The most prevalent diseases are :

• Hepatitis C
• HIV/AIDS
• Tuberculosis

Inmates undergo a medical examination on arrival at the institution. The prevention of epidemic and communicable diseases is of utmost importance. An x-ray is performed on all inmates who show the first symptoms of tuberculosis. A doctor performs this examination.

Risk minimisation programmes in prison aim to reduce drug-related risk of harm. Programmes include testing, vaccination and provision of safe injecting equipment, protection and hygiene products such as bleach.
A needle exchange programme has been in place since 1997. Condoms are made available. The review of this programme shows that:

• Drug use and injection does not increase
• Risk behaviours and transmission of diseases (HIV, Hepatitis C) decrease
• Positive health outcomes have been observed (drastic reduction in overdose cases)
• A number of establishments vouch for the effectiveness of the programme.

The general detention regime

Individuals with mental health problems can be placed in correctional facilities. They are typically placed in the general detention regime. The CPT observed that psychiatric visits were inadequate in correctional facilities. At Teixeiro prison, where 6% of prisoners receive antipsychotic medication, no psychiatrists visited between 2011 and 2016. At Léon prison, where 25% of prisoners have diagnosed personality disorders, one psychiatrist visited for four hours per week. No permanent psychologist was available at any of the facilities visited by the CPT in 2016.¹

In 2005, the prison service established “PAIEM” (Programa de Atención Integral a Enfermos Mentales), a programme for prisoners suffering from certain mental illnesses. PAIEM is active in most facilities. The prisoners who participated in the programme in 2017 totalled 2,029, 4.3% of the prison population (1,892 participants in the SGIP prisons and 137 in Catalonia).² Doctors and psychologists are the primary contributors to PAIEM. The programme also receives periodic support from psychiatrists, personnel specialised in mental health and other professionals such as educators, social workers, legal experts and occupational therapists.² NGOs also participate in the programme’s operation.

The Spanish Ombudsman reported the unsatisfactory performance of PAIEM in most of the prisons visited. Medical care is limited to diagnosing participants and drug monitoring. Appropriate therapeutic treatment is often missing.³

The CPT noted the lack of healthcare professionals contributing to PAIEM in the facilities visited. No psychiatrists or psychologists were affiliated with the programme: only general practitioners or professionals specialising in other fields.¹

The infirmaries in penitentiary centres held 7,432 prisoners with mental disorders in 2020. The percentage of the prison population dealing with serious and chronic mental disorders is estimated at 5%.

Specialised units within correctional facilities

Despite legal provisions, few facilities are equipped with psychiatric units. The two psychiatric prison facilities are in Seville and Alicante, under the control of the Ministry of the Interior.
Brians I prison, in Catalonia, has a psychiatric hospital unit. Brians II has a psychiatric rehabilitation unit that can house 22 patients. This prison also has an arrangement with the Sant Joan de Déu hospital, for the treatment of prisoners with serious mental health problems. These institutions are under the control of the Catalan Department for Justice.

A “polyvalent unit” accommodates female prisoners with mental health disorders at the Wad-Ras prison in Catalonia. The CPT observed that the patients in these units did not receive care or assistance. It deemed the units inappropriate environments for people suffering from mental disorders.⁴

In all units within correctional facilities, as is the case in the general regime, medication is the only treatment provided to people experiencing mental disorders.

Penitentiary psychiatric hospitals

People deemed to have diminished responsibility at the time of the offence due to their mental disorder are legally required to complete compulsory treatment called a “preventive measure” in a penitentiary psychiatric hospital.⁵ The country has two penitentiary psychiatric hospitals, Alicante (Fontcalent) and Seville. They are under the authority of the Ministry of the Interior and have 50 spaces each. In 2018, the Alicante hospital held 230 men and 26 women. The Seville hospital totalled 161 men at that time.²

Both facilities have been criticised for overcrowding, poor organisation and insufficient healthcare personnel. They seem to operate more from a penitentiary mindset than a psychiatric one: “Nearly ten years ago, prison facilities were already warning that these places were becoming substitutes for asylums, which have been prohibited since the psychiatric reform of the 1980s”, according to the platform Salud Mental Fuera de las Prisiones.

The Spanish Ombudsman noted a shortage of specialised professionals, especially in the Seville penitentiary psychiatric hospital. This facility has four psychiatrist posts to address the needs of 169 prisoners; however, in 2017, only one post was filled.³

General psychiatric hospitals

People under “preventive measures” can be held in general psychiatric hospitals if they are not considered “dangerous”.
Police officers are responsible for ensuring security at general psychiatric hospitals. They carry out surveillance of the prisoners held in these facilities.

Psychiatric units within prisons are few and far between, despite the legal measures put in place.