The experiences of ex-offenders living with a mental disorder within three to twelve months following discharge from psychiatric prison care in Zimbabwe: a qualitative study

Background: There are significant challenges in many countries to effectively manage service needs of prisoners with a mental illness. In Zimbabwe, there is no literature on the prevalence of mental disorders among prisoners but it is likely to be as high as in other African countries. Apart from high prison populations which often under resourced, it is also reported that ex-offenders from correctional psychiatric institutions face a range of social, economic and personal challenges once released which often hamper their ability to live adaptive crime-free lifestyles. Although there is extensive literature on experiences of offenders within the criminal justice system, few studies have examined the convergence of the factors affecting those ex-offenders living with mental illness' transition from the prison environment to the community, as related to (i) their experiences upon discharge, (ii) barriers to effective community reintegration of this vulnerable population, and (iii) their service needs. The study addresses this gap. Aims & Objectives: The overall aim of the study was to explore the experiences of ex-offenders with a mental illness within a period of three to twelve months following discharge from psychiatric prison care. Specific objectives included: (1) exploring the experiences and needs of ex-offenders with severe mental illness upon discharge from psychiatric prison care; (2) exploring the key drivers and barriers to community re-integration of ex-offenders with severe mental illness after being discharged from psychiatric prison care; and explore available services and identify further service needs of ex-offenders with mental illness after being discharged from psychiatric prison care. Methods: Thirteen ex-offenders with a severe mental illness who were discharged at Chikurubi Maximum Security Prison participated in the study. There is a dedicated psychiatric facility at Chikurubi Maximum Security Prison and it was being funded externally through MSF. Key informant structured interviews were utilised. All ex-offenders were discharged within a period of three to twelve months, were over eighteen (18) years of age and they participated in the study willingly and provided informed consent. Only those based in Harare Metropolitan Province were included. The research participants were interviewed using a qualitative interview schedule which inquired about the experiences and needs of ex-offenders with severe mental illness; key drivers and barriers to community re-integration following discharge and access to mental health services. Interviews were transcribed verbatim and analysed using the framework approach to identify themes. To facilitate analysis of data, the qualitative analysis computer software NVivo 12 was utilised. Results: Findings of the study were grouped according to three main themes. Theme one highlighted how the prison infrastructure and environment negatively impacted on their mental health. This included dilapidated buildings, no running water, electricity shortages, poor ventilation in cells and overcrowding. The second theme focused on the perceived benefits of the comprehensive and integrated mental health services at Chikurubi Hospital. The third theme looked at the experiences and needs upon discharge from psychiatric prison care. Participants had mixed experiences of integration depending on the severity of the crime committed and whether or not they were integrated back into the same community where the crime was committed. Successful reintegration was challenging given the stigma and discrimination experienced as a result of committing a crime and having a mental health illness. The lack of community based services providing recovery focused interventions was also highlighted as a challenge. Conclusions: The study examined experiences of ex-offenders living with mental illness within three to twelve months following discharge from psychiatric prison care. Chikurubi Psychiatric Hospital provided comprehensive quality services through external funding. Upon discharge, community mental health services focused primarily on clinical recovery in the form of medication, impacting on the mental health of the participants as they re-integrated into the community