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Netherlands

Capital city — Amsterdam

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Panorama

Health

Organisation of health care

Ministry in charge

Ministry of Justice

Every prison facility has a health care unit

yes

  • In May 2022, the CPT noted that at Aruba Correctional Institution (Korrectie Instituut Aruba – KIA), the medical unit had appropriate equipment but was poorly ventilated and too small, and water leaked in through the ceiling.

    At Point Blanche Prison in Sint Maarten, medical equipment was lacking: there was no defibrillator, no sterile material, and no dental chair.

    i
    23/06/2023
    / Comité européen pour la prévention de la torture (CPT)

Number of medical staff (FTE)

335

i
31/01/2021
/ Council of Europe, SPACE I – Report 2021, p. 90.

The number of medical staff (FTE) increases by 4,36 % between January 2020 (321)1 and January 2021 (335).

  1. Council of Europe, SPACE I, Report 2020, p. 83. ↩

  • In May 2022, the CPT noted that healthcare staffing levels were adequate in the three prisons it visited. Doctors were available Monday to Friday from 8:00 a.m. to 5:00 p.m., with consultations organised in the morning. After 5:00 p.m. and on the weekends, an on-call service was in place. Only eight nurses were present on weekdays at Dordrecht Prison, and 20 at Vught Prison, with 24/7 availability. Prisoners had easy access to healthcare staff. They could call them for free to set up appointments. Persons in the EBI, BPG and TA units at Vught Prison complained of the significant delays to see outside specialists.

    At Aruba Correctional Institution (Korrectie Instituut Aruba – KIA), the number of medical personnel had decreased since the CPT’s previous visit in 2014. One doctor visited the prison three times per week, and two nurses were on site on weekdays from 8:00 a.m. to 2:00 p.m. The rest of the time, the medical team was on call. No dental consultations had taken place at the prison for over a year, and prisoners had to be transferred to receive treatment.

    At Centre for Detention and Correction Curaçao (SDKK), healthcare staff was lacking. Three doctors worked on rotation from Monday to Friday, for two hours per day. Six posts for nurses were vacant, and two of the four full-time nurses were present every day from 7:00 a.m. to 3:00 p.m. A dentist was on site for four hours once per week. No psychologists were present, and the psychiatrist was only on site for six hours per week to consult the general prison population.

    At Point Blanche Prison in Sint Maarten, a doctor visited the facility once every two or three weeks for two hours. Two nurses were available, including at least one during the day on weekdays. The rest of the time, a nurse was on call.

    i
    23/06/2023
    / Comité européen pour la prévention de la torture (CPT)

Access to health care

Health care is free

yes

Prisoners may also consult a doctor of their choice, at their own expense (Article 42 of the PBW).

A medical examination is performed upon admission

yes

The medical examination is carried out by a team formed of authorised psychiatrists, psychologists, doctors and nurses. The team assesses whether any care is needed and whether placement in the institution’s psychiatric care unit or in a specialised penitentiary facility is required.
Screening for tuberculosis is carried out on a routine basis. A chest x-ray is taken for high-risk inmates.1

  1. Eveline Thoonen, “Death in State Custody”, Maklu Uitgevers N.V, 2017, p.182. ↩

  • In May 2022, the CPT noted that healthcare staffing was lacking in the three prisons it visited in Aruba, Curaçao and Sint Maarten. Prisoners were not systematically medically screened upon admission. The medical personnel also assisted with security activities, such as drug testing or cavity searches for illicit items.

    The medical screening was performed by a nurse within 24 hours of admission. Prisoners filled out a questionnaire on medical conditions that could be relevant to them, including the risk of suicide. Telephone interpretation was possible for foreign nationals. At Vught Prison and Dordrecht Prison, foreign prisoners complained that they had not received important information in a language they could understand.

    At Aruba Correctional Institution (Korrectie Instituut Aruba – KIA), Centre for Detention and Correction Curaçao (SDKK) and Point Blanche Prison in Sint Maarten, prisoners were not systematically medically screened upon admission, and injuries were not recorded. The examinations were not gender specific and did not account for sexual abuse or gender-based violence. The examinations did not respect medical confidentiality, as they were always carried out in the presence of prison staff.

    i
    23/06/2023
    / Comité européen pour la prévention de la torture (CPT)

A medical file is opened upon admission

yes

Prior to the first medical examination, prisoners must complete a form in which they detail, for example, any medical treatment that they receive a regular basis.

Prisoners can access health care units after

a written request

Every morning, the nursing staff pre-select the inmates who will be seen by the doctor that day.

i
Commissie van Toezicht

Medical examinations are carried out on a confidential basis

yes

Medical confidentiality is guaranteed except in cases “*of legal obligation to share medical data, of conflict of interest, of conflict of obligation or of significant interest”1.

  1. Thoonen, E., “Death in State Custody,” *Maklu Uitgevers N.V., 2017, p. 204. ↩

Dutch disciplinary case law ensures continuity of care throughout the period of detention.[^care]

Specialised care is also provided. A dentist for example, is present in each facility.

Physical health care

There is no specific data on HIV/AIDS, syphilis, chlamydia, hepatitis B and C or the co-infection of tuberculosis and HIV (TB-HIV). The prevalence of any given disease can therefore not be established.

In 2016, the number of arrivals tested, who were either born or who had been convicted within the last five years in a country particularly affected by tuberculosis1, was 12,222. Thirteen tested positive.

  1. more than 10 cases per 100,000 people ↩

Testing for HIV, hepatitis B and C, and sexually transmitted infections (STIs) is available in all facilities. These tests are not mandatory.

Infectious diseases other than tuberculosis are not routinely screened for. Only tests for tuberculosis are regularly carried out.1.

  1. Council of Europe, “Report to the Government of the Netherlands on the visit to the Netherlands from 2 to 13 May 2016”, January 2017, p.28. ↩

Measures are taken to prevent communicable or epidemic diseases. Vaccination against hepatitis B is available to men who having homosexual relations.

Risk reduction measures include free access to condoms. Needle exchange programs, deemed “unnecessary”, are not offered.

Mental health care

Prison facilities
When a mental disorder is identified in a person entering detention, an individual psychiatric treatment plan must be drawn up within ten days of arrival. 1 Outpatient care is provided.
Prisoners with serious mental disorders can be placed in ‘extra care units’ (Extra Zorgvoorziening, EZV), which are present in every prison. Placement is by decision of the head of the institution. The waiting time for placement is very long.

Dedicated psychiatric facilities
Persons suffering from a mental disorder at the time of the offence should, by law, not be subject to a sentence but to an obligation of care called “government disposal” (TBS).

They can be placed in three types of institutions:

  • A Penitentiary Psychiatric Center (PPC), if they refuse treatment or if the “security risk” they pose is deemed high2.
  • A forensic psychiatric centre (Forensisch Psychiatrisch Centrum, FPC), if they suffer from major psychiatric disorders (such as schizophrenia).
  • A forensic psychiatric clinic (Forensisch Psychiatrische Klinieken, FPK), if they pose a lesser risk. Their consent to treatment is required. A detainee can only be transferred there if he or she is released on parole. The FPKs are the only specialised institutions under the control of the Ministry of Health.

Persons with mental disorders can be placed in a prison if the specialised institutions lack space.
Prisoners may be transferred from prisons to a specialised institution if their state of health and the “security risk” require it.

The Caribbean Overseas Territories do not have specialised facilities for people with mental health problems. People are transferred to the mainland or remain in prison.
Vulnerable care units (FOBA in Curaçao, IBA in Aruba) accommodate detainees requiring psychiatric care. The CPT highlights the deplorable living conditions at the IBA in Aruba: the cells are not maintained and no activities are offered to the detainees, who are usually left without care. It warns that this situation is inadequate to meet the needs of the detainees in this unit.

General Psychiatric Hospitals
Patients are transferred to a psychiatric hospital if their condition requires special treatment.
General psychiatric hospitals may also receive detained persons in an emergency if they present a serious danger to themselves or others.

  1. Scientific Research and Documentation Centre (WODC), Trajectories of Forensic Care in the Prison System, 2016, p. 32. (in Dutch) ↩

  2. Council of Europe, Report to the Government of the Netherlands on the visit from 2 to 13 May 2016, 2017, p. 30. ↩

  • In May 2022, the CPT noted a sufficient number of psychologists and psychiatrists to treat the incarcerated population. Prisoners with mental health problems may be placed in EZV units, which are present in all prisons. Those in a state of crisis may be transferred to PPCs in order to receive specialist assistance in an appropriate medical environment. In all the prisons visited, prisoners at risk of suicide were placed in cells alone, either in clothing that could not be torn or naked, as they awaited a specialist mental health team. This isolation, resulting from confinement to a cell for most of the day, little or no contact with staff, and a poor regime, is antithetical to the care necessary for those at risk of suicide or self-harm.

    At Aruba Correctional Institution (Korrectie Instituut Aruba – KIA), Centre for Detention and Correction Curaçao (SDKK) and Point Blanche Prison in Sint Maarten, agitated individuals in the psychiatric unit were sometimes subjected to chemical restraints. They were not kept informed of the medication injected.

    A psychiatrist now visits Aruba Correctional Institution (Korrectie Instituut Aruba – KIA) twice weekly. Persons with mental health disorders are placed in the unit for at-risk individuals. The unit does not provide an appropriate therapeutic environment, as little support is available.

    At Centre for Detention and Correction Curaçao (SDKK), three people with mental health disorders had no specific area to hold them. However, the forensic psychiatric support unit (FOBA), which has a capacity of 21, was holding 19 men. The cells are single-occupancy, clean and in good condition. The prisoners could leave their cells twice per day for a total of four hours and could go outside. No individualised programme is available, and few activities are offered.

    At Point Blanche Prison in Sint Maarten, a psychiatrist visited the facility 10 to 20 times per year, and a nurse visited once weekly.

    i
    23/06/2023
    / Comité européen pour la prévention de la torture (CPT)

The guards assigned to the dedicated units (EZVs) within prisons receive training in patient care. The CPT observes that “they work in cooperation with psychologists and social workers”. The staff/prisoner ratio here is higher than elsewhere1.

  1. Council of Europe, “Report to the Government of the Netherlands on the visit to the Netherlands carried out from 2 to 13 May 2016”, January 2017, p.24 . ↩

  • In May 2022, the CPT noted that the forensic psychiatric support unit (FOBA) at Centre for Detention and Correction Curaçao (SDKK) and the IBA unit at Aruba Correctional Centre (KIA) did not provide an appropriate therapeutic environment for prisoners with mental health issues. This was due to a shortage of adequately trained personnel and the near-total lack of therapeutic activities.

    At Centre for Detention and Correction Curaçao (SDKK), nine surveillance officers in pairs were present at all times in the forensic psychiatric support unit (FOBA). They all received training on how to deal with people with mental disorders. Most have been in this unit for a long time and are very dedicated to their work.

    i
    23/06/2023
    / Comité européen pour la prévention de la torture (CPT)

Prisoners with drug addictions, whether on remand or convicted, have access to substitution treatment. Guidelines for the prevention of drug-related deaths are issued to facilities.

  • In May 2022, the CPT noted that the prison service’s approach regarding substance abuse was still a punitive one. Only a few prisoners had access to substitution treatment using methadone. Incarcerated persons could also be transferred to rehabilitation clinics. Mandatory drug testing was carried out regularly; positive results led to disciplinary sanctions.

    At Aruba Correctional Institution (Korrectie Instituut Aruba – KIA), Centre for Detention and Correction Curaçao (SDKK) and Point Blanche Prison in Sint Maarten, urine testing was carried out by the staff treating the person with substance use disorder, which affected the relationship between the patient and the healthcare staff.

    i
    23/06/2023
    / Comité européen pour la prévention de la torture (CPT)