CONDITIONS OF DISABLED INDIVIDUALS IN PENITENTIARY INSTITUTIONS, THE INSTITUTION FOR INVOLUNTARY PSYCHIATRIC TREATMENT AND TEMPORARY DETENTION ISOLATORS Prison administrations are complaining that they have been experiencing serious difficulty in looking after prisoners with mental problems after the closure of the Medical Institution for Accused and Convicted Persons. It has become especially difficult to provide necessary psychiatric aid to remand prisoners with mental illnesses. They seldom receive a psychiatrist’s consultation and fulfillment of their treatment regime requirements usually depends upon the willingness of the prisoner itself or the support of his/her co-inmates. The penitentiary system has no standards on initial psycho-physical assessment of prisoners and management of problems identified. Initial medical examination of prisoners in penitentiary institutions is performed by family doctors. A psychiatrist’s consultation is provided only when it is already late, when patients actually show signs of acute psychosis demonstrating manifestly inadequate behavior. Mental problems generated by arrest as well as relatively mild psychic disorders remain unnoticed. Analysis of prisoners’ medical files showed that prisoners’ psycho-physical health assessment on admission is formalistic; no multi-profile evaluation is performed. Somatic, psychological/psychiatric, social and legal needs remain unidentified. Accordingly, no actions are planned and implemented to deal with the problems revealed. A serious problem in the penitentiary system is the established practice that beneficiaries demand excessive doses of psychotropic medications and, if denied, demonstrate aggressive and manipulative behavior. A majority of prisoners taking psychotropic medications are suffering from accompanying personality disorders and somatic problems. Excessive use of psychotropic medications by prisoners is an abnormal practice connected with drug addiction and personality disorders. The penitentiary healthcare system does not provide prisoners having personality disorders with quality and effective mental health services. The imprisonment regime is not differentiated or adapted to needs of prisoners with personality problems; this results in deterioration of the patients’ mental health restricting their psycho-social aptitude on the one hand and complicating the work of the medical personnel and the prison staff on the other hand. The penitentiary system does not ensure beneficiaries with adequate psychiatric/narcologic assistance and appropriate psycho-social rehabilitation. No psycho-educational work is carried out and, despite the high risk that addiction to benzodiazepines either already exists or may develop soon, prisoners are not offered gradual reduction in the use of drugs and some replacement psycho-social measures. The monitoring showed that, in the penitentiary institutions, prisoners are provided psychiatric assistance without their informed consent, which hinders the establishment of a positive therapeutic relationship between the doctor and the patient, which is especially important in a prison setting where a prisoner cannot freely choose his own doctor. “Patients should be provided with all relevant information (if necessary in the form of a medical report) concerning their condition, course of treatment and medications prescribed.”105 In the course of monitoring, the monitoring group identified a series of cases where persons with mental problems were not receiving adequate treatment and their condition was most likely deteriorating. When a prisoner is admitted to a penitentiary institution, the examining doctors are entering a note in the relevant section of the prisoner’s medical card about post-self-injury scars found but the doctors are not interviewing the prisoners about the origin of these wounds. Nor are the prisoners questioned about having any suicidal thoughts or aspirations to help recognize the likelihood of suicidal behavior in the future. Suicides and para-suicides are not differentiated and, hence, no appropriate psychiatric/psychological assistance and observation are offered. The healthcare personnel and the staff of the institutions are not equipped with algorithms for the management of aggressive behavior, depression or stress and have not had any professional training in these matters. 105 CPT’s Third General Report, paras. 45-49. 2013 The Committee for the Prevention of Torture (CPT) considers suicide prevention a matter falling within the purview of prison healthcare services and suggests that special attention be paid to training the personnel in recognizing indications of suicidal risk and following appropriate procedures. In this regard, the CPT notes, the periods immediately before and after trial and the pre-release period involve an increased risk of suicide. According to CPT, medical screening on arrival is important as this could relieve some of the anxiety experienced by newly admitted prisoners.106 106 CPT’s Third General Report, paras. 57-59. NPM Report 57