Vivian Mancellari
For almost 3 decades, people with mental disorders in conflict with the law in our country have belonged to a category of forgotten and neglected citizens. In a constant state of alarm raised by various monitoring actors, living conditions in violation of human rights, and unimplemented inter-institutional agreements, Albania still does not have a Special Medical Institution for people with medical conditions.
People with mental health disorders in conflict with the law are treated and live in difficult conditions in our country. This is not only due to the constant state of overcrowding in the institution where they are accommodated and the lack of a special institution for their treatment, but also due to several other factors specific to Albania, which include limited human resources, reluctance of professionals to work in this sector, as well as prejudice and neglect of the community towards this contingent.
Five years ago, the European Court of Human Rights (ECHR) found Albania in violation of the European Convention on Human Rights (ECHR). In the case of “Strazimir v. Albania”, the Strasbourg Court ruled in 2020 that there had been a violation of Article 3 of the ECHR (prohibition of inhuman and degrading treatment), as well as Articles 1, 4 and 5. Among other things, in its decision on this case, the Strasbourg Court found that the Albanian authorities had failed for a long time to establish a special medical institution for prisoners with mental health conditions.
Meanwhile, 5 years later, Albania still does not have a suitable institution, with the features of a hospital, for these people.
Official data in figures
The World Health Organization (WHO) constantly raises the alarm that mental and emotional health disorders are on the rise. Meanwhile, official data on people with mental health disorders who commit criminal offenses in our country highlight the need for new capacity building.
According to data from the General Directorate of Prisons (GDPSH), in the Institution for the Execution of Criminal Decisions (IEVP) Lezha, in the last 5 years the following have been treated:
- In 2021 – 328 citizens with medical measures;
- in 2022 – 381 citizens with medical measures;
- in 2023 – 430 citizens with medical measures;
- in 2024 – 442 citizens with medical measures; and
- By May 2025, 458 citizens were treated with medical measures, of which 303 with the medical measure "compulsory treatment" and 155 with the medical measure "temporary hospitalization", and 110 of them were recidivists.
Meanwhile, according to the latest data, 461 citizens are accommodated in this institution, or 147% above the official capacity of 186 people that this institution is expected to accommodate.
At the Prison Hospital Center (PHC), where female citizens are accommodated by court order with "medical measures", in the last 5 years the following citizens have been treated:
- In 2021 – 28 citizens with medical measures;
- in 2022 – 25 citizens with medical measures;
- in 2023 – 25 citizens with medical measures;
- in 2024 – 35 citizens with medical measures; and
- by May 2025 – 38 citizens with medical measures.
During this year, 16 citizens were admitted to the QSB with medical measures by court decision, psychiatric-legal expertise and for health problems.
Prisoners with mental health problems are accommodated in all the country's correctional institutions. They are also housed in psychiatric hospitals, as in the case of the mental health service with beds in Shkodra, where 3 patients have been held for years with a court-ordered "compulsory hospital treatment" medical measure.
Meanwhile, from the information received from some of the District Prosecutors' Offices of General Jurisdiction regarding medical measures, it results that the criminal offense that these citizens commit the most is "Domestic Violence."
Referring to the figures from year to year, or even from month to month, an increase in the number of people sent to the Lezha Penitentiary Institution is seen. The General Directorate of Prisons, through an electronic communication, confirms as a worrying issue the increase in cases with medical measures.
The Albanian Helsinki Committee (AKHH), a monitoring organization of the prison system, reports an increase in people with mental health disorders, not only in Shënkoll, but also in other prison institutions.
"In recent years, an increase in people with mental health disorders has been observed in these institutions, I am talking here about anxiety, depression, which over time and with their confinement in an institution, the situation can sometimes worsen and there have been cases where these people have even ended their lives," says Nosiana Burnazi, from AHC.
Prison system – Reported situation over the years
Article 46 of the Criminal Code “Medical and educational measures” provides that medical measures may be imposed by the court after a forensic psychiatric examination, against irresponsible persons who have committed a criminal offense. For each case, the court is obliged to reassess the measure determined in the decision every year.
According to Ahmet Prençi, head of the National Mechanism for the Prevention of Torture, under the umbrella of the Ombudsman, due to the lack of judges, this obligation has not been fulfilled.
"There was a problem with the delays that were made for their medical check-ups that are done permanently every year, but this problem was last year. With the reform that was made, this procedure for their assessment is now being implemented correctly through the institute of legal psychiatry and the courts that make permanent decisions for these persons," said Prençi.
From its periodic monitoring of the country's correctional institutions, the Albanian Helsinki Committee assesses that there is a problem in the personalized medical treatment of persons accommodated in these institutions.
"From the monitoring we have conducted, we have found that in most cases medical follow-up is carried out based on the person's request, thus making medical treatment not systematic and periodic, but being specific only when the citizen refers a complaint or presents a specific medical concern," says Nosiana Burnazi.
In 2023, the Albanian Helsinki Committee monitored three cases of loss of life of citizens deprived of liberty, one of which was suicide.
In all three of these cases, the lack of periodic monitoring of health status by medical staff and immediate follow-up of concerns expressed by prisoners remains problematic.
"The treatment of citizen QH, who ended his life in September 2023 in the premises of the Lezha Penitentiary Institution while executing the sentence converted to a medical measure, highlighted a non-systematic health follow-up by the medical staff. The treatment offered to him in a pharmacological measure was accompanied by limited recreational activities, according to his request and desire," AHC reports.
"At the same time, the failure to include uniformed institutional staff in training on the proper management of emergency cases, such as suicides, has not served to neutralize or reduce the psychological consequences for them," the report continues.
About 1 month later, the AHC verified in the Drenova Prison (Korça), the complaint of the prisoner diagnosed with mental health disorders, IJ, who claimed an unfair measure of placement in the special supervision sector, after claiming that he had been held for about 6 days under the use of force and neutralization with handcuffs by the institutional staff. The AHC observers reported that the decision taken against the prisoner was arbitrary and unlawful, as the prison authorities had failed to argue the need for the imposition of this measure against the danger that the convict could cause to himself or others.
Meanwhile, the use of handcuffs and chains, confirmed by the testimonies of other fellow prisoners and staff representatives, was illegal and in violation of the international standards of the CPT (Committee for the Prevention of Torture) and the jurisprudence of the ECHR.
A constant problem in the prison system is the shortage and inadequacy of both specialized medical and psychosocial staff, especially in the Lezha Penitentiary Institution where there are constant vacancies. According to the AHC, the number of psychosocial workers employed compared to the number of citizens accommodated in the institution, calls into question the effectiveness of the treatment they receive in the institution.
"From the verification of the documentation that we carry out at the time of monitoring, for psychosocial treatment, it has resulted that the documentation has often been completed in a formal manner, with expressions that we have found in some files of some citizens," says Burnazi.
There is also a low interest among doctors to be employed in these institutions. According to Ahmet Prençi and Nosiana Burnazi, mechanisms are needed to encourage these professionals to work in the prison system and with this category of people.
From a social perspective, sociologist Gëzim Tushi believes that the difficulty faced by psychosocial workers, psychologists and psychiatrists working in these institutions should be accompanied by favorable financial policies.
"For psychologists, psychiatrists, or other figures who work in such penal institutions, there should be a differentiation in salaries so that they are motivated," says Tushi.
Inside Shenkoll prison
Upon entering the institution, the prisoners-patients of Shenkoll prison were in their rooms. In these rooms intended to accommodate 3 people, they are staying 9, 10, or even 12. One after another, these men stretch their hands beyond the bars of the doors to take the bowls of food that the staff is distributing to all the rooms, which they will then eat sitting on their beds.
Source: Supreme State Audit Office
The director of this institution, Mr. Valentin Macaj, who accompanied us during our visit, commented that this way of eating not only negatively affects the mental health of these people, but also creates difficulties in cleaning the premises. For this reason, Mr. Macaj indicated that work was being done to build a canteen, with the help of a foreign investor.
What is noticeable in all the interior spaces, including the rooms, is the presence of moisture on the walls. In the two buildings that accommodate 461 citizens, built in 1985 to serve as labor camps, and reconstructed in 2020 to receive the prisoners of Zaharia, the symptoms of old and depreciated buildings have reappeared. In addition to these two buildings, there are 3 other buildings on the territory of this institution that have been out of operation since the 2019 earthquake.
The reconstruction seems to have mainly affected the part where the rooms are located. The kitchen and food storage give the impression that this part of the building has never been touched, while the old tiles, broken in places, are present in all the rooms.
"We do not build walls," says the director of the institution, Mr. Macaj, emphasizing that in addition to internal functioning and optimal service, other responsibilities belong to the Ministry of Infrastructure and the Construction Institute. The latter has evaluated the buildings and it is planned to reconstruct and erect new buildings, after the demolition of those that are out of function.
The institution's progress is affected by factors of various natures. Macaj describes some of the most serious challenges it faces, and the ways in which it tries to cope with and minimize them.
122 of the citizens accommodated there are abandoned and their needs, from clothing to food, are met by the institution, which provides them through assistance from various religious communities.
According to the director, another problem is the heating of the premises. The company that installed the screw beds in the ground broke the heating boiler pipes because they worked without a wiring map. Macaj says that he is dealing with the repairs himself.
Currently, the Lezha Penitentiary Institution lacks 3 psychiatrists, while the dentist and three part-time doctors (2 general practitioners and 1 psychiatrist) were appointed in June 2025. Director Macaj confirms the concern that both doctors and nurses, as well as civil servants, refuse to go to work at this institution.
During the visit to the institution, we were informed that there are 3 ambulances in working condition, while a new ambulance was expected to be provided by the General Directorate. Also, an Albanian foundation in Belgium was raising funds to bring another complete ambulance.
From the latest monitoring carried out by the Albanian Helsinki Committee, it results that out of the 5 ambulances in total at the Lezha Penitentiary Institution, 3 of them are not in working order, and the other two have numerous defects.
During the conversation with the director of the institution, Mr. Macaj stated that for the citizens who are accommodated in this institution, there is prejudice and negligence on the part of the hospital staff who wait for them outside the institution.
"Doctors treat them like third-party people," says Macaj, recalling a case of the loss of life of one of the people present there, who arrived at the emergency room with signs of life, and later lost his life.
On the evening of February 3, 2025, 49-year-old Daut Laze, sentenced to compulsory treatment, managed to escape by climbing over the wall of Shënkoll prison. His absence was only noticed the next morning in the early hours of the morning, during the change of shifts and the conduct of the appeal.
Recalling this case, the director of the institution, Mr. Macaj, states that this person should not have been in the Shenkoll Penitentiary Institution, so he managed to escape because the format of the institution is such; with open doors.
Macaj says that the institution he runs suffers from unnecessary burdens, with citizens brought there by court order who are outside the category of people with mental disorders that the institution accommodates.
The presence of various organizations, foundations, and religious communities has brought significant improvements to the situation in the institution. They contribute with aid, investments, organization of various activities, and music therapy, which help improve the emotional state of the prisoner-patients.
The director of the institution, now renamed the Special Medical Institution, positively evaluates several improvements that have come over the years, such as the doubling of staff salaries compared to 2013, the provision of new uniforms, and the covering of their transportation costs.
Often, progress in these institutions comes as a result of initiatives taken by managers and staff, who try to do the best with the opportunities they have. Such is the case of Mr. Valentin Macaj, who in his vision for the future of the institution he leads, aims to create a hospital center funded entirely by donations.
"We currently have nurses and doctors 24 hours a day, but we want to create a mini hospital, which would save human resources and open new jobs for the area," says Macaj.
Unimplemented agreement
On 23.11.2021, the Cooperation Agreement "On the treatment of persons with mental health disorders with medical measures" was signed between the Ministry of Health and Social Protection and the Ministry of Justice. This agreement turns out to have been implemented unilaterally only by the General Directorate of Prisons. The agreement effectively continues to be unimplemented, as citizens with medical measures continue to be accommodated in an institution under the Ministry of Justice due to the non-functioning of a Special Medical Institution, in violation of the commitments undertaken in the Agreement, where the Joint Action Plan provided that the functioning and transfer of patients accommodated in the Lezha Prison to the Special Medical Institution under the Ministry of Health and Social Protection would be completed by 2023.
Last year, by order of the Prime Minister, the Lezha Institution for the Execution of Penal Decisions changed its name to the Special Medical Institution. The “de facto” transition to an institution that coincides with the new name would mean the existence of a center with the features of a hospital, a health institution where only the outer perimeter would be guarded by the security forces of the Prisons Directorate.
The Ombudsman, through the National Mechanism, has repeatedly drawn the attention of central institutions to the establishment of the Special Medical Institution under the Ministry of Health, Social Affairs and Health as soon as possible.
"We are in the process of European integration and all institutions are monitored for this issue. So this problem must definitely be resolved within the framework of integration because a prison cannot be accepted for this category of people, when the standard requires that it should be a hospital," says Ahmet Prençi.
Regarding this social and institutional wound, psychiatrist Neli Demi recalls that this is a problem that has been going on for more than 2 decades.
"I personally dealt with something like this in 2003-2004, and it still hasn't found a final solution. I know there are plans, but there have been plans since I was working for WHO, in the early 2000s, and plans are never a certainty that they will be realized," says Demi.
In the Intersectoral Justice Strategy 2024-2030, the Ministry of Justice, together with the Ministry of Health, Social Affairs and Public Health, plan to provide the necessary resources for the establishment and functioning of the Special Medical Institution for the treatment of persons with mental health disorders with medical measures.
