Toward a Trauma-Informed Prison System in India: A Systematic Review and Case for Mental Health Reform and Post-Carceral Reintegration

Background: Mental illness and trauma are increasingly recognized as public health crises within global prison systems. In India, this crisis is exacerbated by chronic overcrowding, prolonged undertrial detention, inadequate psychiatric care, and widespread stigma surrounding mental illness. The Prison Statistics India 2022 report underscores the scale of the problem: a 131.4% occupancy rate, 75.8% undertrial population, and a dramatic underreporting of mental illness. While suicide rates among incarcerated individuals remain high, the current criminal justice infrastructure fails to acknowledge trauma as a core issue. This review seeks to critically examine the existing literature on trauma-informed approaches within correctional systems, with a focus on the Indian context, and identify best practices that can inform systemic mental health reform and post-carceral reintegration.

Methods: A systematic review was conducted using PubMed, PsycINFO, ProQuest, Scopus, and Google Scholar. Search terms included combinations of “trauma-informed care,” “prison mental health,” “incarceration,” “India,” “post-carceral reintegration,” “telemental health,” and “undertrial prisoners.” Inclusion criteria were: (1) studies focused on trauma or mental health in incarcerated populations, (2) research conducted in India or applicable to the Indian context, (3) studies involving post-release support or reintegration, and (4) evaluations of trauma-informed or digital mental health interventions. The total number of articles that met the inclusion criteria were 428 of which 193 were selected for systematic review. PRISMA-2020 guidelines were used to screen and select articles, with final inclusion of 34 articles after full-text review.

Results:

1. Underreporting and invisibility of trauma: Many incarcerated individuals in India experience trauma related to arrest, custodial violence, and prolonged legal uncertainty, yet few receive any psychiatric diagnosis or treatment.
   
   
2. Lack of structured mental health services: Most prisons lacked regular psychological screenings, evidence-based interventions, or dedicated mental health staff.
   
   
3. Emergence of culturally embedded practices: Programs like Vipassana meditation and Sudarshan Kriya showed promise as low-cost, culturally acceptable interventions that align with trauma-informed principles.
   
   
4. Need for digital intervention models: Given the shortage of mental health professionals (0.75 psychiatrists per 100,000 population), studies highlighted the potential of mobile counseling apps, telehealth services, and helplines for post-release mental health support.
   
   
5. Institutional resistance: Several studies noted correctional staff's lack of training in mental health literacy and reluctance to engage in trauma-sensitive practices, reflecting systemic barriers.
   

Implications: This review highlights an urgent need to embed trauma-informed care as a foundational element in India's prison reform efforts. Key recommendations include: (1) nationwide implementation of trauma screening protocols using tools like ICD-11, (2) mandatory staff training in trauma-informed approaches, (3) integration of culturally rooted healing practices within prison mental health programming, and (4) development of a nationwide digital trauma counseling infrastructure for post-carceral reintegration. By reframing prison mental health from a punitive to a healing paradigm, India has the opportunity to align criminal justice with human rights, public health goals, and restorative justice. A trauma-informed prison system is not only a policy imperative—it is a moral and social necessity.