MEDICS CATALONIA PROJECT First Part: Summary about the project

Levels of Psychiatric attention in Catalan prisons (The 3 levels share computerized clinical history. It is shared among the 80% of our Public Health System since 2015) Small Prisons Consultant Psychiatrist Large Prisons Psychiatric Nursing Departments In the big complex of Brians 1 Penitentiary Hospital First Second Third

Psychiatric visits and self-harms Period from 1st January 2013 to 30th April 2014 Population Psichyatrics visits Self-harms Attempted suicide Suicide Number Ratio % Youth Prison 787 126 0,16 33 4,19 1 0,13 Br1 Female 508 2506 4,93 54 10,63 26 5,12 0,20 Br1 Men 2669 3728 1,40 66 2,47 23 0,86 0,04

NURSING STAFF Acute pain Abuse of drugs Lack of impulse control A better assessm of indiv. needs Improve self- management Profess. training courses Psycotherap. treatment Pharmaco-logical treatment Help family

MEDICS CATALONIA PROJECT Second Part: According to our staff

(1) In order to identify psychopathological disorders and possible sources of help, our staff believes the following: 1st. PROTOCOL information + a link or contact with a professional expert in psychopathology 2nd. TRAINING courses (according to directors, treatment area + health staff, the lack of trained staff in health is the most negative factor that affects their intervention) 3rd. PSYCOTHERAPEUTIC TREATMENT (individual or group psychological treatment)

(2) In order to identify psychopathological disorders and possible sources of help, our staff believes the following: 4th. To increase outdoor activities + family visits 5th. To prompt the inmates in joining in self-help groups + to start therapeutic activities 6th. To give more support to the inmates students who attend classes and who require it

MEDICS CATALONIA PROJECT Third part: Conclusions and Proposals

CONCLUSIONS (1) In general, for all the penitentiary staff: To increase the motivation, activating incentive policies (only 13% of Catalan correctional officers answered the questionnaires) PROFESSIONAL TRAINING for all groups, supplemented by on line curses and material (this means a low cost activity for the Administration) To work on a MULTIDISCIPLINARY TEAM BASES AMONG PROFESSIONALS (First of all, it’s necessary to show the groups how to gain coordination. Once they have learnt some coordination techniques, the training courses can be given) Teachers should be able to identify what are the personal problems which influence the inmates

CONCLUSIONS (2) For Inmates with psychopathological problems: To carry out personal programmes in order to treat each patient, so: «a Taylor made programme for each inmate with a mental disorder is needed and a personal social rehab programme is required» (medication, psychological study -structural analysis of social behaviour and social interactions-, activities, therapeutic outings...)

PROPOSALS (1) In psychiatric/psychopathological issues: The computerized medical report should be shared by all the medical staff and other professionals (clinical psychologist, educators, social workers) To develop the idea of personal treatment plans To set up psychiatric multidisciplinary teams To create inside and outside the prison system a psychiatric coordination policy

PROPOSALS (2) In order to improve the care of inmates with mental disorders To start an outpatients program outside the prison system in the facilities provided by the community, in low and medium security units under specialized supervision (ex. security measures with low or moderate risk of recidivism). To set up, in those units and also for serious cases, a specialized team made up by a forensic doctor, a specialist in legal medicine and a psychiatrist. To establish a network of psychiatric outpatient’s services outside prison. To empower the psychiatrists and criminal justice technicians, so they can propose the judges the most suitable centre in which the patient should be assigned

FINAL CONSIDERATION Do all offenders with psychopathological disorders have to be in prison? It will obviously depend on: 1. What kind of offense they have committed 2. What sort of mental disorder they are suffering from So, it’s essential a good diagnosis, an appropriate treatment and a correct follow up, both inside and outside the prison (Judges have to be assured that offenders will be supervised and that there will be no security reasons which advice that the offender has to remain in prison)

According to the recommendation R(2006)2 of the Committee of European Ministers 12.1 says: «People who suffer from mental illness which mental health condition is incompatible with detention in prison should be arrested in an establishment designed for this purpose». 12.2 says: «If these people are in jail, their situation and their needs should be governed by special rules» 42.3 says: «Agreements with the community services are necessary in order to continue the cares, if after the release, the person consents»

THANKS FOR YOUR ATTENTION !!