Belgium: “prison isn’t a place for care”

Vinciane Saliez. Prison healthcare is administered by the Justice Department and has limited funding. The economic piece is thus extremely important. As Committee for the Prevention of Torture (CPT) reports demonstrate, there is far too few staff, and too little consideration is given to health.

Although the law is clear that prisons exist for “repairing, rehabilitating and reinserting” people, health and healthcare are not taken sufficiently into account. Depending on the institution, serious failures exist. For example, one Brussels prison has a single psychiatrist for its 850 prisoners and he is’s there one half-day a week. Some people, after receiving chronic illness diagnoses outside, are told once inside that it’s “all in your head”. Other people, when remanded, have had treatment cut off.

Many people lack healthcare: some have less than they did outside and others had none before. Prison could be an opportunity to treat them.

Healthcare professionals are very isolated, have a heavy workload and lack specific training. Yet we know that it’s a complex branch of medicine. The incarcerated population may be relatively young but prisoners need specific treatments. Once you put the pieces together, it’s easy to understand how things can go off the rails. The entire system depends on people’s goodwill but goodwill isn’t enough in a failing system.

Kris Meurant. Every prison is its own unique microcosm. Belgium has 35 prisons and each one is a very different specific entity. Prisoners are really isolated by the dilapidated old buildings and the discomforts of the new ones.

Legally, tThe 12 January 2005 law relating to the continuity of care is legally perfect. In reality, it was never implemented. Inside-outside equivalence and respect for the continuity of care have thus never been observed. Belgium is in a legally awkward situation and that’s indicative of the lack of consideration that prison healthcare gets.

You have to wonder what meaning to ascribe to sentences that deprive people of freedom and what ressources to invest in real reentry policies.

This policy hasn’t, for the time being, been thought through. If sentences and reentry are hand in hand from day one, you can imagine some nice outcomesgood prospects. Today, the opposite approach is taken and prison constitutes lost time. It can only be negative, as much for incarcerated people as for staff.

Health promotion falls under the remit of Belgian regions, so I.Care, like other organisations, is financed regionally. Some of our work is performed complementarily to the healthcare system and some clearly exists to compensate on a small scale for the system’s failures.

VS. Our work is carried out based on the Ottawa Charter’s definition of health promotion. There are a thousand ways to act from this point of view. Health extends far beyond physical health. The World Health Organisation defines it as a complete state. So we try to give individuals more control over their health and ways to improve it. The essence of our work is based on people’s power to act. We have a few ways of meeting our goals: we help build individual aptitudes, called psychosocial skills, as much as we strengthen community action; we work on the carceral environment; we organise for healthy public policy.

This focus allows us to develop our work in a way that’s always consistent with our philosophy. Incarcerated people often have very little experience with psychotherapy work. So we have to figure out how to be a resource in their daily life.

KM. We go door-to-door from cell to cell, which is anything but typical. But it’s a precondition of ours, in order to limit refusals or difficulties with travel. It’s an unusual stance and we own it. We go see people who’ve asked for nothing and that creates openings.

VS. We try as much as possible to do walk-throughs and we’re often told no. It’s like working on the street, it means getting close to people. That often destabilises prison authorities. We don’t show up to do one action. We come with the idea of promoting health and, wherever possible, we set up a project based on what emerges from incarcerated people or staff. For example, for our “28 days” project on menstrual precariousness, our teams saw the commissaries and women ordering menstrual products and toilet paper. So we looked at the problem, analysed the situation and needs. Same goes for the library: in one facility, all the books, whether they were about health or something else, were from the 1960s and 1970s. Prisoners don’t have internet access, but staying informed is essential. We therefore reviewed the library’s entire health section with the librarians who up until then were making do with what they had. Our newsletter “MursMurs” has an “advocacy and information” section aimed at professionals that also coordinates our work. Little by little, we try to move forward, connected as much as possible to real life.

After five years of this work, I’ve observed that prison is completely inappropriate for the people it incarcerates. To endure prison and be able to reintegrate, you need to speak French or Dutch, be literate, have outside support, money, a job offer and housing when you leave and above all be in good health.

Yet incarcerated folks are vulnerable in multiple ways. Every request is made in writing but some people can’t write or don’t speak the language. There’s a gap between the system as designed and the people inside it.

KM. Prison fears change and movement. I.Care is a group working against the tide and prompting action. In the end, once an initiative is in place, authorities realise it’s going well. We don’t just run a single project for five years;, we try to stick to as many aspects of real life as possible. With every new impulse, new discussions spark additional prospects.

VS. Sometimes, change comes from asking questions. The movement isn’t only present in projects but in minds. It’s interesting to raise strategic questions through guards, wardens or politicians. We sometimes suggest to ministers or representatives visiting prisons that they ask certain questions. The goal isn’t to respond ourselves but to prompt reflection. One prison warden told us that we’d opened her eyes to things she’d never seen despite 20 years in the field. When we ask questions, we open people’s eyes. But that also means that letting us in is uncomfortable.

KM. We’re definitely aware of the difficulty our teams have entering prisons as changemakers. Their ability to endure things should be highlighted. We always feel like we’re simply “tolerated” inside.

VS. A lot of convicted folks who are deemed responsible for their actions struggle with mental illness. They receive almost no care. In some facilities, those with glaring needs may wait three or even six months for a psychologist to come. That also depends on the institution.

Brussels has many more services than do rural institutions. In some prisons, there’s almost no possibility of psychiatric care and everything to do with psychological services depends on outside organisations. They may send psychologists or social workers. These external services are also half-allowed: the slightest strike or personnel change can suspend mental health care. There’s also the psychosocial department whose mission is primarilymoreso to advise on releases. These psychologists are often asked to provide psychological care or support. So they wear two hats, assistance and control, which raises a lot of questions.

We work very little in psychiatric annexes. It’s very hard to get into them. It’s quite interesting to see where the annexes are, architecturally. Often, in a star-shaped prison, they’re located in a small hallway where no one goes. These are an institution’s most invisible areas. Mental health is prison’s poor relation. Yet the political will to get people out of these annexes as quickly as possible and to put them in dedicated facilities does exist.

KM. Despite the efforts of the last few years, there still aren’t enough resources. This is absolutely not a criticism of annex staff. Their drive alone keeps things together despite an outrageous lack of resources. For a few years, the provinces have organised care transports for prisoners to try to shuttle people toward the hospital sector and dedicated units. That’s a positive thing to support. Access is not guaranteed and, most of all, it’s a solution after the fact.

First of all, people held in annexes and deemed not responsible for their actions shouldn’t be in prison. You have to see annexes as a world within a world. There are a number of things we don’t know about these wings;, we don’t visit them and they have fewer resources. Some people stay there for a few months, or even years, for lack of something better.

Outside, the mental health industry has been undergoing reform for several years. Places are being eliminated in psychiatric departments to create mobile health teams. That’s not helping things.