levels among prison staff, thereby affecting how workers interact with the inmates.
International practice dictates that prison staff and management should maintain an open line of communication to avoid the problems of having a disgruntled workforce (Appelbaum & Hickey, 2001). However, evidences from African prisons show that senior authorities exclude junior officials from decision-making processes (Tapscott, 2006). Consequently, proposals to improve the management of mentally ill prisoners face opposition from prison warders, as they are apprehensive about change (Tapscott, 2006). An alternative assessment of this issue shows that if senior authorities involve junior employees in decision-making, they would get support from all stakeholders (Appelbaum & Hickey, 2001).
Tapscott (2006) says many African prisons also lack a standardised prisoner treatment regime. A 2003 study showed that many African countries used conflicting standing orders to guide prisoner treatment (Tapscott, 2006). The UN Economic and Social Council identified this problem in the 1990s, and recommended that one government ministry should formulate management policies (Nigerian Prisons Service Manual, 2011). The organisation also revealed that most standing orders used by African prisons are outdated (Nigerian Prisons Service Manual, 2011). In fact, some African countries have not changed these orders since the colonial period. Consequently, many prison practices in African countries do not meet international standards.
Summary
The management of mentally ill prisoners in Nigeria demands reform. New Nigeria (2006) explains this fact by proposing a change of attitudes among policymakers and prison staff alike. The challenge of reforming these correctional facilities should mainly focus on changing the mentality of prison officers (who are accustomed to a particular order of activities) (PRAWA, 2013). More problematic is the influence that some individuals have on sustaining the punitive culture in correctional facilities (New Nigeria, 2006). Changing the attitude of prison authorities concerning the management of mentally ill prisoners may take time, but the structural and administrative issues hindering prison reforms could take a shorter time to solve. Sound leadership, from senior authorities, is crucial in changing the management of Nigerian prisons, but sensitising prison staff about the needs of mentally ill prisoners is more important in cementing the gains that may emerge from this process.
Nigeria is among a few African countries that have started to reorient the training curriculum of prison officials to meet international human rights standards (New Nigeria, 2006). Other countries that have undertaken similar initiatives include Kenya, Ghana, Libya, and South Africa (among other countries) (Tapscott, 2006). Linked to the need for sensitising prison staff about the importance of respecting human rights is the need for new management acumen to promote the effective management of budgets and the proper allocation of resources to special prison populations. Tapscott (2006) says the reorientation of prison practices is important in improving the management of prison facilities and the proper functioning of correctional facilities. Through this proposal, Tapscott (2006) insists that prison facilities would benefit from improved service provision and the proper allocation of resources to meet the special needs of mentally ill prisoners. However, the success of such an initiative largely depends on the commitment of the Nigerian government to allocate more resources for prison services. Certainly, without adequate resources, prison officials would have trouble educating, training, or providing enough facilities to meet the special needs of mentally ill prisoners. Although most of the issues described here explain the challenges facing mentally ill prisoners in Nigeria, Kaggwa (2012) says many African prisons also suffer the same challenges. Indeed, the Special Rapporteur on Prisons and Conditions of Detention in Africa says that the poor conditions that characterise Nigerian prisons mirror the plight facing mentally ill prisoners in other African prisons as well (Kaggwa, 2012).
Comprehensively, decades after independence, many African prisons maintain the legacy of colonial era prisons. The philosophy that informs the operations of these prisons is retributive and clashes with the human rights of mentally ill prisoners (Amnesty International, 2008). The rising crime rates in Nigeria and the lack of adequate resources to meet the needs of special populations in these prisons paint a bleak future for the management of mentally ill prisoners in Nigerian prisons. Overall, these prisons have failed to deliver on their role in rehabilitating offenders because they face many challenges. The process of addressing these issues requires a complete shift of attitude regarding the management and administration of these correctional facilities.
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