The only country in Europe without a prison-hospital for the mentally ill
Author: Brejdon Xhavara
Albanian courts regularly face various crimes such as murder, lethal assault, physical violence, etc., the perpetrators of which are persons with mental health problems. Often their crimes are among the most barbaric. Those charged with minor crimes are in many cases acquitted, while those who have committed more serious crimes, or are violent, are simply imprisoned. According to the Albanian Helsinki Committee, since January 2019, there are 279 people, with medical measures held in penitentiary institutions, who have mental health problems.
Albania is the only country in Europe that imprisons this category of people in the same prisons as other people who have committed crimes. Although they need medication, or other services such as neurologists, psychiatrists, psychologists, etc.
Law no. 44/2012 requires the state to guarantee mental health care. However, Albania lacks a special hospital for housing and treating people with mental health problems. Although the courts consistently issue decisions to sentence this category of criminals in the hospital for medical treatment, this does not happen. Since there is no such hospital.
ACQJ spoke with the head of the Albanian Helsinki Committee, Mrs. Erida Skëndaj “In terms of prevention very little has been done by institutions and mainly the media that occasionally raises the awareness of the population with shows / chronicles where psychologists, neurologists or psychiatrists are interviewed and provide information about the forms of mental disorder, how it manifests itself and what are the influencing factors ”.
In Albania, there are currently two health institutions that care for patients with mental disorders, the Neuro-Psychiatric Hospital No. 5 in Tirana and the Elbasan Psychiatric Hospital, where patients with more severe mental disorders are treated.
Kudrete is one of the women who has been suffering from mental health for more than 17 years. During these years she has been treated on an outpatient basis at the health centers and Psychiatric Hospital No. 5 in Tirana.
Her health situation deteriorated during a family incident, where as a result she was admitted to hospital No. 5 where she was receiving outpatient treatment. Her parents denounced her for the violence, resulting in her later being prosecuted by the criminal authorities.
Right decisions, wrong choices
On the day of the trial, the family retracted the charges, showing remorse and the case was closed with the decision for Kudrete to be treated in one of the residential institutions, to receive outpatient treatment.
According to the procedure, the police had to implement the decision to accompany her to the residential institution to receive outpatient treatment, but according to the law “On the treatment of persons suffering from mental health” she had to go to the residential center for the treatment of these persons which does not exist.
In the absence of this center, the police together with the prosecution decided to send her to the Prison Hospital, contrary to the court decision.
According to the Helsinki Committee, this is a violation of human rights.
“This category that is accommodated at the prison hospital is contrary to Article 46 of the Criminal Code, because Albania has failed to build a special medical institution (not prison) for them. They are distributed in two institutions, namely the Prison Hospital (in a smaller number) and the Special Penitentiary Institution of Zaharia (in considerable numbers).
Institutional exhaustion and fatigue of older parents
Under the traditional white headscarf, a blood pressure and diabetes sufferer leaves her apartment to walk to the University Hospital Center near the prison hospital to meet her daughter, Kudrete who suffers from poor mental health, schizophrenia, a disease which has as its main effect thinking disorders and manifests itself occasionally through depressed behavior.
Fatmira has to pass the check points set up by the State Police employees, first the bags full of food and clothes have to be checked and then she has to undergo the physical check to meet her daughter.
The meeting is held in a room with very poor conditions which may physically and mentally aggravate the patients, where in front of her are set up bars that prevent physical contact.
She told the ACQJ: “It has been months that I came here every Monday, we withdrew the accusation and repented, but no one listened to us, now I come here tired from life, suffering and no one tells us a good word, when will we get her out of here and the girl will continue her treatment as before “.
Kudrete previously was treated at the neuro-psychiatric hospital on an outpatient basis, staying in the care of doctors. Her family had the opportunity to meet her every day, even sit in the cafe, so she had her freedom, her rights were respected as a person but also as a patient.
ACQJ interviewed the Ombudsman, Ms. Erinda Ballanca: “The Ombudsman, in the role of the National Mechanism for the Prevention of Torture, Cruel, Inhuman or Degrading Treatment or Punishment, has drawn attention to the situation in mental health care hospitals in Albania.”
In the period 2014 – 2019, a total of 22 inspections were performed in psychiatric hospitals. But what was ascertained during these inspections? “Contrary to article 28 of law no. 44/2012 “On Mental Health”, it was found that in these institutions continued to be brought, based on court decisions, persons with mental health disorders who have committed criminal offenses for which the courts have decided on compulsory treatment in a medical institution”.
Residential institutions in our country are also provided by law, but none has been built yet, further aggravating the mental situation of patients suffering from disorders. In the state budget, for the period 2015 – 2020, no special fund is provided for the establishment of the Special Medical Institution, as provided by law no. 44/2012, dated 08.05.2012 “On Mental Health”.
Even the penitentiary institutions did not escape the coronavirus pandemic. Some people in prison 313 in Tirana, who were infected by “Covid 19”, were transferred to the prison hospital, QSUT for treatment. Meanwhile, in this hospital were 22 people suffering from mental health disorders. In the absence of a specialized hospital, prisoners with mental health problems were sent to prison 325 in the “Ali Demi” neighborhood, where women suffer their sentence, to make way for those who became infected in other prisons.
During the 3 months in quarantine, the General Directorate of Prisons, together with the Ministry of Health and Social Welfare, did not allow these patients to meet their relatives thus preventing physical, visual and emotional meetings. Sources from the Ministry suggest that computers would be installed in the meeting rooms to talk through the “Skype” application with the prisoners.
As part of the ACQJ investigation, we went to Prison 325 to find out how the virtual patient communication method works. We asked when they would be transferred from there to the prison hospital at QSUT and when the visits could restart, one of the guards replied that “we have an order that none of the patients will be allowed to talk on Skype with their relatives and that we have no answer as to when they will be relocated from here ”.
Fatmira, Kudrete’s mother told the ACQJ: “I have not seen her for more than 3 months, I do not know any information and no one tells me when I will be able to meet her and calm her down as to why I did not come these 3 months, I have nowhere to complain.”
We recall that the Albanian Helsinki Committee attended one of the cases of patients with mental disorders in the European Court of Human Rights, where it managed to win the case. The ECtHR unanimously stated that it had found a violation of Article 3 (prohibition of inhuman or degrading treatment) of the European Convention on Human Rights due to inadequate living conditions in the prison hospital where Mr. Strazimir was detained under inadequate psychiatric care, and in violation of Article 5 (right to liberty and security / right to a lawful detention imposed in a speedy manner by a court), in particular due to his continued deprivation of liberty in a prison and not in a medical institution, because his appeal against the detention measure has remained pending before the Supreme Court since 2016.
In the press release, the ECtHR notes that there is a failure of the Albanian authorities to build a medical institution for the treatment of persons with mental healh disorders, whose freedom has been restricted by court order, which requires compulsory treatment.
Albania is instructed to establish appropriate institutions for this problem and to ensure that the complainant receives psychotherapy and not just medication.
In the end, Albania was to compensate the complainant with 15 thousand euros and to cover 2,500 euros of court costs.
The Albanian Helsinki Committee and the Ombudsman have long sought and made recommendations for the establishment of a special institution to treat persons with mental health disorders, who are deemed so by court decision. However, there is still nothing new in this regard and patients have been forced to stay in prisons, risking the deterioration of their mental health and being denied any social and legal rights.
*Original title adapted from Albanian (Në kërkim të një burgu për vrasësit e sëmurë)
**Note: The Ministry of Health and Social Welfare has never responded to our requests for information.