Introduction: Rethinking The Prison Pipeline
Sometimes, people end up in prison not because they are bad, but because they were unwell — and no one recognized it in time. In popular imagination, prison is often seen as the final destination for those who have committed morally reprehensible acts. But reality is more complex. Sometimes, people end up behind bars not because they are inherently ‘bad,’ but because they were unwell—often without recognition, intervention, or systemic support, or because the system failed to intervene in time. This article explores how untreated mental illness, systemic neglect, and legal blind spots can funnel vulnerable individuals into the criminal justice system, and what reforms are urgently needed.
The Invisible Crisis: Mental Illness In The Criminal Justice System
- High prevalence of mental disorders: 15–20% of prisoners worldwide suffer serious mental illness (Fazel & Seewald, 2012, The Lancet; Fazel et al., 2016; WHO, 2022).
- Pre-arrest vulnerability: Many of these individuals were already struggling before their arrest—with homelessness, unemployment, substance use, or trauma compounding their condition.
- Criminalization of symptoms: Behaviors stemming from mental illness—such as public disturbances, aggression, or withdrawal—are often misinterpreted as criminal intent rather than cries for help.
Legal Blind Spots: When The System Misses The Signs
- Lack of mental health screening: Arrest procedures rarely include psychiatric evaluations. Police officers are not trained to distinguish between criminal behavior and psychiatric symptoms.
- Insufficient use of Section 22 of the Bharatiya Nyaya Sanhita, 2023 – previously Section 84 of the Indian Penal Code, 1861 – or insanity defenses globally: Section 22 of the Bharatiya Nyaya Sanhita, 2023 (previously Section 84 of the IPC, 1861), which provides protection for those ‘incapable of knowing the nature of the act,’ remains grossly underutilized—both in India and globally—due to stigma, inadequate documentation, and weak legal representation.
- Pretrial detention traps: Individuals with mental illness may be deemed “unfit to stand trial” but are still held in custody for months or years, often in solitary confinement, worsening their condition.
- Need for Collaboration between Courts and Psychiatrists: Judges and psychiatrists must collaborate to assess competency and recommend treatment instead of incarceration.
Case Study: The Forgotten Man
A composite story reflecting the silence of hundreds behind bars.
Consider the case of Ramesh (name changed), a 32-year-old man arrested for trespassing in a government building. He had been living on the streets, talking to himself, and wandering aimlessly. No one realized he was suffering from paranoid schizophrenia. He was jailed, denied medication, and eventually became violent—leading to further charges. It was only after a legal aid lawyer intervened that he was transferred to a psychiatric facility. But by then, he had spent 18 months in prison.
This case is a composite illustration based on multiple reported incidents of mentally ill individuals in Indian prisons.
Case Laws And Key Reports: The Legal And Human Rights Landscape
The relationship between mental illness and incarceration in India has been repeatedly examined by courts, commissions, and researchers. The following cases and studies illustrate both the progress made and the systemic failures that continue to criminalize mental illness.
Important Case Laws
- Shalini v. State of Tamil Nadu (2020): In this judgment, the Court intervened to protect a mentally ill man who had been wrongfully imprisoned for minor offences. It reaffirmed that individuals suffering from psychiatric conditions require treatment and rehabilitation, not punishment.
- Sheela Barse v. Union of India (1993): The Supreme Court held that the detention of mentally ill persons who had committed no offence is illegal and unconstitutional, ordering state governments to strengthen mental health facilities and ensure humane care. As established in Sheela Barse v. Union of India (1993), the Supreme Court declared the detention of non-criminal mentally ill persons unconstitutional.
- The Case of Machal Lalung: Machal Lalung, a man from Assam, was arrested in 1951 and spent over 54 years in custody without trial. His eventual release in 2005 followed NHRC and media intervention, revealing severe procedural neglect and systemic apathy toward mentally ill detainees.
Key Reports & Findings
- NHRC Tihar Jail Report (2016): The NHRC found that many inmates with untreated mental illness were detained for prolonged periods without medical evaluation or trial. The report emphasized the urgent need for psychiatric screening, access to medication, and reform in prison management.
- People’s Union for Democratic Rights (PUDR) Report (2019): PUDR documented cases of homeless individuals with schizophrenia and bipolar disorder imprisoned under minor charges such as trespassing or loitering. The report exposed how poverty, stigma, and institutional neglect perpetuate the criminalization of mental illness.
- Ministry of Home Affairs Report (2007) on Detention of Mentally Ill Persons: The report exposed extreme misuse of long-term detention, noting cases where under-trial prisoners were confined for 34 to 38 years for minor offences, without judicial review or trial updates.
- Empirical Evidence from Psychiatric and Media Studies: The Kerala Study (2014) found that 6% of prisoners in a district jail had at least one psychiatric diagnosis, underscoring the magnitude of untreated mental illness in prisons. IndiaSpend (2025, May 10) report concluded that over one in four inmates in several Indian prisons suffered from diagnosable mental disorders (excluding substance use), most of which remained undetected or untreated.
Together, these cases and reports demonstrate a consistent pattern: the Indian justice system continues to conflate illness with crime, failing to provide timely psychiatric care, due process, and rehabilitation. While judicial and institutional interventions have laid important groundwork, a coordinated reform between the judiciary, mental health professionals, and prison authorities remains imperative to transform punishment into recovery.
The Treatment Gap: Why Help Comes Too Late
- Mental health infrastructure is inadequate: In India, there are fewer than 0.75 psychiatrists per 100,000 people. Prison mental health services are even more scarce.
- Stigma and silence: Families often hide mental illness due to shame, leading to delayed diagnosis and abandonment.
- No continuity of care: Even when treatment begins in prison, there is no system to ensure follow-up after release—leading to relapse and re-incarceration.
These failures form a tragic cycle of neglect and punishment — but it’s a cycle that can be broken.
The crisis, however, is not irreversible. Several actionable reforms can turn this system from punitive to therapeutic.
Breaking The Cycle: What Needs To Change
Early Intervention And Community Care
- Strengthen primary mental health services and outreach programs.
- Train police and first responders in mental health first aid.
Legal Reform And Advocacy
- Mandate psychiatric evaluations for all detainees showing signs of distress.
- Expand use of mental health courts and diversion programs.
Prison Reform
- Establish dedicated mental health units in jails.
- Ensure access to medication, therapy, and peer support.
Post-Release Support
- Link released individuals to community clinics, housing, and employment services.
- Create legal aid cells focused on mental health advocacy.
- Recovery doesn’t end at release — without community support, freedom can become another kind of isolation.
Conclusion – From Punishment To Public Health
The evidence is overwhelming: the crisis of mental illness behind bars is not a failure of individual character but a catastrophe of systemic design. Cases like Machal Lalung, who spent over half a century detained without trial, and the official reports detailing decades-long incarcerations for minor offenses, demonstrate that the legal system consistently conflates illness with criminal intent. When police lack training, courts lack integrated psychiatric assessment, and communities lack adequate mental health infrastructure, the prison becomes the default, dehumanizing solution.
Breaking this tragic cycle requires moving beyond incremental reforms. It demands a paradigm shift where we treat mental health as a public health imperative, not a policing problem. This means urgent, large-scale investment in early intervention programs to prevent the pipeline from forming, mandating psychiatric screening at the point of arrest, and finally, establishing comprehensive post-release support to ensure recovery doesn’t end at the prison gates. We cannot continue to punish symptoms. The justice system must now exercise its full capacity not to confine, but to restore dignity and health to the vulnerable.
References
- Ministry of Home Affairs. (2007). Detention of mentally ill persons in prisons and hospitals: Status report. https://www.mha.gov.in/sites/default/files/DetentionMentally13Dec2007_61.pdf
- (2025, May 10). The brewing mental health crisis in Indian prisons. https://www.indiaspend.com/governance/the-brewing-mental-health-crisis-in-indian-prisons-963116
- Shalini v. State of Tamil Nadu, W.P. No. 24896 of 2020 (Madras HC).
- National Human Rights Commission. (2005). Machal Lalung intervention summary (primary NHRC records).
- National Human Rights Commission. (2016). Tihar Jail mentally ill prisoners report.
- People’s Union for Democratic Rights. (2019). Report on mentally ill and homeless prisoners in Delhi.
- Rao, G. P., et al. (2014). Psychiatric morbidity among prisoners. Indian Journal of Psychiatry, 56(3), 266–272. https://pmc.ncbi.nlm.nih.gov/articles/PMC4040062/
- Sheela Barse v. Union of India, AIR 1993 SC 378.
