Prisoners. Prisoners with mental health problems are usually placed in ordinary prison regimes. Limmattal prison has an “urgent care service” for prisoners experiencing a mental health crisis. The service has four shared cells and one individual cell.
Prisoners on therapeutic measures. Prisoners subject to in-patient treatment can be detained in a prison, if the facility has the necessary equipment and specially trained staff. These prisoners may be placed in dedicated areas of the prison, but due to the lack of mental health cells or wings, and the increase in numbers of prisoners on such measures, they are most often placed on ordinary prison regimes.
Prisoners who are sentenced to indefinite incarceration, and those on in-patient treatment who are deemed to be high-risk, are usually detained in high-security units. The European Committee for the Prevention of Torture (CPT) found that conditions in such units, where very little treatment is provided, were akin to solitary confinement. The CPT considers such placements, which can last several months and even years, to be “particularly dangerous”.
There are two psychiatric wings at Orbe Plain prison in Vaud canton. These wings are for prisoners with severe mental illness and those subject to in-patient treatment. Prisoners on therapeutic measures who require intensive care take up a considerable proportion of the nursing team’s capacity, meaning nurses are less available for other prisoners. Orbe Plain prison does not have enough capacity in these services, with, in 2015, only eight spaces available for the 55 people who were on treatment orders.
Access to mental healthcare¶
A prisoner should be seen by a healthcare professional within the first 24 hours of their incarceration. The initial appointment should include a questionnaire that covers addictions, suicidal tendencies and mental health. If the medical team at Champ Dollon prison in Geneva identify a mental health problem, they refer the prisoner to a general practitioner or psychiatrist.
The CPT found that, in Schwyz prison, the questionnaire is completed by prison officers and does not include an examination by a doctor. It noted that in Stampa and Farera prisons (Ticino canton) the medical examination only takes place some four or five days after arrival.
Prisoners wait on average three months to see a psychologist. In July 2018, in Champ-Dollon prison, more than 40 prisoners were on the waiting list for an appointment with the psychologist. Prisoners on therapeutic measures wait on average one month.
Provision of mental health treatment¶
Prisoners. A treatment plan should be appended to the individual sentence plan of a prisoner experiencing mental ill-health. No such treatment plans are made in Basel-City canton. However, prisoners do have access to appointments with mental health professionals. At these appointments the prisoner’s needs are assessed to ensure that detention is not unreasonably detrimental to their mental health.
Prisoners at Champ-Dollon prison may be put on a psychiatric treatment plan under the care of a psychiatrist. The psychiatrist provides regular consultations and psychologists run weekly group therapy sessions. The most common treatment option is medication.
Prisoners on therapeutic measures.
Prisons housing people on in-patient treatment are supposed to put in place a ‘treatment implementation plan’ on arrival to prison. In reality however, there is often a delay of up to several months before such a plan is put in place. Prisoners on indefinite incarceration have no such treatment plan. They can, if they wish, request treatment from the psychiatrist but the decision to treat remains at the psychiatrist’s discretion. Any such treatment would focus on the prevention of reoffending.
Prisoners with addictions. Monitoring of prisoners with substance addictions varies widely between cantons. In some cantons, treatment is provided by an external service that specialises in substance abuse. Treatment may include substitution programmes. Prisoners who have begun a substitution programme prior to incarceration are able to continue the programme. In Vaud canton, psychotherapy and specific programmes for addiction or perpetrators of sexual offences are available.
The composition of prison mental healthcare teams varies by canton. Generally, medical teams are made up of general practitioners, psychiatrists and nursing staff. Some prisons also employ psychologists. The largest prison facilities have several doctors, psychiatrists and psychologists on a permanent rota basis. These psychologists then offer clinics several times a week in the smaller facilities. In Basel-Country canton, psychiatrists are available only if required. The women’s prison at Hindelbank (Berne) has a visiting psychiatrist twice a week, and a psychologist is available Monday-Friday.
Some cantons, including Zoug, St. Gall, Appenzell Outer-Rhodes and Soleure, have no mental healthcare teams based in the prisons. Rather, visiting psychiatrists regularly attend to provide care.
The psychiatric units of Orbe Plain prison in Vaud have only one clinical lead and there is a high turnover of staff in the mental healthcare teams. Therapists often change every two months, which means that treatment programmes must start again from the beginning. The Geneva Grand Council (Prison) Visiting Committee (Commission des visiteurs du Grand Conseil) reported several complaints received from prisoners on therapeutic measures about the lack of availability of psychiatrist appointments.
Requests for medical appointments in prison are usually made in writing, via a post system, to prison nursing staff. However, in small facilities it is prison staff who deal with the requests.
Medical appointments are usually confidential. The CPT found however, that in Schwyz prison, officers are routinely present during consultations. Medical files are not kept securely, and can be accessed electronically in some facilities. Prison officers therefore have direct access to prisoners’ medication records.
Medication is usually prescribed, prepared and distributed by healthcare professionals. In the evenings and at weekends, prison officers distribute medication.
The CPT found that in Stampa and Farera prisons, prison officers are responsible for preparing medication. This is also the case in Schwyz prison when healthcare staff are not available.
There is no federal legislation governing treatment of a prisoner in the event of a mental health crisis. Some cantons transfer prisoners in crisis to a psychiatric ward if the prison facility is unable to meet the prisoner’s needs. The prisoner may be placed in solitary confinement whilst awaiting transfer. Prisons in Vaud canton rarely use solitary confinement in such cases, and ensure medical observation throughout any such placement.
A “crisis intervention service” in Limmattal prison takes prisoners in mental health crisis from any of the five prisons in Zurich canton. Prisoners may remain in the facility for up to ten weeks. In 2019, the service had 40 prisoner-patients.
In an emergency, medication can be forcibly administered, in accordance with the same rules as for non-incarcerated patients, i.e. only where there exists a serious risk of harm to the prisoner or to others. Mechanical restraint can also be used for several hours. In Hindelbank prison, such a measure can be prescribed by a nurse and overseen by the prison doctor.
Prison officer training¶
Prison officers undergo basic mental health training lasting approximately five days. The training covers the range of psychiatric disorders and how to prevent suicides. Officers may also volunteer for further training on managing prisoners with mental disorders, which lasts approximately two weeks. This training is supplemented with a three-week placement in a psychiatric ward.
Continuity of treatment¶
If a prisoner who is in the process of being released experiences mental ill-health, a judge may impose an “in-patient treatment measure”.