Prevent violence in educational correctional institutions, address overcrowding and improve conditions in psychiatric hospitals

The new report published today by the Council of Europe's anti-torture Committee (CPT) on its ad hoc visit to Serbia in November - December 2024, focuses on the physical safety of the children held in the juvenile educational-correctional facility in Kruševac, as well as the situation of child and adult patients treated in various psychiatric clinics, both forensic and civil. The response by the authorities has been published together with the report.

Juvenile educational-correctional facility in Kruševac

Some improvements were noted since the CPT's visit in 2023, including better material conditions and reduced recorded incidents of use of force. However, the institution retained an excessively punitive culture, outweighing its educational purpose. The Committee remains seriously concerned about children's safety, specifically the continued use of batons by staff (at times causing serious injury) and frequent, severe inter-juvenile violence, including sexual violence. Placement of the alleged victim in the closed-regime block, which could easily be construed as a punishment, is appalling, the committee stressed.

The CPT reiterates its 2023 recommendation to the Serbian authorities to prevent excessive use of force by staff on juveniles and prohibit batons as a legitimate means of force in educational-correctional facilities. Prompt forensic medical examination and psychological support should be ensured when sexual abuse is alleged; the allegations should be sent on to the prosecutor and police.

The closed-regime block was marked by long lock-up times and a lack of purposeful regime for the children. A comprehensive programme of structured activities for children on the Block should be developed, the CPT recommended.

Special prison hospital

The delegation received some allegations of ill-treatment and verbal abuse by staff. The CPT noted one recorded disciplinary case in which a patient was punched by a staff member, resulting in a sanction.

Despite some refurbishment, overall conditions in the hospital have remained poor since the CPT's previous visit in 2021. Severe overcrowding had reached a saturation point. Mechanical restraint (fixation) was used frequently and for extended periods, with patients routinely placed in incontinence pads. In the view of the committee, this practice may well be considered degrading. Treatment still consisted mainly of pharmacotherapy, with individual treatment plans not systematically updated.

Women faced specific issues, including a lack of sanitary hygiene products. The failure to provide women in a prison setting with such items can amount to degrading treatment, the CPT stresses.

The Serbian authorities should improve procedures for the reporting of injuries and ensure that medical examinations follow any violent incident, the CPT says. They should also establish a multi-sectoral forensic treatment strategy based on the least restrictive care, invest in step-down facilities for patients to be discharged into the community, urgently develop psycho-social activities and occupational therapy for all patients, increase the number of healthcare staff, and ensure that the use of mechanical constraint is in line with the national guidelines and CPT standards.

In respect of female patients, immediate steps should be taken to ensure that all patients have adequate quantities of essential personal hygiene products free of charge, including sanitary towels. A gender-specific screening should be in place upon admission, including for the detection of any history of sexual abuse and other gender-based violence. Access to specialist support services for victims should be improved.

Lastly, the Committee considers that, contrary to the current practice, children must never be admitted to the prison hospital, as it cannot adequately meet their specific needs.

Adult psychiatric facilities (Laza Lazarević Clinic and Kovin Hospital)

Although most patients spoke positively about staff, several ill-treatment allegations were received. Kovin Hospital premises were largely renovated and in good condition, but material conditions at the Laza Lazarević Clinic were deteriorating, despite certain improvements. The absence of outdoor access at Laza Lazarević's Belgrade site, flagged since 2004, has persisted. Treatment remained overwhelmingly pharmacological, with cursory individual plans. Mechanical restraint was used frequently, including in the presence of other patients, with instances of long-term fixation going undocumented.

The Serbian authorities should strengthen forensic treatment programmes within the civil hospitals, increase staffing, and comply with national restraint guidelines aligning with international standards.

Child psychiatry (Laza Lazarević Adolescent Unit and Clinic for children and adolescents in Belgrade)

No ill-treatment allegations were received. However, the CPT has several concerns, particularly the absence of outdoor fresh air access, over-reliance on pharmacotherapy, and frequent fixation of children shortly after admission, sometimes overnight, often in the view of other patients, and not always duly recorded. The authorities should revise existing practices of the use of means of restraint on child patients in psychiatric institutions, prioritising non-invasive de-escalation techniques.

The CPT has serious misgivings about cases of long-term placement of children in acute psychiatric facilities in Serbia, sometimes lacking medical justification and an independent review of the need for continued placement. Certain children were isolated from other patients, had no direct contact with their families and the outside world, no outdoors access, and their regime was critically limited. The Committee considers that such treatment may be considered inhuman or degrading.

The Serbian authorities should transfer these children to a suitable non-medical setting where they can receive the appropriate support and care. Pending this, the living conditions and regime in the psychiatric clinics in which the children are placed should be immediately improved. The children should be provided with meaningful daily human interaction, daily access to age-appropriate activities, education, and an access to an outdoor area, as well as contact with their families and other persons of trust.

In their response, the Serbian authorities provide information and outline measures taken in response to the recommendations made by the CPT.

The CPT and Serbia

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The European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) visits places of detention in the states parties to the European Convention for the Prevention of Torture to assess how persons deprived of their liberty are treated with a view to strengthening, if necessary, the protection of such persons from torture and from inhuman or degrading treatment or punishment. These places include prisons, detention centres for children, police stations, immigration detention centres, psychiatric hospitals, and social care homes. After each visit, the CPT transmits a report containing its findings and recommendations to the government concerned.