4.2% of inmates, around 1,800, have serious mental disorders, but only one in five (393) is treated in one of Spain’s two prison mental hospitals, while the rest remain in regular prisons.

This is how from White Paper on Health Care for people with severe mental disorders in prisons in Spain presented by experts from the Spanish Society of Legal Psychiatry (SEPL) and the Spanish Society of Prison Health (SESP) this Wednesday.

The prison population is 55,180 peopleof which 44,394 are serving their sentences in prisons located in communities without transferable prison powers -that is, all but Catalonia, the Basque Country, and Navarra-.

4.2% of inmates in these 14 communities have serious mental disorders, although the figure could be much higher, because nearly half of those evaluated by psychiatrists accepted this diagnosis. Between 80 and 90% will eventually develop a mental disorder during their lifetime.

However, only 22% of inmates with high mental health care needs are treated in one of Spain’s two prison psychiatric hospitals, located in Seville and Alicante.

“Spain is the only country with this model. The very high percentage of people with TGM who are in prison is an unfortunate situation,” said Dr. Alfredo Calcedo-Barba, former SEPL president.

Young man, psychotic and addicted

Seven out of ten inmates are diagnosed with TGM they haven’t had any follow-up on their predicament before going to jailin which the prison environment can be an opportunity to treat their mental health and stabilize their disorder symptoms, say psychiatrists.

The most common profile of inmates with a high need for mental health care is that of a young male between the ages of 18 and 30 with addictive co-morbidities or multiple pathologies that further exacerbate their condition.

They also have poor medical follow-up and adherence to treatmentwho frequently drop out of school, lack financial resources and a stable home and are frequent repeat offenders.

A double stigma also weighs on them, namely mental disorders and imprisonment; According to Calcedo-Barba, although the majority have a health card, administratively those who are cared for by the National Health System are deemed not to have one.

There are even rehabilitation units and mental health centers that reject TGM sufferers with security measures and only treat them after they are released.

Unfilled place

Prison health care shares, but exacerbates, the same reality of scarcity of national public systems: professional aging, lack of professional horizons, fleeing abroad in search of better conditions, excess guards or unfilled positions are added. have lower salaries than their SNS counterparts.

In prisons that are the responsibility of the Secretariat General of Correctional Institutions with 83% coverage, only a third of those offered have been covered, namely 159 out of 481.

Thus, the average ratio of prison doctors in the central administration is 5.2 per 1,000 inmates, far below Europe, which is 8 per 1,000; Likewise in prisons there is 1 pharmacist for 1,244 convicts, while in the community there is only 1 pharmacist for every 100 people.

In psychiatry specifically, only one in ten positions offered by 2022 will be filled; Dedicated psychiatric consultations are carried out by professionals who are employed as part-time interconsultants, with dedication varying depending on the size of the center, which is approximately 3 hours a week.

If there is no contract psychiatrist, a specialist consultation is carried out at a referral hospital.

Even in the two prison mental hospitals, the endowment falls short of European figures, with a ratio of 0.8 in Alicante and 2.6 in Seville compared to 5 specialists for every 100 people in Germany, France, Italy and the UK.

Basque Country and Catalonia, references

Facing this model, experts appreciate other reference models implementing innovative treatment systems such as Catalonia and the Basque Country.

Until the prison health system is properly integrated into the regional health system -something that should happen within 18 months of the enactment of the 2003 law on SNS Cohesion and Quality-, violates the principles of equality, equal opportunity, roots and quality of care guaranteed by health laws, both companies have warned.

“The experience in Spain shows that prison administrations are not the best suited to provide and manage health care for people in court,” concluded Calcedo-Barba.