Mental Health Commissioner John M. Cachia said he believes “in a prison culture which carefully balances correction, recovery, well-being, and rehabilitation.”
Cachia was asked for his reaction following the death of Colin Galea, who earlier this month became the 13th prisoner to die in custody in the last three years. Galea died in hospital two days after a suicide attempt.
Allegations of maltreatment of prisoners had surfaced in the media weeks prior to Galea’s death. Prisoners were allegedly put in solitary confinement and other reports indicated the use of a restraining chair and bed for misbehaving inmates. Prison director Colonel Alex Dalli is under pressure to resign from his job, with the Opposition criticising the government for doing little to rectify the situation.
In his replies to questions from The Malta Independent, Cachia said self-harm and suicide attempts by prisoners may sometimes be viewed as manipulative rather than the communication of distress.
A reduction in self-harm incidents and prison suicide rates can only be achieved when the potentially traumatising and retraumatising impact of prison is recognised and addressed, he said.
Specific action that could be taken for a preventive approach include robust initial assessments on a prisoner’s arrival to address the heightened risk of suicide early on in custody and ongoing risk assessments to detect changes in mood as early as possible.
There should also be recognition that difficult behaviour may also be a sign of distress, Cachia said. Heightened emphasis on the quality of relationships among prisoners and between prisoners and prison staff could offer other indications.
A whole-of-prison stepped-care approach that attempts to support people with the most appropriate service when they need it would greatly be of help. Prisoners have multiple simple needs which may not reach a level that requires mental health specialised care, he said.
Intensive specialist services that are easily available when clinically required should be available while all prison staff need mental health training and support to enable them to maintain a caring and non-judgemental approach and to look after their own health.
Cachia said that as a group, prisoners have higher suicide rates when compared to the rest of the population. Suicide rates in prisons are increasing, even in jails where the number of prisoners is decreasing.
There is not just more suicidal behaviour within institutions but a lot of people who get imprisoned show a lot of mental health problems including suicidal thoughts and behaviour through the course of their lives, Cachia said. According to studies quoted by the World Health Organisation, pre-trial detainees have a suicide attempt rate of about 7.5 times, and sentenced male prisoners have a rate of almost 6 times the rate of males out of prison in the general population, he added.
Asked whether he believes that inmates are being given enough attention on mental health issues, Cachia said that the correctional service in Malta today has its ad-hoc mental health service which is licensed and functions independently. The mental health team at the prison has a number of dedicated and very hard-working professionals and includes psychiatrists, nurses, psychologists, and doctors and a clinical director who is a very experienced psychiatrist.
In keeping with the Mental Health Act, he said his Office primarily monitors prison inmates who require mental health care against their will and “our assessment of the safeguarding of rights in persons subjected to involuntary care is positive with very well documented applications and a constructive and cordial dialogue with care providers.”
Scientific literature and experience show that loss of liberty, feeling unsafe, isolation, and high-risk periods around arrival, trial, court hearings and release, are factors that increase prisoners’ vulnerability. On the subject of suicide, “my Office has repeatedly warned about the need for persons, in society at large not just prison inmates, to express emotions and to seek help about common psychological concerns such as anxiety or depression,” Cachia said.
Distress with accompanying subtle changes in prisoners’ mood is not always easy to detect. Seeking care and support should be a pathway towards empowerment rather than something shameful. Although reaching out for help is a personal decision, the ability of prison staff members to interact and build relationships with prisoners is critical, Cachia added.
The commissioner said he has not been in touch with the prison authorities about the prevailing situation. “Since there are a number of magisterial inquiries into the specific prison deaths and an administrative inquiry, the Office of the Commissioner for Mental Health will avoid making specific statements that may in any way obstruct or influence the legal or administrative procedures currently being conducted. That said, the Office will assist as required within the mandate assigned to it by the Mental Health Act,” he said.