Priorities for addressing mental health conditions and substance use disorders in prisons in sub-Saharan Africa: expert consensus from a Delphi panel.

People who are incarcerated in Africa are not a focus of global mental health research, and incarceration is absent from many international mental health guidelines. Given the dearth of knowledge and services, priorities for research and practice should be established. The Delphi method was used to identify priority challenges related to mental health and substance use disorders among people who are incarcerated in sub-Saharan Africa. Experts in the field completed four iterative electronic surveys. The first survey was an open-ended question about priorities. In subsequent surveys participants used a Likert scale to rate the importance of each priority. 97 experts from 27 countries (20 in sub-Saharan Africa) completed the first survey (64% of those targeted). The 38 priority challenges fell into ten thematic areas: pathways for care during incarceration; the health-care workforce; alternatives to incarceration; the specific needs of women; acute conditions; involvement of non-health-care staff; policy; infrastructure and carceral conditions conditions; re-entry into the community; and people awaiting trial. These priority challenges can guide the efforts of practitioners, policy makers, and researchers to address mental health conditions and substance use disorders among people in prisons in sub-Saharan Africa. Investment in the health-care workforce, policies, and prison infrastructure, as well as developing non-carceral solutions, are needed to support behavioural health in people who are incarcerated.