Amid rising concerns over prison deaths, including a recent death-row inmate’s fall, experts highlight alarming mental health crises in Sri Lanka’s overcrowded facilities, where 27% of prisoners exhibit suicidal behaviour and urgent reforms are needed.

Sri Lanka’s prison system is under intense scrutiny following multiple deaths in custody, including the recent case of a death-row inmate convicted in the high-profile killing of former Parliamentarian Amarakeerthi Athukorala. The incident, involving a fall at Welikada Prison, has reignited debates about the mental well-being of inmates in an overburdened correctional environment.

Forensic psychiatry specialist Dr. Chittahari Abhayanayaka, co-author of a chapter on Forensic Psychiatry and Prison Mental Health in Sri Lanka, emphasises that prisoners require tailored clinical mental healthcare. In a detailed interview with The Morning, Dr. Abhayanayaka pointed out that mental health conditions are significantly more prevalent in prisons than in the general population.

According to available data, around 27 per cent of prisoners in Sri Lanka have shown some form of suicidal behaviour. This statistic underscores a broader crisis: nearly 30 per cent of newly admitted inmates experience significant psychological distress. Overcrowding exacerbates the problem. Designed for 10,000–15,000 inmates, the system now holds close to 40,000, far exceeding capacity and leading to severe strains on infrastructure and services.

Mental Health Toll in a Strained System

Correctional psychiatry focuses on delivering mental healthcare within the unique constraints of the prison environment. Dr. Abhayanayaka explains that while the mental illnesses seen in prisons mirror those in the community – such as depression, anxiety, psychotic disorders, and substance use disorders – the setting amplifies challenges. Safety concerns, limited resources, and institutional rules complicate treatment.

Prevalence rates paint a stark picture. Depression affects about 10.5 per cent of prisoners compared to 4 per cent in the general population. Psychotic disorders rise from 1 per cent in the community to 3 to 4 per cent behind bars. Substance use disorders are rampant, impacting 30 to 70 per cent of inmates, with many offences directly linked to drugs or alcohol. In Sri Lanka, roughly half of remand prisoners and two-thirds of convicted ones have connections to drug-related crimes.

Self-harm and suicidal ideation are critical concerns. The prison environment – marked by uncertainty, isolation, loss of freedom, violence, and stigma – intensifies pre-existing vulnerabilities. Overcrowding, in particular, removes daily structure and meaningful activity, fostering hopelessness.

Recent incidents, including deaths in custody, highlight these risks. Reports indicate multiple prison-related fatalities in recent years, prompting calls for better oversight and healthcare.

Diverse Needs Across Prisoner Categories

Mental health needs vary significantly depending on an inmate’s stage in the legal process. Suspects in police custody often face acute anxiety and fear due to uncertainty. Remand prisoners, who constitute nearly two-thirds of Sri Lanka’s prison population, endure prolonged stress from repeated court delays and lack of routine. This group shows particularly high rates of mental health issues and suicidal behaviour.

Convicted prisoners may have more structure through work programmes but risk institutionalisation and long-term hopelessness, especially with extended sentences. Death-row inmates confront a unique psychological burden: exclusion from many activities, combined with the gravity of their situation, leading to severe depression and anxiety.

Dr. Abhayanayaka stresses that understanding these differences is essential for effective intervention. Uncertainty erodes mental resilience, while structure can provide some stability.

Vulnerable Groups Face Heightened Risks

Certain populations within prisons are especially vulnerable. Female prisoners often grapple with family separation, worries about children, and disrupted household roles. Some mothers keep young children with them, which preserves bonds but exposes families to an unsuitable environment and adds maternal stress due to lack of privacy.

Young prisoners face developmental challenges compounded by separation from family and exposure to hardened environments. Transgender inmates encounter stigma, discrimination, and placement issues that heighten isolation. Foreign prisoners deal with language barriers, cultural differences, and severed family ties, complicating access to services.

These groups require targeted support to mitigate compounded traumas.

Why Prison Mental Healthcare Matters for Society

Providing adequate mental healthcare in prisons is a state responsibility and a human rights imperative. Imprisonment punishes through loss of liberty; it should not equate to denial of healthcare. Prisoners depend entirely on the system for treatment, often entering with unmet needs from disadvantaged backgrounds.

Untreated conditions, particularly substance use disorders, pose risks upon release. Most inmates return to communities, and without intervention, they may reoffend or strain families and social services. Prisons can serve as key intervention points for identifying and addressing previously undiagnosed issues.

Broader societal benefits include reduced recidivism, healthier families, and lower public health burdens. Dr. Abhayanayaka advocates for equivalence of care – prisoners should receive standards comparable to the community, with doctors acting as advocates for this vulnerable group.

Reforms and Responsibilities

Experts call for comprehensive reforms. Entry screening, ongoing observation, medication, psychosocial support, and continuity of care from prison to community are vital. Collaboration between government, healthcare professionals, and civil society is essential.

Addressing root causes like overcrowding through alternatives to incarceration, faster judicial processes, and expanded community mental health services could reduce the prison population and associated pressures. Investments in training for correctional staff and specialised forensic psychiatry resources are overdue.

Sri Lanka’s prison statistics reflect systemic challenges shared regionally, with high overcrowding rates across South Asia. Recent political and economic shifts, including post-2022 recovery efforts, provide an opportunity to prioritise human rights and rehabilitation in the justice system.

Without urgent action, the cycle of mental distress, reoffending, and societal costs will persist. As Dr. Abhayanayaka notes, improving prison mental health is not just about inmates – it strengthens the entire society by fostering rehabilitation, equity, and long-term stability.

Image: ICRC