Transcript Mental health services in the Belgian prison system Dr. Sven Todts Medical director Belgian prison health care service bucharest 2013

Mental health services in the Belgian prison system
Dr. Sven Todts
Medical director
Belgian prison health care service
bucharest 2013
The Belgian prison system
Per 12/2/2013: 11760 prisoners (107/100.000)
1028 electronic surveillance
Remand:
3774 (32,1 %)
Condemned:
9721 (57,2 %)
Mentally disordered offenders: 1265 (10,7 %)
(30% of all MDO, others in hospitals or community)
33 prisons (cap 8950): overpopulation in remand prisons
4 prisons under construction (NIMBY-problems!)
3 closed facilities for minors (>= 16yrs): not inmates
1 rented prison in the Netherlands (600 detainees)
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Mentally disordered offenders (“interned”)
Considered not guilty, detention is measure to protect
society
Aims:
1. Protection of society
2. Provision of treatment for condition
3. Provision of treatment in order to reintegrate
Decision making:
Commission for the protection of society: 1 judge, 1
lawyer, 1 MD (psychiatrist)
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MDO: definition (law of 1964, under revision)
1. Presence of a mental disorder: State of insanity or state of severe
mental disorder (eg drug use):
2. As a consequence of disorder, “unfit to control behaviour” at two
times:
- at the moment of the facts
- at the moment of the decision
(yes/no decision: no room for qualification)
3, Danger to himself/herself or to third parties
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MDO in prison settings
North
Psychiatric wards
Social defence unit
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South
Antwerpen
61
Mons
38
Louvain
51
Jamioulx
31
Bruges
61
Lantin
43
Ghent
120
Namur
31
Forest
107
Berkendael
11
Paifve
199
Turnhout
120
Merksplas
333
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MDO in prison: staff
Care teams: psychiatrists, nurses, psychologists, social
workers, therapists (but: not enough staff to cover all
problems)
Supposed to take care of psychiatric cases among general
prison population as well
Psychosocial service: separate reporting service:
psychiatrists, psychologists, social workers: reports on
dangerousness, need of treatment, etc.
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Levels of care/security (%): Flemish region
Care
intensity ►
Security ▼
Low
Medium
High
Total
Low
7
8
4
19 (112)
Medium
5
17
24
46 (275)
High
11
9
15
35 (212)
Total
23
34
43
100 (599)
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Possibilities:
Low security level:
- community (ambulatory, psychiatric care centres,..)
- regional general psychiatric hospitals
Mid-security level:
- forensic psychiatric units in regional psychiatric hospitals
High-security level:
- forensic psychiatric centres
- centres for social defence (prison/health)
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Planning:
Expansion of community treatment (but: responsability of regional
governments)
Expansion of medium security FPU (but: hospitals are private initiatives,
no possibility to force them)
Construction of PFC
Decided:
Ghent (north): 272 units (male)
Antwerp (north): 180 units (male)
Proposed:
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PFC (north): 20 – 30 units (female)
Paifve (south) dedicated prison for MDO: turn into FPC
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Psychiatric problems in general prison population
As all over Europe, subjective feeling of increasing
problems
No scientific reporting
Hardly any structured help: no psychologists, no social
workers, no psychiatric beds that are available
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A marker of psychiatric problems
Use of psycho-active medication per age group
<30
30 - 40
>40
30%
25%
20%
15%
10%
5%
0%
benzodiazepines
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neuroleptics
antidepressants
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substitution
Comparison with general population (health survey 2008)
60
50
40
30
general
20
prison
10
0
prescription
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psychotropic
no prescription
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Lifetime use of illegal substances inside and
outside of prisons
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Lifetime use in Belgian prisons
70
60
50
40
% drugs
30
20
10
0
1970 1985 1992 2003 2006 2008 2010
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Lifetime use: per product
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Answers/plans
Psychiatry:
Plans to turn psychiatric wards in regional second-line treatment
units (when MDO have more or less left to FPC’s)
Third line psychiatric crisis centre is planned (2016)
Drugs:
Expansion substitution programs (now 5%)
Expansion of drug free prison units
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