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NPM network meeting on medical care in prisons and psychiatric institutions

The Deputy Ombudsman and Head of the National Preventive Mechanism (NPM) Ivan Šelih and Adviser to the Ombudsman Jure Markič, MSc, attended the meeting of the Network of National Preventive Mechanisms (NPM) for SV Europe, held from 5 – 6 July 2017 in Podgorica, the capital of Montenegro, where they addressed the issue of providing medical care in prisons and psychiatric institutions.

In his opening address, Deputy Ombudsman Šelih as the chairperson of the Network's legal group stressed that the assessment of the state of medical care should be based on the general principle that prisoners are entitled to the same level of health care as everyone else. This is a fundamental and inalienable right of every imprisoned person. Only adequate health care can ensure a high quality of life in a closed institution. Inadequate medical care my lead to inhuman and degrading treatment. It also should not be ignored that the healthcare service makes an important contribution to preventing poor treatment by carefully monitoring prisoners’ health status, providing appropriate medical care, alerting (responding) to possible health concerns and by preventive activities.

In the continuation of the meeting the participants exchanged their views regarding the accessibility of physicians, equal provision of medical care, consent to medical treatment and confidentiality, preventive healthcare measures, assistance to persons with special needs, professional independence, and competence. All these are the aspects that are monitored by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) on its visits to the healthcare services in prisons.

One of the conclusions of the meeting was that the healthcare service in prisons should be part of the public healthcare network (it is organised this way in our country), with an emphasis on special and additional tasks and position of healthcare service in providing medical care to imprisoned persons.

Health care is undoubtedly also very important for patients who are detained in psychiatric hospitals. Furthermore a Slovenian representative pointed out the need of distinguishing between detention in a ward under special supervision and the medical treatment itself. The lively discussion on this important issue was also continued on the second day of the meeting. Although initially it appeared that the view of the participants were different, after the discussion it turned out that in principle they agreed, which made it possible – on the basis of the opinions expressed – to draw a suitable conclusion that would undoubtedly represent a guideline not only for all NPMs in this area but also more broadly. In accordance with CPT standards, the basic principle governing this area should be the patients' right to give their free and informed consent to treatment. The admission of a person to a psychiatric establishment on an involuntary basis should not be construed as authorising treatment without their consent. It follows that every competent patient, whether voluntary or involuntary, should be given the opportunity to refuse treatment or any other medical intervention. Any derogation from this fundamental principle should be based upon the law and only relate to clearly and strictly defined exceptional circumstances.