ROUMIEH, Lebanon: Marwan is a clean-cut, well-built young man who smiles often and speaks perfect English. He is also a convicted murderer. An inmate at Roumieh prison, Marwan was diagnosed with schizophrenia and lives in the Blue House, or psychiatric ward. He has been in prison for 12 years and is due to be released in three years’ time.
“Sometimes I hear voices,” says Marwan, whose name has been changed to protect confidentiality. “These voices tell me things that are so bad. They’re evil. Sometimes I see the devil, and he talks to me ... When I hear these voices, I try to wake up and listen to music ... it relaxes me.”
Marwan says that he committed murder while in the grip of his delusions.
“I think I killed somebody because I was sick,” he says, looking at the floor. “If I was on medicine I wouldn’t have done it.”
Asked if he thinks prison has helped him get better, Marwan smiles sadly. “I don’t think so,” he says. “I’m always sad ... I feel like I’m the saddest man in the world.”
Hundreds of prisoners like Marwan, who committed crimes while suffering from a mental disorder, end up in prison and not in treatment, according to doctors and NGOs who work with mentally ill criminals.
A 2010 World Health Organization study on the Lebanese mental health care system found that 6-10 percent of prisoners suffer from psychosis. Suzanne Jabbour, director of the Restart Center for Rehabilitation of Victims of Torture and Violence, an NGO that provides psychiatric treatment for prisoners at Tripoli prison, says that the 20 or so prisoners living in the Blue House at Roumieh are the lucky ones.
“The problem is not with the people in the Blue House, who have been diagnosed and are undergoing treatment,” says Jabbour. “The problem is the people in jail without any diagnosis and who are suffering from mental illness. You can find enormous numbers of inmates suffering from mental disorders.”
Jabbour says that the prison system provides barely any services for mentally ill prisoners.
“The government doesn’t provide any specific support when it comes to psychiatric services in general,” she says. “It is NGOs that are providing inmates with psychiatric services, medication, psychotherapy, and follow-up care.”
According to Jabbour, the organizations are struggling to provide the limited services that are currently available. “The NGOs are severely lacking in material, financial and human resources,” she says. “They are not capable of fulfilling this huge need in regard to psychological services.”
Part of the problem is the legal system itself, according to Ziad Achour, a lawyer for the Association of Justice and Mercy, or AJEM, an NGO that works in Roumieh prison.
“The Lebanese law dealing with criminal insanity hasn’t been revised since 1943,” says Achour. “The judge evaluates the prisoner and decides whether they have a mental illness.”
Because most judges aren’t trained to spot mental illness, many prisoners suffering from psychological diseases go undiagnosed, says Dr. Antoine Saad, national adviser for Mental Health Lebanon and co-author of the WHO study.
“In a specific case, if the judge needs more information, they will send an expert in order to get a report on the situation of this particular prisoner,” says Saad. “But the judges have little or no understanding of mental health matters.”
These “experts” are usually forensic doctors who can specialize in anything from general medicine to pediatrics, not forensic psychiatrists, says Jabbour.
Once a mentally ill prisoner has landed in jail, it is almost impossible for them to serve their sentences in a psychiatric hospital, according to Dr. Rudy Abi Habib, a psychologist who works with AJEM and treats inmates at Roumieh prison.
“Legally, I can’t do anything,” says a frustrated Abi Habib. “Reopening cases takes a lot of time and bureaucracy, and I don’t even know if it is possible. I’ve seen many paranoid schizophrenics who committed their crime under the effects of their delusion, and I would swear to it ... they should be treated. Society must put them away for treatment, but in Roumieh, they don’t receive treatment. They’re just put away.”
Saad says that letting these prisoners slip through the cracks of a flawed system is dangerous not only to them but to the public, since these prisoners are more likely to relapse once they’ve been released.
“If you look at statistics in a prison population of 4,000 inmates during a specific period in time and see how many of them have a diagnosis of mental illness, then do a screening to see what crimes they committed, you will be shocked to see how many of them are in and out of jail and constantly relapsing,” he says.
Dr. Jocelyn Azar, a psychiatrist who works with Restart and treats prisoners at Tripoli prison, says that this lack of services is partially due to a general lack of education concerning mental health in Lebanon.
“We don’t have the awareness yet,” says Azar. “Even when it comes to general psychiatry, we’re not at this stage. It’s still taboo. We don’t have the structure or the medical system. You need money, people, laws – you need a system in place.”
Azar says that this system is crucial in order to ensure that prisoners with mental health problems are rehabilitated. “The situation would be better if we had better trained specialists in prisons and other rehabilitative services,” she says. “It would protect people on the outside.”
Even in the Blue House, Marwan says he doesn’t have access to regular psychotherapy. “We have a doctor here,” he says. “He comes every Thursday to check up on us and give us medicine. But unfortunately, we don’t have a therapist here. I don’t have anyone to talk to.”
Marwan says that after 12 years in prison, he’s terrified of what awaits him on the outside. “I’m scared to get out,” he says. “I can’t think of what I will do when I get out. I can’t forget what I did.”
He looks out the window at the sun-drenched concrete walls surrounding him. “I’m sure God will help me,” says Marwan. “He has to help me.”
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