Monitoring Report - Institution for the Execution of Penal Decisions in Fushë-Krujë The Institution for the Execution of Penal Decisions in Fushë-Krujë was monitored by the experts of the European Institute of Tirana on 12 May 2011. The maximum housing capacity of this facility is 312 people. At the time of the visit, there were 387 people in the institution of whom 29 pre-detainees. The institution has a separate section for pre-detainees with a maximum accommodation capacity of 30 persons. There were 19 inmates with mental health problems at the time of EIT visit. The building is divided between high security and normal security sections. The Institution Director and staff showed utmost willingness to cooperate. Preliminary remarks The EIT visit at the Fushë-Krujë Unit showed that there were no remarkable changes to be noted in comparison with the previous visit on 27 September 2010. The inmates no longer complained about the number of telephone calls they were allowed to make; however, they complained about not being allowed to make telephone calls beyond noon hours. Water supply continues to be limited to three times a day, morning, noon and evening at reduced time intervals. Although the Institution has a heating system, it is not operated during the winter time. Despite the EIT recommendations from its previous visits, there is not yet a special section for people aged 18-21. Although there is an Agreement between the Ministry of Justice and the Ministry of Health under which Regional Hospital doctors will examine inmates in this Institution, especially those with mental problems, in practice it is not implemented. Therefore, the Institution needs to have an in-house psychiatrist, but the institution’s organization chart does not comprise the post of one psychiatrist. During the visit, some of the inmates reported that medical service delivery was inadequate. In particular, there were complaints about delays in cases of emergency. There were also complaints about meals. All the cells have en-suite toilets; however, water supply is limited to reduced hours three times a day. 1. Treatment There were no reports of instances of deliberate torture and/or abuse. 2. Medical services As regards medical service delivery, the Institution employed 12 medical staff, of whom three general physicians - one of them also serving as chief of section - one dentist, one pharmacist and seven assistant doctors. The Institution’s organization chart does not comprise the post of a psychiatrist. At the time of the visit, only one of the doctors was on duty; the chief of the sector and the other doctor were assigned to other institutions. There were several complaints with regard to dental services. The stomatologist pointed out the lack of necessary medications as the reason for the situation. The EIT experts reviewed the medical files and the psycho-social files of 19 patients suggested by the general physician and the chief of the social care sector as having mental health problems. In addition, the experts visited in their cells 12 inmates with mental health
problems. Visits in the cells revealed that the rooms were overpopulated and humid. The experts took note that one of the inmates diagnosed with major depression and described as suicidal in his medical file was in control of his own medications. The medical files revealed that:
- In the absence of the psychiatrist, in-mates with mental health problems were taken
- The files showed problems with the diagnosis (e.g., the diagnosis for patient A.Gj. was
described as moderate epilepsy with personality disorders – without defining which disorder exactly – the epileptic status in itself is a serious condition).
- Another person with epilepsy, P.M., was not on medication.
- There were cases of treatment without diagnosis or combinations of medications
o The patient D.T was on strong medication - haloperidol. Several weeks later he
was given the wrong diagnosis of schizophrenic-affective personality;
o The patient B.D was on Amitriptyline, although no diagnosis was made;
o Without diagnosis, the patient G.S. was on Tegretol, Loram and Librium,
although the last two medications should not be used together;
o The patient N.A was on Tegretol, Loram and Promethazine, although the last
two medications should not be taken together;
- There was no neurological and psychiatric description of the symptoms.
3. Personnel The Social Care Sector was comprised of ten employees of whom one was the Chief of Sector, one social worker, two psychologists, five education specialists and one library specialist. The EIT experts met with the Chief of the Sector and one of the psychologists to learn more about the needs of the employees in this Sector. From conversations, as well as from information in the files, the experts were made aware of the serious efforts to treat inmates with mental health problems in an effective way, despite the limitations and difficulties related to the concrete conditions:
- The psychologists had received training and were in possession of detailed formats for
psychological reports, as well as detailed intervention schedules. However, these formats and schedules were completed only sporadically.
- The educators, too, were provided with report formats and detailed progression forms
for each inmate; however, the psychosocial folders contained little information on the interventions used.
- The diagnoses made by psychologists were not clear; nor had they noted the respective
medical codes or made reference to the diagnostic tools used. In one instance, the experts came across reference to scores from the Beck test on depression; however, even in this particular instance, test administration date was not recorded.
- The psychologists passively waited for the psychiatrist’s feedback on the diagnosis,
whenever such help was available. The psychiatrist left no written report in the patient’s folder and diagnoses were changed without justification (e.g., inmate D.T was first diagnosed with Schizoid Personality Disorder and later it was changed into Schizotypal Personality Disorder).
- Often, the reports were written in a non formal language (e.g. the patient was
described as someone who makes up malicious gossip, with a complicated personality, etc.) and treatment objectives did not match symptom descriptions.
- Clinical data of disease progression were missing and so were detailed plans towards
- Examinations were made over irregular time schedules for no express reason or
justification (sometimes daily, weekly or even monthly).
- Inmates had received various theoretical trainings (such as aggressive behavior and
relevant treatment, suicidal risk minimization, etc.). However, it was not clear whether these trainings were deemed necessary and effective by the trainees (as there were no written evaluations by trainees on the quality of training).
4. Material conditions EIT experts received many complaints in relation to food. There was a shop where inmates could buy various necessary items. Relatives deposited money in their accounts so that inmates could use it to purchase the necessary goods. This activity was carried out in full transparency. Family members were allowed to bring food parcels to the inmates. Lighting and ventilation were appropriate. The cells had large windows and the inside of the building was penetrated by plenty of natural light. Electricity was supplied without interruption; however, electric lighting was weak due to low voltage. With regard to personal hygiene, inmates did not complain about the hygiene items provided by the institution. However, at the time of the visit, the showers were out of order. As regards sanitation conditions, all cells had en-suite toilets. The condition of the toilets was acceptable. The Institution had a laundering facility which was operational at the time of EIT visit. Bedding was provided by the institution. Inmates with mental health problems were placed in the specially designated section or the Institution’s hospital. However, their airing and sports activities were implemented together with the other inmates. 5. Regime and activities The right to maintain contact with family and friends was properly applied. In accordance with the new General Prison Regulation, the number of meetings that inmates can have in a month has increased to four. Also, inmates can make eight telephone calls in a month. Several
inmates complained to EIT experts about not being allowed to make telephone calls in the afternoon and evening hours. Contacts with the outside world were also allowed. Inmates were allowed to communicate with their legal counselors as well. Under the new General Prison Regulation, inmates are entitled to the right to information which is actually implemented by allowing inmates to have access to electronic and printed media. TV and radio sets are permitted in all pre-detention units in the country. The right to activities in fresh air was implemented in accordance with the conditions in the institution. A reporting system was in place. The right to fresh air was applied in the proper manner. All inmates had access to fresh air twice a day. Total time spent in fresh air was 3.5 – 4 hours daily. In relation to education, the institution has a library and reading corner and inmates may take books with them to read in the cell. There is an Agreement with the Ministry of Education and Science to provide inmates with lessons under the compulsory 9-year education system. In addition, professional training such as English language and computer courses was delivered for inmates. The right to religious belief was respected and there was a special room for religious practice. The new General Prison Regulation stipulates that inmates should be provided with employment opportunities. EIT experts noted that some inmates were actually involved in housekeeping jobs, mainly cleaning. However, they received no payment for their labor. Recommendations Based on findings from the monitoring and conversations with the social care and medical staff, the following recommendations are made:
1. Steps should be taken to make possible that one psychiatric doctor is hired in the
2. The psychologists should be trained to use the various psychological tests designed to
identify mental disorders most frequently affecting individuals at risk in incarceration facilities.
3. Opportunities should be provided for exchanges with other professionals involved
with mental health-care in order to expose the Institution’s staff to diagnostic, treatment and daily support activities for people afflicted by mental disorders.
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