MHL in the criminal justice system

Previous studies have indicated that people with mental illness are over-represented within the criminal justice system (CJS) compared with the public. ^{Reference Fazel and Seewald21–Reference Termeer and Szeto24} This over-representation has been a growing concern for healthcare providers, policymakers, correctional officers, human rights advocates and lawyers. ^{Reference Peterson and Heinz25,Reference Adjorlolo26}

Studies have claimed that MHL within the CJS is under-researched. ^{Reference Hebert22,Reference O’Leary27} Among those studies that examined MHL among correctional officers, one assessed their mental health knowledge and work-related self-efficacy (N = 40) using the Multiple-Choice Knowledge of Mental Illness Test. The study found that correctional officers had lower levels of mental illness knowledge, but an elevated level of self-efficacy, when working with people in prison with mental illness. Officers with higher education qualifications reported higher MHL than those with lower qualifications. ^{Reference Podkova28}

MHS in the criminal justice system

Stigma towards people with mental illness is considered to be high among correctional officers in developed countries. Research suggests that this may, in part, be due to media coverage reports portraying individuals with mental illness as violent. ^{Reference Termeer and Szeto24} In the USA, one study exploring stigma perceptions among judges and attorneys discovered that judges and prosecutors had negative attitudes toward mental illness. As such, they viewed such people who had encountered the CJS as a greater risk to the community. ^{Reference Batastini, Lester and Thompson29} Similarly, another study found that probation officers rated people in prison with mental illness as dangerous compared with those without mental illness. ^{Reference Eno Louden, Manchak, Ricks and Kennealy30}

Furthermore, one study in the USA found that older custodial staff had more negative attitudes toward people with mental illness. ^{Reference Hull31} Some studies have argued that these stigmatising attitudes may result in discrimination against people in prison with mental illness, being restricted in accessing treatment and leading to punitive measures. As a result, this could have a negative impact on the well-being and treatment outcomes of people with mental health difficulties. ^{Reference Hull31} In contrast, other studies found neutral and positive attitudes toward mental illness by probation, parole and custodial officers. ^{Reference Oostermeijer, Morgan, Ross, Grimmond and Reavley32,Reference Murphy33} Others found that daily contact with people in prison diagnosed with mental illness was associated with positive attitudes compared with monthly contact. ^{Reference Lowder, Ray and Gruenewald34}

Training of correctional officers

There is evidence that mental health training modalities, such as Crisis Intervention Teams (CITs) and Mental Health First Aid (MHFA), can improve correctional officers’ attitudes towards mental illness. ^{Reference Eno Louden, Manchak, Ricks and Kennealy30} MHFA was developed in Australia in 2001 and is defined as ‘the help provided to a person developing a mental health problem or in a mental health crisis’. ^{Reference Kitchener and Jorm35} MHFA is a training programme for anyone with limited or no experience and who desires to identify mental health issues and provide early assistance to people who want emotional or mental healthcare. ^{Reference Kitchener and Jorm35} One study examined the effectiveness of MHFA among 105 jail staff in the USA who completed the MHFA training, and reported that it was beneficial for both their employment and everyday life. ^{Reference Schweers36}

Furthermore, the CIT was developed in the USA in 1998 by a police officer in response to the events following the fatal shooting of a man who had wielded a knife and with a history of mental health and substance use. ^{Reference Watson and Fulambarker37} Since then, the CIT has been proposed as a promising intervention model to address certain challenges faced by correctional officers when interacting with people experiencing mental illness symptoms. ^{Reference Canada, Watson and O’kelley38} One study examined the perceptions and preparedness of correctional officers working with people incarcerated with mental illness and in crisis. Among participants, some correctional officers were certified in CITs while others were not.

That study found that the two groups showed no differences in perceptions. However, those correctional officers who were certified in CITs reported feeling more equipped to engage with people in prison experiencing mental health symptoms and those in crisis. This group of CIT-certified correctional officers also demonstrated more positive attitudes toward these individuals. ^{Reference Petracek39}

Forensic mental health services in Zimbabwe

The World Health Organization’s Special Initiative for Mental Health Assessment (2020) highlighted that forensic mental health services in Zimbabwe house a significant portion of the country’s mental health patients. For example, the Zimbabwe Prisons and Correctional Service (ZPCS) operates two special forensic institutions in Harare and Bulawayo, at Chikurubi and Mlondolozi maximum-security prisons, respectively. The Zimbabwe Mental Health Act (MHA) of 1996 (Section 107) governs these facilities for the assessment and treatment of both males and females with mental illness and who are detained in these special forensic institutions. The MHA (Statutory Instruments 15, Section 107 of 1996a), the Mental Health Regulations Statutory Instrument 62 of 1999, the Mental Health Policy of 2004 and the Prisons Act (chapter 7:11) are the key legislative frameworks that guide these special institutions. ⁴⁰ Approximately 478 individuals with mental illness (not convicted) were admitted at Chikurubi Special Institution (Northern region) against a holding capacity of 150, resulting in severe overcrowding. Meanwhile, at Mlondolozi (Southern region) it was reported that 301 patients were admitted against a holding capacity of 406. ^{Reference Zhakata41}

The present study

There is limited research conducted in LMICs, such as Zimbabwe, that have explored MHL and MHS in regard to mental illness. Most research in Zimbabwe has explored rehabilitation interventions to reduce inmate reoffending, ^{Reference Shonhayi42–Reference Tigere and Ndlovu44} but this does not tell us about the level of care provided by the services themselves. Therefore, to address this gap, our study aimed to examine MHL and MHS in the ZPCS in regard to mental illness. Our first task was to determine whether MHL is related to MHS among this group; if such a relationship is demonstrated, increasing MHL may be a means of decreasing MHS. As a result, our primary hypothesis was that increased MHL (as measured by the Mental Health Literacy Scale (MHLS), in which a higher score indicates increased literacy) would be inversely related to MHS in this group (as measured by Attitudes Towards Mentally Ill Offenders (ATMIO)), where a higher score indicates low stigma). The following hypotheses were exploratory: officers with more experience are likely to show a positive attitude towards mental illness (H1); officers who have daily contact in prison with people with mental illness are likely to show positive attitudes and knowledge about the condition (H2); and officers who have received mental health awareness training are likely to (a) show a positive attitude towards people in prison with mental illness and (b) have higher levels of MHL (H3).