Across Europe, prisons have become ground zero for a growing mental health crisis. This crisis is not just about the vulnerabilities of those incarcerated, but also about the failures of our public institutions. Despite longstanding international obligations, mental health care in detention remains wholly insufficient.¹

On any given day, over 1,5 million people are imprisoned across Europe.² While mental health conditions are widespread in society, they are dramatically amplified behind bars. According to the World Health Organization (WHO), about one in three people in detention live with a mental health condition, double the rate in the general population.³

This overrepresentation is no accident. The same factors that increase the risk of poor mental health also increase the risk of incarceration.⁴ Furthermore, prisons have absorbed the burden of underfunded psychiatric institutions, becoming de facto mental health facilities, though they are utterly unsuited to this role.⁵ Overcrowding, constant noise, lack of privacy, and punitive measures like solitary confinement actively worsen mental health conditions.⁶

Nonetheless, the right to health is inalienable, even in detention. The principle of equivalence holds that healthcare in detention must meet the same standards as in the community.⁷ The European Court of Human Rights has repeatedly affirmed that States are obliged to provide the requisite medical assistance and ensure conditions compatible with human dignity. Recent judgments go further, questioning whether prisons are ever appropriate for people with serious mental conditions.⁸

Despite decades of international guidance, thousands suffer from untreated or misdiagnosed mental health conditions in detention. This is not incidental, it is structural. RESCALED’s research across 15 European countries, as part of the RESIZE project, found seven critical shortcomings⁹:

1. Governance gaps: In most countries, health care in detention is managed by justice ministries, not health ministries. This creates an institutional conflict between punishment and care. Integration with national health systems is rare, leaving health in detention isolated and fragmented.
2. Chronic understaffing: Prisons are expected to manage complex health needs with a fraction of the workforce available in the community. There are too few mental health specialists, leading to underdiagnosis, inappropriate treatment, and staff burnout.
3. Lack of infrastructure: Many with severe mental health conditions are placed in ordinary prisons instead of specialized facilities. Therapeutic environments are in short supply, and those that exist are overwhelmed.
4. Inadequate screening and care: Psychiatric screenings are inconsistent and often substandard. Vulnerable groups -women, young adults, the elderly- rarely receive specialized, trauma-informed care.
5. Uneven access to community services: Partnerships with external providers are inconsistent and often unstable. Many are released without support, increasing the risk of relapse and reoffending.
6. Lack of continuity of care: Mental health support often ends abruptly at release, with little or no handover. This undermines the principle of continuity of care, a basic patient right. 
7. Data deficiencies: Many countries fail to collect or report data on key indicators like prevalence of mental disorders or suicide. Without data, there is no accountability or evidence-based policy.¹⁰

These failures are not isolated; they are symptoms of a system designed for containment, not care. Centralized prisons prioritize security and efficiency at the expense of health and dignity. Even as rhetoric shifts toward restorative justice, mental health care remains marginal, often reduced to crisis management.

Detention houses offer a clear path forward, built on three principles: small-scale, differentiation, and community-integration.

1. Small-scale: Detention houses accommodate small groups (8-30 people), enabling personalized care and meaningful relationships between staff and residents.
2. Differentiation: Facilities are tailored to specific needs like mental health conditions, as required by European human rights law. Staff are trained in relevant approaches, and regimes are adapted accordingly.
3. Community-integration: Detention houses are embedded in local communities, allowing residents to access local health clinics and programs to promote continuity and quality of care.

Across Europe, many facilities already embody this approach, demonstrating that more humane and community-connected forms of detention are both possible and already being realized.¹¹ Detention houses succeed where centralized prisons fail because they function as part of a broader ecosystem. They connect directly to community health services, ensuring residents remain part of the wider system of treatment and support.

Given the evidence that centralized carceral institutions consistently undermine basic rights, it is clear that a fundamental rethinking of our approach is necessary. The path forward lies in shifting responsibility for mental health back to health systems and embedding care within the broader community ecosystem, as exemplified by the RESCALED approach.

About the RESIZE project: To address the issues highlighted in this blog post, RESCALED is leading the “Reshaping Correctional Competencies through RESCALED Innovation” (RESIZE) initiative. Find out more here.

Read the full report on Mental Health

1. The scope of this report encompasses prisons and where appropriate, detention facilities. For the purpose of this report, the latter refers to facilities where individuals serve sentences involving the deprivation of liberty. The following settings do not fall under the scope of this report: juvenile detention centers, police stations, immigration holding centers, psychiatric hospitals, social care homes, etc. ↩︎
2. Although it is estimated that 6 million people are incarcerated every year in the WHO European Region. See World Health Organization (February 2023). Status report on prison health in the WHO European Region, XI.
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3. World Health Organization. (s.d.). Health in Prisons European Database (HIPED). Retrieved October 8, 2025 from https://www.who.int/data/region/europe/health-in-prisons-european-database-(hiped). For this purpose, the World Health Organization defines mental health conditions as depression, bipolar affective disorder, schizophrenia and other psychosis, dementia, and developmental disorders, including autism. ↩︎
4. Council of Europe. (May 2022). Prisons and probation: a Council of Europe White Paper regarding persons with mental health disorders (PC-CP (2021) 8 Rev 6). ↩︎
5. Schildbach, S., & Schildbach, C. (October 2018). Criminalization Through Transinstitutionalization: A Critical Review of the Penrose Hypothesis in the Context of Compensation Imprisonment. ↩︎
6. MacDonald, M. (June 2018). Overcrowding and its impact on prison conditions and health. Council of Europe. (February 2019). Organisation and management of health care in prison, 37.  ↩︎
7. Council of Europe Committee of Ministers. (April 1998). Recommendation No. R (98) 7 of the Committee of Ministers to member states concerning the ethical and organizational aspects of health care in prison; United Nations. (December 2015). Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules), Rule 24; Council of Europe. (June 2006). European Prison Rules (Recommendation REC(2006)2), Rule 40. ↩︎
8. For more details on this extensive case-law, see the full report.  ↩︎
9. The countries surveyed were Albania, Austria, Belgium, Bosnia and Herzegovina, Croatia, Denmark, Germany, Greece, Italy, the Netherlands, North Macedonia, Portugal, Romania, Slovenia, and Spain ↩︎
10. Findings based on the survey conducted by RESCALED as part of the RESIZE project, as well as data from World Health Organization. (February 2023). Status report on prison health in the WHO European Region. ↩︎
11. For example, Belgium’s detention and transition houses, Italy’s Residenze per l’Esecuzione delle Misure di Sicurezza (REMS), Spain’s PAIEM program, Switzerland’s Vollzugszentrum Klosterfiechten, Portugal’s Torres Novas, and the Netherlands’ Huis van Herstel. For more inspirational practices, see RESCALED. (s.d.). Inspirational practices. Retrieved October 8, 2025, from https://inspirational-practices.rescaled.org/.  ↩︎