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Portugal

Capital city — Lisbon

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Panorama

Health

Organisation of health care

Ministry in charge

Ministry of Justice and Ministry of Health

  • An interdepartmental task force presented a proposal to the government in which they recommended transferring the supervision of health care to the Ministry of Health and integrating it into the national health service. According to their report, continuity between health monitoring outside of prisons and within prisons would enable better care for chronic illnesses, reduced costs from new tests, a decreased possibility of drug resistance and a drop in care follow-up issues and criminal recidivism.

    i
    30/04/2024
    / CNN Portugal

Every prison facility has a health care unit

yes

Number of medical staff (FTE)

230

i
31/12/2022
/ Council of Europe, SPACE I Report 2023, table 19.

The main care provided in prison is pharmaceutical treatment, general medicine and psychiatric care. Specialized medicine and hospitalization are provided by public hospitals (National Health Service) and the São João de Deus Prison Hospital1. The medical team consists of nurses, general practitioners, psychiatrists, pharmacy technicians and pharmacists.
Prisoners held in Funchal prison can, since December 2021, access remote medical consultations.

  1. Directorate General for reintegration and penal services, “Report on activities and self-assessment, 2017“, 2018, p. 72. ↩

Hospitals do not have units dedicated to prisoners. The latter are cared for within the services, under the supervision of prison officers.

Access to health care

Health care is free

yes

The prisoner may choose an external doctor. The costs are then at their own expense. This request must be addressed in writing to the warden of the establishment (article 60 of the Regulations).

A medical examination is performed upon admission

yes

A clinical assessment must be made within 24 hours of entering prison. A nurse collects the information necessary to open the medical file. A doctor is required to consult within a maximum of 72 hours (article 53 of the Regulations). This consultation includes screening for contagious and communicable diseases (article 61 of the Regulations).

A medical file is opened upon admission

yes

During the admission consultation, the nurse opens a medical file containing personal information on the state of health of the prisoner. The individual clinical file accompanies the prisoner during their prison journey, even in the event of a transfer. It is accessible in the event of their return to prison. The medical file can be dematerialized.

Prisoners can access health care units after

a written request

Medical examinations are carried out on a confidential basis

yes

Portuguese law ensures the confidentiality of medical interviews (article 32 of the Code for the enforcement of punishment). Persons having access to data relating to the health of the prisoner are bound by professional secrecy, even after the end of their duties (article 57 of the Regulations).
Observers report frequent non-compliance with confidentiality rules. Health workers appear not to be sensitized to this clause.

Access to care must be ensured in continuity and quality. The prisoner’s access to health care must be identical to that of any free citizen (article 32 of the Code for the enforcement of punishment).

Drugs are distributed by the nursing staff. Medication is prepared by pharmacists and/or pharmacy assistants. The prisoner takes their medication under the nurse’s supervision 1.

  1. Directorate General for reintegration and penal services, “Report on activities and self-assessment, 2017“, 2018, p. 72. ↩

A hospital transfer is decided by the Directorate General of Prison Services (DGRSP). In the event of a medical emergency, the warden of the institution may decide, alone, on this transfer. The DGRSP must be notified as soon as possible (article 34 of the Code for the enforcement of punishment).

Physical health care

Infectious diseases are most prevalent in Portuguese prisons. In 2020, prisoners were particularly affected by: HIV (3.9%), hepatitis C (8.5%), and hepatitis B (1.6%).1

  1. World Health Organization, “Status report on prison health in the WHO European Region 2022”, 2023, p. 353. ↩

Hepatitis and AIDS care is provided by the National Health Service in the hospital units closest to the prison.1

The World Health Organization’s report details that:

  • 11 prisoners, accounting for 14.5% of those diagnosed with tuberculosis in 2020, are receiving treatment.
  • 386 prisoners, representing 87.3% of the prison population diagnosed with HIV, are receiving treatment.
  • 81 prisoners, which is 8.5% of those diagnosed with hepatitis C, are being treated.2

  1. Directorate General for reintegration and penal services, “Report on activities and self-assessment, 2017“, 2018, p. 74. ↩

  2. World Health Organization, “Status report on prison health in the WHO European Region 2022”, 2023, p. 351. ↩

Preventative measures for epidemics and contagious diseases are implemented. The warden may, on the advice of the medical service, remove a contagious person.
Each prison develops and submits a plan for health promotion and disease prevention to the Directorate General. This plan focuses particularly reducing risk behaviour.
A doctor (or other qualified person) carries out regular inspections of prisons. Recommendations are submitted to the warden. These recommendations concern the food that is distributed, hygiene and cleanliness of the facility, sanitation, heating and ventilation. If the warden of the institution ignores the recommendations, the physician may refer the matter to the Directorate General (DGRSP) (article 37 of the Code for the enforcement of punishment).

Free screening tests are offered periodically to prisoners (article 61 of the Regulations).

The World Health Organization’s report states that condoms are distributed in all Portuguese prisons, but none of these facilities distribute syringes.1

  1. World Health Organization, “Status report on prison health in the WHO European Region 2022”, 2023, p. 350. ↩

Mental health care

Persons suffering from mental disorders are detained in facilities within prisons or in psychiatric hospitals.
Since 1998, the São João de Deus Prison Hospital has had a psychiatry and mental health department. It provides clinical assistance, outpatient care and hospitalization of patients. The service has 18 beds for men and eight for women.
Santa Cruz do Bispo - Men Prison has a psychiatric ward with 73 individual cells, nine dormitories and a double cell for prisoners with mental disorders.

Prison wardens at Caxias Prison Hospital and in the psychiatric wing of the Santa Cruz do Bispo prison are trained to provide care for people with mental disorders.

In its 2020-2022 report, the Portuguese Bar Association’s Human Rights Commission (CDHOA) has observed that the Tires correctional facility struggles to meet the needs of prisoners suffering from mental disorders.1

  1. Portuguese Bar Association’s Human Rights Commission (CDHOA), “Relatório Visitas Estabelecimentos Prisionais 2020-2022”, 2023, p. 11. (in Portuguese) ↩

Persons who are addicted to drugs can benefit from a substitution program (methadone, subutex, antagonists, suboxone).

In its 2020-2022 report, the Portuguese Bar Association’s Human Rights Commission (CDHOA) notes that following the establishment of a care unit, the Lisbon prison now provides a support programme specifically designed for prisoners with addictions.1

  1. Portuguese Bar Association’s Human Rights Commission (CDHOA), “Relatório Visitas Estabelecimentos Prisionais 2020-2022”, 2023, p. 34. (in Portuguese) ↩