10. Method, modalities and procedure for transfer of prisoners with mental illness. –Transfer of a prisoner with mental illness to the psychiatric ward of the medical wing of the prison or to a mental health
establishment set up under sub-section (6) of section 103 or to any other mental health establishments within or outside the State shall be in accordance with the instructions issued by the Central Government or State Government, as the case may be.

11. Standards and procedures of mental health services in prison. – The mental health establishment referred to in sub-section (7) of section 103 shall conform to the minimum standards and procedures as specified in Schedule.

Schedule: Minimum standards and procedures for mental health care services in prisons

1. Prompt and proper identification of persons with mental health problems should be done.

2. Screening of all inmates during the time of entry to prison including the following:
a. Mandatory physical and mental status examination
b. Questionnaire screening for substance use
c. Urine testing for common drugs of abuse
d. Periodic random urine drug testing

3. Identification of persons with serious mental illness and proper treatment and follow-up for this group.

4. Ensuring the availability of minimum psychiatric medication in the prison to facilitate prompt treatment (Antipsychotic medication, antidepressant medication, anxiolytic medication, mood
stabilizers, anticonvulsant medication, etc).

5. Availability of psycho-social interventions for prisoners with a range of mental health problems.

6. Protocols for dealing with prisoners with suicidal risk, with behavioural problems and crises related to mental illnesses as well as to prison life.

7. Suitable rehabilitation services for prisoners with mental illness. Specific attention to the aftercare needs of prisoners with mental illness including providing medication after release, education of
family members, steps to ensure treatment compliance and follow-up, vocational arrangements, and for those without families, arrangements for shelter.

8. Implementing of National Mental Health Program inside the central prisons

9. Dealing with the psychological stress of prison life
a. Counselling for stress needs to be provided to all prisoners in both individual and group settings.
b. Prisoners must be encouraged to proactively seek help for any emotional problems, substance use problems or physical health problems.
c. Training the prison staff in simple counselling skills. Empowering some of the sensitive, motivated convicted prisoners to be effective peer counsellors.
d. One to one counselling upon entry, during periods of crises and upon need or request.

10. Addressing substance use problems
a. Identification of substance use problems through questionnaires, behavioural observation and urine drug screening.
b. Detoxification services and making suitable pharmacotherapy available for detoxification.
c. For persons with dependence, making available long-term medication as well as motivational and relapse prevention counselling.
d. Specific interventions to be made available include the following:
i. Tobacco cessation services (behavioural counselling, nicotine replacement therapy, other long-term tobacco cessation pharmacotherapy.
ii. Alcohol – benzodiazepines for detoxification, vitamin supplementation for associated nutritional problems, counselling and long-term medication.
iii. For Opiates – buprenorphine or clonidine detoxification, long-term medication including opioid substitution (methadone/buprenorphine; opioid antagonists like naltrexone).
iv. All drug users need to be evaluated for injecting use, for HIV/STI (including Hepatitis B and C screening) and appropriately treated.
v. There is a need for urgent human resource enhancement.

11. Professional Human Resources in the Prison. [All central prisons must ensure the presence of at least]:
i. 1 doctor for every 500 patients. In addition, every prison must have one each of the following specialists providing care – physician, psychiatrist, dermatologist, gynecologist and surgeon.
ii. 2 nurses for every 500 prisoners
iii. 4 counsellors for every 500 prisoners. These trained counsellors (with a degree in any social sciences/any recognized degree with counselling experience (medical counselling/legal counselling/ psychosocial counselling/rehabilitation/education) can carry out the following tasks
a. Assessment
b. Counselling
c. Crisis intervention (family crisis, bail rejection, verdict pronouncement, interpersonal difficulties, life events, serious physical or psychiatric illness)
d. Legal counselling, pre-discharge counselling
e. Rehabilitation counselling
f. Substance use counselling
g. Training prison staff and peer counsellors

12. Inpatient services
a. At least a 20-bedded psychiatric facility for every 500 prisoners

13. Prison aftercare services
a. All prisoners should have pre-discharge counselling on coping strategies, healthy life style practices and support systems they can access
b. For persons with mental illness they shall be referred to any mental health establishment for after care in community

14. Documentation
a. Computerised data base and tracking system for all prisoners
b. Surveillance of health conditions on a regular basis with adequate emphasis on confidentiality and proper information regarding these procedures to the prisoners
c. Health records for prisoners with basic health information, pre-existing health problems, health problems that develop during imprisonment, details of evaluation and treatment, hospitalization details, health status and advice at release
d. This information must be given to the prisoner to facilitate continuing health care after release.

15. All central prisons shall have dedicated tele-medicine services to provide health care

16. Following medicines shall be made available
Risperidone, Olanzpine, Clozapine, Haloperidol, Chloropromazine, Trihexyphendyl, Imipramine, Amitriptyline, Fluoxetine, Sertraline, Paroxetine, Valproate, Carabamazapine, Lithium, Clonidine, Atomoxetine, Lorezpam, Diazepam, Oxezepam Disulfiram, Naltrexone, Acamprosate, Nicotine Gums, Varenicline, InjFluphenazine Inj Haloperidol, InjFluphenthixol, InjLorezpam, Inj Diazepam, Inj Promethazine Inj Thiamine/Multivitamin

[F. No. V-15011/09/2017-PH-I (iv)]