Guest editorial: Reframing mental health in places of detention – from descriptive epidemiology to transformative practice

Mental health in prisons and other detention settings is no longer a peripheral concern. It is a central public health challenge and a pressing human rights issue. A third of people living in detention in the WHO European Region experience a mental health disorder – many also struggle with substance use and trauma, while the risk of suicide remains alarmingly high (WHO Regional Office for Europe, 2023).Despite the growing body of evidence on prevalence, far less attention has been paid to interventions and systemic responses that prevent harm, ensure continuity of care and promote recovery (WHO Regional Office for Europe, 2024). This special issue of the International Journal of Prison Health responds to that gap in literature, bringing together innovative research, lived experience and practical models of care to inform both policy and practice.The rationale for this issue is rooted in the increasing recognition that mental health and incarceration are profoundly intertwined. Confinement can aggravate mental illness, particularly in overcrowded, under-resourced settings, marked by isolation, inadequate care and systemic neglect (United Nations Office on Drugs and Crime (UNODC), 2015; European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), 2025). Conversely, untreated or poorly managed mental health and substance use disorders are important contributors to incarceration and recidivism (Bahji, 2024).While research has extensively documented the scale of the problem, there is far less evidence on how to address it – particularly in low-resource environments, non-Western contexts and among under-represented groups such as women, youth and LGBTQ+ people (United Nations Office on Drugs and Crime, 2010; OHCHR and WHO, 2023). Addressing these disparities requires rights-based, person-centred care and greater attention to structural barriers.Recent global dialogues have called for a paradigm shift, from reactive responses to proactive evidence-informed systems of support that span the entire detention continuum. This includes early detection and treatment, peer-led models, aftercare and social reintegration (WHO, 2014; Joo et al., 2022). The current issue reflects that shift, presenting diverse contributions from countries at various stages of reform. Several common threads emerge: the centrality of human rights and dignity; the importance of intersectoral partnerships; and the value of care models tailored to context, culture and lived experience (OHCHR and WHO, 2023; United Nations, 2021).The article by SaberiZafarghandi et al. examines Iran’s long-standing harm reduction programme in prisons, offering critical insight into how public health crises, such as the HIV epidemic, can catalyse system-wide change (SaberiZafarghandi et al., 2025). This case study demonstrates that even in politically and economically constrained settings, large-scale, evidence-based interventions are possible when aligned with public health principles (United Nations Office on Drugs and Crime and World Health Organization, 2020; European Monitoring Centre for Drugs and Drug Addiction, 2021).Equally compelling is the role of physical activity as a rehabilitative tool. Research shows that purposeful activity enhances mental well-being and supports psychological resilience in custodial settings (Dlestikova and Miklósi, 2025; Liguori and Calella, 2025). However, barriers – especially among women – may require more intensive supervision and support to help integrate physical activity into daily routines (Koddebusch et al., 2025).These challenges are echoed in the experiences of older people in custody. A study from Norway explores how ageing intersects with incarceration, revealing how limited accessibility, lack of geriatric care and exclusion from rehabilitative activities compound mental health risks and hinder reintegration efforts (Rocha, 2025). As prison populations age, age-responsive policies that uphold dignity and support healthy ageing behind bars become increasingly urgent.Four manuscripts in this issue examine how systemic conditions and subjective experiences shape mental health outcomes. The study on perceived prison conditions and recidivism among women in Tihar Jail, India (Sandhu and Malhotra, 2025) highlights how poor staff–inmate relationships, lack of autonomy and absence of meaningful activities contribute to distress and reoffending. Complementing this, a cross-sectional study from Ethiopia explores how environmental and psychological factors, notably poor sleep quality mediated by incarceration conditions, affect mental health in correctional settings (Naser et al., 2025).Another article highlights often-overlooked aspects of prison design. A narrative review on lighting argues that limited daylight exposure and inadequate artificial lighting can dysregulate circadian rhythms, worsen mood and hinder rehabilitation (Urrutia-Moldes, 2025). In a broader conceptual contribution, a framework integrating social determinants with the stress process model offers a roadmap for holistic assessment and structural reform that extends beyond individual treatment (Ndindeng, 2025).This need for systems-level change is further echoed in the article on prison staff training (Stárek and Vlach, 2025). It traces the shift from punitive control to rehabilitative ethics, emphasizing how staff education can shape prison climate and mental health outcomes [European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT), 2025; United Nations, 1990]. Similarly, the paper on LGBTQ+ lives in UK prisons (Thomas and Glazzard, 2025) reveals the gap between policy and practice, demonstrating how inadequate implementation undermines well-being and rights, and calling for better data, training and accountability (WHO Regional Office for Europe, 2023; OHCHR and WHO, 2023).Mental health risks do not end at the prison gate. A study from the USA on suicide following release from pre-trial detention emphasizes the vulnerability of the post-custody period (Chukwuorji et al., 2025). The findings highlight the urgent need for improved transitional care and suicide prevention strategies tailored to this high-risk phase.Together, these contributions provide a timely and necessary counterbalance to the descriptive literature on mental health in detention. They shift the focus to solutions, albeit imperfect, context-specific and evolving, grounded in real-world practice and guided by rights-based principles (WHO Regional Office for Europe, 2024). They also highlight the importance of learning across borders, adapting good practices and reimagining care systems to reflect not only the vulnerabilities of those in prison, but also their capacity for healing, change and reintegration.The COVID-19 pandemic sharpened global awareness of mental health vulnerabilities but also revealed the limitations of our current systems. In prisons and other closed settings, where people are often at their most fragile, it emphasized the urgent need for evidence-based responses to address these persistent challenges (WHO Regional Office for Europe, 2024).This special issue is a call to action: to strengthen the evidence base for prevention and treatment, to embed mental health more fully within broader criminal justice and public health frameworks and to reaffirm our shared responsibility to ensure that no one is left behind.