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.

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.

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.

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.

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.

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.²

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 high³.
• 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.⁴ In May 2022, the CPT noted that Curaçao FOBA unit, which has a capacity of 21, was holding 19 men. The cells were 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 was available, and few activities were offered.⁵

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.

Prison facilities
Prison facilities must have on duty at all times, a psychiatrist as well as nursing staff with sufficient psychiatric training.
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.

In May 2022, the CPT noted that there were sufficient psychologists and psychiatrists to meet the needs of the prison population at the three prisons visited (Dordrecht, Vught, Zolle). A psychiatrist is present 10 to 20 times a year at Point Blanche prison in Sint Maarten and twice a week at the Aruban Correctional Institution (Korrectie Instituut Aruba - KIA).²

Dedicated psychiatric facilities
In 2016, the staff of psychiatric prisons (PPC) comprised 94 prison officers with two years’ training in psychiatric care and 18 psychiatric nurses. The care team included 11 psychologists and two social psychiatric nurses³.
Forensic psychiatric centres (FPC) do not have prison guards. Staff is trained in security. Psychologists and psychiatrists are trained in caring for prisoners. Nurses, trained as social workers or socio-therapists, provide socio-therapeutic follow-up for patients. Additional training courses are offered every year, for example in aggression management.

In May 2022, the CPT noted that the FOBA unit 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 FOBA unit. 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.⁴

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.
Prisoners with addictions are generally placed in centres dedicated to detoxification. They may also be admitted to specialized facilities such as PPC, FPC or FPK if they also suffer from psychological disorders. They benefit from methadone substitution treatment or long-term withdrawal therapy.
Product-dependent prisoners of Curaçao prison can access consultations at a dedicated addiction treatment centre outside the prison.

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.[^cpt]