A primary care team¹ is present in each prison, providing outpatient services. The team consists of at least one general medical practitioner and two nurses. Psychiatrists, dentists and occasionally pharmacists may also be available. Other specialists (e.g. ophthalmologists, gynaecologists, dermatologists etc.) are rarely present. Patients suffering from certain conditions are taken to hospital. There are insufficient doctors available. Requests for medical consultations are subject to delays. Sixteen out of 82 establishments have a pharmacy on site.

Each prison is attached to a particular hospital, which must be equipped with a secure unit to receive patients (hospital beds with a police guard).

Inmates must be allowed access to the same care that they would receive in the outside world. Social organisations have revealed that these rights are not respected. There is a clear inequality of access in this area.

The prison administration is responsible for the health of prisoners, according to the legislation, and must provide them with medication.
Detainees with mental health problems are mostly treated with medication. The lack of psychiatrists and psychologists in detention could explain this trend. Some detainees suffering from schizophrenia are reportedly overmedicated, according to the CPT. The Committee questions the consent to be given to medication, which seems to be sometimes imposed on the detainee.

Prisoners undergo a medical examination on arrival at the institution. The prevention of epidemic and communicable diseases is of utmost importance.

An x-ray is performed on all prisoners who show the first symptoms of tuberculosis. A doctor performs this examination.

A survey conducted, in 2022, by the Ministry of Health on a sample of 5,512 prisoners revealed that only 65% to 73% of prisoners claim to remember having been offered screening for HIV, hepatitis B and C or syphilis. 97.4% of prisoners diagnosed were receiving treatment. This percentage is higher among women. 22.1% of prisoners have been vaccinated for hepatitis B.¹

Risk minimisation programmes in prison aim to reduce drug-related risk of harm. Programmes include testing, vaccination and provision of safe injecting equipment (without disinfectant), protection and hygiene products such as bleach.
A needle exchange programme has been in place since 1997. Condoms are made available. The review of this programme shows that:

• Drug use and injection does not increase
• Risk behaviours and transmission of diseases (HIV, Hepatitis C) decrease
• Positive health outcomes have been observed (drastic reduction in overdose cases)
• A number of establishments vouch for the effectiveness of the programme.

A survey conducted, in 2022, by the Ministry of Health on a sample of 5,512 prisoners revealed that 21.2% of the prison population was aware of the needle exchange programme. 2.3% of prisoners surveyed stated that they had used needles that had already been used.¹

The general detention regime

Individuals with mental health problems can be placed in correctional facilities. They are typically placed in the general detention regime. The CPT observed that psychiatric visits were inadequate in correctional facilities. At Teixeiro prison, where 6% of prisoners receive antipsychotic medication, no psychiatrists visited between 2011 and 2016. At Léon prison, where 25% of prisoners have diagnosed personality disorders, one psychiatrist visited for four hours per week. No permanent psychologist was available at any of the facilities visited by the CPT in 2016.¹

In 2005, the prison service established “PAIEM” (Programa de Atención Integral a Enfermos Mentales), a programme for prisoners suffering from certain mental illnesses. PAIEM is active in most facilities. The prisoners who participated in the programme in 2017 totalled 2,029, 4.3% of the prison population (1,892 participants in the SGIP prisons and 137 in Catalonia).² Doctors and psychologists are the primary contributors to PAIEM. The programme also receives periodic support from psychiatrists, personnel specialised in mental health and other professionals such as educators, social workers, legal experts and occupational therapists.² NGOs also participate in the programme’s operation.

The Spanish Ombudsman reported the unsatisfactory performance of PAIEM in most of the prisons visited. Medical care is limited to diagnosing participants and drug monitoring. Appropriate therapeutic treatment is often missing.³

The CPT noted the lack of healthcare professionals contributing to PAIEM in the facilities visited. No psychiatrists or psychologists were affiliated with the programme: only general practitioners or professionals specialising in other fields.¹

The infirmaries in penitentiary centres held 7,432 prisoners with mental disorders in 2020. The percentage of the prison population dealing with serious and chronic mental disorders is estimated at 5%.

Specialised units within correctional facilities

Despite legal provisions, few facilities are equipped with psychiatric units. The two psychiatric prison facilities are in Seville and Alicante, under the control of the Ministry of the Interior.
Brians I prison, in Catalonia, has a psychiatric hospital unit. Brians II has a psychiatric rehabilitation unit that can house 22 patients. This prison also has an arrangement with the Sant Joan de Déu hospital, for the treatment of prisoners with serious mental health problems. These institutions are under the control of the Catalan Department for Justice. In May 2023, the Trade Union Confederation of Workers’ Commissions (Comisiones Obreras, CCOO) requested the opening of a prison psychiatric wing in Galicia. 1,206 prisoners in the region have received diagnoses of mental health issues.

A “polyvalent unit” accommodates female prisoners with mental health disorders at the Wad-Ras prison in Catalonia. The CPT observed that the patients in these units did not receive care or assistance. It deemed the units inappropriate environments for people suffering from mental disorders.⁴

In all units within correctional facilities, as is the case in the general regime, medication is the only treatment provided to people experiencing mental disorders.

Penitentiary psychiatric hospitals

People deemed to have diminished responsibility at the time of the offence due to their mental disorder are legally required to complete compulsory treatment called a “preventive measure” in a penitentiary psychiatric hospital.⁵ The country has two penitentiary psychiatric hospitals, Alicante (Fontcalent) and Seville. They are under the authority of the Ministry of the Interior and have 50 spaces each. In 2018, the Alicante hospital held 230 men and 26 women. The Seville hospital totalled 161 men at that time.²

Both facilities have been criticised for overcrowding, poor organisation and insufficient healthcare personnel. They seem to operate more from a penitentiary mindset than a psychiatric one: “Nearly ten years ago, prison facilities were already warning that these places were becoming substitutes for asylums, which have been prohibited since the psychiatric reform of the 1980s”, according to the platform Salud Mental Fuera de las Prisiones.

The Spanish Ombudsman noted a shortage of specialised professionals, especially in the Seville penitentiary psychiatric hospital. This facility has four psychiatrist posts to address the needs of 169 prisoners; however, in 2017, only one post was filled.³

General psychiatric hospitals

People under “preventive measures” can be held in general psychiatric hospitals if they are not considered “dangerous”.
Police officers are responsible for ensuring security at general psychiatric hospitals. They carry out surveillance of the prisoners held in these facilities.

Psychiatric units within prisons are few and far between, despite the legal measures put in place.

The Ombudsman has noticed a lack of specialist personnel, notably in the prison psychiatric hospital in Seville. There are four vacancies for psychiatrists in the institution. At the time of the delegation’s visit in 2017, there was only one psychiatrist available to meet the needs of 169 inmates¹.