Ambulatoire Forest. It is important to remember that prison is far from being a place of care. Prison is a totalitarian environment in which this issue is not a priority. In Belgium, healthcare equality is recognised in the Law of Principles of 12 January 2005 (loi de principes du 12 janvier 2005), which covers the penitentiary administration, as well as the legal status of prisoners. The law states that persons deprived of liberty must have access to medical care of the same standard that they would receive outside of prison. Unfortunately, this law is often ignored in practice. For instance, there is a serious lack of doctors and psychiatrists in prisons.
The beginning of a person’s stay in prison is synonymous with discontinuity of care. In theory, medical staff should ensure that individuals receiving treatment prior to being incarcerated continue to do so while in detention. In reality, this is rarely the case and a different form of treatment is often proposed. Prisoners suffering from addictions are not adequately cared for. They face difficulties accessing general medical care, not to mention specialist treatment for addiction.

Prisons often act as a conduit for worsening drug addiction. It is common for individuals to enter prison without a substance use disorder but begin using substances while incarcerated. There is also a tendency for those who already use drugs to partake in harder drugs or to use substances on a more regular basis.

Prisoners with alcohol addiction are not given satisfactory care. Some patients with alcohol dependency are forced to undergo detox with no treatment. Yet alcohol withdrawal is more dangerous than that of heroin and can even be fatal.

AF. We visit prisons in Brussels on a daily basis and monitor 80 to 90 patients on average. We treat individuals who are currently in detention and those serving sentences outside of prison. We can only care for individuals who expressly request treatment, however, oftentimes, the patient’s family or lawyer has encouraged them to seek help. Regardless of a patient’s reason for reaching out to us, we always try to propose a genuine support programme for them.
We take a comprehensive approach to patient care: each person is monitored by a psychologist and a social worker. Some patients may initially be reluctant or feel that the support might be “mandatory”. This is nevertheless an opportunity for them to benefit from care, in some cases for the first time. Judges equally view this as a sign of a willingness to engage in care and reintegration.

Our work consists of making connections and helping people to recognise what led them to substance abuse. At the start of their programme, patients tend to deny or downplay their addictions. They can’t manage to put their feelings or pain into words. With time, patients begin to realise that they can discuss certain topics that they never dared talk about before and that this can help them. This step is crucial, as there is a close correlation between the ability to name what one experiences and the ability to control one’s impulses.

It is impossible to work on substance abuse without considering the bigger picture, such as socio-economic factors or the break-down of relationships with loved ones due to incarceration. Oftentimes, substance abuse is triggered by dysfunction in the family unit or difficulty building relationships. As such, it is essential that prisoners maintain or re-establish links to family and friends, as well as to the outside world more generally.

It is equally important for individuals to nurture relationships they form whilst in detention. Prison is often described as a place of exclusion, but it is also a social setting in which new connections can be forged.

The medical aspect of treating addictions should also not be overlooked. There is no doctor in Ambulatoire Forest team but we do our best to work with them to ensure our patients receive medication to treat withdrawal. Offenders often face discrimination in medical settings, a problem which is only made worse when addiction comes into play.

We value collaboration. It is in the interest of our patients that we are in touch with the professionals in the prisons who know them. This link with penitentiary staff is key: they are routinely in contact with prisoners and are often the first to spot any troubles with substance use. Prison staff can facilitate the recovery process, but they can also place hurdles on a prisoner’s path to treatment.

Some prison guards welcome our visits, others less so. Attitudes vary depending on the member of staff. Their position is not an easy one either, as we come from two different words. Unlike penitentiary staff, we at Ambulatoire Forest are not employed by the judiciary authorities.

AF. Relapse is common in the recovery journey and, unfortunately for those who have been incarcerated, it is likely to coincide with another stay in prison. For this reason, it is important for us to emphasise that we are there for patients and willing to support them during this time. When individuals are released from prison​,​ they are confronted with an enormity of challenges. Therefore, we want to be present during transitional periods and aim to meet the person being released at least once a week and at most every 10 days. We take baby steps. When there is a relapse, we do everything we can to be at the person’s side during this time. It is a mammoth task.

There is still a lot to accomplish in this regard. Very few institutions agree to work with patients living with addiction, even fewer if they have served time in prison. The few that do not automatically refuse cannot keep up with demand and patients are placed on waiting lists for several months.

Nevertheless, residential care is essential for many of our patients. Aftercare centres offer patients the opportunity to learn a variety of things including how to manage their impulses, sustain non-conflictual relationships with others, stick to a routine, and eat at least once a day, for example.

However, many people who are released from prison face closed doors when trying to reintegrate into society. To give an example, one of our patients decided they wanted to re-join an aftercare centre on their release. We contacted 40 different centres but none of them were willing to even assess their application.

The vast majority of people leave prison unable to arrange medication-assisted treatment for after their release. In the best-case scenario, prisoners are required to attend one to two days of treatment before their release. However, if they take antidepressants or antipsychotic drugs, they receive no support and instead must wait to see a doctor when they have left prison. This is extremely dangerous​,​ as withdrawal from these types of medication can trigger a host of compulsive behaviours.

When it comes to releasing prisoners, as with the system as a whole, it is too simple to place the blame solely on prisons. This is the result of a dysfunctional system and/or one which neglects the fringes of society. Prison is no more than the fruit of the penal system.