Varuh ДЌlovekovih pravic

NPM Network of SE Europe on the treatment of persons with mental disorders in detention

The Deputy Ombudsman and Head of the National Preventive Mechanism (NPM) Ivan Šelih, and the Ombudsman's Advisers Jure Markič and Robert Gačnik, attended the meeting of the Network of National Preventive Mechanisms (NPM) for SE Europe, held from 25 – 26 May 2017 in Belgrade, the capital of Serbia, where they addressed the issue of persons with mental disorders in detention. This is one of the particularly vulnerable population groups that can be detained in various closed institutions, such as police stations, prisons, social welfare institutions, psychiatric hospitals and others.

The meeting was attended by all members of the Network and some other representative of NPM or human rights protection institutions, and of international organisations.

In his opening address, Deputy Ombudsman Šelih as the chairperson of the Network's legal group stressed that persons with mental disorders are socially marginalised and as such are particularly vulnerable and helpless. Because of the difficulties they face, they can hardly manage to protect their own interests, write an application or appeal, etc. As such they are particularly prone to several risks and discrimination, as well as to possible abuse during detention. All NPM are accordingly bound to ensure that these persons receive appropriate and dignified treatment.

The main objective of the Network is to establish intensive mutual cooperation and exchange of experience, create synergies among the network members, provide mutual assistance, and create conditions for the efficient implementation of the NPM mandate. Therefore, this meeting was an excellent opportunity to exchange experience in our daily practice of dealing with persons with mental disorders in detention.

The treatment of persons with mental health problems is nevertheless determined by several standards, including the Convention on the Rights of Persons with Disabilities. The core message of all standards is to provide those with disabilities equal, adequate and decent treatment, adequate and decent accommodation, and access to medical and other assistance. To comply with the international standards in this field, all persons with severe mental disorders should be placed in appropriate institutions and facilities. They should be provided special activities and training. In order to be provided suitable treatment, they must be recognised as such. It is important to subject them to a thorough examination so as to prevent their possible further victimisation and abuse during detention. In this regard we should not ignore the need to educate the staff of those institutions concerned so as to enable them to identify these persons, acknowledge their needs, provide them additional care, and also learn de-escalation techniques, etc.

The introductory part of the meeting was followed by workshops with a lively exchange of views and practices. Thus, the participants came to the conclusion that additional training in working with such persons should be organised for police officers, which should aim at specialisation, certification and evaluation of the training programmes. The participants unanimously agreed that in the event that an individual person is found to show signs of a mental disease or disorder, the police should immediately inform the competent medical personnel thereof, and the police may only provide assistance to such personnel in the event of the mentally disturbed person's dangerous behaviour.

As regards mentally disturbed persons in prisons, the participants agreed that such persons do not belong in ordinary prisons but should be provided additional care in so-called prison hospitals or other healthcare facilities. It was also found that the treatment of so-called forensic patients in individual states is not uniformly regulated; in some it is within a prison hospital and elsewhere within a special department of a general hospital (as is the case in Slovenia). Dealing with this group also requires additional training in working with such persons to be organised for prison personnel, which should aim at specialisation, certification and evaluation of the training programmes.

An interesting exchange of opinions concerned the admission of persons with mental disorders to psychiatric hospitals or social care institutions, and there was a presentation on arrangement procedures of admission to closed wards of psychiatric hospitals in individual countries. There were thus a few interesting questions opened regarding consent to placement and the possible consent of (the person's) legal representative. Regarding this issue, the relevant regulation in Slovenia was presented in detail, especially in connection with the Constitutional Court's decision to partially repeal the Mental Health Act in this part. However, the participants were unanimously of the opinion that placing a person who does not give consent to detention in a closed unit (according to the law in Slovenia this applies to a ward under special supervision) of a psychiatric hospital or a social welfare institution should be decided upon by the competent court in the shortest possible time. The participants further discussed issues relating to the difference between consent for detention and consent for medical intervention, as well as to the use of special safeguarding measures.