• Forensic patients cannot be given graduated leave 
• SL doesn't have a purpose-built forensic hospital
• Monitoring the treatment of a prisoner with mental illness is challenging 

There are no legal mechanisms in Sri Lanka to monitor detainees once they are released and forensic patients cannot be given graduated leave or a trial of community-based activities prior to their release. 

These concerns were raised in a Chapter on Forensic Psychiatry and Prison Mental Health in Sri Lanka which was authored by C Abhayanayaka, L A P de Alwis and T.S.S. Mendis, and published in the South Asian Perspectives in Mental Health and Psychology' Forensic Psychiatry and Prison Mental Health in South Asia, last year (2025).

Healthcare in SL

Over the last two decades, the country has been striving to achieve a community-based, decentralised service structure for mental health services The Government allocates less than two per cent of the annual health budget for mental health, amounting to about US$ 0.44 per capita (S. Raja, S.K. Wood, V. de Menil and S.C. Mannarath's Mapping mental health finances in Ghana, Uganda, Sri Lanka, India and the Lao People's Democratic Republic.

Treatment for mental illness is provided by both the public and private sectors. In 2021, up to 73 Per cent of the hospitals had psychiatric outpatient services, while close to half had facilities to provide inpatient admissions for mental illness (46 Per cent). Acute inpatient units are now present in every District, with many also offering intermediate-care rehabilitation facilities. In 2021, there were 21 inpatient units and three child and adolescent units. Psychiatrist-led multidisciplinary teams provide inpatient and outpatient services in most tertiary-care hospitals. Where there are no psychiatrists, services are provided by medical officers (MOs) who have a year of additional training in psychiatry and have obtained a Diploma in Psychiatry. In many Districts, specially appointed MOs, known as MOs of Mental Health (MOMH), provide psychiatric services under the supervision of a psychiatrist or a diploma-trained MO. MOMHs are fully qualified doctors with three months of additional training in common mental illnesses who provide community-based care in many Districts. They are expected to be the first level of specialist care for those with mental illness. They work closely with the country’s primary care network, accepting referrals and passing on the more complex patients to specialist psychiatric care. The MOMHs and the diploma-trained MOs fill the gap in services due to the lack of an adequate number of psychiatrists. Sri Lanka has only 0.6 psychiatrists per a population of 100,000.

Correctional services

Sri Lanka has four large prisons for convicted prisoners, 18 remand prisons, and 12 prison camps (two of which are open camps), with a capacity for approximately 10,000 prisoners. However, in 2023, these institutions housed an average daily population of about 27,000 detainees, exceeding the capacity by more than double. Sri Lanka has an incarceration rate of 127 per a population of 100,000, a figure much higher than her neighbours - India, Pakistan, and Bangladesh - but comparable with other Asian countries (the World Population Review's Incarceration rates by country 2024). Sri Lankan prisons employ about 5,200 prison guards. This number is about 1,000 positions short of the available cadre positions for the authorised number of inmates. Furthermore, the number of staff involved in rehabilitation, vocational training, and welfare are limited in comparison with the total number of inmates and the high turnover rate. This results in most prisoners never getting access to individualised rehabilitative activities. Despite the availability of free healthcare within prisons, severe shortages of medications, equipment, and qualified staff hinder the effectiveness of prison health services (the Human Rights Commission of Sri Lanka's Prison Study).

A total of 17.5 Per cent of new prisoners were documented as having a mental illness and were receiving treatment. A prevalence of 22.7 Per cent, a value much higher than what is found in the general population, was found in a study of suicidal behaviours in prisons. The illicit drugs predominantly used by detainees appear to be cannabis and heroin. A large portion of prisoners who continue to use illicit substances in prison have been found to have a dependence on these drugs. Despite these findings, Sri Lankan prisons do not have dedicated drug services. There are no harm minimisation services, such as opioid replacement therapy. There are State-run rehabilitation centres where prisoners may be diverted for compulsory rehabilitation. Two of the largest rehabilitation centres, with a capacity of close to 1,000 inmates, are run by the military and function under a non-medical model. Even these centres do not have robust post-discharge support for detainees who complete the one-year-long rehabilitation program, leading to high rates of relapse and recidivism. The recidivism rate in Sri Lanka is about 20 Per cent. 

Forensic psychiatry services in SL

In Sri Lanka, forensic psychiatry services are very much centralised, with most specialist services concentrated around the major Cities of Colombo, Kandy, and Galle. Thus, forensic psychiatric services are routinely carried out by general adult psychiatrists as well as child and adolescent psychiatrists. Services such as assessing mentally-ill offenders and victims, providing opinions to courts and advice to judicial medical officers (JMOs are specialist doctors in forensic medicine and pathology, and are employed by the Government to conduct autopsies, examine injuries, and give expert evidence to courts), constitute a significant portion of the daily workload of a general psychiatrist. Many generalist psychiatrists offer in-reach services to their local prisons. Sri Lanka does not have a purpose-built forensic hospital. Instead, the care of mentally-ill offenders is primarily provided by the Forensic Inpatient Service at the National Institute of Mental Health in Angoda (an outer suburb of Colombo, around eight kilometres from the Colombo City) (NIMH is the largest tertiary Hospital for Mental Healthcare and has a bed capacity of over 1,000 beds) and, to a lesser extent, by regional inpatient units. Sri Lanka only started specialist training in forensic psychiatry in 2011. Since then, six forensic psychiatrists have completed training. However, four of them have migrated out of the country.

Services in Colombo

Forensic psychiatry services in Colombo are organised around the Forensic Inpatient Service of the NIMH. In addition to the large inpatient service, the Colombo service conducts outreach clinics in the National Hospital, and an in-reach clinic at the Welikada Prison Hospital.

Forensic Inpatient Service 

The NIMH has the largest and busiest Forensic Inpatient Service. Located within the NIMH, it is the only Unit recognised under the law to receive and detain forensic patients. Thus, it is the only Facility that can accept patients after a finding of not guilty by reason of insanity or unfit for trial. for detainment. as part of their disposal.

The Colombo Forensic Inpatient Service consists of two inpatient units: one male and the other female. The male unit has a bed capacity of 100 beds, and the female unit has 22 beds. These units are not purpose-built; instead, existing wards of the Angoda Mental Hospital have been converted into forensic psychiatry wards. Thus, the Colombo Forensic Inpatient Service is ill-equipped to contain and rehabilitate high-risk offenders. Such offenders are almost always screened at the Prison level to prevent admission. Consequently, the milieu within the Colombo Forensic Inpatient Service is not significantly different from that of a general inpatient unit.

Forensic Inpatient Service Male Unit—Ward 21

The Forensic Inpatient Service Male Ward is located on the third floor of a three-floor building, which was one of the original six three-storey blocks present at the time the Angoda Mental Asylum opened. The ward occupies a single floor of this building, arranged as a dormitory, with 100 beds taking up most of its floor space. It is more common than not for the ward to be over capacity with more patients than beds.

The ward has a level of security comparable to that of a medium-secure unit. The ward is always locked, with a staff member or a security officer posted at the entry. The main entrance opens into an airlock before the entry door into the patient area. Patients and visitors are searched before entry into the ward. All searches are conducted manually without the aid of X-ray baggage screening systems or hand-held security wands. Conducting a body search on a patient or visitor would be unusual. There are no seclusion facilities within the ward. The ward can only be reached by climbing a stairwell of six flights of stairs arranged in a spiral. There is no lift access, which makes it difficult for anyone with disabilities to access the unit.

Detainees are not stratified according to the risk or the acuity of illness. Thus, it is common for acutely unwell patients to share the same space as those who are cured of illness or for someone with a minor offence to share the same space as someone with a very serious offence, such as murder.

Forensic Rehabilitation Unit 

One floor below the Forensic Inpatient Service Male Ward is the Forensic Rehabilitation Unit. The unit has the same level of environmental security available in the said ward. There are facilities for arts and crafts as well as exercise equipment. From the unit, a staircase leads to an enclosed, secure garden area of approximately 500 square metres, which is divided into a horticulture project and a playground. The unit has a full-time occupational therapist and several nurses who run activities on most days of the week. They can provide group activities for about 20 to 30 patients.

Forensic Inpatient Service Female Unit—Ward 25

The Forensic Inpatient Service Female Ward is a 22-bed unit located in a single-storey building within the NIMH. The ward has a simple design, typical of most other adult psychiatry units in the NIMH. The ward is a long structure, with 22 beds arranged in two rows in the form of a dormitory. At one end of the ward, there is the entrance and the nursing station, and at the other end, there are the toilets and a seclusion room. Just outside the unit, there is a hall for rehabilitation activities. The security level in the ward is similar to a low-secure unit, with little to no perimeter security. The entrance to the ward has no airlock design and opens into the campus grounds of the NIMH. The hall built for rehabilitation is an open structure with no locking-up facilities. Thus, only patients with a very low risk of aggression and absconding can be taken for rehabilitation activities. Overcrowding is rarely a problem in the ward.

Detainees in the Colombo Forensic Inpatient Service

The majority of the patients admitted to the Forensic Inpatient Service are remandees who have been committed for trial, where the judicial authorities have inquired about the mental state of the defendant. In some, the issue of fitness for trial has been raised, while in others, their behaviour in the courts has raised doubts about the presence of a mental illness. Some magistrates refer defendants who are acutely unwell for treatment through a direct referral to the Forensic Inpatient Service, despite a different pathway being in existence for prisoners to be referred for treatment under the Mental Diseases Ordinance. A few are sent by higher courts for the assessment of their criminal responsibility when an issue of not guilty by reason of insanity has been raised. In addition to the above patients, about one-fourth of the detainees in the unit have been detained under the Criminal Procedure Code after a finding of not guilty by reason of insanity or unfitness for trial. This group often ends up spending months to years in hospital, as opposed to the other patients who are often summoned back to courts within a few weeks. The Male Ward of the Forensic Inpatient Service receives close to 10 admissions every week, while in the Female Ward, this number is close to two or three. Most admissions are acutely unwell, suffering from acute psychosis, mania, or severe depression, requiring assertive treatment. Once treatment is completed and where no detention orders exist, the patients are sent back to custody to face their court matters.

Services in Kandy and Galle

Out of the two forensic psychiatrists, one works in Colombo and the other in Kandy. A forensic psychiatrist was working in Galle until 2023. Both the Kandy and Galle services consist of an inpatient service, a prison in-reach program, and a community forensic service. In the absence of a dedicated physical unit for forensic patients, male and female beds have been allocated from the male and female general psychiatry inpatient units of the Kandy National Hospital and the Galle National Hospital (Karapitiya) to be used for the admissions of forensic patients. These beds are serviced by the nursing and the allied health staff of the Hospitals’ general inpatient psychiatry units. In Kandy, the forensic psychiatrist is assisted by several psychiatry registrars and one MO. In Galle, since the forensic psychiatrist there left his post for employment overseas, a general psychiatrist has been providing cover for the functions of the forensic unit. Prisoners from regional prisons, from the Central (Kandy) and Southern (Galle) Provinces, are admitted to the Kandy and Galle Hospitals inpatient psychiatry beds when in need of assessment or treatment under the Prisons Ordinance. The typical duration of stay is a few days to weeks.

Unlike the Colombo service, which refers all discharges back to the local mental health services, the Kandy and Galle forensic services conduct limited outpatient follow-up clinics for forensic patients once released from custody. High-risk patients are identified and provided additional input, including closer follow-up and liaisons with local general psychiatric services. Similar to the Colombo service, the Kandy and Galle services have outpatient clinics for non-custodial mentally ill offenders, victims of crime, and other patients requiring capacity assessments referred by the local magistrate and High Courts. In addition, multiple referrals come from JMOs attached to regional hospitals and university forensic departments. Preparing forensic reports constitutes a major workload for both services.