Health care

New Publication – SPT Health-Care Checklist for NPMs

“The availability and the quality of health-care in prisons are crucial indicators in assessing the risk of cruel, inhuman and degrading treatment, and even torture.

National preventive mechanisms should ensure that they cover health-care issues comprehensively in order to fulfil their preventive mandate. The checklist … is recommended as a self-assessment tool to remind national preventive mechanisms of the critical health issues that they should consider in their evaluations of places of deprivation of liberty. The checklist is expected to reveal a general pattern of health-care issues that are, or are not, being addressed in their visit reports.”

National preventive mechanism checklist on health-care issues relating to the monitoring of places of detention (UN Doc. CAT/OP/7), published by the UN Subcommittee on Prevention of Torture 24 May 2019 (§2-3).  

Healthcare by Marco Verch (trendingtopics) 2019.

The SPT’s newly-published checklist breaks the issue of health-care down into eight specific areas. At just 3 or so pages in length, the resource can be easily used in practice. According to the checklist, NPMs (or other monitors for that matter) should ideally examine the following areas when visiting any given detention facility:

  • Admission procedures;
  • Files and records;
  • General health services;
  • Mental health services;
  • Health staff;
  • Sensitivity and professional ethics;
  • Practice;
  • And prison health environment.

The above focus on ‘health staff’ is especially interesting, as the checklist queries whether staff have been trained on the documentation of torture as well as on key instruments such as the Istanbul Protocol, UN Convention against Torture, San Jose Guidelines and the Nelson Mandela Rules.

The stated overall objectives of this internal checklist are to:

“(a) Remind national preventive mechanisms of the important health-care issues that need to be noted during their visits;

(b) Identify gaps in the capacity of national preventive mechanisms to monitor health aspects of torture prevention and, if necessary, strengthen their health expertise.”

The SPT authors of this helpful resource stress that the checklist is designed for internal use only and not as an instrument for assessing actual conditions in places of detention. As such, NPMs are encouraged to design their own health-care assessment tools for use in monitoring places of detention, which certain monitoring bodies have done so.

If readers can recommend any monitoring tools specifically on health-care, please do let us know. We would be very happy to hear from you.


Download the NPM health-care checklist in English.

Consult the SPT’s other resources for NPMs.

Read Professor Juan E. Méndez’ (2019) article ‘Right to a Healthy Prison Environment: Health Care in Custody Under the Prism of Torture’. 

View Penal Reform International’s Mental health in prisons: A short guide for prison staff.

Posted by mp in Health care, NPMs, Places of detention, SPT

Making A Difference: Norway’s NPM

Have you ever wondered if NPMs are making a difference in practice? For many of us interested or otherwise engaged in torture prevention the above conundrum is a recurrent question. After all, if the sum total of any preventive work is at best negligible, or even worse, why waste the time and effort?

In its newly published 2018 Annual Report the Norwegian NPM takes a fresh look at this fundamentally important question, devoting a full chapter to gauging impact. Most positively, in four of its past five Annual Reports the NPM has retrospectively cast its eye over the year of activities to document effected change.

Even though Canada and Norway are quite different national contexts, not least in terms of size of geography and population, Norway’s industrious NPM has nonetheless advanced some illuminating insights into how one NPM is making a difference on the ground through its preventive work.

making a difference

As noted in these pages just a few months ago, Norway ratified the OPCAT in 2013 and designated the Parliamentary Ombudsman as the NPM. The NPM has been operating since 2014 and consists of an independent department within the Parliamentary Ombudsman, comprising a team of multi-disciplinary staff. Detailed information about the structure and operation of Norway’s NPM can be found in the 2018 Annual Report.

The Norwegian NPM has described in detail how it is making a difference in practice in chapter 5 of the 2018 report. In these pages it has sketched out the all-important process of follow-up to monitoring visits, as follows:

“After each visit, the NPM publishes a report describing its findings and making recommendations for preventing torture, inhuman and degrading treatment. Much of the preventive work begins after the reports have been published.

We ask all places we visit to provide written feedback on how the recommendations have been followed up within three months of the visit report being available.

The feedback we received throughout the year indicates that the institutions generally followed up the recommendations in a thorough manner. The majority of places have implemented numerous measures that play an important role in reducing the risk of inhuman and degrading treatment …

Certain recommendations require limited effort to follow up, while others are more challenging. This means that the NPM’s follow-up can sometimes continue over a long period, and at other times be concluded relatively quickly.” (49)

The report highlights the measured impact of the Norwegian NPM’s activities vis-a-vis specific thematic areas. These include the following:

  • Documenting the use of force in detention;
  • Preventing the use of coercive measures;
  • Ensuring the right to information can be exercised in practice;
  • Facilitating the participation of detainees in decisions which impact on them;
  • Improving the material conditions of detention;
  • Enhancing injury reporting procedures;
  • And minimizing resort to solitary confinement, isolation and segregation.

It bears noting that in 2018 a sizeable number of these gains were made in child welfare, health care and immigration detention settings. In one instance a child welfare facility was even temporarily closed due to allegations of abusive use of force.

Making a difference

As in Canada, resort to solitary confinement, isolation and segregation by different detaining authorities, including in prisons and health care settings, has been a significant cause for concern for the Norwegian NPM. In late 2018 the NPM also published a separate thematic report on the use of segregation in mental health care institutions, a summary of which is available in English.

In conclusion, the 2018 Annual Report of the Norwegian Parliamentary Ombudsman offers Canadian (and other) readers a very welcome insight into how decisive change can be effected in a range of detention settings and, it should be stressed, over a relatively short period of time. For those persons on the receiving end of such change, the positive impact ought not to be underestimated.


Visit the English version of the Norwegian NPM’s website.

Listen to an interview with the Norwegian NPM Director, Helga Fastrup Ervik, and learn more about the activities of her institution.

Read the current and past Annual Reports of the Norwegian NPM.

Read the summary of the December 2018 report, Segregation in mental health care institutions – risk of inhuman treatment.

Posted by mp in Health care, Norway, NPMs, Places of detention, Prisons, Psychiatric detention, Solitary confinement

COPCAT Shorts – Mistreatment & Violence against Women during Reproductive Health Care and Childbirth

Mistreatment and violence against women during reproductive health care and facility-based child birth is a serious violation of women’s human rights which occurs across all geographical and income-level settings. In a statement published in 2014, the World Health Organization reported that disrespectful and abusive treatment occurs during childbirth in facilities and includes “outright physical abuse, profound humiliation and verbal abuse, coercive or unconsented medical procedures (including sterilization), lack of confidentiality, failure to get fully informed consent, refusal to give pain medication, gross violations of privacy, refusal of admission to health facilities, neglecting women during childbirth to suffer life-threatening, avoidable complications, and detention of women and their newborns in facilities after childbirth due to an inability to pay.”

The Special Rapporteur on violence against women, Study on mistreatment and violence against women during reproductive health care with a focus on childbirth, April 2019.


UN violence against women expert
Dubravka Simonovic, Special Rapporteur on violence against women presents her report at the 38th Regular Session of the Human Rights Council, 20 June 2018
– UN Photo/Jean-Marc Ferré

The Special Rapporteur on violence against women, Dubravka Šimonović has identified the issue of mistreatment and violence against women during reproductive health care and childbirth as the subject of her next thematic report to be presented at the 74th session of the General Assembly in September 2019.

Canadian readers will vividly recall that the UN Committee against Torture expressed concern about the forced sterilization of Indigenous women and girls during its examination of Canada in November 2018.  

The UN Special Rapporteur on violence against women is seeking views on four questions relating to the issue of mistreatment and violence against women during reproductive health care and childbirth. Canadian civil society is kindly invited to have its say on this key issue.

The deadline for submissions is 17 May 2019. Please see below for more information.


Read more about the UN Special Rapporteur on violence against women’s new study.

See what the UN Committee against Torture said about the forced sterilization of Indigenous women and girls in Canada in 2018.

Read more about the UN Special Rapporteur on torture’s recently launched consultation on domestic violence.

Posted by mp in Absolute prohibition of torture, Health care, UN Special Rapporteur, UNCAT

Top UN Disability Expert Urges OPCAT Ratification & End to Disability Based Deprivation of Liberty

A leading United Nations disability expert concluded an 11-day mission to Canada on Friday by urging the country to ratify the OPCAT in a broader focused, critical End of Mission Statement. In the same document the UN expert expressed concern about the over-representation of persons with disabilities in adult and youth prisons and their deprivation of liberty on the basis of disability in healthcare settings.

The Special Rapporteur on the rights of persons with disabilities, Catalina Devandas Aguilar, wound up her extended mission to Canada in the nation’s capital, Ottawa, on 12 April 2019, having visited cities and communities in Ontario, Québec, New Brunswick and Nova Scotia.

disability expert
Catalina Devandas Aguilar, United Nations, Special Rapporteur on the Rights of Persons with Disabilities during A Day For All, Event. 3 December 2015. UN Photo / Jean-Marc Ferré

In the statement the UN disability expert highlighted an array of concerns, including vis-à-vis Canada’s legal and policy framework. In this connection she urged Canada to ratify the OPCAT as well as other key international human rights instruments.

In relation to the wider issue of deprivation of liberty Catalina Devandas Aguilar advanced various concerns, not least concerning prisons. She stated:

“I am very concerned about the overrepresentation of persons with disabilities, particularly those belonging to indigenous or other minority communities, in both prisons and the juvenile justice system. I have also received alarming information that persons with psychosocial disabilities are diverted to mental health courts for minor offences where they are subjected to higher penalties and stricter regimes.”

More generally, the UN Special Rapporteur expressed disquiet about deprivation of liberty on the basis of disability in Canada.

In January 2019 the UN disability expert issued a report, ‘Rights of persons with disabilities’, which underscored the widespread deprivation of liberty of persons on the basis of impairment:

“The deprivation of liberty on the basis of impairment is a human rights violation on a massive scale. Persons with disabilities are systematically placed into institutions and psychiatric facilities, or detained at home and other community settings, based on the existence or presumption of having an impairment. They are also overrepresented in traditional places of deprivation of liberty, such as prisons, immigration detention centres, juvenile detention facilities and children’s residential institutions. In all these settings, they are exposed to additional human rights violations, such as forced treatment, seclusion and restraints.” (§85)

Disability expert
Abandoned psychiatric institution by Michael Hummel (2009).

The UN disability expert witnessed glimpses of this depressing global reality during her mission to Canada, voicing the following concerns:

“Provincial and territorial legislation across Canada provides for the involuntary hospitalization and treatment of persons with psychosocial disabilities, in contradiction to article 14 and 25 of the CRPD. For example, the Mental Health Act of British Columbia contains very broad criteria for involuntary admissions and, once detained, a person can be forcibly treated without their free and informed consent, including forced medication and electroconvulsive therapy.”

As highlighted on this website a few weeks ago, a critical report by the Office of the Ombudsperson of British Columbia cast a long, dark shadow over the efficacy of fundamental detention safeguards in the province’s mental health institutions. In a word, they have been mostly ignored in practice.

The UN expert’s End of Mission Statement continues:

“I have been informed that the rates of involuntary admissions and community treatment orders are increasing across Canada. Similarly, the number of inpatient beds in psychiatric hospitals, particularly in forensic units, is also increasing. In addition, different interlocutors told me that there is a significant number of persons with psychosocial disabilities who no longer need to be in the hospital but cannot leave due to the lack of community-based alternatives.”

“I urge the provincial and territorial governments to transform their mental health systems to ensure a rights-based approach and well-funded community-based responses, ensuring that all health care interventions are provided on the basis of free and informed consent.

“I have also noticed that there is a lack of independent monitoring of mental health facilities and institutions. I would like to recommend the provincial and territorial governments to establish independent monitoring mechanisms for centers of deprivation of liberty, including hospitals and institutions.”

Several of the above concerns regarding the deprivation of liberty on the basis of disability and use of coercion were also underscored by the UN Special Rapporteur on the right to health during a November 2018 mission to Canada.

In a report issued earlier this year the Canada OPCAT Project also highlighted the lack of independent oversight of such institutions, a point echoed by the UN Committee against Torture during its November 2018 examination of Canada.

Whether Canada will act on these collective concerns, including by ratifying the OPCAT, remains to be seen. Regrettably, there is little to suggest that OPCAT ratification is a political priority for the Canadian Government at the present moment, despite its past assertions to the contrary.  

On a slightly more positive note the UN Special Rapporteur concluded her End of Mission Statement by emphasizing the following:

“As a highly-developed nation, Canada still lags behind in the implementation of its obligations under the Convention on the Rights of Persons with Disabilities. There are significant shortcomings in the way the federal, provincial and territorial governments of Canada respect, protect and fulfill the rights of persons with disabilities. Notwithstanding, the country has the potential to undertake a major transformation and fully embrace the human rights based approach to disability introduced by the Convention. The various pilot initiatives and good practices in place could, if adequately scaled up, promote systemic change for persons with disabilities in Canada.”  

The UN Special Rapporteur’s full report on her visit to Canada is scheduled to be presented to the UN Human Rights Council in March 2020.

Finally, Canadian civil society actors may also wish to take note that, in August/September 2019, the UN Committee on the Rights of Persons with Disabilities will draft the List of Issues Prior to Report in relation to Canada and its second periodic review. This moment will be a timely opportunity for Canadian civil society to indicate to the UN Committee the key issues to which Canada should be responding in its subsequent report. The Canada OPCAT Project will keep readers posted of any developments in this respect.


Read the End of Mission Statement.

Read the UN Special rapporteur report focused on ending deprivation of liberty on the basis of disability. Lire le rapport en français.

An alternative version of the report designed for wider distribution is also available.

Explore the Special Rapporteur’s dedicated website.

Visit the related OHCHR website on Catalina Devandas Aguilar’s work.

Posted by mp in Health care, OPCAT, Places of detention, Prisons, Psychiatric detention, UN Special Rapporteur, UNCRPD

Committed to Change – Involuntary Mental Health Detention in B.C.

In a critical new report by the Office of the Ombudsperson of British Columbia a long, dark shadow is cast over the efficacy of fundamental detention safeguards in the province’s mental health institutions.

The March 2019 report, Committed to Change: Protecting the Rights of Involuntary Patients under the Mental Health Act, reveals some unsettling findings regarding the far-reaching extent to which mental health law-related safeguards are ignored in practice by health-care practitioners in the province of British Columbia, as the Infographic below succinctly illustrates.

Committed to Change
Committed to Change Infographic (March 2019)

Patient rights in B.C. are protected through a series of legal procedures which practically take the shape of written forms to be completed on admission. These crucial forms bring to life an array of key detention-related safeguards. Routinely these forms must be completed upon admission of a person to psychiatric detention, demonstrating that the detention criteria has been met, consent to treatment has been obtained, there has been a notification of the patient’s rights, and his or her relatives have been notified. As the Commitment to Change report reveals, these basic rights have frequently been ridden roughshod over in practice.  

The press release accompanying the report quotes B.C. Ombudsperson Jay Chalke as stating:

“Involuntary detention and treatment is the most intrusive form of mental health care available. This is a failure to comply with the Mental Health Act, the law that allows people who are gravely ill – our friends, daughters, sons, parents and grandparents – to receive timely treatment while protecting their legal rights … The state, when it uses such an extraordinary power, has a critically important duty to follow the law. This includes properly completing documentation of what is happening to an individual and why. To not do so is not only unacceptable, it is contrary to law.”

The report’s findings were based on an investigation that reviewed admission records of every involuntary admission in the province that took place in June 2017. In 2016-2017 alone, some 15000 persons were involuntarily admitted to mental health institutions in the province.

A detailed analysis of mandatory admission forms from June 2017 found that across the province, all of the required forms were completed in only 28% of involuntary patient admissions, as the above Infographic illustrates. Key findings include:

  • A number of directors of designated facilities admitted and detained people involuntarily without adequate information and reasons to demonstrate how the patient met the criteria for admission;
  • There was no consent for treatment form in 24% of patient admissions across all health authorities;
  • A number of directors of facilities  permitted the psychiatric treatment of involuntarily detained patients in circumstances where the patient objected to treatment and no Consent for Treatment form was completed;
  • There was no rights advice form for more than half of the involuntary patients. This form advises the patient of their legal rights including how to get legal advice and challenge their detention;
  • The health-care authorities acted unreasonably in failing to adequately monitor, audit and address designated facilities’ compliance with the involuntary admission procedures under the Mental Health Act.

Interested readers may also wish to watch the following short animation, which captures the main findings of the B.C. Ombudsperson’s report.

According to the report, there exists in the province of British Columbia some 77 acute in-patient mental health units and other psychiatric facilities. Canada-wide, the Canada OPCAT Project has calculated at least 234 such facilities (please see chapter 3 of the 2018 report, Instituting An NPM in Canada – Lessons Based on Global OPCAT Practice). The wide-spread disregard of fundamental safeguards in detention in British Colombia is therefore especially worrying in view of the large numbers of such facilities.

In its Executive Summary the report states:

“We were disappointed to find significant levels of non-compliance when we reviewed the forms. In many cases, forms were simply not completed. In many other cases, the forms were completed late or in a manner that did not provide anything close to adequate reasons.” (p.6)

It also underscored the key point:

“Failure to complete these forms is not just a matter of missed paperwork; it is a failure to follow the law. The safeguards in the Mental Health Act protect the inherent rights and dignity of some of the most vulnerable people in our society. When they are not observed, the balance between individual rights and society’s interest in protecting people with mental illness is upset.” (p. 7)

The B.C. Ombudsperson’s Office report makes 24 recommendations, all of which have reportedly been accepted in principle by government and health authorities.

In this same connection it bears noting a recent report of the Special Rapporteur on the rights of persons with disabilities, Catalina Devandas Aguilar. In her 2019 report, which was presented at the 40th session of the UN Human Rights Council on 5 March 2019, the UN Special Rapporteur has questioned the very notion of deprivation of liberty on the basis of impairment. Her reports merits a close reading, as it goes a considerable way in questioning the international legality of this extremely wide-spread practice.

From an oversight perspective, however, the UN expert’s report also stresses:

“National preventive mechanisms, national human rights institutions and independent mechanisms for the promotion, protection and monitoring of the implementation of the Convention must be expressly mandated to carry out inquiries and investigations in relation to the deprivation of liberty of persons with disabilities and provide them with assistance in accessing representation and legal remedies. Disability-specific settings of deprivation of liberty, such as psychiatric facilities and other institutions, must be effectively monitored. Having accurate data on the numbers of persons with disabilities deprived of their liberty will also allow monitoring of the trends and changes over time, thus enabling better preventive and deinstitutionalization strategies.”

If and when Canada ever ratifies the OPCAT, NPMs under the OPCAT will have a key role in monitoring Canada’s in-patient psychiatric facilities.

Under the OPCAT NPMs should regularly monitor psychiatric institutions and social care homes. For example, in England and Wales the Care Quality Commission undertakes this vitally important function, issuing a range of reports on mental health institutions, residential care and nursing homes as well as its flagship annual report on the implementation of the Mental Health Act. Similarly, the Parliamentary Ombudsman of Norway annually visits a significant number of such facilities, some reports of which can be found in English.  The monitoring of such domains is also currently a priority area for the Swiss NPM, the Commission nationale pour le prévention de la torture. There additionally now exist useful practical tools on the monitoring of such detention settings (please see under Other Resources).


Read the full report, Committed to Change: Protecting the Rights of Involuntary Patients under the Mental Health Act.

Browse the accompanying press release.

Examine the related Infographic.

Committed to Change

Read the UN Special Rapporteur on the rights of persons with disabilities 2019 report, Ending Deprivation of Liberty on the Basis of Disability.

Watch the presentation of the 2019 report of the UN Special Rapporteur on the rights of persons with disabilities at the 40th session of the UN Human Rights Council on 5 March 2019.

Study the New-Brunswick Ombud’s 2019 report on the deliberate ill-treatment of mental health patients at a facility in the province.

Posted by mp in Health care, Oversight bodies, Psychiatric detention

Academic News & Views – Juan Méndez on the Right to a Healthy Prison Environment

Respect for the dignity of prisoners is a fundamental right, intrinsically linked to States’ obligations to maintain a healthy environment for persons deprived of liberty. A healthy environment requires structural integrity of prison systems, access to medical care and treatment, health care services, including dental, psychological, and rehabilitative services, and opportunity for prisoners to exercise. 

For women prisoners and other vulnerable persons, prison systems must recognize and provide necessary special arrangements for the safety and wellbeing of such persons. Additionally, health care professionals play a critical role in detecting and documenting instances of torture, and it is vital that all health professionals be trained in the Istanbul Protocol to utilize it properly. It can be vital to the fate of victims of torture and can transform a health professional’s role from one of not only therapist but also advocate for victims.

Conclusion taken from the recent article, ‘Right to a Healthy Prison Environment: Health Care in Custody Under the Prism of Torture’ by Professor Juan E. Méndez, Washington College of Law, American University.

Juan Méndez
Juan Ernesto Méndez, Special Rapporteur on Torture and other cruel, inhuman or degrading treatment or punishment addresses during the 16th Session of the Council of Human Rights
– UN Photo/Jean-Marc Ferré (2011).

In the article Professor Méndez addresses the following areas as they apply to a healthy prison environment:

  • Conditions of detention;
  • Medical care and health services in prison;
  • Women and other vulnerable persons in prison or detention, including LGBTI and disabled persons;
  • Istanbul Protocol and Nelson Mandela Rules.

The conclusion highlighted above draws on all of these threads as well as the invaluable insights of Professor Méndez in his former capacity of UN Special Rapporteur on Torture from 2010-2016.

Read the full article in English.

Reference: Méndez JE, ‘‘Right to a Healthy Prison Environment: Health Care in Custody Under the Prism of Torture’ (2019) 9(1) Notre Dame Journal of International & Comparative Law 40.


Who is Professor Juan E. Méndez? Read his full United Nations biography.

Watch the video of the former UN Special Rapporteur on Torture, Juan E. Méndez ‘In His Own Words’.

Read past Canada OPCAT Project Academic News & Views.

Posted by mp in Health care, Places of detention, Prisons