General and specialised medical care is usually provided in detention facilities.
Medical teams are insufficient in number and skills. There is an absence of specialists across the board: physiotherapists, dentists, ophthalmologists, dermatologists.
The medical team is usually made up of nurses. On-call medical service is generally limited to daytime hours.
A shortage of medical staff is a major problem. Sometimes, a doctor has to examine 20 to 50 prisoners within a two-hour period.
The working conditions for healthcare professionals are seen as difficult: insufficient equipment, finances, training, organisation, etc.

Prisons without a medical-surgical centre transfer inmate patients to public hospitals.

Continuity of care for inmates poses a problem: there is no protocol to link medical follow-up before, during and after imprisonment.

Nurses usually dispense medicine, although sometimes wardens or prisoners handle distribution. Some wardens do not always respect medical prescriptions.

Certain hospitalisations involve security measures, which often delay access to health care.
In 2017, 40% of medical transfers at St-Gilles prison were carried out with a delay.

Skin diseases remain a major problem in prison. AIDS, tuberculosis, hepatitis C, heart disease and diabetes are especially prevalent among inmates.

Patients with an infectious disease, such as tuberculosis or scabies (disease associated with poor hygiene), are side-lined. Directors sometimes place prisoners with the same illness (diabetics, drug addicts, etc.) in the same section, usually for practical reasons like organising movement. These people are sometimes denied the right to work. As a result, medical services regularly see these inmates suffer from ostracisation or discrimination.

Risk reduction actions are limited. There are only a few pilot projects (including for suicide-related risks).

In principle, mental health patients (perpetrators of offences who are recognised as not being responsible for their actions) stay in a specialised facility. There are five of these facilities, in Ghent, Antwerp, Paifve, Mons and Tournai. (See “Prison Estate”). They are divided into three categories:

• Social Defence Establishment (EDS): there is one in Paifve, reserved exclusively for inmates who are mental health patients. It is managed by the prison administration
• Civil Hospitals: there are two, in Mons and Tournai. They have a section reserved for mental health patients. The entire facility reports to the Ministry of Health. Patients wait in prison psychiatric wings between two to four years, without adequate care, for a place to become available. The prolonged wait to be placed in a civil hospital was denounced by the Council of Europe’s Committee for the Prevention of Torture (CPT). Belgium was condemned by the European Court of Human Rights in September 2016 in pilot judgement W.D. v. Belgium.
• Forensic psychiatry centres: there are two, in Ghent and in Antwerp. This type of facility only accepts mental health patients. Its operation is mixed. The FPS Justice manages security and infrastructure, and the Ministry of Health manages treatment.

In a public statement on 13 July 2017, the CPT noted the particular situation of mental health patients within social movements. These patients appear to be even more vulnerable than other prisoners (see “Prison Staff”).

Three new forensic psychiatry centres have been announced in Aalst, Wavre and Paifve, with no specific timeline.

The psychosocial service is understaffed in almost all of the country’s prisons.

There is a high number of drug addicts. A study reveals that 33% of the prisoners questioned say that they use drugs on a regular basis.
Another study reveals that 68% of prisoners are considered to be highly dependent on legal or illegal psychotropics. Antidepressants are used for lack of a genuine course of care. 43% of the prescriptions issued are for antidepressants and anti-anxiety drugs.
There are several actors engaged in handing prevention missions. About 50% of prisoners are thought to have access to these prevention programs.
Risk reduction actions are limited. There are a few pilot projects (including for suicide-related risks).

Several actors and projects seek to intervene and ensure a preventative approach within the institutions. According to research, 50% of prisoners have access to prevention programs.
Actions regarding risk reduction are limited. Only a few pilot projects exist (including those related to suicide).

There is a disproportionate number of people with mental disorders, and the lack of mental health professionals is significant. Requests for external support for the treatment of psychiatric illnesses may, in certain cases, entail a waiting period of one to two years.