The situation for psychiatric patients in Albanian prisons and hospitals raises many “grave” concerns, including a lack of therapeutics, overcrowding, staff shortages, and a lack of mattresses and bedding, according to a Council of Europe (CoE) report.
The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment carried out an ad hoc visit to Albania between 23 and 26 November 2021 to assess the situation of forensic psychiatric patients in Albanian institutions.
In particular, they sought to follow up on the long-standing recommendation that all such payments be transferred to a proper psychiatric facility. They visited the Zaharia Special Institution in Kruja, the Prison Hospital in Tirana and Lezha Prison, all of which house psychiatric patients.
The committee require the Albanian authorities to respond to their report including a full breakdown of action taken to implement recommendations, within three months. This should be followed up every three months going forward, the report states.
Something the CPT found “striking” was that within five years, the number of male psychiatric patients increased by more than 40% to 217. This, they wrote, is due to the fact that “hardly any forensic patients” are discharged. This is due to a “lack of adequate outpatient care and accommodation in the outside community”. It continues that patients were only discharged if families were able and willing to take care of them, but most had lost contact with their family, so this was not an option.
The CPT recommended the authorities assess the need for inpatient hospital care and explore alternatives such as psychiatric hospitals, community-based long-term care, and better outpatient care.
Previous recommendations had centred on creation of a special forensic psychiatric facility at Lezha Prison, but this had been repeatedly postponed, apparently due to the earthquake in 2019 and the COVID-19 pandemic. The Albanian authorities assured the CPT that patients were scheduled to be transferred there, on 28 and 28 November, coincidentally, the day after the delegation left.
In the Kruje facility, the CPT noted a poor state of repair, severe overcrowding, and a lack of staff, including no psychologist. In total, there were eleven nurses, four orderlies, and three psychiatrists for 320 individuals.
They also noted that the only real treatment for patients was drugs and there was an almost total lack of therapeutic activities due to a lack of staff.
As for Lezhe Prison where patients were due to be transferred to, the CPT noted “with concern” a number of fundamental flaws. For example, they observed that when the transfer is complete, the facility would be “severely overcrowded’ due to the increase in psychiatric patients. They noted that kitchen areas, observation rooms and offices had been turned into accommodation areas and beds had been added to cells that were already at capacity.
They also saw there were no communal spaces for socialising and psycho-social activities, no lockable storage areas for patients, and the outdoor exercise yards were “in a deplorable state” lacking any sporting facilities, rest areas, or shelter.
“Both detention blocks did not resemble in any way a health-care establishment…Given the carceral setting and the total lack of communal spaces, the temporary facility at Lezha Prison does not have the potential to provide a therapeutic environment to patients,” the report states.
The authorities said they were committed to implementing the long-standing recommendation to create a specialist forensic facility as a matter of priority.
In the Prison Hospital in Tirana where female patients are kept, while improvements were noted, “a number of deficiencies were observed”. These include austere cells, hardly any furniture, and some patients only having a piece of foam as a mattress and no bedding. Patients also said their family were responsible for purchasing toilet paper, sanitary towels and toothbrushes.
A lack of shelter in the exercise yard was also observed and patients reported a decrease in lack of access to fresh air.
“All female patients interviewed by the delegation indicated they were only able to go to the open air for only one hour per day.”
They also said no sports or other activities were provided and there were no spaces inside for any kind of activities. They do not have access to radio, television, or even board games.
“In short, patients usually remain locked up in their cells for up to 23 hours a day, the only occupation being reading books from the hospital’s library or reading material provided by families,” the report states, noting that some patients were kept alone in a cell, further exacerbating their condition.
To make matters even worse, due to the pandemic and a lack of vaccines for patients, some had not seen family members for over 18 months. The authorities told the CPT that the day after their visit, all female patients who wanted a COVID-19 vaccine were vaccinated.
The CPT urges the Albanian authorities to redouble their efforts to implement their plan to set up such an institution without further delay, in order to provide all forensic psychiatric patients with a therapeutic environment and a multi-disciplinary treatment programme,” the report concludes.
