Mental health care during pretrial detention in the Netherlands

A care request does not have to wait for the next hearing

Anyone who becomes seriously disturbed in detention must report this as clearly as possible to the staff and request a medical assessment. State what is changing now and why waiting feels unsafe. Immediately unsafe situations require direct contact with the staff present; only a letter to the lawyer is too indirect for this. The official information about care in detention makes it clear that physical and mental health care are part of the responsibility of the prison system.

It is useful for a loved one to pass on specific observations via the official contact route of the institution. For example, describe a sudden change in contact or a known treatment appointment that has been interrupted, without making a diagnosis yourself. Ask how relevant healthcare information reaches the medical service safely. The facility may be limited in what it reports back due to confidentiality. That does not mean that the information is not received. If there are serious concerns, also let the lawyer know what was actually passed on, so that he or she can determine whether an appropriate legal or practical follow-up step is necessary.

Who assesses and coordinates the treatment

DJI describes the medical intake and the medical service. Health questions are asked upon arrival and relevant information from previous practitioners may be required. Provide current medication, practitioner, allergies and specific recent changes as accurately as possible. A family member who only knows the brand name of an old drug may report this as uncertain information. Avoid deriving dosages yourself from old packaging. The practitioner must assess what is needed; a list from home is important input, but not an instruction to continue exactly the same regimen without checking.

Various expertise is available within the facility and care can be coordinated in a psycho-medical consultation. Therefore, ask who a request should be addressed to and when you can expect a response or assessment. Our practical conclusion is that a specific question such as I want to discuss the interrupted treatment is easier to follow than a general message that everything is going wrong. This does not deny the seriousness, but makes visible what assessment or transfer is necessary and who should be able to act on it.

Interrupted treatment requires targeted transfer

Existing treatment outside detention may contain information that is important for current care. Consider current medications, recent changes, risks previously discussed and agreements about follow-up care. DJI explains that written permission is requested from previous healthcare providers to request information from the file. Discuss what data is needed and for what purpose. It is practically important that the right practitioner is contacted and that their contact details are correct. A general reference to my file with the GP may not provide sufficient direction for several practitioners.

Distinguish between a care summary and a complete lifelong file. Not every old detail is necessary to solve a current interruption. At the same time, too limited a selection can miss important information. Ask the healthcare provider which summary is clinically appropriate and how it is delivered safely. The lawyer does not have to automatically receive every medical document to be able to signal that transfer is not taking place. A good organization ensures that the content reaches the right practitioner and provides the defense with sufficient information about the problem to discuss a necessary next step.

Care, expert research and criminality are not synonyms

A treatment discussion focuses on health and appropriate care. A forensic investigation may have other questions, for example about the functioning of the alleged offense or risks that are relevant to a judicial decision. The presence of psychological complaints does not make these questions interchangeable. Treatment also does not automatically mean that someone committed the offense or that there is a legal basis for exclusion from punishment. When conducting research, ask who is conducting it, what questions are being asked and what will be done with the outcome. This helps not to confuse healthcare contact with evidence gathering or legal assessment.

Our analysis is that this separation actually makes collaboration possible. For example, a lawyer can explain why the burden of an interrogation requires attention, while the practitioner assesses the current health. A judge then decides on procedural actions or deprivation of liberty within the applicable legal framework. Not every medical disability leads to the same legal consequences. The rules on pre-trial detention contain their own conditions. Therefore, let the concrete functional consequences be described instead of just presenting a diagnosis as a decisive argument for an outcome that another authority must assess.

Extra care does not automatically mean a punitive measure

DJI distinguishes, among other things, an Extra Care Facility and a Penitentiary Psychiatric Center. An additional care environment may be appropriate for people who do not function well in the regular regime, but placement requires assessment. It is not a provision that a loved one or lawyer can order independently with one request. Ask what care needs have been identified and how it is assessed whether the current environment is appropriate. A request that only refers to the name of a department may provide less information than a concrete description of problems with sleeping, contact, functioning or safety that an expert should investigate.

Also distinguish between a care decision, a disciplinary measure and a disciplinary decision. They may play in the same period, but have different bases and legal protection routes. A restriction that someone experiences as a punishment cannot be qualified without the decision. Ask for the relevant written information and let the lawyer assess which part needs to be addressed legally. In the meantime, the demand for care continues to exist. A dispute about the placement or the regime is not a reason to only mention a current deterioration in an objection letter and not report it to the medical service.

Load capacity must be discussed at the specific moment

Psychological complaints can affect concentration, understanding and the ability to follow an interrogation or hearing. Report this to the lawyer before the relevant procedural act. Give examples of what does not work, when it happens and what assessment or adjustment seems necessary. The Public Prosecution Service mentions the right to report illness, need for medication and necessary care upon arrest. During pre-trial detention, it remains important that the professionals involved know which current disability is at play. An old diagnosis without explanation about current functioning sometimes provides insufficient information for a targeted practical decision. (OM mentions the right to report illness, medication requirement and necessary care upon arrest)

A request for interruption, investigation or other provision must be tailored to the situation. Don't let an attorney suggest a medical conclusion that hasn't been established, but also don't wait until after the conversation to say you could barely follow what was happening. Note which notification was made to whom and what response followed. This may be relevant for later assessment of progress. The aim is that a procedural action takes place carefully with an eye on actual limitations, without subsequently citing care problems as a general reason for an undesirable outcome.

Fictitious: medication information does not reach the right person

In this completely fictional example, Daan ends up in a remand center. He is on ongoing treatment but cannot clearly remember the name of his current medication. His sister emails a long personal history to the general address of an agency involved. The lawyer only hears later that the problem is mainly that the medical service has not received up-to-date treatment data. The sticking point is therefore not immediately the question of whether the judge should release Daan. First, it must be determined how the transfer of care and current assessment are organized and whether there is an immediate lack of safety.

After consultation, the correct contact details and specific consent for information transfer will be arranged. The healthcare provider assesses which current information is sent; the lawyer discusses separately what consequences the situation has for an upcoming interrogation. The fictional example does not include any prescribed treatment or predicted placement. It shows why a large amount of information does not equal a useful transfer. By distinguishing the care question, recipient and legal follow-up question, everyone can take their own responsibility without the complete medical history being spread untargeted through the criminal justice chain.

Medical data requires a purpose and an appropriate recipient

The Penitentiary Principles Act contains the right to medical care. Within that healthcare relationship, rules also apply to medical information. Ask who has access, how you can request access and how factual inaccuracies can be discussed. A practitioner, director and lawyer do not automatically have the same role or the same information needs. If a medical certificate seems necessary for a legal application, discuss which question it should answer and which document is appropriate. The complete patient file is not by default the best substantiation for every procedure.

A targeted description of limitations can be more legally useful than undifferentiated medical details. For example, state that continuity of an existing treatment requires attention and which concrete assessment is missing, insofar as this is factually correct and can be shared appropriately. Let the lawyer and healthcare provider coordinate the route. If information is requested or shared against your wishes, ask for an explanation of the basis and available protection. Do not assume unlimited secrecy in every conceivable legal situation, but neither do you assume that detention makes all privacy rights disappear. The concrete data flow deserves its own assessment.

Seven fields for care without untargeted distribution

The map below is intended to organize a care question, not to determine the treatment yourself. Keep medical content with the appropriate care recipient and discuss separately what the attorney needs. Note the date and uncertainties so that an old schedule is not mistaken for a current instruction. In the event of acute unsafety, immediate reporting to the staff takes precedence over calmly completing this overview.

• Current problem: what change or interruption is happening now, since when and what makes assessment urgent?
• Existing care: current practitioner, contact route and known appointments, with a distinction between confirmed data and reminder.
• Medication information: available current list, last known changes and who can medically confirm the accuracy.
• Transfer: what specific information seems necessary, who arranges consent and how the healthcare provider can safely supply it.
• Recipient: medical service for treatment, lawyer for process questions and what information each recipient actually needs.
• Response: date of request, receipt, response given and the agreed follow-up assessment or contact person.
• Continuity: possible transfer or release, follow-up appointments and who ensures that the care information reaches the right care provider.

A complaint may be necessary, but has a different function than care

If a care question is not handled properly, ask about the appropriate complaint or mediation route. The RSJ describes medical mediation and possible appeal options. Medical actions and decisions by the director may require different routes. Therefore, have it determined what you are complaining about, what written response exists and what term applies. A general request to any authority does not automatically save every period. Save the specific requests and answers. If necessary care is not provided, ask at the same time how current assessment will still be organised; a complaints procedure may be too slow for this.

Continuity of care also deserves attention when pre-trial detention ends or someone is transferred. A legal decision regarding freedom does not automatically resolve the transfer to a subsequent practitioner. Discuss who provides relevant information and what follow-up appointment is necessary. The guide to pre-trial detention addresses the issue of freedom separately. Good support maintains both realities: health requires appropriate professional care, while criminal proceedings have their own decisions and guarantees. By concretely linking responsibilities, help can be organized in a timely manner without promising medical or legal outcomes.