Report to the Estonian Government on the visit to Estonia carried out ...

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Report to the Estonian Government on the visit to Estonia carried out ...

ong>Reportong> ong>toong> ong>theong> Esong>toong>nian Governmenong>toong>n ong>theong> visit ong>toong> Esong>toong>niacarried out by ong>theong> European Committeefor ong>theong> Prevention of Torture and Inhumanor Degrading Treatment or Punishment (CPT)from 23 ong>toong> 30 September 2003


- 3 -CONTENTSCopy of ong>theong> letter transmitting ong>theong> CPT's report .................................................................................. 5I. INTRODUCTION .................................................................................................................... 7A. Dates of ong>theong> visit and composition of ong>theong> delegation.............................................................. 7B. Establishments visited .............................................................................................................. 8C. Consultations held by ong>theong> delegation ...................................................................................... 9D. Co-operation between ong>theong> CPT and ong>theong> Esong>toong>nian authorities.............................................. 9E. Immediate observations under Article 8, paragraph 5, of ong>theong> Convention....................... 10II. FACTS FOUND DURING THE VISIT AND ACTION PROPOSED.............................. 11A. Police establishments.............................................................................................................. 111. Preliminary remarks ........................................................................................................ 112. Ill-treatment..................................................................................................................... 123. Conditions of detention................................................................................................... 15a. police arrest houses................................................................................................ 15b. oong>theong>r police detention facilities.............................................................................. 194. Safeguards against ong>theong> ill-treatment of persons deprived of ong>theong>ir liberty ....................... 19B. Prisons...................................................................................................................................... 221. Preliminary remarks ........................................................................................................ 222. Ill-treatment..................................................................................................................... 233. Material conditions.......................................................................................................... 244. Activities ......................................................................................................................... 25a. remand prisoners.................................................................................................... 25b. sentenced prisoners................................................................................................ 275. Health care services......................................................................................................... 286. Central Prison Hospital, Tallinn...................................................................................... 297. Oong>theong>r issues ..................................................................................................................... 31a. contact with ong>theong> outside world............................................................................... 31b. discipline, segregation, and means of restraint...................................................... 32c. complaints and inspection procedures................................................................... 34


- 4 -C. Psychiatric establishments..................................................................................................... 351. Preliminary remarks ........................................................................................................ 353. Patients’/residents’ living conditions .............................................................................. 364. Staff and treatment .......................................................................................................... 375. Restraint of agitated and/or violent patients/residents .................................................... 406. Safeguards ....................................................................................................................... 41a. initial placement and discharge procedures........................................................... 41b. safeguards during placement ................................................................................. 46III. RECAPITULATION AND CONCLUSIONS...................................................................... 49APPENDIX ILIST OF THE CPT'S RECOMMENDATIONS, COMMENTSAND REQUESTS FOR INFORMATION............................................................................... 55APPENDIX IILIST OF THE NATIONAL AUTHORITIESAND NON-GOVERNMENTAL ORGANISATIONSWITH WHICH THE CPT'S DELEGATION HELD CONSULTATIONS............................. 67


- 5 -Copy of ong>theong> letter transmitting ong>theong> CPT's reportStrasbourg, 14 April 2004Dear Madam, Dear Sir,In pursuance of Article 10, paragraph 1, of ong>theong> European Convention for ong>theong> Prevention ofTorture and Inhuman or Degrading Treatment or Punishment, I enclose herewith ong>theong> report ong>toong> ong>theong>ong>Governmentong> of Esong>toong>nia drawn up by ong>theong> European Committee for ong>theong> Prevention of Torture andInhuman or Degrading Treatment or Punishment (CPT) following its visit ong>toong> Esong>toong>nia from 23 ong>toong> 30September 2003. The report was adopted by ong>theong> CPT at its 53 rd meeting, held from 1 ong>toong> 5 March2004.I would like ong>toong> draw your attention ong>toong> paragraph 144 of ong>theong> report, in which ong>theong> CPTrequests ong>theong> Esong>toong>nian authorities ong>toong> provide, within six months, a response setting out ong>theong> actiontaken upon its visit report. The CPT would ask, in ong>theong> event of ong>theong> response being forwarded inEsong>toong>nian, that it be accompanied by an English or French translation. It would also be most helpfulif ong>theong> Esong>toong>nian authorities could provide a copy of ong>theong> response in electronic form.I am at your entire disposal if you have any questions concerning eiong>theong>r ong>theong> CPT's report orong>theong> future procedure.Yours faithfully,Silvia CASALEPresident of ong>theong> European Committee for ong>theong>Prevention of Torture and Inhumanor Degrading Treatment or PunishmentMinistry of JusticeTnismägi, 5aEE - 100 TALLINN


- 7 -I. INTRODUCTIONA. Dates of ong>theong> visit and composition of ong>theong> delegation1. In pursuance of Article 7 of ong>theong> European Convention for ong>theong> Prevention of Torture andInhuman or Degrading Treatment or Punishment (hereinafter referred ong>toong> as "ong>theong> Convention"), adelegation of ong>theong> CPT carried out a visit ong>toong> Esong>toong>nia from 23 ong>toong> 30 September 2003. The visit formedpart of ong>theong> CPT's programme of periodic visits for 2003, and was ong>theong> second periodic visit ong>toong>Esong>toong>nia ong>toong> be carried out by ong>theong> Committee. 12. The visit was carried out by ong>theong> following members of ong>theong> CPT:- Ole Vedel RASMUSSEN (Head of delegation)- Aleš BUTALA- Emilia DRUMEVA- Tatiana RDUCANU- Erik SVANIDZE.They were supported by ong>theong> following members of ong>theong> CPT's Secretariat:- Bojana URUMOVA- Michael NEURAUTER,and assisted by- Enda DOOLEY, Direcong>toong>r of Prison Health Care, Irish Prison Service, Dublin,Ireland (expert)- James MacKEITH, Consultant Forensic Psychiatrist, London, United Kingdom(expert)- Meelis LEESIK (interpreter)- Margus PUUSEPP (interpreter)- Vivian RENNEL (interpreter)- Eve TARM (interpreter)- Piret VIILU (interpreter).1The first periodic visit ong>toong> Esong>toong>nia ong>toong>ok place from 13 ong>toong> 23 July 1997; ong>theong> CPT also carried out an ad hoc visitfrom 15 ong>toong> 21 December 1999, focusing on ong>theong> situation in ong>theong> Social Welfare Home in Valkla and on ong>theong>conditions of detention in police arrest houses. The visit reports and ong>theong> responses of ong>theong> Esong>toong>nian authoritieswere published in Ocong>toong>ber 2002 (documents CPT/Inf (2002) 26, 27, 28 and 29).


- 8 -B. Establishments visited3. The delegation visited ong>theong> following places:Establishments under ong>theong> Ministry of ong>theong> Interior- Harju Arrest House, Saue- Jõgeva Arrest House- Kohtla-Järve Arrest House- Narva Arrest House- Tallinn Arrest House- Tartu Arrest House- Harju Police Headquarters, Saue- Kohtla-Järve Police Station- Narva Police Headquarters- Põhja Police Department, TallinnEstablishments under ong>theong> Ministry of Justice- Central Prison Hospital, Tallinn- Tallinn Prison- Tartu PrisonEstablishments under ong>theong> Ministry of Social Affairs- Ahtme Psychiatric Hospital- Kernu Social Welfare Home.


- 9 -C. Consultations held by ong>theong> delegation4. In ong>theong> course of ong>theong> visit, ong>theong> delegation held consultations with Ken-Marti VAHER,Minister of Justice, and Allar JÕKS, Legal Chancellor of ong>theong> Republic, as well as with seniorofficials from ong>theong> Ministries of Justice, ong>theong> Interior, and Social Affairs. It also met representativesof non-governmental organisations active in ong>theong> CPT's areas of interest.A list of ong>theong> national authorities and non-governmental organisations met by ong>theong> delegation,is set out in Appendix II ong>toong> this report.D. Co-operation between ong>theong> CPT and ong>theong> Esong>toong>nian authorities5. The degree of co-operation received by ong>theong> CPT's delegation from ong>theong> Esong>toong>nian authoritiesduring ong>theong> visit was excellent. In particular, ong>theong> reception received at all places visited, includingthose which had not been notified in advance, was very good.However, ong>theong> principle of cooperation set out in ong>theong> Convention is not limited ong>toong> steps takenong>toong> facilitate ong>theong> task of a visiting delegation. It also requires that decisive action be taken ong>toong>improve ong>theong> situation in ong>theong> light of ong>theong> Committee’s key recommendations.6. At ong>theong> end of ong>theong> visit, ong>theong> delegation informed ong>theong> Esong>toong>nian authorities that it was gravelyconcerned by ong>theong> failure ong>toong> implement ong>theong> CPT's key recommendations made in ong>theong> reports on ong>theong>1997 and 1999 visits concerning ong>theong> conditions of detention in police arrest houses, despiteassurances ong>toong> ong>theong> contrary given by those authorities. 2The CPT must stress that if such a state of affairs were ong>toong> persist, it would be obliged ong>toong>consider having resort ong>toong> Article 10, paragraph 2, of ong>theong> Convention 3 .23Cf. in this regard paragraphs 25 ong>toong> 29 below.Article 10, paragraph 2, reads as follows: "If ong>theong> Party fails ong>toong> cooperate or refuses ong>toong> improve ong>theong> situation inong>theong> light of ong>theong> Committee's recommendations, ong>theong> Committee may decide, after ong>theong> Party has had anopportunity ong>toong> make known its views, by a majority of two-thirds of its members ong>toong> make a public statement onong>theong> matter".


- 10 -E. Immediate observations under Article 8, paragraph 5, of ong>theong> Convention7. At ong>theong> end-of-visit talks on 30 September 2003, ong>theong> delegation made three immediateobservations under Article 8, paragraph 5, of ong>theong> Convention.The first immediate observation concerned Kohtla-Järve and Narva Police Arrest Houses, aswell as oong>theong>r arrest houses where similar conditions of detention prevailed. The cumulative effecong>toong>f ong>theong> execrable material conditions and ong>theong> impoverished regime applied ong>toong> all detainees held inthose establishments amounted, in ong>theong> delegation's view, ong>toong> inhuman and degrading treatment. Thesituation was exacerbated by ong>theong> fact that persons were being held under such conditions forprolonged periods. The delegation requested that urgent steps be taken ong>toong> improve conditions ofdetention in police arrest houses.The second immediate observation was made in respect of ong>theong> "restraining cells" at TartuPrison. Each of those cells was fitted with four metal rings anchored ong>toong> ong>theong> floor, in order ong>toong> securea person hand and foot while lying spread-eagled on ong>theong> back. The delegation requested that ong>theong>four metal rings in each of those cells be removed immediately, and that it be ensured that fourpointrestraint using metal cuffs ong>toong> immobilise a detainee is never used.The third immediate observation related ong>toong> ong>theong> Central Prison Hospital, where ong>theong> materialconditions had, in most respects, deteriorated since ong>theong> CPT's first visit in 1997. All patients (exceptthose suffering from tuberculosis) were locked up in ong>theong>ir cells for 24 hours per day, without evenbeing offered outdoor exercise; in addition, a number of cells did not have natural light, since ong>theong>windows were covered with metal plates. The delegation requested that:(i)(ii)all patients, whose health status permits, be offered at least one hour of outdoorexercise per day; and thatmetal plates be removed from ong>theong> windows of cells accommodating patients.8. The observations were confirmed in a letter dated 22 Ocong>toong>ber 2003 addressed by ong>theong>President of ong>theong> CPT ong>toong> ong>theong> Esong>toong>nian Ministry of Justice. The Committee requested ong>theong> Esong>toong>nianauthorities ong>toong> provide, within three months, an account of ong>theong> measures taken in response ong>toong> ong>theong> firstimmediate observation and, within one month, an account of ong>theong> measures taken in response ong>toong> ong>theong>second and third immediate observations.By letters of 30 Ocong>toong>ber 2003, 31 December 2003 and 13 January 2004, ong>theong> Esong>toong>nianauthorities provided comments on various issues raised by ong>theong> delegation at ong>theong> end of ong>theong> visit,including ong>theong> immediate observations referred ong>toong> above. This information has been taken inong>toong>account in ong>theong> relevant sections of ong>theong> present report.


- 11 -II.FACTS FOUND DURING THE VISIT AND ACTION PROPOSEDA. Police establishments1. Preliminary remarks9. The CPT's delegation carried out follow-up visits ong>toong> six police arrest houses, and ong>toong> ong>theong>police stations or headquarters attached ong>toong> three of those establishments (Harju, Kohtla-Järve andNarva). It also visited, for ong>theong> first time, ong>theong> Põhja Police Department in Tallinn.10. The police may hold a person suspected of a criminal offence on ong>theong>ir own authority for upong>toong> 48 hours. The person concerned must be interviewed by a police "investigaong>toong>r" within 24 hours,starting from ong>theong> time of deprivation of liberty. If an investigaong>toong>r is not yet in a position ong>toong> bringcharges at ong>theong> end of ong>theong> initial 48 hour period, ong>theong> period of police cusong>toong>dy can be extended by ong>theong>order of a judge for up ong>toong> 10 days. In exceptional cases, police cusong>toong>dy can subsequently beextended ong>toong> a maximum of 30 days. If ong>theong> person concerned has not been charged by that time, heor she must be released. 4 Throughout this detention period of up ong>toong> 30 days, prior ong>toong> ong>theong> bringing offormal charges, ong>theong> person will be held in a police arrest house.Persons against whom a criminal charge has been brought may be remanded in cusong>toong>dy by aninvestigating judge, and placed in ong>theong> remand section of a prison; however, ong>theong> Imprisonment Act of2000 has introduced ong>theong> alternative possibility of placing such persons in a police arrest house. 5Furong>theong>r, on ong>theong> decision of ong>theong> relevant police investigaong>toong>r, remand prisoners may be returned ong>toong>police cusong>toong>dy from prison (and placed in a police arrest house), if this is considered necessary for ong>theong>preliminary investigation; ong>theong> delegation found certain cases where remand prisoners were returned ong>toong>arrest houses for periods up ong>toong> one month (cf. in this regard paragraph 22 below).Oong>theong>r possible grounds for placement in a police arrest house include administrativedetention (up ong>toong> 30 days) of persons found guilty of minor offences, 6 short prison sentences (up ong>toong>three months) 7 and, on authorisation by ong>theong> relevant prosecuong>toong>r, ong>theong> detention (up ong>toong> 14 days) ofsentenced prisoners who could provide information related ong>toong> a criminal offence committed byanoong>theong>r person. 8To sum up, ong>theong> maximum periods during which persons may be held in a police arrest house haveincreased since ong>theong> CPT's previous visit. 9 In practice, during ong>theong> September 2003 visit, ong>theong> delegationfound cases where persons were being held in an arrest house for three months or even longer.456789Cf. Section 67 of ong>theong> 1961 Code of Criminal Procedure (as amended up ong>toong> 2003).Cf. Section 90 (1) of ong>theong> Imprisonment Act (2000). It should be noted that persons may be held on remand upong>toong> six months or, exceptionally, up ong>toong> one year (cf. Section 74 of ong>theong> 1961 Code of Criminal Procedure, asamended up ong>toong> 2003).Cf. Section 85 of ong>theong> Imprisonment Act (2000) and Section 48 of ong>theong> Penal Code (2001).Cf. Section 85 of ong>theong> Imprisonment Act (2000).Cf. Section 337 of ong>theong> 1961 Code of Criminal Procedure (as amended up ong>toong> 2003).Such periods were previously limited ong>toong> a month.


- 12 -11. It should also be noted that a new Code of Criminal Procedure was adopted in 2003 and willenter inong>toong> force in July 2004. Its relevant provisions will be discussed in subsequent sections of thisreport (cf. paragraphs 17 and 36 ong>toong> 38).2. Ill-treatment12. The majority of persons deprived of ong>theong>ir liberty interviewed during ong>theong> visit made noallegation of ill-treatment in police cusong>toong>dy. In particular, ong>theong> delegation received hardly anycomplaints about ong>theong> manner in which detained persons were treated by cusong>toong>dial staff of arresthouses. However, ong>theong> delegation did receive some allegations of ill-treatment by oong>theong>r policeofficers; those accounts included being punched, kicked or struck with baong>toong>ns, and related both ong>toong>ong>theong> time of apprehension as well as ong>theong> time spent in a police establishment. In certain cases, ong>theong>delegation was able ong>toong> verify that ong>theong> persons concerned had been held in police establishmentsduring ong>theong> periods ong>toong> which ong>theong> ill-treatment in question had been ascribed; moreover, certain ofong>theong>m provided accurate descriptions of ong>theong> offices where ong>theong>y claimed it had taken place. Therewere also a few cases - examples of which are set out in ong>theong> following paragraph - where ong>theong>delegation gaong>theong>red supporting medical evidence, consistent with ong>theong> persons' accounts of illtreatment.13. In one case, a detainee alleged that he was severely beaten by police officers in a room(adjacent ong>toong> ong>theong> duty officer's premises) at ong>theong> Põhja Police Department in Tallinn at ong>theong> beginningof 2003. In particular, he claimed that he was punched on ong>theong> right cheekbone and kicked on ong>theong>right side of ong>theong> chest while he was lying on ong>theong> floor. Apparently, due ong>toong> ong>theong> injuries he sustainedon that occasion, ong>theong> person required emergency treatment at a hospital. The delegation's docong>toong>rsreviewed ong>theong> relevant hospital record from January 2003, which contained an identical account ofong>theong> person's allegations of ill-treatment, and indicated furong>theong>r that he displayed: a haemaong>toong>ma (10 x4 cm) and pain on palpation on ong>theong> right part of ong>theong> chest in ong>theong> area of ribs 8 ong>toong> 10; abrasion(0.5 cm) and redness on ong>theong> right cheek; and fractures of right ribs 8 ong>toong> 10. In ong>theong> view of ong>theong>delegation's docong>toong>rs, ong>theong> injuries recorded are consistent with ong>theong> person having been ill-treated inong>theong> manner which he described.Anoong>theong>r detainee alleged that, at ong>theong> time of his apprehension in an apartment some twoweeks prior ong>toong> his interview with members of ong>theong> delegation, a police officer from ong>theong> Lõuna PoliceDepartment in Tallinn kicked him on ong>theong> right side of his chest while he was lying on ong>theong> floor. Theperson complained ong>toong> one of ong>theong> delegation's docong>toong>rs of persisting pain on ong>theong> right side of ong>theong> chest,which felt worse on deep inhalation; upon examination, he displayed tenderness over ong>theong> anteromedialaspect of ribs 6 ong>toong> 8 on ong>theong> right side, ong>theong> area being tender ong>toong> direct pressure and ong>toong> indirectsternal pressure. In ong>theong> view of ong>theong> delegation's docong>toong>r, those injuries are consistent with ong>theong>person's allegations of having been struck in ong>theong> manner which he described.


- 13 -14. As in 1999, ong>theong> delegation received far fewer allegations of police ill-treatment as comparedong>toong> ong>theong> CPT's first visit ong>toong> Esong>toong>nia in 1997. Neverong>theong>less, ong>theong> information set out in paragraphs 12 and13 illustrates ong>theong> need for continued vigilance on ong>theong> part of ong>theong> Esong>toong>nian authorities. Furong>theong>r,according ong>toong> ong>theong> Annual ong>Reportong> for 2002 of ong>theong> Office of ong>theong> Legal Chancellor, of ong>theong> 74 complaintsagainst ong>theong> police received by ong>theong> Office in ong>theong> course of that year, "many related ong>toong> impolitebehaviour, insults, or unjustified violence".The CPT recommends that senior police officers regularly instruct police officers that:ill-treatment will not be ong>toong>lerated; all relevant information regarding alleged ill-treatment willbe investigated; and perpetraong>toong>rs of ill-treatment will be subject ong>toong> severe sanctions.15. As regards, more particularly, ong>theong> alleged use of excessive force at ong>theong> time of apprehension,ong>theong> CPT fully recognises that ong>theong> arrest of a criminal suspect is often a hazardous task, in particularif ong>theong> person concerned resists apprehension and/or is someone whom ong>theong> police have good reasonong>toong> believe represents an immediate danger. The circumstances of an apprehension may be such thatinjuries are sustained by ong>theong> person concerned (and by police officers) without this being ong>theong> resulong>toong>f an intention ong>toong> inflict ill-treatment. However, no more force than is reasonably necessary shouldbe used when effecting an apprehension. Furong>theong>rmore, once apprehended persons have beenbrought under control, ong>theong>re can be no justification for ong>theong>ir being struck by police officers. TheCPT recommends that police officers be reminded of ong>theong>se precepts.16. During ong>theong> visit, ong>theong> Esong>toong>nian authorities provided ong>theong> delegation with statistics ofcomplaints of police violence and related criminal cases 10 initiated against ong>theong> officers concerned.For ong>theong> year 2000, ong>theong>re had been 19 such complaints, two of which resulted in criminalinvestigations; in 2001, ong>theong>re had been 14 complaints and five criminal investigations; in 2002, 13complaints and three criminal investigations and, from January ong>toong> September 2003, ong>theong>re had been12 complaints. In order ong>toong> obtain a more complete and up-ong>toong>-date picture, ong>theong> CPT would like ong>toong>receive an account, covering ong>theong> period from 1 January 2003 ong>toong> ong>theong> present time, of allcomplaints of police violence received and ong>theong> outcome of ong>theong> relevant disciplinary and/orcriminal proceedings (allegations, brief descriptions of ong>theong> findings of ong>theong> relevant court orbody, verdict, sentence/sanction imposed).17. In ong>theong> interests of prevention of police ill-treatment, ong>theong> CPT cannot overemphasise ong>theong>importance of all persons in respect of whom prolongation of police cusong>toong>dy beyond 48 hours isproposed being physically brought before ong>theong> judge who must authorise that measure. 11 In this regard, itis pleased ong>toong> note that ong>theong> new Code of Criminal Procedure requires ong>theong> Prosecuong>toong>r's Office ong>toong> bring acriminal suspect before an investigating judge for ong>theong> adjudication of an application for cusong>toong>dy onremand. 12 The CPT would like ong>toong> receive confirmation that, under ong>theong> new Code of CriminalProcedure, ong>theong>re is no longer ong>theong> possibility for detained persons ong>toong> waive ong>theong>ir right ong>toong> bebrought before ong>theong> judge who must decide on ong>theong> prolongation of police cusong>toong>dy beyond 48 hours.101112The CPT has also noted with interest that ong>theong> Legal Chancellor may recommend disciplinary or criminalproceedings against individual police officers. In 2001, ong>theong> Office of ong>theong> Legal Chancellor recommended thatdisciplinary proceedings be initiated against police officers in three cases, and that criminal proceedings beinitiated in one case.Cf. in this regard paragraph 21 of CPT/Inf (2002 (26) and paragraphs 33 ong>toong> 34 of CPT/Inf (2002) 28.Cf. Section 217(8) as well as 131(2), (3) and (4) of ong>theong> 2003 Code of Criminal Procedure (ong>toong> enter inong>toong> force on1 July 2004).


- 14 -18. It is axiomatic that judges and public prosecuong>toong>rs must take appropriate action when ong>theong>re areindications that ill-treatment by ong>theong> police may have occurred. In this regard, ong>theong> CPT recommendsthat, whenever criminal suspects brought before an investigating judge or public prosecuong>toong>r atong>theong> end of police cusong>toong>dy or ong>theong>reafter allege ill-treatment by ong>theong> police, ong>theong> judge or prosecuong>toong>rshould record ong>theong> allegations in writing, order immediately a forensic medical examination andtake ong>theong> necessary steps ong>toong> ensure that ong>theong> allegations are properly investigated. Such anapproach should be followed wheong>theong>r or not ong>theong> person concerned bears visible externalinjuries. Furong>theong>r, even in ong>theong> absence of an express allegation of ill-treatment, ong>theong> judge orprosecuong>toong>r should order a forensic medical examination whenever ong>theong>re are oong>theong>r grounds ong>toong>believe that a person brought before him could have been ong>theong> victim of ill-treatment.19. The CPT wishes ong>toong> stress that ong>theong> duty of care which is owed by ong>theong> police ong>toong> persons inong>theong>ir cusong>toong>dy includes ong>theong> responsibility ong>toong> ensure ong>theong> safety and physical integrity of detainedpersons. The importance of this principle was highlighted by a serious incident which was broughtong>toong> ong>theong> delegation's attention in ong>theong> course of ong>theong> September 2003 visit. The case in question was asuicide by a detainee (hanging using a belt) which had taken place in one of ong>theong> temporary holdingcells at Narva Arrest House three days prior ong>toong> ong>theong> delegation's visit ong>toong> ong>theong> establishment.In this connection, it should be emphasised that for many persons, ong>theong> fact of having beendetained by ong>theong> police will be a highly stressful experience. It follows that police officers should bealert ong>toong> any potential for self-harm and, more specifically, ensure that newly-detained personsdo not have ready access ong>toong> means of harming ong>theong>mselves (belts, ties, broken glass, etc.).The CPT wishes ong>toong> be informed of ong>theong> outcome of ong>theong> inquiry initiated following ong>theong>above-mentioned incident, and of any measures taken in response.20. It is also axiomatic that ong>theong> proper moniong>toong>ring of cusong>toong>dy areas is an integral component ofong>theong> police's duty of care. This implies that ong>theong>re should be an ongoing presence of police officers inong>theong> vicinity of cells which are accommodating detained persons. Furong>theong>r, ong>theong> situation of personsdetained should be regularly moniong>toong>red through direct visual control. It is also important that meansshould exist (e.g. a call system) enabling detained persons ong>toong> attract ong>theong> attention of a police officer.The CPT recommends that immediate steps be taken ong>toong> ensure that all police cells, includingthose in arrest houses, are adequately moniong>toong>red, taking inong>toong> account ong>theong> above remarks.21. Conditions of detention in police arrest houses are dealt with detail in ong>theong> following section.The CPT's delegation considered that, in certain of those establishments, ong>theong> conditions amounted ong>toong>inhuman and degrading treatment.


- 15 -22. Finally, certain remand prisoners alleged that ong>theong>ir return ong>toong> arrest houses for lengthy periods(cf. paragraph 10) - and, in some cases, subsequent transfer from one arrest house ong>toong> anoong>theong>r –constituted a “pressure” or “intimidation” tactic employed by police investigaong>toong>rs, who were wellaware of ong>theong> extremely poor conditions which prevailed in certain of those establishments. In thisregard, an examination of ong>theong> relevant documents revealed that ong>theong> precise reason for authorising aremoval of a particular inmate from a prison was not always given.The Committee remains firmly of ong>theong> view that it would be far preferable for furong>theong>rquestioning of persons committed ong>toong> prison ong>toong> take place in prison raong>theong>r than on police premises.The return of prisoners ong>toong> police premises for whatever purpose should only be sought andauthorised when absolutely unavoidable.The CPT reiterates ong>theong> recommendation made in paragraph 23 of its 1997 visit report(cf. CPT/Inf (2002) 26), that, in respect of every occasion on which inmates are removed fromprison at ong>theong> request of a police investigaong>toong>r, a formal record be kept of ong>theong> reason for ong>theong>irremoval and of all measures taken during ong>theong>ir presence on police premises.3. Conditions of detention23. At ong>theong> outset, ong>theong> CPT's basic standards for conditions of detention in police cusong>toong>dy should berecalled.All police cells should be clean, of a reasonable size for ong>theong> number of persons ong>theong>y are usedong>toong> accommodate, and have adequate lighting (i.e. sufficient ong>toong> read by, sleeping periods excluded) andventilation; preferably, cells should enjoy natural light. Furong>theong>r, cells should be equipped with ameans of rest (e.g. a fixed chair or bench), and persons obliged ong>toong> stay overnight in cusong>toong>dy should beprovided with a clean mattress and clean blankets.Persons in police cusong>toong>dy should be allowed ong>toong> comply with ong>theong> needs of nature in clean anddecent conditions, and be offered adequate washing facilities. They should have ready access ong>toong>drinking water and be given food at appropriate times, including at least one full meal (i.e. somethingmore substantial than a sandwich) every day. Persons held for extended periods (24 hours or more)should be provided with appropriate personal hygiene items and, as far as possible, be offered outdoorexercise every day.a. police arrest houses 1324. In most countries visited by ong>theong> CPT, persons are held for only a relatively short time on policepremises. However, as already indicated (cf. paragraph 10), in Esong>toong>nia a person can be held in a policearrest house for prolonged periods, which can reach - and, on occasion, exceed - three months. Personsheld for such periods of time are entitled ong>toong> expect conditions of detention which are significantly betterthan ong>theong> elementary requirements described above, as well as a proper regime of activities.The 2003 visit revealed that arrest houses in Esong>toong>nia were - ong>toong> an even greater extent than in1997 or 1999 - in effect being used as prisons.13As regards health care in police arrest houses, cf. paragraphs 39 ong>toong> 40 below.


- 16 -25. In its first report ong>toong> ong>theong> Esong>toong>nian authorities, drafted following its 1997 visit, ong>theong> CPT washighly critical of conditions of detention in police arrest houses. 14 In ong>theong> report on its 1999 visit, ong>theong>Committee acknowledged ong>theong> progress made in terms of ong>theong> material environment offered by newarrest houses. Neverong>theong>less, it noted that a number of aspects of ong>theong> new facilities wereunsatisfacong>toong>ry, and that ong>theong> older arrest houses 15 remained unacceptable; with a view ong>toong> improvingong>theong> situation in ong>theong> establishments concerned, it made a number of specific recommendations. 16Despite ong>theong> assurances given by ong>theong> Esong>toong>nian authorities, 17 ong>theong> 2003 visit revealed that ong>theong>yhave in fact failed ong>toong> implement ong>theong> CPT's key recommendations concerning conditions of detentionin arrest houses.26. The material conditions under which detained persons (in police cusong>toong>dy, on remand orsentenced) were being held in certain police arrest houses, including those in Kohtla-Järve andNarva, were appalling; conditions also remained very poor in Jõgeva.Detainees were locked up 24 hours per day - with no outdoor exercise - in cells that werefilthy, dimly lit (with no access ong>toong> natural light, and poor artificial lighting) and severelyovercrowded (up ong>toong> 15 persons in a cell of 15 m²). 18 The unpartitioned lavaong>toong>ries - where personswere obliged ong>toong> relieve ong>theong>mselves in ong>theong> direct presence of ong>theong>ir cellmates - exacerbated ong>theong> effectsof ong>theong> very poor ventilation, rendering ong>theong> already dank air nauseating. In many cases, persons wereprovided with no mattresses and blankets, and lacked basic personal hygiene products. Thecumulative effect of ong>theong> execrable material conditions and ong>theong> impoverished regime could well bedescribed as inhuman and degrading. This state of affairs was exacerbated by ong>theong> fact that personswere being held under such conditions for prolonged periods (i.e. for up ong>toong> three months and, onoccasion, even longer).As regards, more particularly, ong>theong> arrest house at Narva, following complaints made bydetainees, ong>theong> Office of ong>theong> Legal Chancellor performed an on-ong>theong>-spot inspection of ong>theong>establishment in February 2003. In a letter subsequently addressed ong>toong> ong>theong> Minister of ong>theong> Interior,ong>theong> Legal Chancellor recommended inter alia that improvements be made ong>toong> lighting, and that atleast one daily hour of outdoor exercise be offered ong>toong> detainees; furong>theong>r, he indicated that ong>theong>internal regulations violated Section 45 (1) of ong>theong> Imprisonment Act of 2000, which relates ong>toong>"requirements of construction technology, health and hygiene", as well as lighting. It is clear fromong>theong> delegation's findings that no action has been taken on ong>theong> Legal Chancellor's recommendations.1415161718Cf. paragraph 38 of CPT/Inf (2002) 26.Those included ong>theong> Kohtla-Järve and Narva Arrest Houses.Cf. paragraphs 22 ong>toong> 26 of CPT/Inf (2002) 28.Cf. paragraphs 22 ong>toong> 24 of ong>theong> response of ong>theong> Esong>toong>nian ong>Governmentong> ong>toong> ong>theong> CPT's 1999 visit report (CPT/Inf(2002) 29).In a number of cases, ong>theong> levels of arrest house overcrowding in September 2003 actually exceeded thoseobserved by ong>theong> CPT in 1997 and 1999.


- 17 -27. The relatively new arrest houses at Tallinn and Tartu offered better material conditions;however, notwithstanding ong>theong> recommendations made by ong>theong> CPT in its 1999 visit report, ong>theong>yremained devoid of lavaong>toong>ry partitioning, and ong>theong> small (3.3 m²) cells at Tartu were still being usedas overnight accommodation. As for ong>theong> Harju Arrest House in Saue (an older facility, though onewhich also offered better material conditions than Jõgeva, Kohtla-Järve or Narva), with ong>theong>exception of ong>theong> provision of mattresses, no improvements had been made since 1997; in particular,it remained impossible ong>toong> lie down in cells where ong>theong> sleeping platform was interrupted by a verticalstructure. 1928. An impoverished regime - 24-hour in-cell lock-up - remained ong>theong> norm for everyonedetained in an arrest house. Of ong>theong> six arrest houses visited by ong>theong> delegation, Jõgeva was ong>theong> onlyone where detainees were being offered ong>theong> opportunity ong>toong> take outdoor exercise, albeit only twice aweek or so. Even if a particular establishment was equipped with yards, staff shortages were citedas reasons for not granting outdoor exercise ong>toong> detainees. The promised enlargement of ong>theong> 6 m²"yards" at Tartu Arrest House had not taken place, and ong>theong>y remained unused.As regards contacts with ong>theong> outside world, ong>theong> Internal Rules of Tallinn Arrest Housepermitted one two-hour visit once a week. However, many persons detained at oong>theong>r arrest housescomplained that ong>theong>y were allowed only one 15-minute visit per month.29. The material conditions of detention of juveniles were no different, and ong>theong> regime offeredong>toong> ong>theong>m no less impoverished, than was ong>theong> case for ong>theong>ir adult counterparts. Particular mentionshould be made of a 16-year old boy held at Narva Arrest House, who - due ong>toong> lack of space inordinary cells - had been placed in a punishment cell of 2.5 m² for ten days with no mattress orblankets. In a number of cases, juveniles were placed in ong>theong> same cells as adults, including forprolonged periods. Such a situation is ong>toong>tally unacceptable.30. As already mentioned (cf. paragraph 7), at ong>theong> end-of-visit talks on 30 September 2003, ong>theong>delegation made an immediate observation concerning Kohtla-Järve and Narva Police ArrestHouses, as well as oong>theong>r arrest houses where similar conditions of detention prevail. It requestedong>theong> Esong>toong>nian authorities ong>toong> take urgent steps ong>toong> improve conditions of detention in police arresthouses and, in particular, ong>toong> ensure that:(ii)(i)(iii)all persons held overnight in an arrest house are immediately provided with a cleanmattress and clean blankets as well as with personal hygiene products (ong>toong>ilet paper,soap, ong>toong>oth brush and paste, ong>toong>wel, sanitary ong>toong>wels, etc.);all persons who are detained for prolonged periods are granted at least one hour ofoutdoor exercise per day;all cells are fitted with adequate artificial lighting.19Cf. in this regard paragraph 41 of CPT/Inf (2002) 26, read in conjunction with paragraphs R-17 and R-18 ofeach of ong>theong> responses (interim and follow-up) of ong>theong> Esong>toong>nian authorities (both of which have been publishedunder reference document CPT/Inf (2002) 27).


- 18 -31. In response ong>toong> ong>theong> above-mentioned immediate observation, 20 ong>theong> Esong>toong>nian authoritiesacknowledged that ong>theong> situation was not satisfacong>toong>ry, indicating that conditions in arrest housesremain an issue of concern ong>toong> ong>theong>m and that "ong>theong> improvement of ong>theong> situation is ongoing".Responding ong>toong> item (i) above, ong>theong> authorities indicated that "a sufficient number of bedsheetsets have been provided […]; bedsheets are changed regularly". It was furong>theong>r indicated thatpersons are provided with "basic ong>toong>iletries, if necessary." The CPT wishes ong>toong> receiveconfirmation that "bedsheet sets" include clean mattresses and clean blankets.With reference ong>toong> item (ii), it was affirmed that, of ong>theong> 17 arrest houses in Esong>toong>nia, onlyfour 21 have "appropriate walking yards", where "persons have ong>theong> possibility ong>toong> stay in ong>theong> open airfor an hour a day"; in ong>theong> remaining 13 establishments, construction or renovation of walking yardswas envisaged for 2004.As for item (iii), it was indicated that "artificial lighting and ventilation have beenimproved" in six arrest houses 22 and will be brought "inong>toong> compliance" in ong>theong> remaining arresthouses in 2004.32. It is clear from ong>theong> response of ong>theong> Esong>toong>nian authorities that much work remains ong>toong> be done.Acknowledgements that ong>theong> situation is problematic are a first step, which must be followed byresolute and sustained action - founded on a solid, properly-resourced strategy - ong>toong> improve conditionsof detention in arrest houses. The CPT calls upon ong>theong> Esong>toong>nian authorities ong>toong> take all necessarysteps ong>toong> implement, without furong>theong>r delay, its recommendations concerning materialconditions of detention in police arrest houses. 23 The strategy for improving conditions ofdetention should include regular independent inspections of ong>theong> premises concerned.The CPT recommends that immediate steps be taken ong>toong> ensure that juveniles placed inarrest houses are accommodated separately from adult detainees. Juveniles detained forprolonged periods should be provided with a programme of educational activities (includingphysical education).Furong>theong>r, ong>theong> CPT trusts that it will receive a copy of ong>theong> standard design for arrest houses. 2433. As regards ong>theong> organisation of a regime of activities, while recognising that it is difficult inestablishments with an unpredictable turnover, ong>theong> CPT recommends that, as a first step, readingmatter be provided ong>toong> persons held in arrest houses. Consideration should also be given ong>toong>permitting ong>theong>m ong>toong> keep radios or television sets in ong>theong>ir cells.The CPT also recommends that anyone held in an arrest house for a prolonged periodshould be permitted ong>toong> maintain contacts with ong>theong> outside world according ong>toong> ong>theong> sameprinciples as those which should apply ong>toong> a person held in prison (cf. in this regard paragraphs71 ong>toong> 75 below).2021222324Cf. ong>theong> letter dated 13 January 2004 of ong>theong> Esong>toong>nian Minister for ong>theong> Interior ong>toong> ong>theong> Executive Secretary of ong>theong>CPT.The Järva (Paide), Jõgeva, Rapla, and Viljandi Arrest Houses.The Järva (Paide), Lääne-Viru (Rakvere), Rapla, Tallinn, Tartu, and Valga Arrest Houses.Cf. paragraphs 39 ong>toong> 41 of CPT/Inf (2002) 26 and paragraphs 23 ong>toong> 25 of CPT/Inf (2002) 28.Cf. in this regard paragraph 22 of CPT/Inf (2002) 29; furong>theong>r, during ong>theong> September 2003 visit, officials fromong>theong> Ministry of ong>theong> Interior confirmed that a standard design for arrest houses (with walking yards, and"separated" sanitary facilities) had been drawn up.


- 19 -34. To close this section on a more positive note, ong>theong> Esong>toong>nian authorities indicated during ong>theong>visit that ong>theong>y expect ong>theong> building of a new regional prison in Ida-Viru County (cf. paragraph 42below) ong>toong> reduce ong>theong> strain on arrest house capacity, obviate ong>theong> need for prolonged placements, andlead ong>toong> an improvement of conditions of detention.b. oong>theong>r police detention facilities35. At Põhja Police Department in Tallinn, ong>theong> four very small (2.4 m²) sobering-up cells and alarger (6.7 m²) holding cell - all of which were being used for overnight accommodation - weredevoid of furnishings (except for a bench), mattresses, bedding, and had no access ong>toong> natural light.Furong>theong>r, artificial lighting and ventilation were poor, and ong>theong> cells were dirty. The CPTrecommends that ong>theong> aforementioned shortcomings be remedied.More generally, conditions of detention in all police establishments in Esong>toong>nia shouldbe reviewed, having regard ong>toong> ong>theong> criteria set out in paragraph 23 above.4. Safeguards against ong>theong> ill-treatment of persons deprived of ong>theong>ir liberty36. It may be recalled that under ong>theong> Esong>toong>nian Constitution, persons deprived of ong>theong>ir libertyshall be given ong>theong> right ong>toong> notify a third party of ong>theong>ir cusong>toong>dy. 25 Furong>theong>r, ong>theong> Code of CriminalProcedure (applicable at ong>theong> time of ong>theong> visit) stipulates that criminal suspects are given ong>theong>opportunity ong>toong> notify a third party "through a preliminary investigaong>toong>r, prosecuong>toong>r or ong>theong> court ifsuch notification does not damage ong>theong> criminal proceedings". 26 However, ong>theong> new Code ofCriminal Procedure (adopted in 2003, and due ong>toong> enter inong>toong> force on 1 July 2004) makes no explicitreference ong>toong> this fundamental safeguard.The forms entitled "Proong>toong>col of detention of a criminal suspect" - which such persons wererequested ong>toong> sign - contained spaces for recording notification of a third party. However, in some ofong>theong> forms examined during ong>theong> visit, ong>theong> relevant entries were left blank; furong>theong>r, certain detaineesclaimed that ong>theong>y had not been given an opportunity ong>toong> exercise this right.37. The CPT recommends that ong>theong> new Code of Criminal Procedure be amended ong>toong>include explicit reference ong>toong> ong>theong> right of notification of cusong>toong>dy, incorporating fully ong>theong>principles set out by ong>theong> Committee in its previous visit reports (cf. in particular paragraph 29of CPT/Inf (2002) 28). In ong>theong> interim, ong>theong> right of notification of cusong>toong>dy should be developedin subsidiary regulations.Appropriate action should also be taken ong>toong> ensure that ong>theong> right of notification ofcusong>toong>dy is rendered fully effective in practice, with respect ong>toong> all categories of personsdeprived of ong>theong>ir liberty by ong>theong> police (including administrative detainees).2526Cf. Article 21 of ong>theong> Constitution, which also provides that this right "may be restricted only in ong>theong> cases andpursuant ong>toong> procedure provided by law ong>toong> combat a criminal offence or in ong>theong> interests of ascertaining ong>theong> truthin a criminal procedure".Cf. Section 11 (1) and also Section 108¹ (5) of ong>theong> 1961 Code of Criminal Procedure (as amended up ong>toong> 2003).


- 20 -38. The right of criminal suspects ong>toong> have prompt access ong>toong> a lawyer of ong>theong>ir choice, and ong>toong>confer with him or her, already has a formal basis in ong>theong> Constitution as well as in ong>theong> Code ofCriminal Procedure. 27 The new Code of Criminal Procedure furong>theong>r provides that a suspect has ong>theong>right ong>toong> confer with a lawyer in private, and that ong>theong> latter may be present during interrogation; ifnecessary, interrogation may be postponed in order ong>toong> ensure ong>theong> presence of a lawyer. 28 Moreover,it is stipulated that a lawyer "may participate in a criminal proceeding as of ong>theong> moment when aperson acquires ong>theong> status of a suspect". 29The CPT welcomes ong>theong> provisions contained in ong>theong> new Code and trusts that appropriatesteps will be taken ong>toong> ensure that ong>theong>y are fully complied with in practice. The right of accessong>toong> a lawyer should be enjoyed by anyone who is under a legal obligation ong>toong> attend - and stay at- a police establishment. Furong>theong>r, appropriate provision should be made for persons who arenot in a position ong>toong> pay for a lawyer. The CPT suggests that ong>theong> Bar Association be consultedin this context.39. As regards access ong>toong> a docong>toong>r, notwithstanding ong>theong> recommendations made by ong>theong> CPTfollowing its 1997 and 1999 visits concerning health care in police arrest houses, ong>theong> 2003 visitrevealed that persons admitted ong>toong> such establishments were still not benefiting from a thoroughmedical screening promptly on arrival; this is all ong>theong> more serious considering ong>theong> above-mentionedincrease of ong>theong> maximum periods of detention (cf. in this regard paragraph 10).In many cases, even severely inong>toong>xicated persons or those with visible injuries were notreceiving appropriate medical attention. Particular mention should be made of ong>theong> death fromalcohol poisoning, one week prior ong>toong> ong>theong> delegation's visit, of a man placed in a temporary holdingcell at Kohtla-Järve Arrest House. In ong>theong> CPT's view, if decisive action is not taken, ong>theong> lack ofmedical attention - combined with ong>theong> ong>toong>tally inappropriate material environment prevalent in manypolice cells - will continue ong>toong> present a serious danger ong>toong> vulnerable categories of detainees.40. Replying ong>toong> ong>theong> delegation's end-of-visit observations on health care in police arrest houses,ong>theong> Esong>toong>nian authorities indicated:"Police prefectures have concluded agreements with local family physicians in order ong>toong>provide preliminary health examinations and health care services. Full-time medicalassistants employed by ong>theong> police also carry out preliminary medical checks in detentioncentres. At ong>theong> moment requirements concerning ong>theong> provision of medical examination arefulfilled in [five arrest houses 30 ]; soon oong>theong>r police prefectures will conclude agreements forong>theong> provision of health care services."27282930Cf. Article 21 of ong>theong> Constitution and Sections 11(1) and 35¹(1) of ong>theong> 1961 Code of Criminal Procedure (asamended up ong>toong> 2003).Cf. Sections 33(2) and 34(4) and (5) of ong>theong> 2003 Code of Criminal Procedure (ong>toong> enter inong>toong> force on 1 July2004).Cf. Section 45(1), read in conjunction with Section 33(1), ibid. A suspect is defined as "a person who has beendetained on suspicion of a criminal offence, or a person whom ong>theong>re is sufficient ground ong>toong> suspect of ong>theong>commission of a criminal offence and who is subject ong>toong> a procedural act".The Lääne-Viru (Rakvere), Narva, Pärnu, Tallinn and Tartu Arrest Houses.


- 21 -Obviously, ong>theong> CPT welcomes ong>theong> action being taken in this area. It would like ong>toong> receive adetailed account of ong>theong> progress made ong>toong>wards providing proper health care in all policearrest houses.The CPT also wishes ong>toong> reiterate that a docong>toong>r must be called without delay whenever aperson in police cusong>toong>dy requests a medical examination; police officers should not seek ong>toong> vetsuch requests (cf. also in this regard paragraph 51 of CPT/Inf (2002) 26).41. Finally, it must be noted that persons in police cusong>toong>dy were still not being given a form ong>toong>keep, setting out all ong>theong>ir rights in a straightforward manner. The CPT calls upon ong>theong> Esong>toong>nianauthorities ong>toong> implement ong>theong> recommendation it has made repeatedly in ong>theong> past concerningong>theong> provision of written information on rights ong>toong> all persons deprived of ong>theong>ir liberty by ong>theong>police, at ong>theong> very outset of ong>theong>ir deprivation of liberty (cf. paragraph 31 of CPT/Inf (2002) 28).


- 22 -B. Prisons1. Preliminary remarks42. Since ong>theong> CPT's 1999 visit, certain changes affecting Esong>toong>nian prison establishments haveoccurred.In terms of ong>theong> legal framework, ong>theong> Imprisonment Act of 2000 has modified ong>theong> rulesapplicable ong>toong> remand and sentenced prisoners; as for ong>theong> 2001 Penal Act (which entered inong>toong> forceon 1 September 2002), it has led ong>toong> a decrease in ong>theong> use of imprisonment for minor offencesthrough ong>theong> introduction of community service sanctions.Perhaps even more significant are ong>theong> changes which have affected or are envisaged for ong>theong>physical infrastructure of prisons, i.e. ong>theong> programme of building regional prisons in tandem withong>theong> closing of camp-style penal colonies and certain problematic facilities. In this regard, ong>theong> CPTgreatly welcomes ong>theong> closing of ong>theong> Central Prison - which has been made possible by ong>theong> buildingand entry inong>toong> service of ong>theong> new prison at Tartu - and has noted ong>theong> plans ong>toong> build a new regionalprison at Jõhvi (in Ida-Viru County in eastern Esong>toong>nia). 3143. As a general matter of prison policy, ong>theong> Esong>toong>nian authorities have expressed ong>theong> intention ong>toong>decrease ong>theong> role of imprisonment, with ong>theong> objective of reducing ong>theong> prison population ong>toong> 2500(i.e., by some 2000 inmates) by ong>theong> year 2015, and ong>theong> incarceration rate concomitantly from 330 ong>toong>200 per 100 000 of ong>theong> national population. The CPT welcomes those objectives.44. The delegation paid a brief follow-up visit ong>toong> Tallinn Prison, focusing mainly on ong>theong> remandsection and ong>theong> disciplinary block. It also visited ong>theong> new Tartu Prison as a whole. Finally, itcarried out a follow-up visit ong>toong> ong>theong> Central Prison Hospital in Tallinn, which continues ong>toong> be locatedwithin ong>theong> premises of ong>theong> now-defunct Central Prison.Tallinn Prison is located in a compound which includes a number of decommissionedworkshops and industrial production facilities. The prison's remand blocks have a combinedcapacity of 650. On 19 September 2003, those blocks were overcrowded; ong>theong>y accommodated 661persons, including 67 women and one 17-year-old girl.Tartu Prison, which entered inong>toong> service in Ocong>toong>ber 2002, is a modern facility located overten hectares of marshy land in ong>theong> outskirts of ong>theong> old university ong>toong>wn of Tartu in south-easternEsong>toong>nia. The official capacity of ong>theong> prison is 925 (remand: 575; sentenced: 350). On 19September 2003, ong>theong> prison held 894 inmates, 520 of whom were remand prisoners (including 31women).On 19 September 2003, ong>theong> Central Prison Hospital in Tallinn (discussed in paragraphs 66ong>toong> 70 below) accommodated 101 patients (including four women), for a ong>theong>oretical capacity of 120.31The new Ida-Viru Prison is planned ong>toong> enter inong>toong> service in 2005; it will be a cell-type facility (as opposed ong>toong> acamp-style colony) with a capacity of 1000.


- 23 -2. Ill-treatment45. No allegations of ill-treatment of inmates by staff were heard at Tallinn Prison or at ong>theong>Central Prison Hospital. Furong>theong>r, ong>theong> majority of inmates interviewed at Tartu Prison made noallegations of such treatment.However, a number of consistent accounts were heard at Tartu Prison - from prisonersinterviewed individually - relating ong>toong> alleged beatings by masked members of a special squad during anintervention in ong>theong> block for sentenced prisoners in May 2003. According ong>toong> ong>theong> allegations received,ong>theong> special officers - who were armed with machine guns and truncheons - entered ong>theong> outdoor exerciseyards, firing shots in ong>theong> air, and knocking prisoners ong>toong> ong>theong> ground. Special officers were also said ong>toong>have entered accommodation areas within ong>theong> block, where ong>theong>y reportedly struck inmates withtruncheons and forced ong>theong>m ong>toong> lie on ong>theong> floor. The prisoners interviewed claimed that ong>theong> interventionwas carried out as a show of force intended ong>toong> intimidate ong>theong>m.After expressing its concern regarding ong>theong> above-mentioned allegations, ong>theong> delegationrequested ong>theong> authorities at ong>theong> end of ong>theong> visit ong>toong> ensure that a thorough, impartial, and independentinquiry is carried out inong>toong> ong>theong> matter. By letter of 30 Ocong>toong>ber 2003, ong>theong> authorities indicated that aninquiry had been initiated "in order ong>toong> find out ong>theong> exact course of events and ong>toong> prevent suchincidents from happening in ong>theong> future." The CPT welcomes ong>theong> swift response by ong>theong> Esong>toong>nianauthorities and trusts that it will be informed of ong>theong> outcome of ong>theong> inquiry, as well as of anymeasures taken in response.More generally, ong>theong> CPT considers that ong>theong> presence of an authority (e.g. senior judicialauthorities) which is independent from a particular establishment as well as from any special unitwhich may be carrying out an intervention, would have a dissuasive effect on anyone minded ong>toong> illtreatprisoners and greatly facilitate ong>theong> investigation of any allegations of ill-treatment and ong>theong>correct attribution of blame. The CPT recommends that any future involvement in prisons of aspecial intervention squad be moniong>toong>red by such an authority.46. The Direcong>toong>r of Tallinn Prison informed ong>theong> delegation that ong>theong>re were two pending criminalinvestigations against officers of that prison concerning alleged ill-treatment of prisoners. He statedthat in ong>theong> interest of ensuring ong>toong>tal objectivity and impartiality, such investigations should beentrusted fully ong>toong> an authority outside Tallinn Prison.The CPT agrees that ong>theong> persons responsible for an investigation, as well as those actuallycarrying it out, should be independent from those implicated in ong>theong> events. It recommends thatong>theong> Esong>toong>nian authorities take ong>theong> necessary steps ong>toong> ensure that this precept is applied inrespect of all investigations inong>toong> possible ill-treatment by prison officers.47. In both prisons visited, ong>theong> delegation observed that interaction between staff and inmateswas raong>theong>r limited. In this connection, ong>theong> CPT has repeatedly emphasised that building positiverelations with prisoners should be recognised as a key feature of a prison officer’s vocation; as wellas rendering ong>theong> work of prison staff far more rewarding, this will have ong>theong> additional benefit ofenhancing control and security in a prison.


- 24 -48. The CPT recommends that ong>theong> Esong>toong>nian authorities continue ong>toong> give high priority ong>toong>ong>theong> development of prison staff training, both initial and ongoing. In ong>theong> course of suchtraining, considerable emphasis should be placed on ong>theong> acquisition of interpersonalcommunication skills.49. As a positive contrast ong>toong> ong>theong> situation observed during ong>theong> 1997 visit, 32 prison officers atTallinn Prison were not carrying truncheons in full view of inmates in ong>theong> presence of ong>theong>delegation. However, a number of remand prisoners in that establishment alleged that officersresponsible for certain tasks involving movements of prisoners from one part of ong>theong> establishment ong>toong>anoong>theong>r - e.g., taking prisoners out for exercise - still carried truncheons openly when carrying outthose tasks. The CPT recommends that steps be taken ong>toong> ensure that prison officers do notcarry baong>toong>ns in full view of inmates.50. In order ong>toong> gain an up-ong>toong>-date nationwide picture, ong>theong> CPT would like ong>toong> receive ong>theong>following information for ong>theong> period from 1 January 2003 ong>toong> ong>theong> present time:- ong>theong> number of complaints lodged of ill-treatment by cusong>toong>dial staff in establishmentsunder ong>theong> authority of ong>theong> Ministry of Justice and ong>theong> number of disciplinary and/orcriminal proceedings initiated as a result of those complaints;- an account of disciplinary/criminal sanctions imposed on ong>theong> grounds of ill-treatmentby cusong>toong>dial staff.3. Material conditions51. The CPT wishes ong>toong> underline straight away that ong>theong> Esong>toong>nian authorities can be justly proudof ong>theong> material conditions of detention at Tartu Prison; comparing what ong>theong> CPT found at ong>theong>Central Prison during its first visit ong>toong> Esong>toong>nia in 1997 ong>toong> what it found at ong>theong> new prison - in termsof material conditions - is like comparing night and day.The accommodation of all inmates at ong>theong> new prison at Tartu is structured on ong>theong> principle ofsmall living units, comprising a ong>toong>tal of 479 double cells and 48 special cells (isolation, waiting andmedical quarantine) situated throughout two main rectangular blocks, respectively for remand andsentenced prisoners (ong>theong> medical department being contiguous ong>toong> ong>theong> block for remand prisoners).All cells measured some 10 m² and were equipped with fully partitioned integral sanitationfacilities. Access ong>toong> natural light, ventilation and artificial lighting were satisfacong>toong>ry and, with ong>theong>exception of ong>theong> special "restraining cells" (cf. paragraph 79 below), ong>theong> cells were suitablyfurnished. The overall impression was that of a thoroughly modern facility.32Cf. paragraph 71 of CPT/Inf (2002) 26.


- 25 -52. As for ong>theong> remand section (Blocks 1 and 2) of Tallinn Prison, ong>theong> transfer of inmates fromong>theong> now-defunct Central Prison has led ong>toong> overcrowding and, consequently, ong>toong> a deterioration ofmaterial conditions. At ong>theong> time of ong>theong> visit, prisoners were being held six ong>toong> a cell (in cellsmeasuring 15 or 18 m²), instead of four (as was ong>theong> case in 1997), and many cells were in a raong>theong>rdilapidated state; some displayed damage resulting from problems with ong>theong> plumbing (leakage,damp ceilings and walls, mildew and rust damage). 33The CPT recommends that ong>theong> Esong>toong>nian authorities rapidly devise and vigorouslypursue a strategy for reducing ong>theong> occupancy rates in ong>theong> remand blocks of Tallinn Prison ong>toong>no more than four persons per cell, always bearing in mind that ong>theong> strategy should not haveong>theong> side effect of transferring a problem from one establishment ong>toong> anoong>theong>r.Furong>theong>r, in ong>theong> light of ong>theong> above remarks, ong>theong> CPT recommends that ong>theong> necessary repairsbe carried out ong>toong> ong>theong> relevant installations and cells in ong>theong> remand section at Tallinn Prison.53. More generally, ong>theong> CPT has noted that ong>theong> average amount of space per remand prisoner inEsong>toong>nia is 3 m². 34 Such an average does not offer a satisfacong>toong>ry amount of living space; ong>theong>Committee recommends that ong>theong> Esong>toong>nian authorities strive ong>toong> maintain a standard of at least4 m² of living space per prisoner in multi-occupancy cells, and that official capacities becalculated accordingly.4. Activitiesa. remand prisoners54. A fundamental problem as regards remand prisoners in Esong>toong>nia is ong>theong> ong>toong>tal lack of out-of-cellactivities offered ong>toong> inmates.The Imprisonment Act (2000) stipulates that remand prisoners "shall be lodged in lockedcells on a twenty-four hour basis", except for one daily hour of outdoor exercise. The sole in-celldiversion allowed is access ong>toong> "national daily newspapers and books and periodicals song>toong>red at ong>theong>library" which may be supplemented, at ong>theong> discretion of ong>theong> prison direcong>toong>r, with ong>theong> use ofpersonal radios or television sets. Neverong>theong>less, something resembling a regime of activities mustbe offered ong>toong> minors who have been held in cusong>toong>dy for more than a month; ong>theong> relevant provisionstipulates that such persons "shall be allowed ong>toong> continue ong>toong> acquire basic education or generalsecondary education on ong>theong> basis of a corresponding national curriculum". 35The Imprisonment Act (2000) flatly contradicts ong>theong> urgent recommendation made inparagraph 80 of ong>theong> report on ong>theong> 1997 visit, aimed at radically improving regime activities for remandprisoners. Such a blatant refusal ong>toong> implement a CPT recommendation is a very serious matter.333435Cf. in this regard paragraphs 77 and 79 of CPT/Inf (2002) 26 and paragraph R-35 of ong>theong> interim response ofong>theong> Esong>toong>nian authorities (CPT/Inf (2002) 27).Cf. ong>theong> Esong>toong>nian response ong>toong> question 4(b) of Questionnaire 2 of ong>theong> Committee of Experts on remand incusong>toong>dy and its implications for ong>theong> management of penal institutions (document PC-DP (2003) 15).Cf. Sections 90(2) and 93(3), (4) and (5) of ong>theong> Imprisonment Act (2000).


- 26 -55. At ong>theong> time of ong>theong> visit, remand prisoners were being held for 23 hours a day in ong>theong>ir cells.No work or sports activities were offered ong>toong> those prisoners. The deleterious effects of such arestricted regime were exacerbated by ong>theong> lengthy periods of time for which persons could be heldin remand prisons. 36 The only regular out-of-cell activity was a daily hour of outdoor exercise, inareas which - even at ong>theong> new prison at Tartu, where ong>theong>y measured 15 m² - were not sufficientlylarge ong>toong> permit persons ong>toong> exert ong>theong>mselves physically. 37Remand prisoners did have access ong>toong> reading material; furong>theong>r, a number of cells had a radioand television. However, watching television and playing board games is no substitute for a properprogramme of out-of-cell activities; such a programme is of crucial importance for ong>theong> physical andpsychological well-being of any prisoner, wheong>theong>r sentenced or on remand.As regards, more particularly, ong>theong> situation in Tartu Prison, one of ong>theong> most harmful effectsof ong>theong> impoverished regime for remand prisoners held in that establishment was ong>theong> reduction ofhuman contact ong>toong> a bare minimum, due ong>toong> ong>theong> fact that prisoners were held one or two ong>toong> a cell andinmates from different cells could never associate. In this regard, ong>theong> CPT has repeatedly cautionedthat ong>theong> introduction of smaller units for prisoners must under no circumstances be allowed ong>toong> leadong>toong> a generalised system of small-group isolation.The CPT was pleased ong>toong> note that ong>theong> Esong>toong>nian authorities have expressed agreement withong>theong> delegation's end-of-visit remarks concerning ong>theong> above-mentioned matter. 3856. The CPT recommends that ong>theong> Esong>toong>nian authorities take steps, as a matter of urgency,ong>toong> radically improve ong>theong> regime activities for remand prisoners. The aim should be ong>toong> ensurethat remand prisoners are able ong>toong> spend a reasonable part of ong>theong> day outside ong>theong>ir cells,engaged in purposeful activities of a varied nature (group association activities; work,preferably with vocational value; sport). The legislative framework governing remandimprisonment must be revised accordingly.Furong>theong>rmore, ong>theong> CPT recommends that outdoor exercise facilities are made sufficientlylarge ong>toong> enable prisoners ong>toong> exert ong>theong>mselves physically.57. It should also be noted that a radio programme tuned ong>toong> an unpleasantly loud volume wasplayed all day at Tallinn Prison, apparently ong>toong> prevent any communication between inmates placedin neighbouring cells or when using different exercise yards. The CPT recommends that thispractice be discontinued.363738Though ong>theong> average length of time of remand in cusong>toong>dy in Esong>toong>nia is 10 months, this accounts only for ong>theong>period leading up ong>toong> ong>theong> court judgment and does not include ong>theong> time which may be subsequently spent in aremand prison while waiting for an appeal (cf. ong>theong> Esong>toong>nian response ong>toong> question 18 of Questionnaire 1 by ong>theong>Committee of Experts on remand in cusong>toong>dy and its implications for ong>theong> management of penal institutions(PC-DP) (2003)). At Tallinn Prison, one prisoner had already spent five years in ong>theong> remand section.Cf. also paragraph 77 of CPT/Inf (2002) 26.Cf. ong>theong> letter dated 30 Ocong>toong>ber 2003 by ong>theong> Esong>toong>nian Minister of Justice ong>toong> ong>theong> President of ong>theong> CPT.


- 27 -b. sentenced prisoners58. At ong>theong> time of ong>theong> visit, only some 30 % (112 out of 372) of ong>theong> sentenced prisoners at TartuPrison worked. Most of ong>theong> working prisoners (76) were engaged in general services (kitchensupport/food distribution, cleaning/maintenance, workshop support, laundry, sewing, hairdressing,canteen, library); ong>theong> rest (36) were employed by Esong>toong>nian Prison Industries (a public song>toong>ck company)as wood- or metal-workers, and ong>theong>ir work ong>toong>ok place in ong>theong> prison's bright, modern workshops.As for educational activities, 52 sentenced prisoners participated in general education classes(taught in Esong>toong>nian or in Russian) offered by Tartu Adult Upper Secondary School, and 72 ong>toong>ok partin vocational education in wood-work, welding and small business enterprise (also taught in Esong>toong>nianor in Russian) provided by ong>theong> Tartu Vocational Education Centre. In addition, sentenced prisonershad ong>theong> possibility of taking computer and language courses (English and Esong>toong>nian); ong>theong> CPT wouldlike ong>toong> be informed of ong>theong> number of inmates enrolled in those courses.Prisoners enjoyed regular access ong>toong> well-equipped association areas. Large outdoor sportsareas were located in front of ong>theong> block for sentenced prisoners; furong>theong>r, a sports building with awell-equipped gym and weight-lifting room was available for use three times a week. Football andoong>theong>r games were said ong>toong> be organised in summer, as well as ong>theong> occasional sports competitionbetween sections. Furong>theong>r, prison management indicated that several ong>theong>atre performances and twoclassical music concerts had been staged at ong>theong> prison by visiting performers.To sum up, although sentenced prisoners at Tartu Prison did have an appropriate amount ofdaily time outside ong>theong>ir units, ong>theong>re remained a gap between ong>theong> aspirations professed bymanagement and staff and ong>theong> programmes of activities which were actually being delivered ong>toong>many of ong>theong>m; some 37 % did not benefit from a positive regime which might encourage ong>theong>m ong>toong>address ong>theong>ir offending behaviour. The CPT recommends that ong>theong> relevant authorities take ong>theong>necessary steps ong>toong> ensure that all prisoners at Tartu Prison have access ong>toong> an appropriaterange of work, educational, sports and recreational activities.59. It should also be added that life-sentenced prisoners at Tartu Prison could not associate withany oong>theong>r categories of prisoners. In this connection, ong>theong> CPT wishes ong>toong> stress that life-sentencedprisoners are not necessarily more dangerous than oong>theong>r prisoners. Many such prisoners have along-term interest in a stable and conflict-free environment. Therefore, an approach ong>toong> ong>theong>management of life-sentenced prisoners (as indeed ong>toong> all prisoners) should proceed from individualrisk/needs assessment ong>toong> allow decisions concerning security, including degree of contact withoong>theong>rs, ong>toong> be made on a case-by-case basis. The CPT recommends that ong>theong> regime applied ong>toong>life-sentenced prisoners at Tartu Prison be revised, in ong>theong> light of ong>theong> above remarks.60. The Ministry of Justice has indicated that two of ong>theong>ir objectives (ong>toong> be achieved by 2006)are ong>toong> increase ong>theong> number of working prisoners ong>toong> 50% of all prisoners who are able ong>toong> work and, incooperation with ong>theong> Ministry of Education, ong>toong> integrate ong>theong> general and vocational education ofprisoners inong>toong> ong>theong> general education system and ong>toong> increase ong>theong> number of prisoners studying ong>toong> 30%of ong>theong> prison population. The CPT welcomes those initiatives and invites ong>theong> Esong>toong>nian authoritiesong>toong> ensure that remand prisoners are included ong>toong> ong>theong> extent possible.


- 28 -5. Health care services61. Health care staff at Tallinn Prison included a Head Docong>toong>r (who was also direcong>toong>r of ong>theong>Central Prison Hospital), two oong>theong>r docong>toong>rs (one of whom had ong>theong> primary responsibility formedical screening of newly-admitted prisoners), a dentist, and two nurses. Furong>theong>r, a psychiatristattended ong>theong> prison twice a week, and ong>theong>re were three psychologists. Such a staffing level isscarcely sufficient ong>toong> provide adequate health care ong>toong> some 1000 prisoners. In particular, ong>theong>nursing staff resources are clearly inadequate. The CPT recommends that nursing resources atTallinn Prison be reinforced.The situation was somewhat better at Tartu Prison, where ong>theong> health care team consisted oftwo docong>toong>rs, four feldschers, three nursing posts, and a laboraong>toong>ry technician. The prison wasattended by a psychiatrist, a dentist, and a radiologist three days a week, as well as by agynaecologist one day per week. In addition, ong>theong>re were four psychologists.Apparently, ong>theong>re were six vacant posts for health care staff at Tartu; ong>theong> CPT would like ong>toong>be informed which of those posts have been filled.62. The standard of health care facilities was excellent at Tartu, and generally satisfacong>toong>ry atTallinn.The delegation was informed that in ong>theong> context of an ongoing improvement programme ofong>theong> health care facilities at Tallinn, an on-site HIV laboraong>toong>ry and X-ray facilities have been added.As for Tartu, ong>theong> medical facility extended over two song>toong>reys of a building connected ong>toong> ong>theong>remand block, with ong>theong> clinical area on ong>theong> first floor and ong>theong> patient accommodation rooms on ong>theong>ground floor. In addition ong>toong> various consultation rooms, ong>theong> clinical area included a procedureroom, an X-ray and ultrasound suite, a pharmacy preparation room, a laboraong>toong>ry, and a patientwaiting area. The premises were spacious and bright and ong>theong> equipment was brand-new.63. Medical screening of newly-arrived prisoners was systematically taking place at boong>theong>stablishments within 24 hours of arrival; furong>theong>r, incoming prisoners at Tallinn Prison were alsobeing screened by a psychiatrist.64. In its 1997 visit report, ong>theong> CPT made a detailed recommendation, in ong>theong> interests ofprevention of ill-treatment, concerning records which must be drawn up following a medicalexamination of a newly-arrived prisoner (or a prisoner transferred or returning ong>toong> an establishment)or a prisoner examined following a violent incident in prison. In ong>theong>ir response ong>toong> that report, ong>theong>Esong>toong>nian authorities indicated that "[a]ll injuries will be accurately recorded both in ong>theong> medical fileand in an additional separate injuries file ong>toong> which investigative bodies have access. 3939Cf. in this regard paragraphs 93 ong>toong> 95 of CPT/Inf (2002) 26 read ong>toong>geong>theong>r with paragraph R-42 of ong>theong> interimresponse of ong>theong> Esong>toong>nian authorities (CPT/Inf (2002) 27).


- 29 -The information gaong>theong>red during ong>theong> 2003 visit indicated that, although objective medicalfindings relating ong>toong> injuries were being recorded, ong>theong>y were not always accompanied by an accounong>toong>f ong>theong> statements made by ong>theong> persons concerned which are relevant ong>toong> ong>theong> medical examination. Inparticular, medical records frequently failed ong>toong> note ong>theong> prisoner's account of ong>theong> origin of thoseinjuries (or ong>toong> note if ong>theong> person concerned had refused ong>toong> reply ong>toong> ong>theong> relevant questions asked byong>theong> docong>toong>r) as well as ong>theong> docong>toong>r's conclusions in ong>theong> light of ong>theong> objective findings and ong>theong> prisoner'saccount. In fact, ong>theong> docong>toong>r responsible for screening at Tallinn Prison indicated that he did notconsider it his duty ong>toong> ask such questions unless an injury occurred within ong>theong> prison itself.The CPT reiterates its recommendation that ong>theong> record drawn up after a medicalexamination of a prisoner, wheong>theong>r newly-arrived or not, contain:(i)(ii)(iii)a full account of statements made by ong>theong> prisoner concerned which are relevant ong>toong>ong>theong> medical examination, including any allegations of ill-treatment made by him;a full account of objective medical findings based on a thorough examination;ong>theong> docong>toong>r's conclusions in ong>theong> light of (i) and (ii); ong>theong>se conclusions should bemade available ong>toong> ong>theong> prisoner and his/her lawyer.Moreover, ong>theong> CPT recommends that existing procedures be reviewed in order ong>toong> ensurethat, whenever injuries are recorded by a docong>toong>r which are consistent with allegations of illtreatmentmade by a prisoner, ong>theong> record is brought ong>toong> ong>theong> attention of ong>theong> relevant publicprosecuong>toong>r.65. Medical examinations of prisoners at Tartu were taking place in ong>theong> presence of prisonofficers, in contravention of ong>theong> principles of medical confidentiality. The CPT recommends thatmedical examinations of prisoners be conducted out of ong>theong> hearing and - unless ong>theong> docong>toong>rconcerned requests oong>theong>rwise in a particular case - out of ong>theong> sight of prison officers.Furong>theong>r, in ong>theong> light of information gaong>theong>red during ong>theong> visit, ong>theong> CPT would also like ong>toong>receive confirmation that prisoners are examined on an individual basis at Tallinn Prison,and not in ong>theong> presence of oong>theong>r inmates.6. Central Prison Hospital, Tallinn66. The problem of overcrowding at ong>theong> Central Prison Hospital had been resolved with ong>theong>closure of ong>theong> Central Prison. 40 However, in all oong>theong>r respects, ong>theong> hospital's material conditions -which were ong>theong> subject of ong>theong> CPT's principal criticism of ong>theong> establishment in ong>theong> report on its 1997visit 41 - had actually deteriorated.Given ong>theong> hospital's severely dilapidated state, it remained practically impossible ong>toong> maintaineven a minimum level of hygiene in ong>theong> premises. As regards personal hygiene, not even ong>theong> mostbasic products (e.g. soap, ong>toong>ilet paper) were provided free of charge. In addition, a number of cellsdid not have access ong>toong> natural light, since ong>theong> windows had been covered with metal plates, and ong>theong>delegation heard allegations (confirmed by staff) that heating was inadequate in winter. Moreover, allpatients (except those suffering from tuberculosis) were locked up in ong>theong>ir cells for 24 hours per day,without even being offered any outdoor exercise, which was exactly ong>theong> situation found in 1997.4041Cf. also paragraph 42 above.Cf. in this regard paragraphs 103 ong>toong> 109 of CPT/Inf (2002) 26.


- 30 -67. The only activities generally available ong>toong> patients were reading and playing board gamesinside ong>theong> cells; very few prisoners had access ong>toong> radio or television. Access of health care staff ong>toong>patients remained hampered by ong>theong> lack of a call system and ong>theong> fact that patients' cells had ong>toong> beunlocked by prison officers. As for psychiatric patients, ong>theong>ir treatment continued ong>toong> be limited ong>toong>pharmacoong>theong>rapy.68. As already mentioned (cf. paragraph 7), at ong>theong> end-of-visit talks on 30 September 2003, ong>theong>delegation made an immediate observation concerning ong>theong> Central Prison Hospital, requesting that:(i)(ii)all patients, whose health permits, be offered at least one hour of outdoor exerciseper day; and thatmetal plates be removed from ong>theong> windows of cells accommodating patients.At ong>theong> end-of-visit talks, ong>theong> delegation also drew attention ong>toong> ong>theong> precarious situation of ong>theong>hospital's only female patient with tuberculosis, who had been held in a regime akin ong>toong> solitaryconfinement since May 2003, and asked that steps be taken ong>toong> offer her a wider range of diversions(e.g. access ong>toong> a radio and/or television).In response ong>toong> ong>theong> above-mentioned immediate observation, ong>theong> Esong>toong>nian authoritiesconfirmed that ong>theong>y have complied with ong>theong> delegation's requests concerning outdoor exercise andong>theong> removal of ong>theong> metal plates; furong>theong>r, ong>theong>y indicated that ong>theong> woman with tuberculosis has beenoffered ong>theong> possibility ong>toong> participate in social programmes and ong>toong> have a radio.69. The CPT welcomes ong>theong> response of ong>theong> Esong>toong>nian authorities ong>toong> its immediate observation.However, it was deeply concerned ong>toong> learn that plans ong>toong> build a new prison hospital have beendelayed. 42 The Esong>toong>nian authorities must be unwavering in ong>theong>ir efforts ong>toong> withdraw ong>theong> CentralPrison Hospital from service at ong>theong> earliest possible opportunity; ong>theong> premises are inherentlyunsuitable for use as a hospital.70. The CPT calls upon ong>theong> Esong>toong>nian authorities ong>toong> attach a very high priority ong>toong> finding asuitable alternative ong>toong> ong>theong> Central Prison Hospital, which should enable it ong>toong> be closed.In ong>theong> interim, ong>theong> CPT recommends that steps be taken ong>toong>:- offer organised activities ong>toong> all patients at ong>theong> Central Prison Hospital;- guarantee ready access of health care staff ong>toong> patients at all times;- develop psycho-social ong>theong>rapeutic activities for psychiatric patients and adaptong>theong>m ong>toong> ong>theong> individual needs of each of those patients.42The authorities have indicated that "ong>theong> process, starting from detailed planning which takes about two years,must be [re-]started from ong>theong> beginning" (cf. ong>theong> letter dated 30 Ocong>toong>ber 2003 of ong>theong> Esong>toong>nian Minister ofJustice ong>toong> ong>theong> President of ong>theong> CPT).


- 31 -7. Oong>theong>r issuesa. contact with ong>theong> outside world71. The right of remand prisoners ong>toong> receive short-term visits from family members or oong>theong>rpersons is governed by Section 94 of ong>theong> Imprisonment Act (2000). The law stipulates that suchvisits must take place in ong>theong> presence of prison staff, but does not specify ong>theong>ir frequency andduration; instead, it is stipulated that such matters are ong>toong> be determined by ong>theong> internal rules of eachprison. The Esong>toong>nian authorities have indicated that in practice, remand prisoners are granted atleast one hour-long visit per month. In ong>theong> CPT's view, this is not sufficient ong>toong> permit persons onremand ong>toong> maintain appropriate contact with ong>theong> outside world.The CPT recommends that uniform regulations be established for all prisons on ong>theong>question of ong>theong> frequency and duration of visits ong>toong> remand prisoners by family members oroong>theong>r persons. The objective should be ong>toong> offer ong>theong> equivalent of a visit every week, of at least30 minutes duration.Furong>theong>r, ong>theong> CPT wishes ong>toong> stress ong>theong> need for a certain flexibility when applying ong>theong>rules on visits ong>toong> prisoners whose families have difficulties making regular visits. Forexample, such prisoners could be authorised ong>toong> combine several visit entitlements inong>toong> onelonger session.72. Remand prisoners may be denied regular visits from family members by ong>theong> direcong>toong>r of aprison with ong>theong> permission of a preliminary investigaong>toong>r, prosecuong>toong>r or court "if this is necessary ong>toong>ensure ong>theong> conduct of ong>theong> criminal proceedings"; apparently, denial of visits affects some 6 % of ong>theong>remand prison population. 43No restrictions may be made on ong>theong> right ong>toong> receive visits by a lawyer; furong>theong>r, in ong>theong> contexong>toong>f such visits, prison officers must not be within hearing distance. 4473. According ong>toong> ong>theong> Imprisonment Act (2000), sentenced prisoners have ong>theong> right ong>toong> receive atleast one supervised visit, with a duration up ong>toong> three hours, once a month. In addition, prisonersmay be granted unsupervised long-term visits for a period from one ong>toong> three days and, if ong>theong>y haveserved at least one year of ong>theong>ir sentence, 21 days annual home leave. 45The CPT welcomes ong>theong> visiting and leave arrangements for sentenced prisoners in Esong>toong>nia,which are conducive ong>toong> ong>theong> social rehabilitation of a prisoner.434445Cf. ong>theong> Esong>toong>nian response ong>toong> question 11 of Questionnaire 2 by ong>theong> Committee of Experts on remand in cusong>toong>dyand its implications for ong>theong> management of penal institutions (PC-DP (2003) 15).Cf. Section 95(1) of ong>theong> Imprisonment Act (2000).Cf. Sections 24, 25 and 32, ibid.


- 32 -74. Several complaints were heard from remand prisoners regarding arrangements for telephonecontacts. In both prisons visited, ong>theong> practice was for officers ong>toong> bring a telephone on a trolley infront of ong>theong> door of a particular cell, and ong>toong> pass ong>theong> telephone receiver through ong>theong> hatch normallyused for food distribution; ong>theong> person would ong>theong>n be obliged ong>toong> speak in ong>theong> presence of his or hercellmates. Following a number of complaints received on ong>theong> subject by remand prisoners fromTallinn Prison, ong>theong> Legal Chancellor proposed that an effective procedure be established ong>toong> ensureconfidentiality of telephone conversations. The CPT would like ong>toong> be informed of ong>theong> actiontaken following ong>theong> proposal made by ong>theong> Legal Chancellor.75. As regards correspondence, ong>theong> CPT has noted that ong>theong> Legal Chancellor has proposed that ong>theong>Ministry of Justice establish uniform regulations ong>toong> be applied in all prisons. The CPT would like ong>toong>be informed of ong>theong> action taken in this area, as well as ong>toong> receive a copy of any new regulations.b. discipline, segregation, and means of restraint76. Remand prisoners who commit violations against prison discipline may be punished with areprimand, a fine, and/or placement in a punishment cell for up ong>toong> 30 days (adults) or 15 days(minors). 46Sentenced prisoners may be punished with a reprimand, suspension of visits, removal fromwork, and/or placement in a punishment cell for up ong>toong> 45 days (adults) or 20 days (minors). 47As regards disciplinary procedures, ong>theong> delegation noted that prisoners were informed of ong>theong>disciplinary offence of which ong>theong>y had been accused, and had ong>theong> right ong>toong> make statements. 48However, a number of prisoners indicated that ong>theong>y had not been informed of ong>theong> modalities oflodging an appeal. The CPT wishes ong>toong> receive confirmation that prisoners have ong>theong> formalright ong>toong> appeal ong>toong> a higher authority against any sanctions imposed on ong>theong>m. Furong>theong>r, stepsshould be taken ong>toong> ensure that ong>theong> prisoners concerned are given a copy of ong>theong> disciplinarydecision, informing ong>theong>m about ong>theong> reasons for ong>theong> decision and ong>theong> avenues/deadlines forlodging an appeal.77. Any prisoner (remand or sentenced) who repeatedly violates prison regulations or poses aserious threat ong>toong> security may be segregated in an isolation cell until ong>theong> circumstances which led ong>toong>such placement "cease ong>toong> exist". 49 Furong>theong>r, means of restraint (tying, handcuffing, or ong>theong> use of arestraint jacket) may be applied ong>toong> such prisoners for a period not exceeding 12 hours. 50The CPT would like ong>toong> be informed of ong>theong> procedural safeguards applicable in suchcases (right ong>toong> be heard, right ong>toong> appeal ong>toong> a higher authority, etc.).4647484950Cf. Section 100, ibid.Cf. Section 63, ibid.Cf. Section 64(2), ibid.A remand prisoner may also be isolated from oong>theong>r inmates if ong>theong>re is sufficient reason ong>toong> believe that his orher behaviour may adversely affect ong>theong> conduct of criminal proceedings; ong>theong> duration of such isolation isdetermined by ong>theong> preliminary investigaong>toong>r, prosecuong>toong>r, or court (cf. Section 102 of ong>theong> ImprisonmentAct (2000)).Cf. Sections 63, 69, 70 and 103 of ong>theong> Imprisonment Act (2000).


- 33 -78. As ong>theong> time of ong>theong> visit, ong>theong> material conditions in ong>theong> disciplinary block in Tallinn Prisonwere ong>toong>tally unacceptable, ong>theong> cells displaying a state of repair identical ong>toong> that of ong>theong> worst of ong>theong>arrest house cells (cf. paragraph 26 above). The Esong>toong>nian authorities have since indicated that ong>theong>renovation work which had been initiated in ong>theong> disciplinary block has been completed; ong>theong> CPTwelcomes this development.The cells used for disciplinary purposes at Tartu Prison were, on ong>theong> whole, of an adequatestandard.79. The conditions under which prisoners could be physically restrained in ong>theong> special “restrainingcells” at Tartu Prison were ong>toong>tally unacceptable. Those cells were equipped only with a concreteplatform raised some 10 cm from ong>theong> floor, fitted with four metal rings anchored ong>toong> its sides, inorder ong>toong> secure a person hand and foot while lying spread-eagled on ong>theong> back. Handcuffs and anklebelts were available for this purpose. The restraining cells were also used for disciplinarypunishment, i.e. persons could be placed in ong>theong>m without being restrained.As already mentioned (cf. paragraph 7), at ong>theong> end-of-visit talks on 30 September 2003, ong>theong>delegation made an immediate observation concerning ong>theong> above-mentioned cells and requested ong>theong>Esong>toong>nian authorities ong>toong> remove immediately ong>theong> four metal rings and ong>toong> ensure that four-pointrestraint using metal cuffs ong>toong> immobilise a detainee is never used.In response ong>toong> ong>theong> above-mentioned immediate observation, ong>theong> Esong>toong>nian authoritiesconfirmed that ong>theong>y have complied with ong>theong> foregoing requests. The CPT welcomes ong>theong> swift actiontaken by those authorities; 51 neverong>theong>less, it wishes ong>toong> stress that even without ong>theong> metal rings, ong>theong>special cells at Tartu Prison are not suited for disciplinary use, given that ong>theong>y lack furniture.80. More generally, an examination of ong>theong> relevant records revealed that, at Tartu Prison, meansof restraint were used with alarming frequency; 52 ong>theong>y were also applied for prolonged periods - upong>toong> ong>theong> maximum of 12 hours - during which time persons thus restrained were allegedly notpermitted ong>toong> use ong>theong> lavaong>toong>ry. Furong>theong>r, it was clear that means of restraint were applied on occasionas a disciplinary punishment (e.g. for "refusal ong>toong> enter ong>theong> cell" or "use of dirty language").The CPT considers that resort ong>toong> instruments of physical restraint will only very rarely bejustified. If, exceptionally, recourse is had ong>toong> instruments of physical restraint, ong>theong>y should beremoved at ong>theong> earliest opportunity; ong>theong>y should be never applied, or ong>theong>ir application prolonged, asa punishment. Furong>theong>r, in cases where a prisoner is, or becomes, highly agitated, prison staff shouldimmediately contact a docong>toong>r and act in accordance with his or her opinion, raong>theong>r than shacklingong>theong> person concerned ong>toong> furniture or fixtures.The Committee recommends that steps be taken ong>toong> ensure that ong>theong> foregoing preceptsare strictly observed in practice.81. In light of ong>theong> information gaong>theong>red at both prisons visited, ong>theong> CPT recommends that allpersons placed in a disciplinary cell be allowed access ong>toong> reading matter, which should not belimited ong>toong> prison regulations and ong>theong> Bible.5152Cf. ong>theong> letter dated 30 Ocong>toong>ber 2003 of ong>theong> Esong>toong>nian Minister of Justice ong>toong> ong>theong> President of ong>theong> CPT.The number of cases of use of means of restraint at Tartu Prison in one month was approximately equivalent ong>toong>ong>theong> number of such cases at Tallinn Prison over an eight-month period.


- 34 -c. complaints and inspection procedures82. Under ong>theong> Imprisonment Act (2000), prisoners may address letters on a confidential basis ong>toong>ong>theong>ir lawyer, ong>theong> prosecuong>toong>r, ong>theong> court, ong>theong> Legal Chancellor or ong>theong> Ministry of Justice. 53However, a number of prisoners at ong>theong> establishments visited alleged that ong>theong>y lackedinformation as ong>toong> ong>theong> manner in which ong>theong>y could lodge a complaint; furong>theong>r, several alleged thatong>theong>ir complaints had not met with any response, or had been delayed, leading ong>theong>m ong>toong> speculate thatprison officers were screening ong>theong>ir complaints.The CPT recommends that ong>theong> relevant authorities ensure that all prisoners (bothremand and sentenced), throughout ong>theong> penitentiary system, are provided with precise writteninformation on ong>theong> avenues of complaint available ong>toong> ong>theong>m; if necessary, prisoners should alsobe supplied with writing materials. Furong>theong>r, practical measures should be taken ong>toong> ensure thatcomplaints can be transmitted confidentially (e.g. by providing locked complaint boxesaccessible ong>toong> prisoners, ong>toong> be opened only by specially designated persons).83. In ong>theong> report on its 1997 visit, ong>theong> CPT stressed ong>theong> importance it attached ong>toong> regular visits ong>toong>prison establishments by an independent body. 54 In this connection, ong>theong> CPT has noted with greatinterest ong>theong> provisions of Section 108 of ong>theong> Imprisonment Act, which provides for a system of prisoncommittees operating at each establishment and made up of members of ong>theong> public. As far as ong>theong>delegation could ascertain, this system was not yet operative in September 2003. 55 The CPT wouldlike ong>toong> receive ong>theong> comments of ong>theong> Esong>toong>nian authorities on this subject.84. A furong>theong>r supervisory mechanism may be found in ong>theong> Office of ong>theong> Legal Chancellor, whosework appears ong>toong> have had a positive impact (cf. paragraphs 14, 26, 74 and 75 above for illustrationsof ong>theong> Chancellor's work in relation ong>toong> prisons as well as police). The CPT trusts that ong>theong> LegalChancellor will continue ong>toong> maintain a proactive role in ong>theong> prevention of ill-treatment ofprisoners.535455Cf. Section 29(4) of ong>theong> Imprisonment Act (2000).Cf. paragraph 125 of CPT/Inf (2002) 26.Cf. Section 108 of ong>theong> Imprisonment Act (2000).


- 35 -C. Psychiatric establishments1. Preliminary remarks85. The delegation visited Ahtme Psychiatric Hospital and Kernu Social Welfare Home. Theformer was transformed from a State run institution inong>toong> a non-profit foundation (supervised by ong>theong>Ministry of Social Affairs) at ong>theong> beginning of 2003, while ong>theong> latter is administered by ong>theong> Ministryof Social Affairs.86. Ahtme Psychiatric Hospital was built on ong>theong> premises of a former school-house in ong>theong>village of Ahtme (located near Kohtla-Järve). In 1980, ong>theong> hospital was separated from ong>theong> generaldistrict hospital and became an independent institution. It provides in-patient services for a widevariety of patients with different diagnoses and needs from north-east Esong>toong>nia. Involuntary andvoluntary patients were accommodated ong>toong>geong>theong>r in both open and closed units. The number ofadmissions/discharges per week was about 30, with an average length of stay of 20 days (which isong>theong> maximum duration of full payment by ong>theong> Sickness Benefit Fund).The hospital had an official capacity of 77 beds. However, due ong>toong> limited funding by ong>theong>Sickness Benefit Fund, ong>theong> actual capacity was reduced ong>toong> 47 beds (an entire ward with 30 beds wastemporarily taken out of service). At ong>theong> time of ong>theong> visit, it was accommodating 40 in-patients, twoof ong>theong>m involuntary. Fifteen patients were accommodated in ong>theong> closed unit (acute ward) and 25 inong>theong> open unit.At Ahtme, ong>theong> only involuntary patients who could be admitted were persons subject ong>toong> acivil placement. Conditions for such placement are set out in Section 11 of ong>theong> Mental Health Act(1997), which stipulates that persons may only be admitted ong>toong> ong>theong> psychiatric department of ahospital or subjected ong>toong> treatment without ong>theong> consent of ong>theong> person or his or her legal representativeif: (1) ong>theong> person has a severe mental disorder which restricts his or her ability ong>toong> understand orcontrol his or her behaviour, (2) without in-patient treatment, ong>theong> person endangers ong>theong> life, healthor safety of himself or herself or oong>theong>rs due ong>toong> a mental disorder, and (3) oong>theong>r psychiatric care isnot sufficient.87. Kernu Social Welfare Home opened in 1946 on ong>theong> premises of a former manor house(built some 200 years ago) in ong>theong> village of Kernu, some 35 km south of Tallinn. The establishmentcomprises two buildings, on a 22-hectare area, which was also used for various agriculturalactivities. It mainly serves as a long-term residential care institution for male and female residentswith severe learning and/or physical disabilities. In ong>theong> main building (ong>theong> former manor house),ong>theong>re was one closed intensive care unit for female residents only and separate open units for femaleand male residents. A second building, constructed in recent years, accommodated moreauong>toong>nomous residents.At ong>theong> time of ong>theong> visit, ong>theong> establishment was operating at its full capacity with 88 residents(68 female and 20 male). The closed unit was accommodating 22 female residents (official capacity:20). Most residents were staying at ong>theong> establishment on a long-term basis (some since ong>theong> opening ofong>theong> home in 1946). The annual turnover was raong>theong>r low (7 admissions in 2002 and 4 in 2003).As regards ong>theong> legal basis for involuntary placement in social welfare homes, cf.paragraph 115.


- 36 -2. Ill-treatment88. The delegation heard no allegations of ill-treatment by staff - and gaong>theong>red no oong>theong>r evidenceof such treatment - of patients/residents at Ahtme Psychiatric Hospital and ong>theong> Kernu SocialWelfare Home. The atmosphere in ong>theong> two institutions was on ong>theong> whole relaxed, and staffpatient/residentrelations were good. The CPT wishes ong>toong> place on record ong>theong> professionalism andcommitment demonstrated by ong>theong> medical and nursing staff ong>toong>wards ong>theong>ir patients/residents.89. Neverong>theong>less, ong>theong> CPT is seriously concerned about ong>theong> level of violence among residents atKernu Social Welfare Home. The delegation received numerous allegations of verbal and physicalassaults of residents by fellow-residents. Several female residents claimed that ong>theong>y had beenpersistently “terrorised” and beaten by a group of male residents and that ong>theong>y were living inpermanent fear of such assaults. The delegation itself witnessed an incident in which a femaleresident was hit by a male resident, without an appropriate intervention of a member of staff whowas present at ong>theong> time. The victim concerned sustained a haemaong>toong>ma on ong>theong> face and upper lip.The CPT recommends that urgent steps be taken at Kernu Social Welfare Home ong>toong>review ong>theong> management of aggressive/violent residents. For this purpose, a specific policyshould be elaborated and implemented in practice, aimed at reducing ong>theong> risk of interresidentviolence.Furong>theong>r, ong>theong> Committee recommends that all staff members be reminded that ong>theong>y havea duty ong>toong> ensure ong>theong> safety and physical integrity of residents and ong>toong> protect ong>theong>m from oong>theong>rresidents who might wish ong>toong> cause ong>theong>m harm.3. Patients’/residents’ living conditions90. In any psychiatric/social welfare establishment, ong>theong> aim should be ong>toong> offer living conditionswhich are conducive ong>toong> ong>theong> treatment and well-being of patients/residents; in terms of rehabilitation,a positive ong>theong>rapeutic environment. Creating such an environment involves, first of all, providingsufficient living space per person as well as adequate lighting, heating and ventilation, maintainingong>theong> establishment in a satisfacong>toong>ry state of repair and meeting hospital hygiene requirements.Particular attention should also be given ong>toong> ong>theong> decoration of both patients'/residents' rooms andrecreation areas, in order ong>toong> offer patients/residents a stimulating ong>theong>rapeutic environment.91. The living conditions in Ahtme Psychiatric Hospital were overall of a good standard.Throughout ong>theong> establishment, patient accommodation was impeccably clean, well-lit andventilated. Patients were accommodated in spacious rooms with two ong>toong> four beds and had readyaccess ong>toong> sanitary facilities, which were in a good state of repair and cleanliness. No signs of poorbodily hygiene were found. Furong>theong>r, patients were allowed ong>toong> wear ong>theong>ir own cloong>theong>s, and indigentpatients were provided with non-uniform garments.However, some complaints were heard about insufficient heating (in particular, at night).Furong>theong>r, in some rooms patients had no lockable space ong>toong> song>toong>re ong>theong>ir personal belongings. The CPTinvites ong>theong> Esong>toong>nian authorities ong>toong> remedy ong>theong>se deficiencies.


- 37 -92. Throughout ong>theong> establishment, patients had access ong>toong> pleasantly-decorated communal rooms,which were equipped with tables, chairs, a television set and board-games. Patients on ong>theong> openward went for walks in ong>theong> open air. However, due ong>toong> ong>theong> lack of a secure outdoor exercise area, notall patients in ong>theong> closed unit were allowed ong>toong> have access ong>toong> ong>theong> open air.The CPT recommends that immediate steps be taken at Ahtme Psychiatric Hospital ong>toong>ensure that all patients whose state of health permits are offered at least one hour of outdoorexercise per day.93. At ong>theong> Kernu Social Welfare Home, ong>theong> majority of residents were accommodated in two- ong>toong>six-bed rooms of adequate size (at least 5 m² per person). The main building had a number ofstructural deficiencies (e.g. steep and narrow stairs), which could hardly be remedied. At ong>theong> time ofong>theong> visit, it was undergoing extensive renovation work, which was already well advanced. In allrenovated parts (including ong>theong> entire closed unit), ong>theong> living conditions were of a good standard.Rooms were well lit and ventilated, with new furniture (beds, bedside tables, chairs,shelves/cupboards) and personalised decoration. Hygienic conditions were very good. In addition,ong>theong> living conditions in ong>theong> adjacent building for residents with less severe learning disabilities wereoverall of a high standard.By contrast, ong>theong> rooms in ong>theong> main building which had not yet been renovated were in a poorstate of repair. The CPT would like ong>toong> receive detailed information on ong>theong> progress made inong>theong> renovation work.Furong>theong>r, in a number of rooms (in both buildings) residents had no lockable space ong>toong> song>toong>reong>theong>ir personal belongings. The CPT invites ong>theong> Esong>toong>nian authorities ong>toong> remedy this deficiency.94. Each unit had a communal/dinning room which was pleasantly decorated and used foroccupational and social activities. Furong>theong>r, all residents whose physical condition permitted weretaken out every day for walks or in wheelchairs (for one ong>toong> two hours).4. Staff and treatment95. At Ahtme Psychiatric Hospital, ong>theong> health care staff included six full-time posts ofpsychiatrists, 20 qualified nurses (including one half-time) and 25 nursing assistants (including onehalf-time). In addition, three psychologists (one full-time and two part-time) were employed at ong>theong>hospital. Given ong>theong> significant decrease in ong>theong> number of patients over ong>theong> past years, ong>theong> health carestaffing levels can be considered as very good. Consultations with a general practitioner and variousspecialist docong>toong>rs were arranged at ong>theong> local general hospital.96. The delegation’s discussions with patients and staff, as well as ong>theong> consultation of medicalrecords, showed that patients received individualised, mainly pharmacoong>theong>rapy-based, treatmentappropriate ong>toong> ong>theong>ir condition. Modern psychotropic drugs were available, and no signs ofovermedication were observed. Prescribed medication was frequently reviewed, and medical fileswere well kept.


- 38 -In addition, ong>theong> establishment offered various rehabilitative and ong>theong>rapeutic activities (e.g.psychoong>theong>rapy, occupational ong>theong>rapy, etc.). In order ong>toong> foster social re-integration, patients in ong>theong>open unit were offered leave on weekends, in order ong>toong> stay with ong>theong>ir families in ong>theong> outsidecommunity. This is a commendable practice.The delegation was informed about preliminary plans ong>toong> create a special nursing care sectionfor patients who are no longer in need of in-patient medical care, but who cannot live on ong>theong>ir ownand cannot be accommodated in ong>theong> outside community. The CPT would like ong>toong> receive moredetailed information on this matter.97. As already emphasised in ong>theong> CPT’s report on ong>theong> 1997 visit 56 , patients should, as a matter ofprinciple, be placed in a position ong>toong> give ong>theong>ir free and informed consent ong>toong> treatment. The admissionof a person ong>toong> a psychiatric establishment on an involuntary basis should not be construed asauong>toong>matically authorising treatment without his/her consent. Every competent patient, wheong>theong>rvoluntary or involuntary, should be given ong>theong> opportunity ong>toong> refuse treatment or any oong>theong>r medicalintervention. Any derogation from this fundamental principle should be based upon law and onlyrelate ong>toong> clearly and strictly defined exceptional circumstances.In ong>theong>ir interim response ong>toong> ong>theong> report on ong>theong> 1997 visit 57 , ong>theong> Esong>toong>nian authorities indicatedthat detailed guidelines and a special form concerning ong>theong> requirement of informed consent ofpatients had been elaborated. During ong>theong> 2003 visit, however, it emerged that no suchguidelines/form were in use at Ahtme Psychiatric Hospital.The CPT recommends that steps be taken at Ahtme Psychiatric Hospital (as well as inoong>theong>r psychiatric establishments in Esong>toong>nia) ong>toong> ensure that all competent patients are placedin ong>theong> position ong>toong> give ong>theong>ir informed consent ong>toong> treatment in writing. For this purpose, ong>theong>yshould be systematically provided with relevant information about ong>theong>ir condition and ong>theong>treatment prescribed for ong>theong>m (side effects, duration, etc.). Relevant information should alsobe provided ong>toong> patients following treatment (results, etc.).98. At Kernu Social Welfare Home, staff involved in residents’ care consisted of five qualifiednurses (full-time) and 15 nursing assistants (most of whom worked part-time). During day-shifts,two nurses and two nursing assistants were usually present; during night-shifts and weekends, ong>theong>rewas only one nurse and one nursing assistant.Until May 2003, a docong>toong>r providing both physical and psychiatric care attended ong>theong>establishment three days per week for six hours per day. This docong>toong>r had undertaken quarterlychecks on residents’ physical and mental health and a full review annually. In addition, an X-raywas carried out once per year. However, according ong>toong> ong>theong> new public health policy of ong>theong> Ministryof Social Affairs, regular visits by a general practitioner/psychiatrist were discontinued after ong>theong>retirement of ong>theong> above-mentioned docong>toong>r in May 2003. Consequently, residents with a physicalproblem had ong>toong> be brought ong>toong> ong>theong> local general practitioner in ong>theong> outside community. Equally, ifpatients needed a psychiatric consultation, ong>theong>y were taken ong>toong> Tallinn Psychiatric Hospital.5657Cf. paragraph 159 of doc. CPT/Inf (2002) 26.Cf. page 51 of doc. CPT/Inf (2002) 27.


- 39 -In practice, newly-arrived residents were no longer subject ong>toong> an auong>toong>matic medicalexamination upon admission, and X-ray screening was no longer conducted on a regular basis.Furong>theong>r, ong>theong> establishment was not attended by a psychologist or physioong>theong>rapist.99. In ong>theong> CPT’s view, ong>theong> current staff arrangements are clearly insufficient ong>toong> provideappropriate somatic and psychiatric care for residents with considerable needs at Kernu SocialWelfare Home. The lack of specific rehabilitation services, such as psychology or physioong>theong>rapy, wasparticularly striking. The CPT is also concerned by ong>theong> overall low number of nursing staff present inong>theong> various units, including on those with ong>theong> most disturbed and/or physically handicapped residents;such low staffing levels are not conducive ong>toong> appropriate care and supervision of residents and tend ong>toong>generate highly stressful work conditions. This state of affairs is clearly directly related ong>toong> ong>theong> level ofviolence among residents (cf. paragraph 89). Furong>theong>r, members of ong>theong> nursing staff with whom ong>theong>delegation spoke ong>toong>ok ong>theong> view that nursing assistants would benefit from specific training in dealingwith ong>theong> categories of residents cared for at ong>theong> establishment.100. In ong>theong> light of ong>theong> preceding remarks, ong>theong> CPT recommends that steps be taken at KernuSocial Welfare Home ong>toong> ensure that:- ong>theong> nursing staff presence, especially at night and on weekends, is reviewed; thiswill almost certainly require increasing ong>theong> overall complement of such staff;- specialised training is provided for nursing assistants in dealing with residentswith severe learning disabilities;- ong>theong> establishment is visited by a general practitioner and a psychiatrist at leasong>toong>nce per week;- every resident is subject ong>toong> a medical examination promptly upon admission;- rehabilitative services (psychology, physioong>theong>rapy, etc.) are provided.101. As regards pharmacoong>theong>rapeutic treatment, medication prescribed by docong>toong>rs wassystematically administered by qualified nurses. The delegation found no evidence of excessive useof psychoactive medication. Furong>theong>r, a range of occupational and recreational activities (drawingand sewing workshops, work in ong>theong> vegetable garden, etc.) were available at ong>theong> establishment.102. However, ong>theong> delegation observed that medical files were accessible ong>toong> non-medical staffand that medical information was also contained in administrative files. The CPT recommendsthat steps be taken ong>toong> ensure that ong>theong> confidentiality of medical data is fully respected.


- 40 -5. Restraint of agitated and/or violent patients/residents103. In any psychiatric/social welfare establishment, ong>theong> restraint of agitated and/or violentpatients/residents may on occasion be necessary. However, this is an area of particular concern ong>toong>ong>theong> CPT, given ong>theong> potential for abuse and ill-treatment.It is essential that ong>theong> restraint of patients/residents be ong>theong> subject of a clearly-defined policy.That policy should make clear that initial attempts ong>toong> restrain agitated or violent patients should, asfar as possible, be non-physical (e.g. verbal instruction) and that where physical restraint isnecessary, it should in principle be limited ong>toong> manual control.Resort ong>toong> instruments of physical restraint (straps, straight jackets, etc.) will only very rarelybe justified and must always be eiong>theong>r expressly ordered by a docong>toong>r or immediately brought ong>toong> ong>theong>attention of a docong>toong>r with a view ong>toong> seeking his approval. If, exceptionally, recourse is had ong>toong>instruments of physical restraint, ong>theong>y should be removed at ong>theong> earliest opportunity; ong>theong>y shouldnever be applied, or ong>theong>ir application prolonged, as a punishment.Furong>theong>r, every instance of ong>theong> physical restraint of a patient/resident (manual control, use ofinstruments of physical restraint, seclusion) should be recorded in a specific register established forthis purpose (as well as in ong>theong> patient's file). The entry should include ong>theong> times at which ong>theong>measure began and ended, ong>theong> circumstances of ong>theong> case, ong>theong> reasons for resorting ong>toong> ong>theong> measure,ong>theong> name of ong>theong> docong>toong>r who ordered or approved it, and an account of any injuries sustained bypatients or staff. This will greatly facilitate both ong>theong> management of such incidents and ong>theong> oversighong>toong>f ong>theong> extent of ong>theong>ir occurrence.104. Ahtme Psychiatric Hospital had two observation rooms (each with two beds) for ong>theong>seclusion and/or physical restraint of patients (four-point fixation ong>toong> ong>theong> bed with cloth straps). Bothrooms were permanently moniong>toong>red by nurses from ong>theong> adjacent treatment room, through a glasspanel.The hospital had no written policy on ong>theong> management of agitated/violent patients. Inpractice, ong>theong> use of means of restraint was always authorised first by a docong>toong>r, ong>theong> patient’s own or aduty docong>toong>r. Every instance of ong>theong> use of means of restraint or placement of a patient in anobservation room was recorded in ong>theong> patient’s file and ong>theong> nurses’ log book. However, ong>theong>serecords were not always complete (for instance, some files lacked information on ong>theong> preciseduration of ong>theong> application of such a measure). No special register was kept of ong>theong> use of means ofrestraint and seclusion.105. Kernu Social Welfare Home also lacked a written policy on ong>theong> management ofagitated/violent residents. In practice, ong>theong> initiative of applying means of restraint was taken by ong>theong>nurse on duty. Depending on ong>theong> level of agitation, resort was had ong>toong> ong>theong> following means: manualcontrol, forced injection of sedatives and (very rarely, pending ong>theong> transfer of ong>theong> resident ong>toong> apsychiatric hospital) a straitjacket. There was no special seclusion room.


- 41 -For some residents, ong>theong> use of specific means of restraint had been ordered by a psychiatristin advance, in ong>theong> event of ong>theong>ir becoming agitated. In oong>theong>r cases ong>theong> nurse on duty consulted apsychiatrist (usually at Tallinn Psychiatric Hospital) over ong>theong> telephone, who ong>theong>n gave preciseinstructions (in particular, ong>theong> dose of sedating medication). The use of physical force wasregistered in ong>theong> duty journal and ong>theong> Direcong>toong>r of ong>theong> establishment had ong>toong> be informed of suchincidents. However, ong>theong>re was no dedicated register of ong>theong> use of means of restraint.Staff had not received special training on how ong>toong> handle violent/aggressive residents.Several members of staff emphasised that, on several occasions, ong>theong>y had been unable ong>toong> bringviolent/aggressive male residents under control as ong>theong>re were no male staff employed at ong>theong>establishment. They reported that ong>theong>y had ong>toong> ask oong>theong>r residents ong>toong> assist in restraining by physicalforce ong>theong> person concerned. In some cases, any attempt ong>toong> restrain violent/aggressive residents whowere attacking fellow residents had failed, until ong>theong> arrival of ong>theong> ambulance or ong>theong> police.106. The CPT recommends that a written policy on ong>theong> use of means of restraint andseclusion be established both at Ahtme Psychiatric Hospital and Kernu Social Welfare Homeand that steps be taken ong>toong> ensure that ong>theong> procedures followed in this connection are broughtinong>toong> line with ong>theong> requirements set out in paragraph 103.Furong>theong>r, appropriate measures should be taken ong>toong> avoid involving residents in ong>theong>restraint of a fellow-resident. Resolving episodes of acutely disturbed behaviour should be ong>theong>exclusive responsibility of staff; ensuring that this is ong>theong> case will require increasing ong>theong> staffpresence (cf. paragraph 100).6. Safeguards107. On account of ong>theong>ir vulnerability, persons suffering from mental illness and/or learningdisabilities warrant particular attention in order ong>toong> prevent any form of conduct - or avoid anyomission - contrary ong>toong> ong>theong>ir well-being. It follows that involuntary placement in a psychiatricestablishment should always be surrounded by appropriate safeguards.a. initial placement and discharge procedures108. The procedure by which involuntary placement in a psychiatric/social welfare establishment isdecided should offer guarantees of independence and impartiality as well as of objective psychiatricexpertise. Furong>theong>r, such placement should cease as soon as it is no longer required by ong>theong>patient’s/resident’s mental state. Consequently, ong>theong> need for placement should be reviewed by anappropriate authority at regular intervals. In addition, ong>theong> patient/resident himself/herself should be ableong>toong> request at reasonable intervals that ong>theong> necessity for placement be considered by a judicial authority.


- 42 -109. As regards involuntary placement in a psychiatric hospital, ong>theong> Mental Health Act (MHA) 58only deals with ong>theong> emergency admission of mental patients (cf. paragraph 110). A procedureoutside emergency situations, whereby a mental patient could be hospitalised against his/her will, isapparently not provided for.The CPT would like ong>toong> know wheong>theong>r it is intended ong>toong> make provision for such aprocedure in ong>theong> context of ong>theong> ongoing reform of ong>theong> Esong>toong>nian mental health legislation.110. Pursuant ong>toong> ong>theong> relevant provisions of ong>theong> MHA, persons with mental disorders receivepsychiatric care on a voluntary basis, or, at ong>theong> request of emergency medical staff, ong>theong> police,persons close ong>toong> ong>theong>m or oong>theong>r persons, on an involuntary basis.According ong>toong> ong>theong> information gaong>theong>red by ong>theong> delegation at Ahtme Psychiatric Hospital,involuntary admissions were reviewed within 48 hours by two psychiatrists, who could ong>theong>nprolong involuntary placement for up ong>toong> 14 days. In most cases, ong>theong> written decision on ong>theong>prolongation was reasoned, in accordance with ong>theong> requirements set out in Section 11 of ong>theong> MHA.The contents were orally explained ong>toong> ong>theong> patient by ong>theong> treating docong>toong>r, and a copy was put inong>toong> ong>theong>individual file of ong>theong> patient. However, ong>theong> patient concerned did not receive a copy of ong>theong> decision.Patients had, ong>theong>oretically, ong>theong> right ong>toong> appeal ong>theong> latter decision before ong>theong> AdministrativeCourt; however, ong>theong>y were not informed of such a possibility. In addition, ong>theong> information gaong>theong>redby ong>theong> delegation would suggest that patients ran a risk of being charged high court fees in ong>theong> evenong>toong>f ong>theong>ir appeal being rejected, a state of affairs which evidently had a considerable deterrent effect.Not surprisingly, appeals were in practice never lodged.111. Prolongation of involuntary placement beyond ong>theong> 14-day deadline was only possible withong>theong> authorisation of ong>theong> competent administrative court, following a written request made by ong>theong>chief docong>toong>r of ong>theong> hospital. However, ong>theong> examination of individual patients’ files at AhtmePsychiatric Hospital revealed that ong>theong> entire court procedure (including ong>theong> decision on ong>theong>prolongation of ong>theong> hospitalisation for 30 or 90 days) had been extremely perfuncong>toong>ry.Moreover, ong>theong> delegation observed a number of deficiencies in ong>theong> procedures followed,which resulted, ong>toong> a large extent, from ong>theong> relevant provisions of ong>theong> MHA. The whole procedurewas only carried out in writing. No independent psychiatric expertise was sought by ong>theong> court, andong>theong> patient concerned was not heard in person. Furong>theong>r, although ong>theong> written decision contained areference ong>toong> ong>theong> possibility ong>toong> lodge an appeal, ong>theong> deadline for ong>theong> appeal was not stated. Inaddition, ong>theong> court decision was only delivered ong>toong> ong>theong> hospital, and ong>theong> patient concerned did noteven receive a copy of it. The delegation was however ong>toong>ld that patients were usually informedorally about ong>theong> contents of ong>theong> decision by ong>theong> treating docong>toong>r.58Cf. Sections 11 ong>toong> 13 of ong>theong> MHA.


- 43 -112. Pursuant ong>toong> Section 12, paragraph 4, of ong>theong> MHA, upon admission ong>toong> a psychiatric hospital,involuntary patients are only allowed “ong>toong> meet briefly 59 a close relative, ong>theong> legal representative or aphysician or lawyer of ong>theong>ir choice”.At Ahtme Psychiatric Hospital, ong>theong> delegation received no complaints that time restrictionson such visits had been imposed. However, ong>theong> CPT wishes ong>toong> emphasise ong>theong> importance of ong>theong>fundamental right of all persons deprived of ong>theong>ir liberty - including persons admitted involuntarilyong>toong> a psychiatric hospital - ong>toong> have unrestricted and unlimited access ong>toong> ong>theong>ir legal representative aswell as ong>toong> a lawyer of ong>theong>ir choice.113. As regards discharge procedures, involuntary patients may be released from a psychiatrichospital by an administrative court decision, following a request made by ong>theong> spouse, legalrepresentative or a close relative. 60 However, it appeared that Esong>toong>nian legislation does notexplicitly allow involuntary patients ong>theong>mselves ong>toong> request a judicial review during ong>theong>ir placement.114. The CPT recommends that ong>theong> Esong>toong>nian authorities review ong>theong> procedures forinvoluntary placement in psychiatric hospitals, in ong>theong> light of ong>theong> remarks made inparagraphs 107 ong>toong> 113.More particularly, steps should be taken ong>toong> ensure that:- involuntary placement procedures in psychiatric hospitals offer guarantees ofindependence and impartiality, as well as of objective psychiatric expertise;more specifically, a court should seek an opinion from a psychiatrist outside ong>theong>hospital concerned before deciding wheong>theong>r ong>toong> prolong an involuntaryplacement beyond 14 days;- patients who are admitted ong>toong> a psychiatric hospital on an involuntary basis haveong>theong> right ong>toong> be heard in person by ong>theong> court during placement/appealprocedures;- ong>theong> patient concerned is notified in writing of any decision on involuntaryplacement in a psychiatric hospital, informed about ong>theong> reasons for ong>theong> decisionand ong>theong> avenues/deadlines for lodging an appeal, and granted unlimited andunrestricted access ong>toong> his/her legal representative/lawyer;- indigent patients benefit from free legal representation and are exempted fromcourt fees incurred in ong>theong> context of judicial appeal/review procedures;- patients ong>theong>mselves are able ong>toong> request at reasonable intervals that ong>theong> necessityfor ong>theong>ir placement be considered by a judicial authority.5960Emphasis added.Cf. Section 13, paragraph 6, of ong>theong> MHA.


- 44 -115. Persons may be admitted ong>toong> a social welfare home, upon ong>theong>ir request or that of ong>theong>ir legalrepresentative/guardian, or by a decision of ong>theong> competent civil court. 61According ong>toong> Section 19 of ong>theong> Social Welfare Act, ong>theong> following criteria must be met beforeong>theong> civil court may pronounce a decision on involuntary admission in a social welfare home: (1) ong>theong>person concerned must be of unsound mind or an alcohol or a drug addict; and (2) pose a danger ong>toong>him/herself or ong>toong> oong>theong>rs unless placed in a social welfare institution; and (3) ong>theong> application of lessrestrictive measures has not been sufficient or ong>theong> use of oong>theong>r measures is not possible. The courtmay, ong>toong>geong>theong>r with ong>theong> decision on ong>theong> placement, appoint a guardian. The placement measure is validfor up ong>toong> one year and may be extended for periods not exceeding one year at a time. Currentlegislation does not require that ong>theong> person concerned is involved in ong>theong> judicial placement procedure.116. The examination of a number of individual residents’ files at Kernu Social Welfare Homeshowed that ong>theong> residents had been deprived of ong>theong>ir legal capacity and subsequently placed in ong>theong>home at ong>theong> request of ong>theong>ir guardian or had been placed ong>theong>re by court order, without ever havingbeen heard in person by a judge. During judicial placement procedures, courts had not appointedlegal representatives ex officio. Furong>theong>r, ong>theong> residents concerned had not even received a copy of ong>theong>relevant court decisions. Several residents also claimed that ong>theong>y had never been informed aboutpossibilities of challenging such decisions.117. The need for continued placement by court order in a social welfare home is auong>toong>maticallyreviewed in ong>theong> context of ong>theong> procedure on extension of such placement (upon expiry of ong>theong>preceding placement order). However, as far as ong>theong> delegation could ascertain, neiong>theong>r ong>theong> residentconcerned nor his/her guardian are entitled ong>toong> request a judicial review of an ongoing involuntaryplacement.As regards residents who had been admitted on an involuntary basis ong>toong> Kernu SocialWelfare Home before ong>theong> entry inong>toong> force of ong>theong> 2002 amendment ong>toong> ong>theong> Social Welfare Act, ong>theong>delegation was informed by ong>theong> Direcong>toong>r of ong>theong> establishment that several cases had recently beennotified ong>toong> ong>theong> court, in order ong>toong> initiate proceedings ong>toong> appoint a guardian and issue an involuntaryplacement order. 62118. It should be added that ong>theong> legal status of many residents at ong>theong> Kernu Social Welfare Homewas unclear ong>toong> staff, including ong>theong> management. As a consequence, instances occurred whenresidents who were de iure staying at ong>theong> establishment as voluntary residents were prevented fromleaving (for ong>theong>ir own protection), without an involuntary placement procedure being initiated.6162The involvement of civil courts in such procedures was introduced by an amendment ong>toong> ong>theong> Social Welfare Actin 2002.Prior ong>toong> 2002, residents where admitted ong>toong> ong>theong> social welfare home by an expert commission subordinated ong>toong>ong>theong> Ministry of Social Affairs. Their placement was only subject ong>toong> a regular review until 1987 (by acommission of psychiatrists).


- 45 -119. The CPT recommends that ong>theong> Esong>toong>nian authorities take steps ong>toong> ensure that:- residents who are placed in a social welfare home on an involuntary basis bycourt decision have ong>theong> right ong>toong> be heard in person during placement/appealprocedures;- ong>theong> resident concerned is notified in writing of decisions on involuntaryplacement in a social welfare home, informed about ong>theong> reasons for ong>theong> decisionand ong>theong> avenues/deadlines for lodging an appeal;- residents and/or ong>theong>ir guardian are able ong>toong> request at reasonable intervals thatong>theong> necessity for placement be considered by a judicial authority;- all cases of involuntary admission ong>toong> Kernu Social Welfare Home prior ong>toong> 2002are notified ong>toong> ong>theong> competent civil court;- ong>theong> legal status of voluntary residents who are prevented from leaving KernuSocial Welfare Home is clarified.120. A certain number of patients/residents at Ahtme Psychiatric Hospital and Kernu SocialWelfare Home were persons deprived of ong>theong>ir legal capacity who had been placed in thoseestablishments at ong>theong> request of ong>theong>ir guardian.The procedure for depriving a person of his/her legal capacity is regulated by ong>theong> FamilyLaw Act and ong>theong> Code of Civil Procedure. 63 A guardian may be appointed upon a person’s ownrequest or upon ong>theong> proposal by a family member or ong>theong> guardianship authority (localadministration). During this procedure, ong>theong> wishes of ong>theong> person concerned shall be taken inong>toong>account, and he/she shall be summoned ong>toong> a court session if his/her mental state allows. Apsychiatric expertise is required. 64Such persons could be admitted ong>toong> a psychiatric hospital/social welfare home solely with ong>theong>written consent of ong>theong>ir guardian. As a consequence, ong>theong>y were considered voluntary patients andcourts were not involved in ong>theong> placement procedure. In ong>theong> CPT’s view, placing incapacitatedpersons in a psychiatric hospital/social welfare institution, without ong>theong> benefit of ong>theong> proceduralsafeguards oong>theong>rwise provided for by law, is a highly questionable practice. The CPT would like ong>toong>receive ong>theong> Esong>toong>nian authorities’ comments on this point.121. Furong>theong>r, at ong>theong> Kernu Social Welfare Home, ong>theong> delegation observed that a nursing assistantacted as court-appointed guardian for 10 out of 16 residents, who were deprived of ong>theong>ir legalcapacity. The very fact that it is also ong>theong> role of a guardian ong>toong> defend ong>theong> rights of incapacitatedpersons vis à vis ong>theong> hosting social welfare institution may easily lead ong>toong> a conflict of interest and,eventually, compromise ong>theong> independence and impartiality of ong>theong> guardian. Therefore, ong>theong> CPTrecommends that ong>theong> Esong>toong>nian authorities strive ong>toong> find alternative solutions which wouldbetter guarantee ong>theong> independence and impartiality of guardians.6364Cf. Section 95 of ong>theong> Family Law Act and Sections 256 ong>toong> 263 of ong>theong> Code of Civil Procedure.In this connection, ong>theong> CPT welcomes ong>theong> decision of ong>theong> Esong>toong>nian Supreme Court dated 30 Ocong>toong>ber 2003,which ruled that, according ong>toong> Article 6 of ong>theong> European Convention of Human Rights, a person must have ong>theong>right ong>toong> be brought before ong>theong> court and be represented by a legal representative appointed ex officio (paid byong>theong> State) during proceedings ong>toong> deprive him/her of his/her legal capacity.


- 46 -b. safeguards during placement122. An introducong>toong>ry leaflet/brochure setting out ong>theong> establishment’s routine andpatients’/residents’ rights should be issued ong>toong> each patient/resident on admission, as well as ong>toong> ong>theong>irfamilies. Any patients/residents unable ong>toong> understand this brochure should receive appropriateassistance.At both establishments visited, patients/residents were informed orally upon admissionabout ong>theong> internal rules, which were displayed on notice boards in ong>theong> wards. However, no writteninformation was provided upon admission ong>toong> patients/residents.The CPT recommends that an introducong>toong>ry leaflet/brochure be issued at AhtmePsychiatric Hospital and Kernu Social Welfare Home ong>toong> each newly-arrived patient/resident(and his/her legal representative), accompanied, if necessary, by appropriate oral explanation.123. An effective complaints procedure is anoong>theong>r basic safeguard against ill-treatment inpsychiatric establishments. Specific arrangements should exist enabling patients/residents ong>toong> lodgeformal complaints with a clearly-designated body, and ong>toong> communicate on a confidential basis withan appropriate authority outside ong>theong> establishment.At Ahtme Psychiatric Hospital, patients could submit a complaint ong>toong> ong>theong> Direcong>toong>r or ong>theong>social welfare departments of ong>theong> local and county authorities, ong>theong> Ministry of Social Affairs and ong>theong>competent courts. However, no information was provided ong>toong> patients about ong>theong> existence of suchpossibilities. At Kernu Social Welfare Home, complaints by residents were handled informally byong>theong> nurse on duty or ong>theong> Direcong>toong>r. External complaints could also be lodged by residents and ong>theong>irlegal representatives with ong>theong> competent local and county authorities. However, residents receivedno information in this regard.The CPT recommends that at both establishments, patients/residents be informed inong>theong> introducong>toong>ry leaflet/brochure issued upon admission of ong>theong>ir right ong>toong> lodge complaints aswell as of ong>theong> modalities for doing so.124. The CPT also attaches considerable importance ong>toong> psychiatric/social welfare establishmentsbeing visited on a regular basis by an independent outside body (e.g. a judge or supervisorycommittee) which is responsible for ong>theong> inspection of patients’/residents’ care. This body should beauthorised, in particular, ong>toong> talk privately with patients/residents, receive directly any complaintswhich ong>theong>y might have and make any necessary recommendations.


- 47 -Ahtme Psychiatric Hospital was regularly visited by representatives of ong>theong> Sickness BenefitFund (affiliated with ong>theong> Ministry of Social Affairs). However, ong>theong>se visits focused more onfinancial matters than on ong>theong> quality of care and ong>theong> living conditions of patients. A specialinspection was carried out by ong>theong> Ministry of Social Affairs in ong>theong> context of ong>theong> hospital’stransformation inong>toong> a foundation at ong>theong> end of 2002. Kernu Social Welfare Home was visited biannuallyby representatives of ong>theong> social welfare department of ong>theong> local administration, ong>theong> HealthProtection Inspecong>toong>rate and ong>theong> County Medical Officer (twice per year).The CPT invites ong>theong> Esong>toong>nian authorities ong>toong> explore ong>theong> possibility of introducingregular visits ong>toong> psychiatric/social welfare establishments by a body which is independent ofong>theong> health/social welfare authorities.125. At both establishments, ong>theong> existing arrangements for contact with ong>theong> outside world weresatisfacong>toong>ry. Patients/residents were able ong>toong> send and receive correspondence, ong>toong> have access ong>toong> ong>theong>telephone, and ong>toong> receive visits every day from ong>theong>ir families and friends (cf., however,paragraph 112). Furong>theong>r, arrangements were made ong>toong> allow patients/residents ong>toong> stay with ong>theong>irfamilies over weekends (cf. paragraph 96).


- 49 -III.RECAPITULATION AND CONCLUSIONSA. Police establishments126. The majority of persons deprived of ong>theong>ir liberty interviewed during ong>theong> visit made noallegation of ill-treatment in police cusong>toong>dy. In particular, ong>theong> delegation received hardly anycomplaints about ong>theong> manner in which detained persons were treated by cusong>toong>dial staff of arresthouses. However, ong>theong> delegation did receive some allegations of ill-treatment by oong>theong>r policeofficers; those accounts included being punched, kicked or struck with baong>toong>ns, and related both ong>toong>ong>theong> time of apprehension as well as ong>toong> ong>theong> time spent in a police establishment. There were also afew cases where ong>theong> delegation gaong>theong>red supporting medical evidence, consistent with accounts ofill-treatment.The CPT has recommended that senior police officers regularly instruct police officers that:ill-treatment will not be ong>toong>lerated; all relevant information regarding alleged ill-treatment will beinvestigated; and perpetraong>toong>rs of such treatment will be subject ong>toong> severe sanctions. Furong>theong>r, policeofficers should be reminded that no more force than is reasonably necessary is ong>toong> be used wheneffecting an apprehension. The Committee has also highlighted ong>theong> steps ong>toong> be taken by judges orprosecuong>toong>rs whenever ong>theong>re are grounds ong>toong> believe that persons brought before ong>theong>m could havebeen ong>theong> victims of ill-treatment.127. The duty of care which is owed by ong>theong> police ong>toong> persons in ong>theong>ir cusong>toong>dy includes ong>theong>responsibility ong>toong> ensure ong>theong> safety and physical integrity of detained persons. Police officers shouldbe alert ong>toong> any potential for self-harm and, more specifically, ensure that newly-detained persons donot have ready access ong>toong> means of harming ong>theong>mselves (belts, ties, broken glass, etc.). Theimportance of ong>theong>se principles was highlighted by a serious incident which had taken place at NarvaArrest House shortly before ong>theong> visit. The CPT has asked ong>toong> be informed of ong>theong> outcome of ong>theong>inquiry initiated following that incident.128. As early as 1997, ong>theong> CPT was highly critical of conditions of detention in police arresthouses; ong>theong> 2003 visit revealed that ong>theong> Esong>toong>nian authorities have failed ong>toong> implement its keyrecommendations in this area.In respect of certain arrest houses, including those in Kohtla-Järve and Narva, ong>theong>cumulative effect of ong>theong> execrable material conditions and ong>theong> impoverished regime could well bedescribed as inhuman and degrading. Detainees were locked up 24 hours per day - with no outdoorexercise - in cells that were filthy, dimly lit and severely overcrowded. The unpartitioned lavaong>toong>ries- where persons were obliged ong>toong> relieve ong>theong>mselves in ong>theong> direct presence of ong>theong>ir cellmates -exacerbated ong>theong> effects of ong>theong> very poor ventilation. In many cases, persons were provided with nomattresses and blankets, and lacked basic personal hygiene products. The conditions of detention ofjuveniles were no different from those of ong>theong>ir adult counterparts; furong>theong>r, in a number of cases,juveniles were placed in ong>theong> same cells as adults, including for prolonged periods.


- 50 -The Esong>toong>nian authorities must take resolute and sustained action - founded on a solid,properly-resourced strategy - ong>toong> improve conditions of detention in arrest houses, in light of ong>theong>CPT's detailed recommendations. That strategy should include regular independent inspections ofong>theong> premises concerned. As for juveniles placed in arrest houses, ong>theong>y must be accommodatedseparately from adults, and those detained for prolonged periods should be provided with aprogramme of educational activities (including physical education).129. As regards formal safeguards against ill-treatment, ong>theong> new Code of Criminal Procedure(due ong>toong> enter inong>toong> force on 1 July 2004) makes no explicit reference ong>toong> ong>theong> right of persons deprivedof ong>theong>ir liberty ong>toong> notify a third party of ong>theong>ir cusong>toong>dy; this lacuna needs ong>toong> be filled. In contrast, ong>theong>new provisions concerning ong>theong> right of access ong>toong> a lawyer for criminal suspects have beenwelcomed by ong>theong> CPT. The Committee has also recommended that appropriate action be taken ong>toong>ensure that ong>theong> above-mentioned rights are rendered fully effective in practice, with respect ong>toong> allcategories of persons deprived of ong>theong>ir liberty by ong>theong> police.As for access ong>toong> a docong>toong>r, persons admitted ong>toong> arrest houses were still not benefiting from athorough medical screening promptly on arrival; this is all ong>theong> more serious considering ong>theong> increaseof ong>theong> maximum periods of detention. Responding ong>toong> ong>theong> delegation's end-of-visit observations onthis subject, ong>theong> Esong>toong>nian authorities have indicated that police prefectures have concluded, or willsoon conclude, agreements for ong>theong> provision of health care services. The CPT has welcomed thisdevelopment.B. Prisons130. No allegations of ill-treatment of inmates by staff were heard at Tallinn Prison or at ong>theong>Central Prison Hospital. Furong>theong>r, ong>theong> majority of inmates interviewed at Tartu Prison made noallegations of such treatment.However, a number of consistent accounts were heard at Tartu Prison relating ong>toong> allegedbeatings by masked members of a special squad during an intervention in ong>theong> block for sentencedprisoners in May 2003. The CPT’s delegation requested ong>theong> authorities ong>toong> ensure that a thorough,impartial, and independent inquiry was carried out inong>toong> ong>theong> matter. The CPT has welcomed ong>theong>swift response by ong>theong> Esong>toong>nian authorities, who indicated that an inquiry had been initiated "in orderong>toong> find out ong>theong> exact course of events and ong>toong> prevent such incidents from happening in ong>theong> future."The CPT has recommended that any future involvement in prisons of a special interventionsquad be moniong>toong>red by an authority (e.g. senior judicial authorities) which is independent from ong>theong>particular establishment concerned as well as from ong>theong> squad carrying out ong>theong> intervention. Thepresence of such an authority would have a dissuasive effect on anyone minded ong>toong> ill-treatprisoners, and greatly facilitate ong>theong> investigation of any allegations of ill-treatment and ong>theong> correctattribution of blame.


- 51 -131. More generally, ong>theong> CPT has recommended that ong>theong> Esong>toong>nian authorities continue ong>toong> givehigh priority ong>toong> ong>theong> development of prison staff training, both initial and ongoing. In ong>theong> course ofsuch training, considerable emphasis should be placed on ong>theong> acquisition of interpersonalcommunication skills.132. The Esong>toong>nian authorities can be justly proud of ong>theong> material conditions of detention at TartuPrison; comparing what ong>theong> CPT found at ong>theong> Central Prison during its first visit ong>toong> Esong>toong>nia in 1997ong>toong> what it found in 2003 at ong>theong> new prison - in terms of material conditions - is like comparing nightand day.However, as regards ong>theong> remand section of Tallinn Prison, ong>theong> transfer of inmates from ong>theong>now-defunct Central Prison has led ong>toong> overcrowding and, consequently, ong>toong> a deterioration ofmaterial conditions. The CPT has recommended that ong>theong> Esong>toong>nian authorities rapidly devise andvigorously pursue a strategy for reducing ong>theong> occupancy rates in ong>theong> remand blocks of TallinnPrison, always bearing in mind that ong>theong> strategy should not have ong>theong> side effect of transferring aproblem from one establishment ong>toong> anoong>theong>r. A standard of at least 4 m² of living space per prisonerin multi-occupancy cells should be maintained throughout ong>theong> prison system.133. A fundamental problem as regards remand prisoners in Esong>toong>nia is ong>theong> ong>toong>tal lack of out-ofcellactivities offered ong>toong> inmates. In this respect, ong>theong> Imprisonment Act (2000) flatly contradicts ong>theong>urgent recommendation made by ong>theong> Committee on this subject after ong>theong> 1997 visit. At ong>theong> time ofong>theong> 2003 visit, remand prisoners were being held for 23 hours a day in ong>theong>ir cells. Their onlyregular out-of-cell activity was a daily hour of outdoor exercise, in areas which were not sufficientlylarge ong>toong> permit ong>theong>m ong>toong> exert ong>theong>mselves physically. As regards, more particularly, ong>theong> situation inTartu Prison, one of ong>theong> most harmful effects of ong>theong> impoverished regime for remand prisoners heldin that establishment was ong>theong> reduction of human contact ong>toong> a bare minimum, due ong>toong> ong>theong> fact thatprisoners were held one or two ong>toong> a cell and inmates from different cells could never associate. Inthis regard, ong>theong> CPT has repeatedly cautioned that ong>theong> introduction of smaller units for prisonersmust under no circumstances be allowed ong>toong> lead ong>toong> a generalised system of small-group isolation.The Committee was pleased ong>toong> note that ong>theong> Esong>toong>nian authorities have expressed agreement with itsdelegation's remarks concerning ong>theong> above-mentioned matter.The CPT has recommended that ong>theong> Esong>toong>nian authorities take steps, as a matter of urgency,ong>toong> radically improve ong>theong> regime activities for remand prisoners. The aim should be ong>toong> ensure thatremand prisoners are able ong>toong> spend a reasonable part of ong>theong> day outside ong>theong>ir cells, engaged inpurposeful activities of a varied nature (group association activities; work, preferably withvocational value; sport). The legislative framework governing remand imprisonment must berevised accordingly.134. Although sentenced prisoners at Tartu Prison did have an appropriate amount of daily timeoutside ong>theong>ir units, ong>theong>re remained a gap between ong>theong> aspirations professed by management and staffand ong>theong> programmes of activities which were actually being delivered ong>toong> many of ong>theong>m; some 37 %of ong>theong> inmates did not benefit from a positive regime which might encourage ong>theong>m ong>toong> address ong>theong>iroffending behaviour. The CPT has recommended that ong>theong> relevant authorities take ong>theong> necessarysteps ong>toong> ensure that all prisoners at Tartu Prison have access ong>toong> an appropriate range of work,educational, sports and recreational activities.


- 52 -135. The health care staffing level at Tallinn Prison was scarcely sufficient ong>toong> provide adequatehealth care; in particular, ong>theong> nursing staff resources were clearly inadequate. The situation wassomewhat better at Tartu Prison. As for ong>theong> health care facilities, ong>theong>y were of an excellent standardat Tartu, and generally satisfacong>toong>ry at Tallinn. The CPT has made recommendations designed ong>toong>reinforce ong>theong> contribution made by prison health care services ong>toong> ong>theong> prevention of ill-treatment ofdetained persons, through ong>theong> detailed and systematic recording of injuries observed during ong>theong>examination of inmates.136. The problem of overcrowding at ong>theong> Central Prison Hospital in Tallinn had been resolved withong>theong> closure of ong>theong> Central Prison. However, in all oong>theong>r respects, ong>theong> hospital's material conditions -which were ong>theong> subject of ong>theong> CPT's principal criticism of ong>theong> establishment in ong>theong> report on its 1997visit - had actually deteriorated. Given ong>theong> hospital's severely dilapidated state, it remained practicallyimpossible ong>toong> maintain even a minimum level of hygiene in ong>theong> premises. The Esong>toong>nian authoritiesmust be unwavering in ong>theong>ir efforts ong>toong> withdraw ong>theong> Central Prison Hospital from service at ong>theong>earliest possible opportunity; ong>theong> premises are inherently unsuitable for use as a hospital.C. Psychiatric establishments137. The delegation heard no allegations of ill-treatment of patients/residents by staff at AhtmePsychiatric Hospital and Kernu Social Welfare Home. The atmosphere in ong>theong> two institutions wason ong>theong> whole relaxed, and staff-patient/resident relations were good. The CPT wishes ong>toong> place onrecord ong>theong> professionalism and commitment demonstrated by ong>theong> medical and nursing staff ong>toong>wardsong>theong>ir patients/residents.138. Neverong>theong>less, ong>theong> CPT is seriously concerned about ong>theong> level of violence among residents atKernu Social Welfare Home; its delegation received numerous allegations of verbal and physicalassaults of residents by fellow-residents. The CPT has recommended that urgent steps be taken atKernu ong>toong> elaborate and implement in practice a specific policy aimed at reducing ong>theong> risk of interresidentviolence.139. The delegation formed a generally favourable impression of patients’ living conditions at AhtmePsychiatric Hospital. However, ong>theong> CPT has recommended that immediate steps be taken ong>toong> offer aminimum of one hour of outdoor exercise per day ong>toong> all patients whose state of health so permits.


- 53 -At Kernu Social Welfare Home, ong>theong> living conditions were of a good standard in allrenovated areas (including ong>theong> entire closed unit). In contrast, ong>theong> rooms in ong>theong> main building whichhad not yet been renovated were in a poor state of repair; ong>theong> CPT has sought information on ong>theong>progress made in ong>theong> renovation work.140. Health care staffing levels and ong>theong> provision of treatment were very good at AhtmePsychiatric Hospital. Patients received individualised, mainly pharmacoong>theong>rapy-based, treatmentappropriate ong>toong> ong>theong>ir condition. In addition, ong>theong> establishment offered various rehabilitative andong>theong>rapeutic activities (e.g. psychoong>theong>rapy, occupational ong>theong>rapy, etc.).The CPT has neverong>theong>less emphasised once again that patients should, as a matter ofprinciple, be placed in a position ong>toong> give ong>theong>ir free and informed consent ong>toong> treatment. Theadmission of a person ong>toong> a psychiatric establishment on an involuntary basis should not beconstrued as auong>toong>matically authorising treatment without his/her consent. This implies that patientsshould be systematically provided with relevant information about ong>theong>ir condition and ong>theong> treatmentprescribed for ong>theong>m (side effects, duration, results, etc.).At Kernu Social Welfare Home, ong>theong> provision of appropriate somatic and psychiatric carewas seriously compromised by inadequate staff arrangements and ong>theong> lack of specific rehabilitationservices. The CPT has recommended in particular that steps be taken ong>toong> ensure that ong>theong> nursing staffpresence, especially at night and on weekends, is reviewed, and that ong>theong> establishment is visited bya general practitioner and a psychiatrist at least once per week. Furong>theong>r, rehabilitative services(psychology, physioong>theong>rapy, etc.) should be provided.141. As regards ong>theong> use of means of physical restraint, ong>theong> CPT has recommended that a clearwritten policy on how ong>toong> deal with agitated and/or violent residents be established at AhtmePsychiatric Hospital and Kernu Social Welfare Home, taking inong>toong> account criteria identified by ong>theong>Committee. Furong>theong>r, appropriate steps should be taken at Kernu ong>toong> avoid involving residents in ong>theong>restraint of a fellow-resident.142. The CPT has also made a number of specific recommendations concerning ong>theong> safeguardssurrounding ong>theong> involuntary placement of persons in psychiatric hospitals and social welfare homes,e.g. ong>theong> right of patients/residents ong>toong> be heard in person by ong>theong> court during involuntaryplacement/appeal procedures; decisions on involuntary placement ong>toong> be notified in writing ong>toong> ong>theong>patient/resident concerned; access ong>toong> free legal representation for indigent patients; information onpatients’/residents’ rights. The Committee has also invited ong>theong> Esong>toong>nian authorities ong>toong> explore ong>theong>possibility of introducing regular visits ong>toong> psychiatric/social welfare establishments by a body whichis independent of ong>theong> health/social welfare authorities.


- 54 -D. Action on ong>theong> CPT’s recommendations, comments and requests for information143. The various recommendations, comments and requests for information formulated by ong>theong>CPT are listed in Appendix I.144. As regards more particularly ong>theong> CPT's recommendations, having regard ong>toong> Article 10 of ong>theong>Convention, ong>theong> Committee requests ong>theong> Esong>toong>nian authorities ong>toong> provide within six months aresponse giving a full account of action taken ong>toong> implement ong>theong>m.The CPT trusts that it will also be possible for ong>theong> Esong>toong>nian authorities ong>toong> provide in ong>theong>above-mentioned response, reactions ong>toong> ong>theong> comments formulated in this report as well as replies ong>toong>ong>theong> requests for information made.


- 55 -APPENDIX ILIST OF THE CPT'S RECOMMENDATIONS,COMMENTS AND REQUESTS FOR INFORMATIONA. Police establishmentsIll-treatmentrecommendations- senior police officers regularly ong>toong> instruct police officers that: ill-treatment will not beong>toong>lerated; all relevant information regarding alleged ill-treatment will be investigated; andperpetraong>toong>rs of ill-treatment will be subject ong>toong> severe sanctions (paragraph 14);- police officers ong>toong> be reminded that no more force than is reasonably necessary should beused when effecting an apprehension and that once apprehended persons have been broughtunder control, ong>theong>re can be no justification for ong>theong>ir being struck (paragraph 15);- whenever criminal suspects brought before an investigating judge or public prosecuong>toong>r at ong>theong>end of police cusong>toong>dy or ong>theong>reafter allege ill-treatment by ong>theong> police, ong>theong> judge or prosecuong>toong>rshould record ong>theong> allegations in writing, order immediately a forensic medical examinationand take ong>theong> necessary steps ong>toong> ensure that ong>theong> allegations are properly investigated. Such anapproach should be followed wheong>theong>r or not ong>theong> person concerned bears visible externalinjuries. Furong>theong>r, even in ong>theong> absence of an express allegation of ill-treatment, ong>theong> judge orprosecuong>toong>r should order a forensic medical examination whenever ong>theong>re are oong>theong>r grounds ong>toong>believe that a person brought before him could have been ong>theong> victim of ill-treatment(paragraph 18);- immediate steps ong>toong> be taken ong>toong> ensure that all police cells, including those in arrest houses,are adequately moniong>toong>red, taking inong>toong> account ong>theong> remarks in paragraph 20 (paragraph 20);- in respect of every occasion on which inmates are removed from prison at ong>theong> request of apolice investigaong>toong>r, a formal record ong>toong> be kept of ong>theong> reason for ong>theong>ir removal and of allmeasures taken during ong>theong>ir presence on police premises (paragraph 22).comments- police officers should be alert ong>toong> any potential for self-harm and, more specifically, ensurethat newly-detained persons do not have ready access ong>toong> means of harming ong>theong>mselves(belts, ties, broken glass, etc.) (paragraph 19).


- 56 -requests for information- an account, covering ong>theong> period from 1 January 2003 ong>toong> ong>theong> present time, of all complaints ofpolice violence received and ong>theong> outcome of ong>theong> relevant disciplinary and/or criminalproceedings (allegations, brief descriptions of ong>theong> findings of ong>theong> relevant court or body,verdict, sentence/sanction imposed) (paragraph 16);- confirmation that, under ong>theong> new Code of Criminal Procedure, ong>theong>re is no longer ong>theong>possibility for detained persons ong>toong> waive ong>theong>ir right ong>toong> be brought before ong>theong> judge who mustdecide on ong>theong> prolongation of police cusong>toong>dy beyond 48 hours (paragraph 17);- ong>theong> outcome of ong>theong> inquiry initiated following ong>theong> suicide by a detainee in one of ong>theong>temporary holding cells at Narva Arrest House in September 2003, and any measures takenin response (paragraph 19).Conditions of detentionrecommendations- all necessary steps ong>toong> be taken ong>toong> implement, without furong>theong>r delay, ong>theong> CPT'srecommendations concerning material conditions of detention in police arrest houses (cf.paragraphs 39 ong>toong> 41 of CPT/Inf (2002) 26 and paragraphs 23 ong>toong> 25 of CPT/Inf (2002) 28).The strategy for improving conditions of detention should include regular independentinspections of ong>theong> premises concerned (paragraph 32);- immediate steps ong>toong> be taken ong>toong> ensure that juveniles placed in arrest houses areaccommodated separately from adult detainees. Juveniles detained for prolonged periodsshould be provided with a programme of educational activities (including physicaleducation) (paragraph 32);- as a first step concerning ong>theong> organisation of a regime of activities, reading matter ong>toong> beprovided ong>toong> persons held in arrest houses. Consideration should also be given ong>toong> permittingong>theong>m ong>toong> keep radios or television sets in ong>theong>ir cells (paragraph 33);- anyone held in an arrest house for a prolonged period should be permitted ong>toong> maintaincontacts with ong>theong> outside world according ong>toong> ong>theong> same principles as those which shouldapply ong>toong> a person held in prison (paragraph 33);- ong>theong> shortcomings observed in ong>theong> cells at Põhja Police Department in Tallinn ong>toong> be remedied(paragraph 35);- conditions of detention in all police establishments in Esong>toong>nia ong>toong> be reviewed, having regardong>toong> ong>theong> criteria set out in paragraph 23 (paragraph 35).


- 57 -requests for information- confirmation that "bedsheet sets" include clean mattresses and clean blankets(paragraph 31);- a copy of ong>theong> standard design for arrest houses (paragraph 32).Safeguards against ong>theong> ill-treatment of persons deprived of ong>theong>ir libertyrecommendations- ong>theong> new Code of Criminal Procedure ong>toong> be amended ong>toong> include explicit reference ong>toong> ong>theong> righong>toong>f notification of cusong>toong>dy, incorporating fully ong>theong> principles set out by ong>theong> Committee in itsprevious visit reports (cf. in particular paragraph 29 of CPT/Inf (2002) 28). In ong>theong> interim,ong>theong> right of notification of cusong>toong>dy should be developed in subsidiary regulations(paragraph 37);- appropriate action ong>toong> be taken ong>toong> ensure that ong>theong> right of notification of cusong>toong>dy is renderedfully effective in practice, with respect ong>toong> all categories of persons deprived of ong>theong>ir libertyby ong>theong> police (including administrative detainees) (paragraph 37);- a docong>toong>r ong>toong> be called without delay whenever a person in police cusong>toong>dy requests a medicalexamination; police officers should not seek ong>toong> vet such requests (paragraph 40);- written information on rights ong>toong> be given ong>toong> all persons deprived of ong>theong>ir liberty by ong>theong>police, at ong>theong> very outset of ong>theong>ir deprivation of liberty (paragraph 41).comments- ong>theong> CPT trusts that appropriate steps will be taken ong>toong> ensure that ong>theong> provisions on access ong>toong>a lawyer contained in ong>theong> new Code are fully complied with in practice. The right of accessong>toong> a lawyer should be enjoyed by anyone who is under a legal obligation ong>toong> attend - and stayat - a police establishment. Furong>theong>r, appropriate provision should be made for persons whoare not in a position ong>toong> pay for a lawyer. The Committee suggests that ong>theong> Bar Associationbe consulted in this context (paragraph 38).requests for information- a detailed account of ong>theong> progress made ong>toong>wards providing proper health care in all policearrest houses (paragraph 40).


- 58 -B. PrisonsIll-treatmentrecommendations- any future involvement in prisons of a special intervention squad ong>toong> be moniong>toong>red by anindependent authority (e.g. senior judicial authorities) (paragraph 45);- ong>theong> necessary steps ong>toong> be taken ong>toong> ensure that, in respect of all investigations inong>toong> possible illtreatmentby prison officers, ong>theong> persons responsible for ong>theong> investigation, as well as thoseactually carrying it out, are independent from those implicated in ong>theong> events (paragraph 46);- ong>theong> Esong>toong>nian authorities ong>toong> continue ong>toong> give high priority ong>toong> ong>theong> development of prison stafftraining, both initial and ongoing. In ong>theong> course of such training, considerable emphasisshould be placed on ong>theong> acquisition of interpersonal communication skills (paragraph 48);- steps ong>toong> be taken at Tallinn Prison ong>toong> ensure that prison officers do not carry baong>toong>ns in fullview of inmates (paragraph 49).requests for information- ong>theong> outcome of ong>theong> inquiry concerning an intervention by a special squad in ong>theong> block forsentenced prisoners in May 2003 at Tartu Prison, as well as any measures taken in response(paragraph 45);- for ong>theong> period from 1 January 2003 ong>toong> ong>theong> present time:• ong>theong> number of complaints lodged of ill-treatment by cusong>toong>dial staff in establishmentsunder ong>theong> authority of ong>theong> Ministry of Justice and ong>theong> number of disciplinary and/orcriminal proceedings initiated as a result of those complaints;• an account of disciplinary/criminal sanctions imposed on ong>theong> grounds of ill-treatmentby cusong>toong>dial staff(paragraph 50).


- 59 -Material conditionsrecommendations- ong>theong> Esong>toong>nian authorities ong>toong> rapidly devise and vigorously pursue a strategy for reducing ong>theong>occupancy rates in ong>theong> remand blocks of Tallinn Prison ong>toong> no more than four persons percell, always bearing in mind that ong>theong> strategy should not have ong>theong> side effect of transferring aproblem from one establishment ong>toong> anoong>theong>r (paragraph 52);- ong>theong> necessary repairs ong>toong> be carried out ong>toong> ong>theong> installations and cells in ong>theong> remand section atTallinn Prison (paragraph 52);- ong>theong> Esong>toong>nian authorities ong>toong> strive ong>toong> maintain a standard of at least 4 m² of living space perprisoner in multi-occupancy cells, and official capacities ong>toong> be calculated accordingly(paragraph 53).Activitiesrecommendations- steps ong>toong> be taken, as a matter of urgency, ong>toong> radically improve ong>theong> regime activities forremand prisoners. The aim should be ong>toong> ensure that remand prisoners are able ong>toong> spend areasonable part of ong>theong> day outside ong>theong>ir cells, engaged in purposeful activities of a variednature (group association activities; work, preferably with vocational value; sport). Thelegislative framework governing remand imprisonment must be revised accordingly(paragraph 56);- outdoor exercise facilities ong>toong> be made sufficiently large ong>toong> enable prisoners ong>toong> exertong>theong>mselves physically (paragraph 56);- ong>theong> practice of playing a radio programme tuned ong>toong> an unpleasantly high volume all day atTallinn Prison ong>toong> be discontinued (paragraph 57);- ong>theong> necessary steps ong>toong> be taken ong>toong> ensure that all prisoners at Tartu Prison have access ong>toong> anappropriate range of work, educational, sports and recreational activities (paragraph 58);- ong>theong> regime applied ong>toong> life-sentenced prisoners at Tartu Prison ong>toong> be revised, in ong>theong> light ofong>theong> remarks in paragraph 59 (paragraph 59).comments- ong>theong> Esong>toong>nian authorities are invited ong>toong> ensure that remand prisoners are included ong>toong> ong>theong> extentpossible in initiatives aimed at increasing by 2006 ong>theong> number of working and studyingprisoners (paragraph 60).


- 60 -requests for information- ong>theong> number of inmates enrolled in computer and language courses (English and Esong>toong>nian) atTartu Prison (paragraph 58).Health care servicesrecommendations- nursing resources at Tallinn Prison ong>toong> be reinforced (paragraph 61);- ong>theong> record drawn up after a medical examination of a prisoner, wheong>theong>r newly-arrived or not, ong>toong>contain:(i) a full account of statements made by ong>theong> prisoner concerned which are relevant ong>toong> ong>theong>medical examination, including any allegations of ill-treatment made by him;(ii) a full account of objective medical findings based on a thorough examination;(iii) ong>theong> docong>toong>r's conclusions in ong>theong> light of (i) and (ii); ong>theong>se conclusions should be madeavailable ong>toong> ong>theong> prisoner and his/her lawyer(paragraph 64);- existing procedures ong>toong> be reviewed in order ong>toong> ensure that, whenever injuries are recorded bya docong>toong>r which are consistent with allegations of ill-treatment made by a prisoner, ong>theong> recordis brought ong>toong> ong>theong> attention of ong>theong> relevant public prosecuong>toong>r (paragraph 64);- medical examinations of prisoners ong>toong> be conducted out of ong>theong> hearing and - unless ong>theong> docong>toong>rconcerned requests oong>theong>rwise in a particular case - out of ong>theong> sight of prison officers(paragraph 65).requests for information- which of ong>theong> six vacant posts for health care staff at Tartu Prison have been filled(paragraph 61);- confirmation that prisoners are examined on an individual basis at Tallinn Prison, and not inong>theong> presence of oong>theong>r inmates (paragraph 65).


- 61 -Central Prison Hospital, Tallinnrecommendations- a very high priority ong>toong> be attached ong>toong> finding a suitable alternative ong>toong> ong>theong> Central PrisonHospital, which should enable it ong>toong> be closed (paragraph 70);- in ong>theong> interim, steps ong>toong> be taken ong>toong>:• offer organised activities ong>toong> all patients at ong>theong> Central Prison Hospital;• guarantee ready access of health care staff ong>toong> patients at all times;• develop psycho-social ong>theong>rapeutic activities for psychiatric patients and adapt ong>theong>mong>toong> ong>theong> individual needs of each of those patients(paragraph 70).Oong>theong>r issuesrecommendations- uniform regulations ong>toong> be established for all prisons on ong>theong> question of ong>theong> frequency andduration of visits ong>toong> remand prisoners by family members or oong>theong>r persons. The objectiveshould be ong>toong> offer ong>theong> equivalent of a visit every week, of at least 30 minutes duration(paragraph 71);- steps ong>toong> be taken ong>toong> ensure that ong>theong> precepts set out in paragraph 80, regarding resort ong>toong>instruments of physical restraint, are strictly observed in practice (paragraph 80);- all persons placed in a disciplinary cell ong>toong> be allowed access ong>toong> reading matter, which shouldnot be limited ong>toong> prison regulations and ong>theong> Bible (paragraph 81);- ong>theong> relevant authorities ong>toong> ensure that all prisoners (both remand and sentenced), throughoutong>theong> penitentiary system, are provided with precise written information on ong>theong> avenues ofcomplaint available ong>toong> ong>theong>m; if necessary, prisoners should also be supplied with writingmaterials. Furong>theong>r, practical measures should be taken ong>toong> ensure that complaints can betransmitted confidentially (e.g. by providing complaint boxes accessible ong>toong> prisoners, ong>toong> beopened only by specially designated persons) (paragraph 82).comments- ong>theong> CPT wishes ong>toong> stress ong>theong> need for a certain flexibility when applying ong>theong> rules on visits ong>toong>prisoners whose families have difficulties making regular visits. For example, suchprisoners could be authorised ong>toong> combine several visit entitlements inong>toong> one longer session(paragraph 71);- steps should be taken ong>toong> ensure that prisoners subject ong>toong> a disciplinary sanction are given acopy of ong>theong> disciplinary decision, informing ong>theong>m about ong>theong> reasons for ong>theong> decision and ong>theong>avenues/deadlines for lodging an appeal (paragraph 76);


- 62 -- ong>theong> special cells at Tartu Prison are not suited for disciplinary use, given that ong>theong>y lackfurniture (paragraph 79);- ong>theong> CPT trusts that ong>theong> Legal Chancellor will continue ong>toong> maintain a proactive role in ong>theong>prevention of ill-treatment of prisoners (paragraph 84).requests for information- ong>theong> action taken following ong>theong> proposal made by ong>theong> Legal Chancellor ong>toong> establish aneffective procedure ong>toong> ensure confidentiality of telephone conversations (paragraph 74);- ong>theong> action taken ong>toong> establish uniform regulations on correspondence for all prisons, as wellas a copy of any new regulations (paragraph 75);- confirmation that prisoners have ong>theong> formal right ong>toong> appeal ong>toong> a higher authority against anydisciplinary sanctions imposed on ong>theong>m (paragraph 76);- ong>theong> procedural safeguards applicable in cases of segregation and application of means ofrestraint (right ong>toong> be heard, right ong>toong> appeal ong>toong> a higher authority, etc.) (paragraph 77);- comments on ong>theong> implementation of Section 108 of ong>theong> Imprisonment Act (2000), whichprovides for a system of prison committees operating at each establishment and made up ofmembers of ong>theong> public (paragraph 83).C. Psychiatric establishmentsIll-treatmentrecommendations- urgent steps ong>toong> be taken at Kernu Social Welfare Home ong>toong> review ong>theong> management ofaggressive/violent residents. For this purpose, a specific policy should be elaborated andimplemented in practice, aimed at reducing ong>theong> risk of inter-resident violence(paragraph 89);- all staff members at Kernu Social Welfare Home ong>toong> be reminded that ong>theong>y have a duty ong>toong>ensure ong>theong> safety and physical integrity of residents and ong>toong> protect ong>theong>m from oong>theong>r residentswho might wish ong>toong> cause ong>theong>m harm (paragraph 89).


- 63 -Patients'/residents' living conditionsrecommendations- immediate steps ong>toong> be taken at Ahtme Psychiatric Hospital ong>toong> ensure that all patients whosestate of health permits are offered at least one hour of outdoor exercise per day(paragraph 92).comments- ong>theong> authorities are invited ong>toong> improve ong>theong> heating (in particular at night) at Ahtme PsychiatricHospital and ong>toong> provide all patients with lockable space ong>toong> song>toong>re ong>theong>ir personal belongings(paragraph 91);- ong>theong> authorities are invited ong>toong> provide all residents at Kernu Social Welfare Home withlockable space ong>toong> song>toong>re ong>theong>ir personal belongings (paragraph 93).requests for information- detailed information on ong>theong> progress made in ong>theong> renovation work at Kernu Social WelfareHome (paragraph 93).Staff and treatmentrecommendations- steps ong>toong> be taken at Ahtme Psychiatric Hospital (as well as in oong>theong>r psychiatricestablishments in Esong>toong>nia) ong>toong> ensure that all competent patients are placed in ong>theong> position ong>toong>give ong>theong>ir informed consent ong>toong> treatment in writing. For this purpose, ong>theong>y should besystematically provided with relevant information about ong>theong>ir condition and ong>theong> treatmentprescribed for ong>theong>m (side effects, duration, etc.). Relevant information should also beprovided ong>toong> patients following treatment (results, etc.) (paragraph 97);- steps ong>toong> be taken at Kernu Social Welfare Home ong>toong> ensure that:• ong>theong> nursing staff presence, especially at night and on weekends, is reviewed; this willalmost certainly require increasing ong>theong> overall complement of such staff;• specialised training is provided for nursing assistants in dealing with residents withsevere learning disabilities;• ong>theong> establishment is visited by a general practitioner and a psychiatrist at least onceper week;• every resident is subject ong>toong> a medical examination promptly upon admission;• rehabilitative services (psychology, physioong>theong>rapy, etc.) are provided(paragraph 100);


- 64 -- steps ong>toong> be taken at Kernu Social Welfare Home ong>toong> ensure that ong>theong> confidentiality of medicaldata is fully respected (paragraph 101).requests for information- more detailed information on ong>theong> preliminary plans at Ahtme Psychiatric Hospital ong>toong> create aspecial nursing care section for patients who are no longer in need of in-patient medicalcare, but who cannot live on ong>theong>ir own and cannot be accommodated in ong>theong> outsidecommunity (paragraph 96).Restraint of agitated and/or violent patients/residentsrecommendations- a written policy on ong>theong> use of means of restraint and seclusion ong>toong> be established both atAhtme Psychiatric Hospital and Kernu Social Welfare Home and steps ong>toong> be taken ong>toong> ensurethat ong>theong> procedures followed in this connection are brought inong>toong> line with ong>theong> requirementsset out in paragraph 103 (paragraph 106);- appropriate measures ong>toong> be taken at Ahtme Psychiatric Hospital and Kernu Social WelfareHome ong>toong> avoid involving residents in ong>theong> restraint of a fellow-resident. Resolving episodesof acutely disturbed behaviour should be ong>theong> exclusive responsibility of staff; ensuring thatthis is ong>theong> case will require increasing ong>theong> staff presence (paragraph 106).Safeguardsrecommendations- ong>theong> Esong>toong>nian authorities ong>toong> review ong>theong> procedures for involuntary placement in psychiatrichospitals, in ong>theong> light of ong>theong> remarks made in paragraphs 107 ong>toong> 113; more particularly, stepsshould be taken ong>toong> ensure that:• involuntary placement procedures in psychiatric hospitals offer guarantees ofindependence and impartiality, as well as of objective psychiatric expertise; morespecifically, a court should seek an opinion from a psychiatrist outside ong>theong> hospitalconcerned before deciding wheong>theong>r ong>toong> prolong an involuntary placement beyond 14days;• patients who are admitted ong>toong> a psychiatric hospital on an involuntary basis have ong>theong>right ong>toong> be heard in person by ong>theong> court during placement/appeal procedures;• ong>theong> patient concerned is notified in writing of decisions on involuntary placement ina psychiatric hospital, informed about ong>theong> reasons for ong>theong> decision and ong>theong>avenues/deadlines for lodging an appeal, and granted unlimited and unrestrictedaccess ong>toong> ong>theong>ir legal representative/lawyer;


- 65 -• indigent patients benefit from free legal representation and are exempted from courtfees incurred in ong>theong> context of judicial appeal/review procedures;• patients ong>theong>mselves are able ong>toong> request at reasonable intervals that ong>theong> necessity forong>theong>ir placement be considered by a judicial authority(paragraph 114);- ong>theong> Esong>toong>nian authorities ong>toong> take steps ong>toong> ensure that:• residents who are placed in a social welfare home on an involuntary basis by courtdecision have ong>theong> right ong>toong> be heard in person during placement/appeal procedures;• ong>theong> patient concerned is notified in writing of decisions on involuntary placement ina social welfare home, informed about ong>theong> reasons for ong>theong> decision and ong>theong>avenues/deadlines for lodging an appeal;• residents and/or ong>theong>ir guardian are able ong>toong> request at reasonable intervals that ong>theong>necessity for placement be considered by a judicial authority;• all cases of involuntary admission ong>toong> Kernu Social Welfare Home prior ong>toong> 2002 arenotified ong>toong> ong>theong> competent civil court;• ong>theong> legal status of voluntary residents who are prevented from leaving Kernu SocialWelfare Home is clarified(paragraph 119);- ong>theong> Esong>toong>nian authorities ong>toong> strive ong>toong> find alternative solutions which would better guaranteeong>theong> independence and impartiality of guardians (paragraph 121);- an introducong>toong>ry leaflet/brochure ong>toong> be issued at Ahtme Psychiatric Hospital and Kernu SocialWelfare Home ong>toong> each newly-arrived patient/resident (and his/her legal representative),accompanied, if necessary, by appropriate oral explanation (paragraph 122);- patients/residents at Ahtme and Kernu ong>toong> be informed in ong>theong> introducong>toong>ry leaflet/brochureissued upon admission of ong>theong>ir right ong>toong> lodge complaints as well as of ong>theong> modalities fordoing so (paragraph 123).comments- ong>theong> Esong>toong>nian authorities are invited ong>toong> explore ong>theong> possibility of introducing regular visits ong>toong>psychiatric/social welfare establishments by a body which is independent of ong>theong>health/social welfare authorities (paragraph 124).requests for information- wheong>theong>r it is intended ong>toong> make provision for a procedure outside emergency situations,whereby a mental patient could be hospitalised against his/her will, in ong>theong> context of ong>theong>ongoing reform of ong>theong> Esong>toong>nian mental health legislation (paragraph 109);- comments on ong>theong> practice of placing incapacitated persons in a psychiatric hospital/socialwelfare institution, without ong>theong> benefit of ong>theong> procedural safeguards oong>theong>rwise provided forby law (paragraph 120).


- 67 -APPENDIX IILIST OF THE NATIONAL AUTHORITIES AND NON-GOVERNMENTALORGANISATIONS WITH WHICH THE CPT'S DELEGATION HELD CONSULTATIONSA. National authoritiesMinistry of JusticeKen-Marti VAHERPeeter NÄKSElina SIIMONKaija KIRCHMinister of JusticeDeputy Secretary General on PrisonsAssistant ong>toong> ong>theong> Deputy Secretary General on Prisons,CPT's liaison officerForeign Relations Adviser, Prison Department, Liaisonofficer ong>toong> ong>theong> CPTMinistry of Internal AffairsKalev TIMBERGKnut KLAISVarmo REINDeputy Secretary General of Internal SecurityAdviser of ong>theong> Internal Security Police DepartmentCommissar of ong>theong> Police Board, Liaison officer ong>toong>ong>theong> CPTMinistry of Social AffairsSirlis SÕMERIvi AALAKLaine PEEDUHead of ong>theong> Department of Social WelfareHead of ong>theong> Foreign Relations Bureau, Liaison officerong>toong> ong>theong> CPTPrincipal Specialist of Health DepartmentOong>theong>r personsAllar JÕKSLegal Chancellor of ong>theong> RepublicB. Non-governmental organisationsEsong>toong>nian Psychiatric Patient Advocacy Association

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