Inmates serving prison sentences who develop severe mental disorders[1] after their sentencing represent an especially vulnerable category within the general prison population. Standard prison programs cannot be applied to them, nor can the purpose of the prison sentence, as defined by the Law on the Execution of Criminal Sanctions, be achieved. Moreover, the current legal framework does not allow for the substitution of a prison sentence with a security measure of mandatory psychiatric treatment and custody in a healthcare institution. Correctional institutions and district prisons are neither organizationally, staff-wise, nor technically equipped to provide appropriate treatment for inmates with severe mental disorders. Additionally, research on mortality and causes of mortality in Serbian prisons has shown that over 30% of deceased inmates had some form of mental disorder.
Photography: Ana Batrićević
In one of the control procedures initiated by the Protector of Citizens based on a complaint about the violation of the right to healthcare for a prisoner suffering from a severe mental disorder, the Protector of Citizens received reports from the Healthcare Service in the correctional institution. These reports indicated that continuous medication therapy is the only possible treatment, sociotherapy cannot be conducted in penal conditions, and work therapy cannot be implemented because the inmate “is not capable of work due to the nature of his illness and therefore cannot be employed.” Furthermore, the reports stated that the inmate does not have a specific treatment measure, must remain in the correctionl institution while the primary illness is in remission, and will be sent to the Special Prison Hospital when signs of decompensation reappear. These procedures will repeat until the inmate is released from the institution or the sentence is fully served. Following the institution’s further handling of the inmate in this specific case, it was noted that he had been sent to and treated in the Special Prison Hospital in Belgrade more than ten times during his imprisonment, only to be returned to the correctional institution afterward.
In this regard, it is important to note that no correctional institution or district prison in Serbia has established a dedicated department with conditions suitable for the proper treatment and care of inmates suffering from severe mental disorders. These individuals are placed in the institution’s infirmaries together with other patients, and the staff in the healthcare services, except for the psychiatrist specialist if employed in the penal institution, are not specifically trained to work with them. Employees in the treatment services are also not specifically trained to assess the individual needs, capacity for change, and risk level of an inmate with a severe mental disorder for reoffending, nor is it possible to apply the classification and reclassification system to this particularly vulnerable category of the prison population. Correctional institutions and district prisons do not provide conditions for an individualized approach to their treatment, which would include the preparation of an individual treatment plan and the provision of effective psycho-social rehabilitation treatment. The existing practice, which reduces the treatment, psychiatric care, and treatment of those with severe mental disorders to pharmacotherapy, does not contribute to achieving the prescribed purpose of prison sentences and cannot be considered substantially effective treatment. This category of inmates, in addition to pharmacotherapy, requires adequate psycho-social rehabilitation treatment through individual work, occupational therapy, psychotherapy, and other activities that could contribute to better symptom control of the mental disorder and functioning within the prison environment, improvement of the mental health of the inmate, and better reintegration.
There is also the question of the procedures followed by correctional institutions and district prisons when an inmate with a severe mental disorder refuses to undergo treatment. Unlike the security measure of compulsory psychiatric treatment and confinement in a healthcare institution, a prison sentence does not obligate the inmate to undergo treatment. Treatment in such cases is conducted only with the inmate’s consent to the medical intervention.
Taking into account all the aforementioned considerations and starting from the fact that the ministry responsible for health oversees the professional work of healthcare services in correctional institutions, the Protector of Citizens has issued an Opinion[2] highlighting the need for the Ministry of Health to pay special attention to the continuous professional supervision of healthcare services in correctional institutions regarding the provision of healthcare to inmates with severe mental disorders. Additionally, the need for the Ministry of Justice and the Ministry of Health to thoroughly review the position of persons with severe mental disorders serving prison sentences in correctional institutions and district prisons was emphasized. This review should aim to find the most appropriate ways to protect the rights and improve the treatment of these individuals, including taking measures to amend relevant regulations if the analysis shows that existing regulations hinder the full realization of these individuals’ rights in accordance with current standards. This is particularly important given that mental health laws are the strongest tool for protecting persons with mental disorders, including inmates with such conditions.
Finally, in all the regular annual reports since 2011, the Protector of Citizens has emphasized the need for the Administration for the Enforcement of Criminal Sanctions to ensure that all individuals with mental disorders serving prison sentences are relocated from the regular prison regime. These individuals should receive appropriate healthcare corresponding to their illness and treatment needs in a stationary healthcare unit within the institution, a Special Prison Hospital, or another suitable healthcare facility.
Encouragingly, the need to address this issue has been recognized. The Strategy for the Development of the Penal System in the Republic of Serbia for the period 2022–2027[3] includes plans for the construction of a new facility for the Special Prison Hospital in Belgrade and the construction of facilities to house sick inmates in the Niš Correctional Institution and the Požarevac-Zabela Correctional Institution. These facilities will also feature a special department for accommodating individuals with mental disorders.
Dr Nataša Tanjević
[1] Patients suffering from chronic psychotic disorders – Schizophrenia, schizotypal disorders, and delusional disorders from the group F20-F29, according to the Tenth Revision of the International Classification of Diseases and Related Health Problems by the World Health Organization, as well as other mental disorders that require intensive psychiatric treatment (for example, bipolar affective disorders).
[2] Opinion No. 18911 of 17 May 2017.
[3] „Official Gazette of the Republic of Serbia“, No. 142/2022.