Sundhedsudvalget 2024-25
SUU Alm.del Bilag 98
Offentligt
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Strasbourg, 15 November 2024
Secret
CPT (2024) 47
REPORT
TO THE DANISH GOVERNMENT
ON THE VISIT TO DENMARK CARRIED OUT BY
THE EUROPEAN COMMITTEE FOR THE PREVENTION OF TORTURE
AND INHUMAN OR DEGRADING TREATMENT OR PUNISHMENT
(CPT)
FROM 23 MAY TO 3 JUNE 2024
______________
Adopted on 8 November 2024
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CONTENTS
EXECUTIVE SUMMARY
................................................................................................................. 4
I.
A.
B.
II.
A.
INTRODUCTION......................................................................................................................
9
The visit, the report and the follow-up
............................................................................. 9
Consultations held by the delegation and co-operation encountered..................
10
FACTS FOUND DURING THE VISIT AND ACTION PROPOSED
.............................. 12
Police establishments
........................................................................................................ 12
1.
2.
3.
4.
B.
Preliminary remarks
.................................................................................................. 12
Ill-treatment
.................................................................................................................. 13
Safeguards against ill-treatment
............................................................................ 13
Conditions of detention
............................................................................................ 16
Immigration detention establishment
............................................................................ 18
1.
2.
3.
4.
5.
6.
7.
8.
9.
Preliminary remarks
.................................................................................................. 18
Ill-treatment
.................................................................................................................. 19
Conditions of detention
............................................................................................ 20
Health care and vulnerability screening
.............................................................. 22
Custodial staff
............................................................................................................. 25
Discipline and security
............................................................................................. 26
“Observation cells”
................................................................................................... 27
Contact with the outside world...............................................................................
28
Legal safeguards
........................................................................................................ 28
C.
Prison establishments........................................................................................................
31
1.
2.
3.
Preliminary remarks
.................................................................................................. 31
Ill-treatment
.................................................................................................................. 34
Conditions of detention
............................................................................................ 35
a.
b.
4.
material conditions
.............................................................................................. 35
regime
................................................................................................................... 37
Health-care services
.................................................................................................. 39
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5.
Other issues.................................................................................................................
44
a.
b.
c.
d.
e.
f.
g.
h.
i.
D.
prison staff
............................................................................................................ 44
discipline
............................................................................................................... 46
segregation on security grounds
...................................................................... 48
“observation cells”
............................................................................................... 49
“security cells” and mechanical restraint
......................................................... 51
use of force including “special means”
............................................................ 53
strip searches
...................................................................................................... 54
contact with the outside world
........................................................................... 55
information for prisoners and complaints procedures
................................... 57
Psychiatric establishments
............................................................................................... 58
1.
3.
4.
5.
Preliminary remarks
.................................................................................................. 58
Living conditions
........................................................................................................ 59
Therapeutic staff and treatments available
......................................................... 60
Means of restraint
...................................................................................................... 61
a.
b.
c.
6.
7.
nationwide efforts to reduce recourse to means of restraint in psychiatry.
61
recourse to means of restraint in the psychiatric establishments visited
.. 62
procedural safeguards in the context of resort to means of restraint
......... 66
Legal safeguards in the context of involuntary hospitalisation and
treatment.......................................................................................................................
68
Contact with the outside world...............................................................................
70
APPENDIX I:
LIST OF ESTABLISHMENTS VISTED BY THE CPT’S DELEGATION
..................... 71
APPENDIX II:
LIST OF THE NATIONAL AUTHORITIES, OTHER BODIES AND NON-
GOVERNMENTAL ORGANISATIONS WITH WHICH THE CPT’S DELEGATION
HELD CONSULTATIONS
.................................................................................................... 72
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EXECUTIVE SUMMARY
In the course of the 2024 periodic visit to Denmark, the delegation of the European
Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT)
examined the treatment and safeguards afforded to persons deprived of their liberty by the police as
well as the treatment and conditions of detention of prisoners, foreign nationals detained pursuant
to aliens’ legislation and psychiatric patients.
The delegation visited
police establishments
in Aarhus, Albertslund, Bellahøj
(Copenhagen), Horsens and Odense. Further, in the prisons visited, the delegation spoke with
newly-arrived remand prisoners about their treatment by the police.
Most of the interviewed persons in police custody and on remand told the delegation that
they had been treated by the police in a correct manner. The delegation did not receive any
allegations of ill-treatment during police interviews. A few allegations were heard of excessive use
of force during apprehension and of too tight handcuffing behind the back, both at the time of arrest
and during the subsequent transfer in a police vehicle.
The delegation found that persons in police custody were as a rule allowed to notify their
next-of-kin of their deprivation of liberty within a reasonable time, either directly or through the police.
All detained persons interviewed by the delegation confirmed having been offered access to a
lawyer, including an
ex officio
lawyer, although some persons stated that they had only met their
lawyer shortly before their first appearance in court.
At the police stations visited by the delegation, access to a doctor was provided, either
systematically or at the very least whenever the detained persons had visible injuries, were
intoxicated, agitated or expressed any health-related complaints. The delegation also noted that the
police systematically informed detained persons of their rights, first orally immediately upon
apprehension and subsequently in a written form upon arrival to the police station, by means of an
information sheet available in a variety of languages. The CPT was pleased to note that the
information sheet now included information on available avenues of complaint against the treatment
by the police.
The CPT also noted positively the increased recourse to electronic recording of police
interviews; another positive finding was that the training in research-based police interviewing
techniques appeared to be in line with CPT standards. That said, although most of the interviewed
persons had no complaints regarding the manner in which they had been questioned, a few
allegations were received that some police officers would have initiated so-called “informal talks”
encouraging detained persons to “cooperate” prior to the beginning of the formal police interview;
that is, before the persons concerned were given the possibility to benefit from the legal safeguards
for persons in police custody. If true, such practices would be contrary to the aforementioned modern
research-based and human rights focussed approach to police interviewing.
Material conditions in the police establishments visited were generally in compliance with the
CPT’s standards in terms of size, equipment, lighting, ventilation and state of repair and cleanliness,
especially given the short detention periods.
The majority of the detained foreign nationals interviewed by the delegation at
Ellebæk
Centre for Foreigners
stated that they were being treated by staff in a correct manner. Inter-
detainee violence did not appear to be a major problem and whenever it did occur, staff seemed to
react quickly and appropriately.
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The material conditions of detention had considerably improved at Ellebæk Centre since the
2019 visit, mainly due to extensive refurbishment and lower occupancy levels. However, despite
repeated criticism by the CPT and other international and national stakeholders, the environment
remained prison-like. This was demonstrated
inter alia
by the presence of barred windows, barred
gated partitions between the units and the fact that the establishment was staffed by custodial prison
officers carrying handcuffs and pepper spray. Furthermore, prison rules (pursuant to the Criminal
Enforcement Act) were applied by analogy to detained foreign nationals. Urgent action should be
taken to change this situation given that the foreign nationals detained at Ellebæk Centre were
neither criminal suspects nor serving a prison sentence.
The Committee reiterates its view that immigration detention is a form of administrative
detention and should be clearly distinguished from imprisonment as a punishment for a criminal
offence. Therefore, any impression of a carceral environment should, as far as possible, be avoided.
The emphasis should be on minimum internal security regulations and the promotion of normality.
The Danish authorities should take steps to eliminate all prison-like features at Ellebæk Centre,
taking into account the above remarks.
Detained foreign nationals benefitted from an open-door regime under which they could freely
associate with other detainees from the same unit. Approximately half of detained foreign nationals
had a paid job. Further, an activity centre had been made available in a separate building. However,
many detained foreign nationals appeared not to be aware of the availability of the above-mentioned
activities and thus spent most of their days idly. While many detained foreign nationals stayed at
Ellebæk Centre for relatively short periods (up to several weeks), much longer stays (up to several
months) were not uncommon. The Committee therefore reiterates its view that the longer the period
for which foreign nationals are detained, the more developed should be the offer of activities
available to them. Further, steps should be taken to ensure that all detained foreign nationals have
in principle free access to an appropriate outdoor area throughout the day, including on weekends.
Given the low occupancy levels at Ellebæk Centre at the time of the visit, the overall presence
of health care staff could be considered as generally adequate. However, newly arrived detained
foreign nationals were still not subject to a comprehensive medical examination on admission. The
Danish authorities must ensure that all detained foreign nationals newly admitted to Ellebæk Centre
benefit from a prompt physical examination carried out by a doctor or a nurse reporting to a doctor.
The custodial staff complement appeared to be adequate for the currently low occupancy
levels but they still did not receive any specialised training for working with detained foreign nationals.
Steps must be taken to ensure that all staff (in particular custodial officers) working at Ellebæk Centre
are given specific training for working with foreign nationals.
The CPT also made other comments and recommendations,
inter alia
about the use of
disciplinary solitary confinement (stressing that it should never be applied for more than 14 days,
due to the potentially very damaging effects of this measure to the mental health of the persons
concerned), access to the telephone (which should be improved) and the provision of written
information to detained foreign nationals.
The CPT’s delegation visited several
prisons,
including the Western Prison and Police
Square Prison in Copenhagen, as well as Nyborg and Enner Mark Prisons.
At the outset of the visit, senior officials from the Ministry of Justice informed the CPT
delegation that the Danish prison system had for the past several years operated above its intended
capacity, the rate of overcrowding being the highest in respect of remand prisoners (103%) and
sentenced inmates accommodated in closed prisons (102%). Indeed, the four prisons visited were
operating at their full capacity or were even slightly overcrowded all prisoners still enjoyed at least 4
m² of living space.
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Measures taken by the Danish authorities to respond to the increase in the prison population
consisted essentially of building new prisons. In this context, the CPT reaffirmed its view that building
new prisons cannot by itself provide a lasting solution to the overcrowding problem. This can only
be achieved by combining the modernisation of the prison estate with an increased resort to
alternatives to imprisonment. The Danish authorities should step up their efforts to ensure that all
prisons operate within their official capacities and, to this end, a comprehensive strategy and action
plan should be drawn up to manage the prison population, with precise deadlines and budget
allocations.
On 23 May 2024, the Kosovo Parliament ratified the bilateral treaty foreseeing the operation
of a prison in Gjilan (Kosovo) by the Danish Prison and Probation Administration (DPPA), and the
potential transfer there of up to 300 foreign national prisoners sentenced by Danish courts to
deportation in addition to a term of imprisonment. The CPT considers that the treaty could potentially
raise a number of issues of concern. Among others, the bilateral treaty stipulates that criminal
offences committed by Kosovo prison staff working in Gjilan Prison are to be prosecuted by Kosovo
authorities, which would amount to a partial relinquishing of jurisdiction for matters that should in
principle fall within the responsibility of the Danish authorities. Furthermore, the treaty would appear
to be in contradiction with key principles underpinning the Council of Europe Convention on the
Transfer of Sentenced Persons.
The delegation received no allegations of deliberate ill-treatment by custodial staff at any of
the prisons visited. In all the prisons visited, the delegation found that staff behaved generally in a
professional and respectful manner, and many inmates spoke positively about prison officers. As for
inter-prisoner violence, it did exist but did not seem to be a major problem in the prisons visited,
which was both remarkable and commendable given the presence of many members of warring
gangs and of other prisoners who could not be allowed to associate given the high risk of conflict
and abuse. Despite the less-than-optimal staffing levels, prison officers generally succeeded in
keeping all inmates safe and intervened quickly and effectively whenever any instances of inter-
prisoner violence occurred.
As for the material conditions, in all the prisons visited the delegation found the cells to be
generally suitably furnished, well-lit and ventilated, clean and in a good state of repair. The best
material conditions were observed at Enner Mark Prison which should serve as a reference for the
whole prison system. In the other prisons, conditions were also generally adequate despite the
occasional wear-and-tear at Nyborg and Western Prisons. In those two establishments, the
“jalousies” (shutters) were being gradually installed on cell windows, reportedly to prevent prisoners
of different categories from communicating with each other. Whilst access to natural light and fresh
air seemed adequate, these devices severely restricted the view from inside the cells, which was
particularly problematic for prisoners who were segregated or in high-security units and who often
spent 23 hours per day inside their cells.
By far the most problematic issue observed yet again was the absence of in-cell toilets in
most of the cells at Nyborg, Police Square and Western Prisons, especially when combined with
custodial staff shortages. The delegation heard numerous complaints by prisoners at Nyborg and
Western Prisons regarding long delays in access to (and return from) communal toilet facilities,
especially at night. The Danish authorities must take resolute steps to ensure that all prisoners have
unimpeded access to toilet facilities without undue delay at all times (including at night). Preferably,
all cells should be equipped with in-cell toilets. The Danish authorities should put in place a detailed
and budgeted action plan, with clear and realistic deadlines, to achieve this goal.
The CPT gained a very positive impression of the regime at Enner Mark Prison where the
great majority of prisoners could work and were allowed to associate with fellow prisoners and
engage in other activities. The situation was less favourable in the other prisons visited, with
approximately a third of the inmates being involved in work or education at the Western Prison and
about half at Nyborg Prison.
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Both prisons accommodated some segregated and high security prisoners as well as
numerous remand prisoners, who were offered a fairly impoverished regime, spending between 21
and 23 hours per day inside their cells, often for long periods, that is for months and sometimes even
years. The Danish authorities should take steps to develop adequate programmes of activities for
remand prisoners and sentenced prisoners obliged to remain in remand sections. They should also
take measures to offer segregated and high-security prisoners structured programmes of
constructive activities, preferably outside the cells, based on individual projects intended to provide
prisoners with appropriate mental and physical stimulation.
In all the prisons visited, inmates had access to health care, both primary and secondary.
However, apart from the Western Prison, none of the prison establishments benefited from a 24/7
health-care staff coverage, with no health-care staff being present after 3 - 4 p.m. or on weekends.
This was clearly problematic given the size and characteristics of the prisoner populations in the
larger establishments (i.e. Nyborg and Enner Mark Prison) which were accommodating many
remand prisoners for whom these establishments represented a point of entry into the prison system.
Further issues of concern were the impact of custodial staff shortages on the provision of
health care (with scheduled appointments with doctors having to sometimes be cancelled because
there was not enough custodial staff on duty to provide escorts), the inadequacy of access to mental
health care (despite recent positive efforts to recruit prison psychologists and to secure the presence
of psychiatrists), the legal discrimination of foreign prisoners (who were as a rule only entitled to
primary and emergency care) and the persistent absence of systematic and prompt medical
screening of all newly-arrived prisoners. On this last subject, the CPT stressed once again that the
initial medical screening of all persons admitted to a prison should be obligatory, not optional.
The CPT also commented on a number of other issues such as discipline, the use of
“observation” and “security” cells (as well as recourse to fixation), contact with the outside world and
complaints procedures. Among others, the Committee strongly reiterated its position that disciplinary
solitary confinement should never be imposed for more than 14 days and that solitary confinement
as a disciplinary punishment for juveniles should be abolished in Denmark. Further, the CPT called
upon the Danish authorities to limit the duration of prisoners’ placements in “observation cells”, to
abolish the practice of fixation of prisoners for security reasons and to ensure that all remand
prisoners, without exception, effectively benefit from the entitlement of at least one visit lasting one
hour every week.
The CPT’s delegation visited two
psychiatric establishments,
namely the Psychiatric
Departments of Aarhus University Hospital and the Glostrup Psychiatric Centre.
It should be underlined that no allegations of physical ill-treatment by staff were heard from
the patients interviewed by the delegation at either of the psychiatric establishments visited. On the
contrary, the vast majority of the interviewed patients spoke very positively about the staff and the
delegation observed for itself that many staff members displayed a caring and professional attitude
vis-à-vis the patients, as well as a high level of professional commitment. As for inter-patient
violence, it did not appear to be frequent and staff seemed to react quickly and appropriately
whenever any such violence occurred.
The delegation was positively impressed by the excellent living conditions at Aarhus
University Hospital, an establishment which had clearly been thoughtfully designed and which
provided a positive therapeutic milieu for the patients. This applied in particular to the Forensic
Department, where patients were accommodated in a secure yet non-carceral environment.
The therapeutic staff complement at the Psychiatric Departments of Aarhus University
Hospital could be assessed as being fully adequate (and even generous).
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Further, based on interviews with patients and healthcare staff and an examination of
relevant medical documentation, patients at Aarhus University Hospital were offered adequate
pharmacotherapy. The range of individual and group therapeutic activities, some of which were also
offered during weekends, was excellent.
For many years, a major concern for the CPT has been the high frequency of recourse to
and long duration of measures of restraint, including mechanical restraint (fixation) in Danish
psychiatric establishments. The CPT acknowledges the considerable efforts made by the Danish
authorities over recent years to reduce the recourse to means of restraint and notably fixation; these
efforts must continue.
The CPT also examined the legal safeguards in the context of involuntary psychiatric
hospitalisation and treatment and
inter alia
reiterates that steps should be taken to ensure that the
internal review of “civil” involuntary hospitalisation requires the opinion of a doctor independent of
the psychiatric department accommodating the patient concerned. In addition, the frequency of
ex
officio
judicial reviews should be increased for patients detained under a forensic placement
decision, to once per year for example. Further, the current legislation should be amended so as to
introduce the requirement of obtaining an external psychiatric opinion in the context of such judicial
review.
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I.
INTRODUCTION
A.
The visit, the report and the follow-up
1.
In pursuance of Article 7 of the European Convention for the Prevention of Torture and
Inhuman or Degrading Treatment or Punishment (hereinafter referred to as “the Convention”),
a delegation of the CPT carried out a visit to Denmark from 23 May to 3 June 2024. The visit formed
part of the CPT’s programme of periodic visits for 2024 and was the Committee’s eighth visit to
Denmark.
1
2.
The visit was carried out by the following members of the CPT:
-
-
-
-
-
-
Vânia Costa Ramos, Head of the delegation
Gergely Fliegauf
Marie Kmecová
Asbjørn Rachlew
Elsa Bára Traustadòttir
Elisabetta Zamparutti.
They were supported by Borys Wòdz (Head of Division), Monica Martinez and Almut
Schröder from the CPT’s Secretariat, and assisted by:
-
Pétur Hauksson, psychiatrist, former Head of the Psychiatric Department at
Reykjalundur Rehabilitation Centre, Iceland (expert)
Veronica Pimenoff, psychiatrist, former Head of Department at Helsinki University
Psychiatric Hospital, Finland (expert)
Farida A. Christensen (interpreter)
Heidi Flegal (interpreter)
Thomas Harder (interpreter)
Dorthe Kjaer (interpreter)
Karen Rosén (interpreter).
-
-
-
-
-
-
1
The CPT has previously carried out six periodic visits (in 1990, 1996, 2002, 2008, 2014 and 2019) and
one ad hoc visit (in 2012) to Denmark. All the Committee’s reports and responses of the Danish
authorities to date are in public domain (https://www.coe.int/en/web/cpt/denmark) upon the authorities’
request and pursuant to the automatic publication procedure introduced by the Danish authorities in
2018. According to this procedure, all documents related to CPT visits shall be published
automatically, unless the Danish authorities submit within two weeks a request to postpone (for a
period of up to six months) the publication of the document concerned.
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3.
The list of the establishments visited by the CPT’s delegation can be found in Appendix I.
4.
The report on the visit was adopted by the CPT at its 115
th
meeting, held from 4 to
8 November 2024, and transmitted to the Danish authorities on 15 November 2024. The various
recommendations, comments and requests for information made by the CPT are set out in bold type
in the present report. The CPT requests the Danish authorities to provide within six months a
response containing a full account of action taken by them to implement the Committee’s
recommendations and replies to the comments and requests for information formulated in this report.
B.
Consultations held by the delegation and co-operation encountered
5.
In the course of the visit, the delegation had consultations with Carsten Madsen, Deputy
Permanent Secretary at the Ministry of Justice, Andreas Jull Sørensen, Deputy Permanent Secretary
at the Ministry of the Interior and Health, Christina Fløystrup, Head of Division for Return and
Readmission at the Ministry of Immigration and Integration, as well as with other senior officials from
the above-mentioned Ministries.
Further, the delegation met Niels Fenger, Parliamentary Ombudsman, in his capacity as the
Danish National Preventive Mechanism (NPM). It also met representatives of several non-
governmental organisations active in areas of concern to the CPT.
The list of the national authorities, other bodies and organizations met by the delegation is
set out in Appendix II to this report.
6.
The CPT is pleased to note that the co-operation received by its delegation throughout the
visit was excellent at all levels. The delegation enjoyed rapid access to the establishments visited
(including those which had not been notified in advance), was promptly provided with all the
requested information and documents (including medical files) and was able to speak in private with
all the persons deprived of their liberty it wished to interview. The support provided before and during
the visit by the CPT’s Liaison Officer, Hélène Fester from the Ministry of Foreign Affairs, was very
much appreciated.
7.
That said, the Committee wishes to stress that the principle of co-operation set out in Article
3 of the European Convention for the Prevention of Torture and Inhuman or Degrading Treatment
or Punishment is not limited to facilitating the work of visiting delegations; it also requires that
recommendations made by the Committee are effectively implemented in practice.
In this respect, the CPT is concerned by the slow progress (or even the absence of progress)
in the implementation of some of its long-standing recommendations including as regards the
practical implementation of the legal safeguards against ill-treatment of persons in police custody,
the carceral material conditions and prison-like regime at Ellebæk Centre for Foreigners, the material
conditions (especially access to a toilet) in prisons and the restrictive regimes for remand prisoners
and other inmates subjected to segregation or solitary confinement, the health care services for
prisoners and the recourse to mechanical restraint (fixation) in prisons and psychiatric
establishments.
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8.
Detailed comments and recommendations on the aforementioned subjects are set out further
in this report.
2
However, already at this stage, the Committee must stress that it expects the Danish
authorities to be in a position to inform the CPT, in their response to this report, of decisive steps
taken to implement the Committee’s recommendations on the subjects referred to above, in
accordance with the principle of co-operation which lies at the heart of the Convention.
Pending the receipt of the above-mentioned response, the CPT proposes to hold high-level
talks between its representatives and senior (political level) Danish officials, in order to discuss ways
to improve the implementation of its long-standing recommendations. A letter on this subject was
sent to the Danish authorities at the same date as this report, namely on 15 November 2024.
2
See paragraphs 13, 16, 17, 18, 31, 33 to 35, 68, 71, 74 to 86, 107 to 112 and 139 to 158 below.
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II.
FACTS FOUND DURING THE VISIT AND ACTION PROPOSED
A.
Police establishments
1.
Preliminary remarks
9.
At the time of the visit, the general legal framework governing police custody was by and
large the same as the one which had been summarised in the report on the CPT’s 2019 visit.
3
It is recalled that a person suspected of having committed a criminal offence can be held by
the police on their own authority for up to 24 hours. Within that period, the person must be released
or brought before a judge, who may extend police custody for a further 72 hours.
4
Thus, a criminal
suspect may remain in police custody for up to 4 days.
It is also recalled that, pursuant to the Police Act, the police may administratively detain a
person who endangers public order, the safety of individuals or public security, for a period not
exceeding 6 hours or, in the context of public gatherings and crowds, 12 hours.
5
In addition, the
police may hold a person due to illness or other incapacity (e.g. intoxication with alcohol and/or other
substance); in such cases, the deprivation of liberty must be as brief as possible.
6
Further, under the Aliens Act, foreign nationals may be detained by the police for a maximum
of 3 days, for a number of reasons, in particular to ensure their removal or to guarantee the
completion of proceedings concerning their stay in the country.
7
The delegation’s findings suggest that, in practice, the duration of police custody tends to be
short – often well below the above-mentioned statutory time-limits. By way of example, police
custody of criminal suspects did not as a rule exceed 6 hours in the police establishments visited by
the delegation. Moreover, persons who had to be detained overnight were usually transferred to a
local remand prison.
10.
As regards the duties of the police mentioned in Section 10 of the Police Act,
8
the delegation
observed in the psychiatric establishments visited (see paragraphs 149 to 151 below) that the police
often detained and brought to those establishments persons deprived of their liberty for the purpose
of involuntary psychiatric hospitalisation procedure (both “civil” and forensic). It would also appear
that detained persons would frequently be handcuffed whilst being transported to psychiatric
establishments. In this connection,
the CPT would like to be informed of the details of the rules
of police conduct (including as regards the resort to handcuffs
9
and other means of coercion)
with respect to persons being brought against their will to psychiatric establishments. The
Committee would also like to be informed of any special training provided to police officers
in this particular context.
3
4
5
6
7
8
9
See paragraph 9 of document CPT/Inf (2019) 35.
See Article 71 (3) of the Danish Constitution and Section 760 of the Administration of Justice Act.
See Sections 5 (3), 8 (4) and 9 (3) of the Police Act.
See Section 10 of the Police Act.
See Sections 35 to 37 of the Aliens Act and paragraph 24 below.
As well as in the Mental Health Act, see paragraph 149 below.
On this, see also the CPT’s general recommendation concerning the use of handcuffs by the police
set out in paragraph 11 of the report on the 2008 visit (CPT/Inf (2008) 26): “As regards handcuffing
during transportation, it should be resorted to only when the risk assessment in the individual case
clearly warrants it and be done in a way that minimises any risk of injury to the detained person.”
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Concerning the presence of police officers inside psychiatric establishments after having
brought detained persons there, and the role performed by police officers in the context of application
of means of restraint vis-à-vis persons hospitalised against their will, reference is made to the
remarks and recommendations in paragraph 150 below.
2.
Ill-treatment
11.
The delegation visited police establishments in Aarhus, Albertslund, Bellahøj (Copenhagen),
Horsens and Odense. Further, in the prisons visited, the delegation spoke with newly-arrived remand
prisoners about their treatment by the police.
Most of the interviewed persons in police custody and on remand told the delegation that
they had been treated by the police in a correct manner. The delegation did not receive any
allegations of ill-treatment during police interviews. A few allegations were heard of excessive use
of force during apprehension (mainly consisting of violently pushing the person to the floor) and of
too tight handcuffing behind the back, both at the time of arrest and during the subsequent transfer
in a police vehicle.
The CPT recommends that it be recalled to all police officers, in suitable intervals, that
they should use no more force than is strictly necessary when carrying out an apprehension
and that where it is deemed necessary to handcuff a person, the handcuffs must never be
excessively tight
10
and should only be applied for as long as is strictly necessary.
3.
Safeguards against ill-treatment
12.
The CPT has consistently emphasised the importance it attaches to the fundamental
safeguards for persons deprived of their liberty by the police, in particular the right of the persons
concerned to inform a relative or a third party of their choice of their situation, the right of access to
a lawyer and the right of access to a doctor. It is recalled that these rights should be enjoyed by all
categories of persons deprived of their liberty and should apply from the very outset of their
deprivation of liberty. Furthermore, persons deprived of their liberty by the police must be expressly
informed, without delay and in a language they understand, of all their rights.
In this context, the delegation learned with interest that a dedicated team of officers had been
tasked at Odense Police Headquarters with overseeing staff’s compliance with the safeguards for
persons in police custody.
This is an example of a good practice which merits being adopted
throughout the country.
13.
The delegation found that persons in police custody were as a rule allowed to notify their
next-of-kin of their deprivation of liberty within a reasonable time, either directly or through the police.
Any delays in notification were found to be exceptional, limited in time and duly motivated in writing.
10
It is noteworthy in this context that new models of handcuffs, preventing their excessive tightening
when a person resists, are now available on the market.
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That said, despite the recommendations made by the CPT in its previous reports, no
measures have been taken to better circumscribe the power of the police to postpone, for
investigation purposes, the right to inform a relative or a third person.
The Committee thus
reiterates its recommendation that the existing legal provisions be amended so as to subject
any delay in the notification of custody to the approval of a senior police officer unconnected
with the case at hand or a prosecutor.
14.
The delegation observed that the police generally facilitated detained foreign nationals’
contacts with their consular or diplomatic representatives, although there seemed to be exceptions
to this rule, with foreign nationals reportedly sometimes only being informed of this right after they
had arrived at a remand unit of a prison.
11
The CPT recommends that the Danish authorities take
appropriate steps to prevent such delays from occurring in the future.
15.
All detained persons interviewed by the delegation confirmed having been offered access to
a lawyer, including an
ex officio
lawyer, although some persons stated that they had only met their
lawyer shortly before their first appearance in court. That said, it emerged from the delegation’s
interviews that criminal suspects were systematically informed by the police, at the time of
apprehension, of their right to remain silent. Further, it seemed that the police would generally
respect the wish of detained persons not to give any statements prior to the arrival of their lawyer.
12
16.
At the police stations visited by the delegation, access to a doctor was provided, either
systematically or at the very least whenever the detained persons had visible injuries, were
intoxicated,
13
agitated or expressed any health-related complaints. The delegation found in the
relevant records instances where the doctor would recommend release or transfer to a health-care
facility of the person due to the person’s state of health (a recommendation usually followed by the
police); on other occasions doctors would not object to the continuation of detention but would
instruct police officers to carry out regular checks (e.g. every hour) in order to be able to alert the
health-care services whenever the person’s condition worsened. In some cases, the delegation saw
notes by doctors stating that detained persons had been advised to consult their family doctors after
release.
The delegation’s medical experts confirmed that injuries observed on detained persons were
recorded, albeit rather superficially and generally without attempts made by doctors to assess
consistency of the injuries with any statements made by detained persons. Further, medical
confidentiality was not fully respected given that medical certificates drawn up by doctors called to
the police stations
14
were part of detained persons’ files, accessible also to non-medically trained
police staff.
The Committee recommends that the aforementioned lacunas as regards the
recording of injuries and confidentiality of medical data be remedied.
11
12
13
14
Or, in the case of foreign nationals detained pursuant to aliens legislation, after their arrival at Ellebæk
Centre for Foreigners, see paragraphs 24 to 58 below.
See, however, paragraph 20 below.
Police officers performed frequent (at least every 15 minutes) and well documented checks on all
intoxicated and otherwise agitated persons (that is, all those placed in
detentioner
cells, see paragraph
21 below).
All police stations had contracts with several doctors who could be called in case of need; further, in
emergency the police would call an ambulance.
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17.
The delegation noted that the police systematically informed detained persons of their rights,
first orally immediately upon apprehension and subsequently in a written form upon arrival to the
police station, by means of an information sheet available in a variety of languages. The delegation
was pleased to note that the aforementioned information sheet had been amended in accordance
with an earlier CPT’s recommendation, by adding information on available avenues of complaint
against the treatment by the police.
That said, not all persons with whom the delegation spoke confirmed having been provided
with the information sheet.
The CPT reiterates its recommendation that steps be taken to ensure
that all persons detained by the police – for whatever reason – are systematically informed
of their rights, orally at the time of deprivation of liberty and through the provision, upon their
arrival at police premises, of a written information sheet setting out their rights in a simple
and accessible language. This information sheet should be available in an appropriate range
of languages. Further, detained persons should be allowed to keep the information sheet with
them.
18.
The information gathered during the visit suggests that whenever a juvenile was taken into
police custody, the police would systematically inform competent social services and, as appropriate,
the juvenile’s parent or other legal guardian. Further, a juvenile would never be questioned without
the presence of at least a representative of social services.
However, despite the recommendation made by the Committee in the report on the 2019
visit, it remained the case that lawyers were neither systematically contacted nor present during such
questioning.
The CPT reiterates its recommendation that the relevant legal provisions be
amended to ensure that juveniles deprived of their liberty by the police are never subjected
to police questioning or requested to make any statement or to sign any document
concerning the offence(s) they are suspected of having committed without the presence of a
lawyer. The option “does not wish to see a lawyer” should never apply to juveniles.
19.
The delegation noted as a positive development the increased recourse to electronic
recording of police interviews; in fact, several police officers with whom the delegation spoke
(especially those dealing with investigating serious organised crime) expressed the view that such
recording should become mandatory in all cases.
The Committee recommends that the Danish
authorities seriously consider taking such a step.
Another positive finding was that the training in research-based police interviewing
techniques (following the so-called “Basic and Advanced SAKA Models”) appeared to be in line with
the CPT standards.
15
“Basic SAKA Model” was applied to initial training in the Police Academy and
“Advanced SAKA Model” to ongoing training, especially for officers investigating serious organised
crime. It is worth mentioning that, at the end of the visit, the Danish authorities informed the
delegation that the guidelines setting out aforementioned training models (which were still classified
at the time of the visit) would be made public in the beginning of 2025.
15
See paragraphs 73 to 81 of document CPT/Inf(2019)9-part (“Preventing police torture and other forms
of ill-treatment – reflections on good practices and emerging approaches”). In particular, the training
emphasized that the purpose of the interview is not to “hunt for evidence” but to gather information
based on a non-judgmental procedure, including the establishing of a rapport, facilitating the suspect’s
free account, active listening and strategic use of evidence.
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Most of police officers with whom the delegation spoke confirmed that they had indeed
received such training, both initially and on an ongoing refresher basis.
16
The delegation was also
informed that since 2016, some 1500 police officers had received such training at the Police
Academy, in addition to a further 1500 who had followed courses organised locally. This continuous
training effort by the Danish authorities is indeed commendable.
At some of the police establishments visited (in particular Bellahøj Police Station in
Copenhagen), the delegation saw dedicated interview rooms which were of an excellent standard,
equipped with audio-video recording devices and furnished in a pleasant non-oppressive manner
(comfortable chairs, sofas and tables, pictures, plants and big windows letting in plenty of natural
light). In the opinion of police officers using those premises, their layout greatly facilitated their work
by stimulating free communication with the suspects. In the CPT’s view,
such dedicated interview
rooms should be the norm in all police establishments and their use should be made
mandatory under the aforementioned SAKA Model, to be updated as necessary.
17
20.
Although most of the interviewed persons had no complaints regarding the manner in which
they had been questioned, the delegation did receive a few allegations that some police officers
would have initiated so-called “informal talks” encouraging detained persons to “cooperate” prior to
the beginning of the formal police interview, that is before the persons concerned were given the
possibility to benefit from the legal safeguards for persons in police custody (notification of custody,
access to a lawyer and to a doctor, and information on rights).
If proven true, such practices would be contrary to the aforementioned modern research-
based and human rights focussed approach to police interviewing.
18
Persons in police custody
should never be questioned by the police without benefiting from safeguards provided for by law, in
particular the right of access to a lawyer.
The CPT would like to receive the Danish authorities’
observations on this subject.
In this context, the Committee also wishes to stress that
the aforementioned introduction
of mandatory electronic recording of all police interviews (from their very start including the
information on the suspect’s legal rights) would help fully eradicate the practice of “informal
talks”.
4.
Conditions of detention
21.
Material conditions in the police establishments visited, both in the holding cells mostly used
to accommodate criminal suspects (venterum) and in cells for intoxicated and agitated persons
(detentioner), were generally in compliance with the CPT’s standards in terms of size (single cells
measuring between 6 and 10 m²), equipment (a washable mattress in
detentioner,
a bench in
venterum,
fire-proof blankets, call system in all cells), lighting (although, except in those at Bellahøj
Police Station, there was no access to natural light in
venterum
cells), ventilation and state of repair
and cleanliness, especially given the short detention periods (see paragraph 9 above). In all police
stations, detained persons had access to good quality communal toilets (and sometimes also a
shower), and arrangements were in place to provide food at normal meal times.
16
17
18
Refresher training was in the form of a 5-day course referred to as “Afhøring II”.
If electronic recording of police interviews becomes indeed mandatory, the SAKA Model will need to
be further updated to reflect this.
As well as the Méndez Principles, see
https://interviewingprinciples.com/.
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At Bellahøj Police Station, the delegation saw that both the
venterum
and the
detentioner
had windows letting in natural light.
The Committee invites the Danish authorities to make efforts
to adopt a similar design in all cells at police stations, especially as regards newly
constructed or refurbished facilities.
22.
The delegation noted that prior to placement in a cell, persons in police custody were
occasionally subjected to a strip search, in which they had to remove all their clothes (i.e. strip down),
instead of following a two-step procedure (first the upper, then the lower body) as recommended by
the CPT to ensure the respect of the person’s dignity. Moreover, strip searches were carried out in
premises under CCTV coverage, with the footage being visible on large screens located in the
operations rooms of police stations (accessible to any staff present in those rooms).
The Committee
recommends that the existing rules be amended so as to introduce a two-step strip search
procedure
19
in all police establishments and to ensure that searches are not performed in
premises under CCTV surveillance.
23.
Some detained persons interviewed by the delegation complained that they had been obliged
to give away their eyeglasses prior to the placement in the cell, which was a problem especially for
persons whose eyesight was strongly impaired. Reportedly, police officers had referred to security
rules in force.
The CPT would like to be provided with details of these rules and, in this context,
would like to be informed whether taking away detained persons’ eyeglasses is a routine
measure or whether it is based on an individual risk assessment.
19
Detained person should first be asked to remove upper clothes, then the search of upper body takes
place, then the person may put upper clothes back on, and only after that the person is requested to
take off lower clothes and is searched below the waist. The principle is that the person should never
be fully naked.
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B.
Immigration detention establishment
1.
Preliminary remarks
24.
The legal grounds for administrative detention of foreign nationals (“non-citizens”) in
Denmark are laid out in Sections 14 to 16 of the 2023 Return Act
20
and Section 36 of the Aliens
Act.
21
According to these provisions, foreign nationals may be detained if non-custodial measures
are deemed insufficient to ensure their expulsion or deportation. This is for instance the case when
persons who are scheduled to be deported do not co-operate with the police in making arrangements
for their deportation or if they do not comply with reporting or residence obligations (Sections 15 and
16 Return Act).
Foreign nationals can further be detained when there are reasonable grounds for suspecting
that they have committed a criminal offence that may result in a sentence to deportation or if they
have entered Denmark in violation of an entry ban (Section 14 of the Return Act). They may also be
deprived of their liberty pursuant to the same Section 14 if they have received a criminal sentence
for entering Denmark with false identity documents;
22
the provision in question can apply to asylum
seekers too. Asylum seekers may in certain cases also be detained if they are to be deported to
another European country under the “Dublin-Regulation”
23
(Section 29a of the Aliens Act), if they
significantly hinder the investigation of their asylum case or if their asylum application is considered
“manifestly unfounded” and detention is deemed necessary to ensure their presence during the
examination of their asylum cases (Section 36 of the Aliens Act).
25.
The maximum time-limit for detention under Section 16 of the Return Act and Section 36 of
the Aliens Act is 3 months for persons “under EU rules”
24
and 6 months for all other foreign nationals.
In exceptional cases, detention can be extended by a further 6 or 12 months respectively, thus up to
a total of 9 and 18 months respectively (Section 37 (8) of the Aliens Act). However, for detention
under Section 14 or 15 of the Return Act, the relevant provisions from the Administration of Justice
Act apply, which do not contain a fixed maximum duration for the detention.
In the CPT’s view, a prolonged detention of persons under aliens legislation, without a time-
limit and with unclear prospects for release or forced removal, could lead to a deterioration of the
mental health of the individual and could easily be considered as amounting to inhuman treatment.
25
The Committee therefore recommends that the relevant legislation be amended in order to
introduce a proportionate absolute time-limit for all cases of detention under aliens
legislation, including under Sections 14 and 15 of the Return Act.
20
21
22
23
24
25
LBK nr 1014.
LBK nr 1009.
In such cases, criminal sanctions are based on Sections 171 and 174 of the Criminal Code.
The “Dublin-Regulation” ensures that an asylum application lodged in one of the EU Member States
is processed by (only) one Member State (as a rule, the country of entry of the foreign national into
the EU). See Regulation No. 604/2013 of the European Parliament and of the Council of 26 June 2013
establishing the criteria and mechanisms for determining the Member State responsible for examining
an application for international protection lodged in one of the Member States by a third-country
national or a stateless person.
The “EU-rules” is a concept defined in Section 2 of the Aliens Act. It covers the rules of the European
Union concerning exemption from visas and cancellation of limitations of travel and taking residence
in connection with the free movement of labor.
See the CPT’s Factsheet on Immigration Detention, CPT/Inf (2017) 3, page 2.
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26.
The law still allows for the detention of minors under immigration legislation; however, the
delegation was informed at the outset of the visit by senior officials from the Ministry of Immigration
and Integration that this was resorted to only in very rare cases. Whilst welcoming this policy,
the
CPT wishes to reiterate its view that – in line with a continuing trend at the European and
international level – measures should be taken to fully abolish immigration detention of
minors.
27.
The delegation carried out a follow-up visit to Ellebæk Centre for Foreigners (hereafter
Ellebæk Centre) which had been visited by the CPT during several previous visits to Denmark,
including the last visit in 2019.
26
At the time of the 2024 visit, Ellebæk Centre was the only
administrative immigration detention centre in the country.
27
Located 25 km north of Copenhagen, on the premises of former military barracks, Ellebæk
Centre had the official capacity of 121 and was accommodating 51 adult male foreign nationals and
one adult female; 32 of them had been detained under Section 16 of the Return Act and 20 under
Section 14 of the Return Act. Most of them were awaiting deportation.
Foreign nationals detained pursuant to Section 14 of the Return Act were referred to by the
Danish authorities as “remanders” (varetægtsfængslet) but in fact all had fully completed their prison
sentences and had no further criminal cases pending (both of the above being express legal
preconditions for a placement at Ellebæk Centre). In addition to their prison sentence, they had also
been sentenced by court to being deported, and the reason for being held at Ellebæk Centre was
precisely to secure their deportation.
The average stay at Ellebæk Centre was 28 days and the median length was 14 days (both
figures referring to the year 2023). Foreign nationals were frequently held there for much longer
periods. Of the persons accommodated at Ellebæk Centre at the time of the visit, 17 had been held
there for more than 2 months and 5 for more than 8 months. One person had been at Ellebæk Centre
for 19 months. In this context,
reference is made to the recommendation in paragraph 25 above.
2.
Ill-treatment
28.
The majority of the detained foreign nationals interviewed by the delegation at Ellebæk
Centre stated that they were being treated by staff in a correct manner. However, the delegation did
hear credible allegations of two recent incidents in the course of which custodial officers had
reportedly violently pushed detained foreign nationals in reaction to minor infringements of rules.
Further, similar to the situation observed during the 2019 visit, the delegation heard many allegations
of some custodial staff using rude or dismissive language towards detained foreign nationals, such
as like referring to them as “pigs”.
The Committee recommends that it be recalled to all staff working at Ellebæk Centre,
in suitable intervals, that any form of ill-treatment of detained foreign nationals (including
verbal abuse) is illegal, unacceptable and will be punished accordingly.
29.
Inter-detainee violence did not appear to be a major problem at Ellebæk Centre and
whenever it did occur, staff seemed to react quickly and appropriately.
26
27
See report of the CPT’s 2019 visit to Denmark (CPT/Inf (2029) 35), pages 52 to 67.
In addition, there were 10 places for persons detained under aliens legislation at Aabenraa Remand
Prison.
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3.
Conditions of detention
30.
It is to be stressed as a positive fact that the material conditions of detention had considerably
improved at Ellebæk Centre since the 2019 visit, mainly thanks to extensive refurbishment and lower
occupancy levels. Living quarters (rooms shared usually by two or three, rarely four detained foreign
nationals) were suitably furnished (beds with full bedding, tables, chairs and chests) and kept clean,
as were communal toilets, washrooms and showers. Personal lockers (“safety boxes”) had been
made available for every detained foreign national albeit many of them were in practice not usable
at the time of the visit due to missing batteries and other dysfunctions. When made aware of the
problem, the Director of Ellebæk Centre assured the delegation that all the lockers would be repaired
without delay.
The CPT would like to receive confirmation that this has indeed been done.
31.
However, despite the repeated criticism by the CPT and other international and national
stakeholders, the environment had remained very much prison-like, as
inter alia
demonstrated by
the presence of barred windows, barred gated partitions between the units and the fact that the
establishment was staffed by prison officers who were carrying handcuffs and pepper spray;
28
furthermore, prison rules (pursuant to the Criminal Enforcement Act) were applied by analogy to
detained foreign nationals. This is unacceptable given that none of the foreign nationals detained at
Ellebæk Centre were criminal suspects or serving a prison sentence at the time of their detention
there.
The Committee must reiterate its view that immigration detention is a form of administrative
detention and should be clearly distinguished from imprisonment as a punishment for a criminal
offence. Therefore, any impression of a carceral environment should, as far as possible, be avoided.
The emphasis should be on minimum internal security regulations and the promotion of normality.
The Committee will come back to these precepts in several other parts of the present chapter (see
paragraphs 35, 44, 47 and 53 below).
The CPT recommends that the Danish authorities take
steps to eliminate all prison-like features at Ellebæk Centre, taking into account the above
remarks.
32.
The delegation observed that when married couples were placed at Ellebæk Centre, they
were separated and accommodated in the men’s and women’s sections respectively. That said, they
could reportedly meet almost every day for a few hours in the visiting area.
The CPT is of the view that when members of the same family are detained under immigration
legislation, every effort should be made to avoid splitting up the family. The Director of Ellebæk
Centre told the delegation that she was aware of the problem and was trying to find a way to
accommodate couples together (unless one of them opposes).
The Committee requests to be
informed whether such a solution has now been found.
33.
Detained foreign nationals benefitted from an open-door regime
29
under which they could
freely associate with other detainees from the same unit. Approximately half of detained foreign
nationals had a paid job (cooking, cleaning, gardening, maintenance and assembling cardboard
boxes).
28
29
Employees of the Danish Prison and Probation Administration (DPPA), see paragraph 44 below.
Rooms were generally not locked at either day- or nighttime in order to allow free access to the
communal toilets. During daytime, detainees could ask custodial staff that their rooms be locked in
their absence.
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Further, an activity centre
30
had been made available in a separate building, access to which
was granted by two pedagogical assistants who could also propose other activities such as football
or basketball.
31
However, many detained foreign nationals appeared not to be aware of the availability of the
above-mentioned activities (or of the procedure to request access to them) and thus spent most of
their days idly, lingering around on the units or watching TV. Further, the delegation was informed
that previously available language and cooking classes had been discontinued due to the lack of
qualified staff.
32
34.
The CPT acknowledges that many detained foreign nationals stayed at Ellebæk Centre for
relatively short periods (up to several weeks). However, much longer stays (up to several months)
were not uncommon (see paragraph 27 above). In the Committee’s view, the longer the period for
which foreign nationals are detained, the more developed should be the offer of activities available
to them.
The CPT recommends that the management of Ellebæk Centre step up their efforts to
expand the offer of organised activities, in particular for those detained foreign nationals who
remain at the establishment for more than a few weeks.
Further,
steps should be taken to
ensure that detained foreign nationals are duly informed, in a language they understand, of
the existing offer of activities and the relevant procedures.
35.
Male detainees had access to two large asphalted outdoor exercise yards (equipped with
shelters against inclement weather), usually for about 30 minutes twice a day. In addition, they had
unrestricted access to small wire net enclosures covered by rigid metal mesh (one enclosure per
unit, each measuring some 10 m²). The Director told the delegation that she wished to increase
detained foreign nationals’ access to outdoor areas but stated that her efforts were considerably
hampered by the requirement to follow prison-level security regulations (see paragraph 31 above).
The Director was of the opinion that, due to this requirement, the only available option was to enlarge
the aforementioned enclosures and, if possible, fit them with some outdoor gym equipment.
However, even when enlarged and so equipped, the enclosures would remain prison-like and of an
oppressive design, inappropriate as outdoor areas for persons detained under aliens’ legislation.
Women had access throughout the day to an outdoor enclosure which was of a similar
oppressive design as the ones used by male detainees, and which measured approximately 2 by 10
meters.
The Committee reiterates its recommendation that the Danish authorities take the
necessary steps to ensure that all detained foreign nationals have in principle free access to
an appropriate outdoor area throughout the day, including on weekends.
30
31
32
The activity centre comprised a large bright room equipped with tables, chairs, a sofa, a table tennis
table, a table-football and a pool table, as well as an indoor gym.
On weekdays for up to 12 detained foreign nationals and for 2 hours in the morning and two hours in
the afternoon.
The language teacher was on long-term sick leave and the cooking teacher had left the establishment.
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4.
Health care and vulnerability screening
36.
Health-care staff complement at Ellebæk Centre consisted of two full-time nurses present in
the establishment on weekdays from 8 a.m. to 4 p.m. and a general practitioner who attended one
working day per week.
33
When the latter was not present, doctors working at a nearby prison were
available on call. In the absence of the nurses, the duty nurse from the Western Prison
34
or an
ambulance could be called. It is positive in this context that all custodial staff had received first-aid
training in the autumn of 2023 and that a refresher course was planned for the autumn of 2024.
In addition, a psychiatrist could be called to come to Ellebæk Centre when needed and a
psychologist visited twice a month offering “crisis management” to the detainees.
35
Further, two
psychomotor therapists worked at the establishment for a total of 18 hours per week.
37.
Given the low occupancy level at Ellebæk Centre at the time of the visit, the overall presence
of health care staff could be considered as generally adequate. However, it appeared that no health-
care staff was available at night, on weekends and on public holidays to check on detained foreign
nationals placed in “special observation” (i.e. to prevent suicide or self-harm) or in disciplinary solitary
confinement cells, and to distribute any prescribed medication (see paragraphs 51, 49 and 42
below).
The CPT invites the Danish authorities to strive to ensure that health-care staff (e.g.
coming from a nearby prison) can be called to Ellebæk Centre also at night, on weekends and
during public holidays, whenever a detained foreign national is placed in solitary confinement
or in “special observation” (i.e. to prevent suicide or self-harm). Regarding the distribution
of medicines by medically untrained custodial officers, reference is made to the comments
and recommendation in paragraph 42 below.
38.
Regrettably, despite the Committee’s long-standing recommendation on this subject, newly
arrived detained foreign nationals were still not subject to a comprehensive medical examination on
admission.
Admittedly, nurses did see all newly-arrived detainees within 72 hours of their admission,
conducting interviews aimed at detecting potential and/or acute health problems in line with the
specific guidelines in place within the prison system (e.g. regarding suicide prevention and self-
harm). The outcomes of the interviews were recorded on dedicated forms and included the nurses’
opinions on the need for further examination or treatment, with a mention on whether the detained
foreign nationals concerned had given their consent to any such examination or treatment. The CPT
welcomes this positive practice.
33
34
35
It is recalled that Ellebæk Centre had the official capacity of 121 and was accommodating 52 detained
foreign nationals at the time of the visit.
See paragraph 74 below.
An additional “specialist” psychologist could be consulted for more complex mental disorders when
needed. Detained foreign nationals diagnosed with a psychosis would be transferred to a psychiatric
establishment.
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39.
However, the physical checks were of a superficial nature, merely consisting of verifying the
blood pressure and pulse, and measuring the height and weight. Usually, detained foreign nationals
were not requested to take off their clothes and thus no injuries (other than those clearly visible on
detainees’ heads or hands) could be detected unless the detainees would mention them
spontaneously. Appointments for a proper medical examination were usually only made when the
nurses considered them necessary for a specific reason.
The delegation was told that, whenever the nurses would (in the course of the
aforementioned interviews) gain the impression that detained foreign nationals might have been
subjected to physical ill-treatment by the police (or might have been involved in any other violent
incident), they were specifically instructed to examine the detained foreign national and record the
respective findings. However, there was still no procedure in place for reporting allegations of ill-
treatment and related injuries to the relevant investigatory authorities.
40.
As already stressed many times in the past, a thorough medical examination on admission
of detained foreign nationals is indispensable for the timely provision of somatic and mental health
care, as well as for the detection and the recording of possible injuries. It is further crucial for
identifying vulnerable persons such as
inter alia
victims of torture or human trafficking and persons
suffering from post-traumatic stress disorders (PTSD), and for detecting somatic and specifically
transmissible diseases.
Consequently,
the CPT calls upon the Danish authorities to ensure that all detained
foreign nationals newly admitted to Ellebæk Centre benefit from a prompt physical
examination carried out by a doctor or a nurse reporting to a doctor.
Regarding the manner in which the examination should be carried out and any
observed injuries recorded, the Committee reiterates its recommendation that the record
drawn up after a medical examination of a detained foreign national (whether newly arrived
or not) contains:
i)
an account of statements made by the person which are relevant to the
medical examination (including his/her description of his/her state of health
and any allegations of ill-treatment);
a full account of objective medical findings based on a thorough examination
(supported by a “body chart” for marking traumatic injuries and, preferably,
photographs of injuries), and
the health-care professional’s observations in the light of i) and ii), indicating
the consistency between any allegations made and the objective medical
findings.
ii)
iii)
Acknowledging that such cases were very rare at Ellebæk Centre,
the CPT nevertheless
wishes to emphasize that whenever injuries are recorded which are consistent with
allegations of ill-treatment made by a detainee (or which, even in the absence of an allegation,
are clearly indicative of ill-treatment), health-care staff should be instructed to systematically
bring the record to the attention of the relevant investigatory authorities. Health-care staff
should further advise detained foreign nationals that the forwarding of the report to the
relevant investigatory authorities is not a substitute for the lodging of a complaint in a proper
form.
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41.
Concerning the identification of possible victims of torture, it is regrettable that a specific and
systematic torture screening was still not taking place despite repeated previous recommendations
to this effect, including from the CPT and the Parliamentary Ombudsman.
The delegation was told that at least some detained foreign nationals might have undergone
such screening prior to their arrival at Ellebæk Centre (e.g. at Sandholm Asylum Centre
36
) but this
was clearly not the case for most of the detainees met by the delegation. Moreover, it remained
unclear whether the results of any such previous screening would be systematically transmitted to
Ellebaek Centre and whether there was any follow-up procedure.
In the light of the above,
the Committee reiterates its recommendation that specific
screening aimed at identifying victims of torture and other persons in situation of
vulnerability be put in place at Ellebæk Centre (unless the results of any such screening
carried out prior to the detainee’s admission are made available to health-care staff working
at the establishment) and that appropriate treatment and care be provided when necessary.
The CPT further recommends that the Danish authorities seek alternatives to
immigration detention for certain vulnerable categories of persons, including victims of
torture and trafficking and persons suffering from severe mental disorders.
37
42.
Medical records examined at Ellebæk Centre by the delegation’s doctor were well kept and
detailed, and their confidentiality respected, as was the confidentiality of health-care consultations.
As far as the delegation could ascertain, custodial staff were never present in the examination room.
Whenever necessary, interpretation during consultations was provided by professional interpreters,
either in person or via a telephone. These were all positive developments as compared with the
situation observed during the 2019 visit.
However, as already mentioned in paragraph 37 above, prescribed medication continued to
be, as a rule, distributed to detained foreign nationals by medically untrained custodial staff. In this
respect, the Committee wishes to stress once again that, in its view, not only the preparation of
individual medicine doses but also their distribution by medically untrained individuals may be
harmful to the health of the patients concerned as it is prone to errors and, in any event, is generally
incompatible with the requirements of medical confidentiality.
The CPT therefore reiterates its
recommendation that prescribed medicines, as a rule, only be prepared at Ellebæk Centre
and distributed by qualified health-care staff.
38
If, very exceptionally, a daily presence of
health-care staff is not possible, steps must be taken to ensure that individual medicine
doses are at least prepared exclusively by a health-care professional and their distribution
respects as far as possible the precepts of medical confidentiality.
43.
The delegation was also concerned by the fact that foreign nationals detained at Ellebæk
Centre were still required to make their requests to see a member of the health-care team by means
of filling in special forms, to be handed over in an open manner to a custodial officer, with the
obligatory mention of the reason for the request. Some of the forms used also contained a standard
pre-printed sentence that “the employee who first receives the request must ensure that it is filled
out correctly, and that the inmate has written a proper reason, if possible, for the request”. The
Director of Ellebæk Centre acknowledged that the existing procedure was incompatible with the
principle of medical confidentiality and informed the delegation that detained foreign nationals would
shortly be enabled to make requests for medical consultations using sealed envelopes.
36
37
38
Which is not a place of deprivation of liberty within the meaning of the Convention.
See the CPT’s factsheet on Immigration Detention, CPT/Inf (2017) 3, page 8.
See also the recommendation in paragraph 37 above.
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The Committee would welcome the Danish authorities’ confirmation that the modified
procedure has now been introduced.
5.
Custodial staff
44.
As mentioned in paragraph 31 above, Ellebæk Centre was staffed by custodial officers
employed by the DPPA. At the time of the visit, the centre employed 33 custodial officers and two
heads of unit. Eight officers were usually present during the day and five at night, including on
weekends. This shift presence of custodial staff appeared to be adequate for the currently low
occupancy level. Nevertheless, the delegation was informed that there had been staff vacancies for
several years and that many officers were obliged to work overtime which apparently caused
frustration and tensions. Reference is made in this respect to paragraph 90 below.
45.
It is regrettable that, despite the recommendation made on this subject by the CPT in the
report on the 2019 visit, custodial staff had still not received any specialised training for working with
detained foreign nationals.
39
The Committee reiterates its recommendation that all staff (in particular custodial
officers) working at Ellebæk Centre be given specific training for this task. The training
should aim at developing staff’s inter-cultural sensitivity and interpersonal communication
and psycho-social skills in the context of immigration detention. Staff should further be
taught to recognise possible symptoms of stress, vulnerabilities and previous experience of
traumatisation displayed by detained persons and to take appropriate action.
46.
Two other issues of concern not addressed since the 2019 visit were that, first, custodial
officers could not be identified by detained foreign nationals (as they wore neither name tags not
identification numbers on their uniforms) and, secondly, continued to routinely carry “special means”
(handcuffs and pepper spray) inside the accommodation areas. Both of these could be perceived as
unnecessary intimidating and prison-like.
The CPT
reiterates its view that the ethos of an immigration detention establishment should
not be carceral and therefore
recommends that staff working within immigration detention
facilities should not routinely carry “special means” (including handcuffs and pepper-spray)
whilst inside the accommodation areas.
Further,
steps should be taken to ensure that custodial officers are always identifiable,
preferably by wearing name tags or short identification numbers in a visible manner at all
times whilst on duty.
39
Apart from a training session on human trafficking, which had been provided once by an NGO.
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6.
Discipline and security
47.
Disciplinary rules applied at Ellebæk Centre were analogous to those followed in prisons.
40
Thus, detained foreign nationals could be placed in disciplinary solitary confinement for up to 28
days.
41
While the sanction had not been applied very frequently in recent past, the delegation noted
that there had been several placements for more than 14 days and one of 28 days in the period
between the beginning of 2022 and mid-May 2024.
42
As stressed many times in the past, the CPT
considers that disciplinary solitary confinement should never be applied for more than 14 days, due
to the potentially very damaging effects of this measure to the mental health of the persons
concerned.
The CPT reiterates its recommendation that disciplinary solitary confinement
should never be imposed for more than 14 days for a given offence (and should preferably
be shorter). Whenever an additional period of disciplinary solitary confinement is imposed
on a detained foreign national, there should be an interruption of several days between the
two placements.
48.
The disciplinary procedure (including as regards the information provided to detained foreign
nationals) and the regime in disciplinary solitary confinement were essentially identical to those
followed in prisons.
In particular, as was the case in some of the penitentiary establishments visited,
43
detained
foreign nationals only received a copy of the disciplinary decision upon their request.
The CPT
reiterates its recommendation that detained foreign nationals placed in disciplinary solitary
confinement always receive a copy of the disciplinary decision in order to facilitate the
exercise of their right to appeal.
49.
According to the information received, detained foreign nationals placed in disciplinary
solitary confinement were usually seen by a nurse shortly after their placement in the cell, on the
same or the following day. However, this was not the case during weekends when no nurse was
present at the centre. The delegation was further told that after the initial visit, a nurse usually came
to see the detainee on a weekly basis. This is not sufficient.
The Committee reiterates its recommendation that, in addition to an initial visit
immediately after the person’s placement, health-care staff should visit detained foreign
nationals in disciplinary solitary confinement regularly thereafter at least once per day
(including on weekends and public holidays) to timely provide the required medical care.
Reference is further made to the recommendation in paragraph 37 to enhance the availability
of nurses on non-working days.
40
41
42
43
As already mentioned in paragraph 31 above, prison regulations were applicable
per analogiam
at
Ellebæk Centre. See also paragraphs 92 to 97 below.
Disciplinary solitary confinement cells were recently refurbished and clean; conditions in them do not
call for any particular comment.
The longest periods of disciplinary solitary confinement in 2022 had been 21 days, 20 days and 15
days (on two occasions); in 2023, 20 days and 15 days (on four occasions) and in 2024 (until mid-
May) 28 days and 17 days.
See paragraph 96 below.
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50.
Detained foreign nationals were occasionally subjected to strip searches. A decision to
subject a detainee to such a search was, as a rule, taken following an individual risk assessment,
usually following a violent incident or upon suspicion of smuggling a prohibited item after a visit. That
said, foreign nationals detained pursuant to Section 14 of the Return Act
44
were reportedly
systematically strip-searched upon arrival. In this context,
the Committee refers to the remarks
and recommendation in paragraph 118 below, which apply fully also to detained foreign
nationals accommodated at Ellebæk Centre.
45
7.
“Observation cells”
51.
Detained foreign nationals who were considered by staff to be suicidal, threatening to self-
harm or otherwise in a very agitated mental state could be placed in a specially equipped
“observation cell”.
46
According to the relevant registers, such placements occurred rarely and were
usually of a short duration, i.e. between one and four hours.
47
Again, the procedure applied for such placements was largely identical to that followed in
penitentiary establishments. In particular, the decision to place a detainee in an observation cell
could also at Ellebæk be taken by custodial staff rather than by a medical doctor.
Further, as was the case for detained foreign nationals held in disciplinary solitary
confinement, no health-care staff came to see the detainees concerned during weekends and on
public holidays.
48
The CPT reiterates its recommendation that the placement of a detained foreign
national in an “observation cell”, as well as its continuation, only be carried out upon the
authorisation of a medical doctor. Reference is again made to the recommendation in
paragraph 37 above to enhance the availability of nurses on non-working days.
52.
Despite the recommendation made by the Committee in the report on the 2019 visit, the
delegation was told that detained foreign nationals considered to be at risk of suicide and self-harm
were placed in the “observation cell” in their underwear and provided with a blanket.
The CPT
reiterates its recommendation that such detainees be always provided with rip-proof clothing
appropriate to their specific needs.
44
45
46
47
48
See paragraph 24 above.
See also paragraph 22 above.
Equipped with a bed (with a mattress and a blanket), a table and a chair, as well as a call system.
The longest stay in the last two and a half years had been of 21 hours.
During the placement in an “observation cell”, a nurse usually came to see the detainee concerned on
the same or the following working day. In addition, custodial staff reportedly came to the cell to observe
and record the detainee’s state several times per hour.
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8.
Contact with the outside world
53.
Detained foreign nationals could receive visits in principle every day for at least one and a
half hour, including on weekends. Upon their arrival, all detainees received a phone card with an
initial credit (equivalent to about 14 EUR) which could be used to make telephone calls from freely
accessible pay phones on the unit corridors. That said, given the very high price of calls from these
phones, especially for calls abroad, the management was actively seeking ways to lower the costs
of phone calls, which is commendable.
However, detainees were not allowed to use their personal mobile phones (even those
without cameras), there was still no access to the Internet (not even a restricted one) nor the
possibility to make video calls using the Voice over Internet Protocol (VoIP) technology.
49
This was
another example of the automatic application of prison regulations, ill-suited in the context of
immigration detention (where the overwhelming majority of detained foreign nationals had no one
who could visit them as their relatives lived abroad).
The CPT recommends that steps be taken to offer detained foreign nationals
accommodated at Ellebæk Centre better access to the telephone, preferably by allowing them
to keep (or at least have regular access to) their own mobile phones. If necessary for reasons
of security, detained foreign nationals could be allowed to keep mobile phones provided the
phone has no camera. For mobile phones equipped with a camera, the rule could be that
detained foreign nationals may only use them in a dedicated room and/or under staff
supervision. Further, detainees at Ellebæk Centre should be provided with access to the
Internet (restricted if needed) and to video calls on a free-of-charge basis.
9.
Legal safeguards
54.
In the report on the 2019 visit, the CPT criticised the fact that not all detained foreign nationals
then interviewed by the Committee’s delegation at Ellebæk Centre had reportedly received a written
copy of their detention order. In their response to that report, the Danish authorities stated that “the
Ministry of Justice has requested the police to ensure that other aliens detained in accordance with
Section 36 of the Aliens Act henceforward are also provided with written information in accordance
with Section 37 (4) in a language which the alien understands or may reasonably be assumed to
understand.”
50
However, many of the detained foreign nationals interviewed at Ellebæk Centre during the
2024 visit told the delegation that they had not received such a document. More generally, some of
the detainees appeared to be unaware of the legal procedures affecting them.
In this context,
the CPT reiterates its recommendation that steps be taken to ensure
that all detained foreign nationals accommodated at Ellebæk Centre be provided with a copy
of the detention order, including information on the grounds for detention and the modalities
to lodge an appeal. Detained foreign nationals who do not understand Danish should further
receive in writing at least a summary of the detention order in a language and manner they
understand.
Further,
the Committee would like to be provided with a detailed and
comprehensive account of all written information given to detained foreign nationals
(including by the police, the Danish Return Agency and the Danish Refugee Council).
49
50
The equipment for video calls was available in a dedicated room, but only used on some days for
online court hearings.
See document CPT/Inf (2020) 26, page 74.
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55.
The Committee welcomes the fact that a full-time social worker had been recruited at Ellebæk
Centre, tasked among other things with providing detained foreign nationals with relevant information
upon admission and during their detention, in particular on the establishment’s house rules and
detainees’ rights. The social worker usually met newly-arrived detained foreign nationals within 24
hours of their admission for “information sessions” in smaller groups or individually;
51
further, the
social worker came to the accommodation units on a regular basis and was available for individual
conversations with the detainees.
As regards written information, the delegation noted as a positive development that detained
foreign nationals were now, as a rule, provided with a comprehensive information brochure (available
in 15 languages) immediately upon their arrival. In addition, the house rules as well as the admission
search procedure (the latter in pictograms) were posted on the wall in the establishment’s admission
area and a short version of the daily schedule (also in pictograms) was posted on the information
boards in the unit corridors.
56.
As regards information on avenues of complaint in particular, several detained foreign
nationals told the delegation that they did not know how to file a complaint. The brochure mentioned
in paragraph … above did indicate that complaints could be filed to the DPPA and specified the
relevant postal address; it also mentioned the possibility to complain subsequently to the
Parliamentary Ombudsman.
However, no information was provided in the brochure (nor anywhere else e.g. on information
boards in the units) on the practical complaint procedure, i.e. how exactly both internal and external
complaints could be filed and who dealt with these complaints within which deadlines. In particular,
no mention was made in the brochure (nor in any other place) of the fact that detained foreign
nationals could request to receive paper and envelopes, and file confidential complaints using
complaint boxes installed inside each accommodation unit.
Further, the manner in which the relevant chapter of the information brochure was drafted (at
least in the English language version) could lead the reader to the incorrect conclusion that
complaints could only be filed against disciplinary sanctions.
52
The CPT recommends that the information brochure at Ellebæk Centre be amended
so as to eliminate the aforementioned lacunas.
57.
A number of interviewed detained foreign nationals claimed that complaints they had lodged
verbally had been immediately dismissed by duty custodial staff, without informing the Director.
Regrettably, the delegation was not in a position to verify these claims given the absence of a
dedicated complaints register at Ellebæk Centre.
The Committee recommends that such a
register be set up. Further, all staff (including custodial officers) should be instructed to duly
report to the Director (or another authorised member of the management) all verbal
complaints received from detained foreign nationals which cannot be resolved on the spot.
51
52
On weekends, the task of providing such information rested with the custodial staff, although the social
worker would meet newly-arrived detained foreign nationals on the first following working day.
See paragraphs 47 and 48 above. In particular, the chapter of the information brochure entitled
“Possibilities to complain” began with the following sentence: “As a general rule, you are entitled to a
justification if you receive a disciplinary penalty”.
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58.
The CPT acknowledges as a positive development since the 2019 visit that the availability of
professional interpretation services (both in person and via a telephone) had considerably improved
at Ellebæk Centre. The establishment’s Director expressly encouraged staff to make more use of
these services and sufficient funds had been made available for that purpose. In addition, electronic
interpretation tools were regularly used.
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C.
Prison establishments
1.
Preliminary remarks
59.
The delegation visited the Western Prison and Police Square Prison in Copenhagen, as well
as Nyborg and Enner Mark Prisons. All have been visited by the CPT in the past and the general
descriptions of these establishments made in the reports on previous visits remain generally valid.
53
60.
At the outset of the visit, senior officials from the Ministry of Justice informed the delegation
that the Danish prison system had for the past several years operated above its intended capacity,
the rate of overcrowding being the highest in respect of remand prisoners (103%) and sentenced
inmates accommodated in closed prisons (102%).
54
At the time of the visit, the overall prison
population stood at 4.191 whilst all the penitentiary establishments together had 4.141 places
(calculated according to the norm of 6 m² of living space per prisoner). Indeed, the four prisons
visited were operating at their full capacity or were even slightly overcrowded,
55
which had obliged
the management to convert some of the single cells into double ones.
56
Granted, all prisoners
enjoyed at least 4 m² of living space but the fact remained that the prison population had been
increasing steadily.
57
According to the delegation’s interlocutors, there were several factors contributing to this
situation. One of the factors was the insufficient capacity of the court system (the duration of court
proceedings in criminal cases had increased from an average of 4,4 months in 2018 to 8,4 months
in 2022),
58
resulting in a very high percentage of remand prisoners (while the total number of remand
prisoners had decreased from 4.387 in 2019 to 3.354 in 2023, about 41% of the total prison
population in Denmark were remand prisoners in 2021) and their long stays in remand prisons or
sections, often for months or even years (the average duration of detention on remand was 8 months
in 2022, the latest available data at the time of the visit).
53
54
55
56
57
58
The Western Prison, the biggest and main penitentiary establishment in the greater Copenhagen area,
was visited many times in the past, most recently during the 2014 visit (see paragraph 43 of document
CPT/Inf (2014) 25). Police Square Prison (previously called Police Headquarters Prison) has likewise
been visited by the CPT on several previous occasions, most recently in 2019 (see paragraphs 44 and
45 of document CPT/Inf (2019) 35). Nyborg and Enner Mark Prisons were last visited in 2008, see
respectively paragraphs 49 – 52 and 45 – 48 of document CPT/Inf (2008) 26.
In open prisons the occupancy was lower, approximately 90%.
At the time of the 2024 visit, the Western Prison (capacity 504) was accommodating 539 inmates
(including 14 women and 168 male sentenced prisoners), as compared with the average of 537 in the
course of the year 2020 (but with the average population having peaked at 541 in 2023). The Police
Square Prison had 25 places and 23 inmates (all but seven on remand), Nyborg Prison had 348 places
and 349 prisoners (including 98 on remand and 150 foreign inmates subject to deportation in addition
to imprisonment), as compared with the average of 316 in the course of the year 2020. As for Enner
Mark Prison, it had the capacity of 236 and was accommodating 260 inmates (including 59 remand
prisoners), compared with the average of 246 in the year 2020.
It is to be stressed that this situation, combined with staff shortages, had a negative impact on the
conditions of detention, regime, health-care and contact with the outside world in the prisons visited.
See paragraphs 68, 73, 76 and 120 below.
The prison population had been 3.879 at the time of the 2019 visit. It is worth adding that Denmark’s
incarceration rate had increased from 66.8 inmates per 100,000 inhabitants in 2021 to 71 inmates per
100,000 inhabitants in 2023, see
SPACE - Council of Europe Annual Penal Statistics - Prisons and
Community Sanctions and Measures (coe.int).
See Danish Courts’ press release dated 29 March 2023 (https://domstol.dk/aktuelt/2023/3/fortsat-
lange-sagsbehandlingstider-i-2022/).
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Other factors included the changing characteristics of prison population with more inmates
belonging to organized crime
59
and serving long sentences, and the limited availability of alternative
measures (especially electronic monitoring
60
) and parole.
61
In particular, the delegation was told that
very few alternatives to remand imprisonment were being used. Although the Danish legislation
provided for the possibility of remand in custody being replaced with bail or a travel ban, these had
reportedly virtually ceased to be used since the late 1980s.
61.
Measures taken by the Danish authorities to respond to the aforementioned increase in the
prison population consisted essentially of building new prisons, including a new establishment (with
200 places) under construction in Zealand and a 400-cell prison soon to be opened in Jutland (in
Sønder Omme). Further, the Parliament had recently decided to increase budget allocations for the
judicial system, with the hope to help shorten the case processing time. The only already existing
new measure of a (substantive) legislative nature mentioned to the delegation was a recently
adopted amendment facilitating access of prisoners serving the last 8 months of their sentence to
half-way homes; however, the delegation’s interlocutors acknowledged that this new provision had
not had any real impact on the prison population so far. The delegation was also informed about
ongoing discussions on a possible introduction of a legal provision according to which persons would
not (in principle) be remanded in custody if the offence they were accused of could result in 6 months
of imprisonment or less. It is noteworthy though that this new draft provision was referred to as
“controversial” and it was reportedly unclear whether (and when) it would ever be adopted.
The CPT is firmly of the view that building new prisons cannot by itself provide a lasting
solution to the overcrowding problem. This can only be achieved by combining the modernization of
prison estate with an increased resort to alternatives to imprisonment. A coherent strategy is
required, covering both admission to and release from prison, to ensure that imprisonment really is
the measure of last resort. Emphasis should be placed on the full range of non-custodial measures
capable of providing judicial supervision during the period preceding the imposition of a sentence,
as well as on measures to accelerate a prisoner's release, including through supervisory means
tailored,
inter alia,
to the prisoner's personality and the nature of the sentence.
Further, the Committee wishes to stress that a prison cannot function effectively if it is
operating at 100% of its capacity or even slightly above capacity. There must always be some margin
for transferring incompatible prisoners from one wing to another or for receiving additional prisoners
or for taking back prisoners returning from leaves. The Council of Europe’s White Paper on Prison
Overcrowding states that “if a given prison is filled at more than 90% of its capacity this is an indicator
of imminent prison overcrowding. This is a high-risk situation, and the authorities should feel
concerned and should take measures to avoid further congestion.”
59
60
61
The increase in organized (including gang-related) violent crime, involving numerous persons accused
of drug and gun offences, was also reportedly one of the reasons why it took longer for the police to
investigate cases and for the prosecution service and courts to prosecute and try the accused.
Which, under the law in force at the time of the visit, could only be used as alternative to a prison
sentence (generally only in respect of juveniles and sick prisoners, as well as prisoners approaching
the end of their sentence) but not as an alternative to remand imprisonment. It is also noteworthy that
electronic monitoring was not available to prisoners sentenced for drug offences.
Access to which had reportedly become more restricted pursuant to recent Ministry of Justice
guidelines (for example, it was virtually inaccessible to prisoners who were known to belong to a
criminal gang). According to representatives of several NGOs met by the delegation at the outset of
the visit, whilst approximately 20% of applications for parole had been rejected in 2019, the percentage
of rejections had doubled by 2023. At Nyborg Prison, staff told the delegation that several years
previously some 60% of prisoners would be released after having served 2/3 of their sentence but that
currently the percentage was much lower (some 20%).
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The CPT calls upon the Danish authorities to step up their efforts to ensure that all
prisons operate within their official capacities. Further, efforts to manage the prison
population should be increased, taking due account of the relevant Recommendations of the
Committee of Ministers of the Council of Europe, including Recommendation No. R(99)22
concerning prison overcrowding and prison population inflation, Recommendation
Rec(2006)13 on the use of remand in custody, the conditions in which it takes place and the
provision of safeguards against abuse, Recommendation Rec(2003)22 on conditional release
(parole), Recommendation CM/Rec(2010)1 on the Council of Europe probation rules,
Recommendation (2014)4 on electronic monitoring and Recommendation CM/Rec(2017)3 on
the European Rules on community sanctions and measures. A comprehensive strategy and
action plan must be drawn up to achieve this goal, including precise deadlines and budget
allocations.
The CPT would like to be informed of the progress in devising such a strategy and
action plan. The Committee would also like to receive more detailed information on the above-
mentioned Parliament decision to increase budget allocations for the judicial system.
62.
During the visit the delegation learned of the ratification by the Kosovo Parliament (on 23
May 2024) of the bilateral treaty foreseeing the operation of a prison in Gjilan (Kosovo) by the Danish
Prison and Probation Administration (DPPA),
62
and the potential transfer there of up to 300 foreign
national prisoners sentenced by Danish courts to deportation in addition to a term of imprisonment.
The Committee requests to be provided, in due course, with the text of the Co-operation
Agreement implementing the aforementioned treaty.
63
In the CPT’s view, the treaty could potentially raise a number of serious issues of concern.
Among others, Article 24, paragraph 1, of the bilateral treaty stipulates that criminal offences
committed by Kosovo prison staff are to be prosecuted by Kosovo authorities,
64
which would amount
to a partial relinquishing of jurisdiction for matters that should in principle fall within the responsibility
of the Danish authorities. Furthermore, the treaty would appear to be in contradiction with two key
principles underpinning the Council of Europe Convention on the Transfer of Sentenced Persons
(ratified by Denmark) that is that any such transfers are to be carried out towards the State of the
person’s nationality and must be voluntary (except where the person to is subject to expulsion or
deportation once they have served their sentence, or have fled or moved to the territory of their State
of nationality, where consent to transfer to the State of nationality is not required).
65
The Committee
would welcome the Danish authorities’ observations on this subject.
Further,
the CPT would
like to receive a detailed schedule for the implementation of the said agreement.
62
63
64
65
The
English-language
version
of
the
Treaty
is
available
under
this
link:
https://www.justitsministeriet.dk/wp-content/uploads/2022/04/Final-treaty-Denmark-Kosovo.pdf.
According to Article 4, paragraph 4, of the Treaty, the Co-operation Agreement, to be signed between
the DPPA and the Kosovo Correctional Service, shall concern “”the functioning of the Prison, the staff,
the facilities, the transport of Prisoners and other tasks that may be carried out by both Parties.”
Regarding the Danish staff (mainly the senior management), the above-mentioned Article states that
“In exceptional cases and with respect to the jurisdiction of the Sending State [i.e. Denmark] and the
principle of
ne bis in idem,
criminal offences committed against or by Staff of the Sending State may
be prosecuted in the Sending State after consultation between the relevant authorities of the Sending
State and the Receiving State [i.e. Kosovo].”
Convention on the Transfer of Sentenced Persons, ETS 112 (see Article 3); Additional Protocol to the
Convention on the Transfer of Sentenced Persons, ETS 167 (see Articles 2 and 3), both ratified by
Denmark. See also the Protocol amending the Additional Protocol to the Convention on the Transfer
of Sentenced Persons, ETS 222, not ratified by Denmark to date.
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2.
Ill-treatment
63.
The delegation received no allegations of deliberate ill-treatment by custodial staff at any of
the prisons visited. In all the penitentiary establishments, the delegation found that staff behaved
generally in a professional and respectful manner, and many inmates spoke positively about prison
officers.
That said, a few prisoners, especially at the Western Prison and Nyborg Prison, complained
about custodial staff having occasionally applied physical force in an excessive manner or used
inappropriate language, essentially in the context of staff responding to incidents and breaches of
prison discipline.
66
Although the delegation could ascertain that these complaints had all been duly followed and
investigated by the respective prison Directors,
the CPT recommends that it be recalled in
suitable intervals to all prison officers – in particular at the Western Prison and Nyborg Prison
– that no more force than is strictly necessary should be used to control prisoners. Further,
custodial staff should be remained that they should always refer to prisoners in a polite and
respectful manner.
In this context, the delegation noted with interest the practice developed at Enner Mark
Prison, consisting of monthly reviews of all instances of use of force by staff. The reviews were
carried out by the establishment’s health and safety department, with a view to analysing how such
incidents could be avoided or at least better handled in the future.
The Committee invites the
Danish authorities to extend this positive practice to all other prisons.
67
64.
As for inter-prisoner violence, it did exist but did not seem to be a major problem in the prisons
visited, which was both remarkable and commendable given the presence of many members of
warring gangs and other prisoners who could not be allowed to associate given the high risk of
conflict and abuse. Despite the less-than-optimal staffing levels (see paragraph 87 below), prison
officers generally succeeded in keeping all inmates safe and intervened quickly and effectively
whenever any instances of inter-prisoner violence occurred.
However, the delegation noted that the recording of incidents of inter-prisoner violence left
something to be desired. In particular, there were no dedicated incident registers, information on
instances of inter-prisoner violence being recorded in inmates’ individual (electronic) files and,
sometimes, in disciplinary records or records of use of “observation” and “security” cells (if inter-
prisoner violence resulted in the application of disciplinary sanctions and/or placement in such cells).
Statistical information on incidents and on their details could be retrieved from the informatic system
but it was a cumbersome process.
In order to facilitate the oversight of inter-prisoner violence,
the CPT recommends that
dedicated incident registers be set up in every prison in Denmark. It would also be advisable
to compile more detailed statistics of incidents, e.g. specifying the type of the violence
involved (verbal or physical) and its severity. Such statistical information could be first of all
collected in each prison and then on the regional and national level.
66
67
Many if not most of these complaints referred to situations which involved inmates’ placement in an
“observation” or a “security” cell, and the application of mechanical restraint (fixation). See further
remarks and recommendations in paragraphs 106 and 111 below.
See also paragraph 115 below.
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3.
Conditions of detention
a.
material conditions
65.
As already mentioned in paragraph 60 above, in all prisons visited inmates had at least 4 m²
of living space per person.
68
Single cell accommodation remained the rule and, in those cells, there
usually was well above 6 m² of living space (often 8 or 9 m²). Whilst the situation was not problematic
in this sense at the time of the visit, the steady rise of prison population was obviously a concern for
the management, especially at the Western Prison (see paragraph 60 above). Further, as already
mentioned in the aforementioned paragraph, it was combined with other factors such as staff
shortages (see paragraph 87 below) which then had a bearing on other aspects of prison life such
as access to activities, health care and possibilities to maintain contact with the outside world.
69
In all the prisons visited, the delegation found the cells to be generally suitably furnished (bed
with full bedding, desk, chair, chest, shelves, washbasin, fridge, call bell), well-lit and ventilated,
clean and in a good state of repair. Exceptions regarding the windows, the absence of in-cell toilets
and the wear-and-tear of certain cells are mentioned in paragraphs 68 and 67 below.
There seemed to be no problems with daily access to a shower (also for prisoners
accommodated in cells without in-cell annexes) and, in general, with the quality and quantity of the
food. Many prisoners (including all inmates on general regime
70
) could cook their own meals; by
contrast, those in high-security units had ready-made meals (delivered frozen to the prison and
warmed up on the spot) served in their cells and some of them complained that the food was
monotonous and not very tasty.
The Committee invites the Danish authorities to look into this
matter.
The delegation was impressed by the initiative of opening supermarket outlets at Nyborg
and Enner Mark Prisons, where inmates could make their shopping almost in the same manner as
people in the outside community;
this is a positive practice that could usefully be expanded to
other prisons.
66.
The best, actually excellent in all aspects, material conditions were observed at Enner Mark
Prison, where the cells measured 12 m² each and were all equipped with a fully partitioned sanitary
annexe (comprising a shower). Well-furnished communal spaces (with kitchens, dining and living
areas) were provided for each small unit of 6 cells. The architectural design of the prison, with large
windows without bars giving onto large open green spaces and a very “discreet” perimeter wall,
reduced the carceral feel (despite the presence of all the modern security features).
In the Committee’s view, in terms of infrastructure and material conditions
Enner Mark
Prison should serve as a reference for the whole prison system.
67.
In the other prisons, conditions were also generally adequate despite the occasional wear-
and-tear (at Nyborg and Western Prisons). That said, there was a rolling refurbishment programme
and it seemed likely that any issues of this kind would be solved within a reasonable time.
68
69
70
This was namely the case in the few single cells converted into double ones.
See paragraphs 73, 76 and 120 below.
Category 3 (e.g. approximately 2/3 of all prisoners at Nyborg and Enner Mark Prisons).
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In those two establishments, the delegation saw that “jalousies” (shutters) were being
gradually installed on cell windows, reportedly in order to prevent prisoners of different categories
from communicating with each other. Whilst access to natural light and fresh air seemed adequate,
these devices severely restricted the view from inside the cells, which was particularly problematic
for prisoners who were segregated or in high-security units and who often spent 23 hours per day
inside their cells.
71
The CPT recommends that the Danish authorities reflect upon ways to
achieve the aforementioned legitimate security objective without depriving inmates of the
outside view from their cells.
68.
By far the most problematic issue observed yet again by the delegation was the absence of
in-cell toilets in most of the cells at Nyborg, Police Square and Western Prisons, especially combined
with custodial staff shortages.
72
The delegation heard numerous complaints by prisoners at Nyborg
and Western Prisons
73
regarding long delays (up to 45 minutes) in access to (and return from)
communal toilet facilities, especially at night (between 7 p.m. and 7 a.m.). A number of prisoners in
the two establishments stated that they had had to urinate into the washbasin and some said they
had occasionally been forced to defecate into a plastic bag.
74
Some inmates told the delegation that
it was an unwritten rule that custodial staff were not to be “bothered” by requests to escort prisoners
to the toilet at night, save in absolute emergencies (e.g. if a prisoner was ill).
The lack of in-cell toilets in many (especially older) Danish prisons and the delayed access
to communal toilets is something the CPT has criticized many times in the past.
75
It is indeed very
disappointing for the Committee to note that Denmark, by all means a wealthy country, has
apparently been unable to solve this decades-old problem until now.
76
The CPT calls upon the
Danish authorities to take resolute steps to ensure that all prisoners have unimpeded access
to toilet facilities without undue delay at all times (including at night).
77
Preferably, all cells
(including in the existing older prisons) should be equipped with in-cell toilets. The Danish
authorities should put in place a detailed and budgeted action plan, with clear and realistic
deadlines, to achieve this goal. The Committee would like to be presented with information
on this action plan and its implementation in the Danish authorities’ response to this report.
69.
At the Police Headquarters Prison the delegation learned that the establishment’s lift had
been broken for several months, which
inter alia
rendered the distribution of food more difficult and
could also pose problems for inmates with reduced mobility and in case of a medical emergency.
The Director assured the delegation that the lift would be repaired in the near future.
The CPT would
like to receive confirmation that this has been done.
71
72
73
74
75
76
77
See paragraph 71 below.
See paragraph 87 below.
Access to a toilet did not seem to be a major issue at Police Square Prison, likely due to its small size
and a better availability of staff.
This was also confirmed by staff and, indeed, the delegation saw a few such plastic bags lying on the
ground after having been thrown out of cell windows by inmates. Staff told the delegation that removing
those bags was the task of prisoners employed as cleaners.
See e.g. paragraph 45 of the report on the 2019 visit (CPT/Inf (2019) 35).
The first time the CPT has stressed the importance of securing ready access to a toilet for all prisoners
was in the report on the very first Committee’s visit to Denmark, in December 1990. See in particular
paragraphs 43 and 94 of document CPT/Inf (91) 12.
See also Rule 19.4 of the European Prison Rules.
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b.
regime
70.
The delegation gained a very positive impression of the regime at Enner Mark Prison where
the great majority of prisoners (86%) could work and were allowed to associate with fellow prisoners
and engage in other activities, even (under certain conditions) when segregated.
78
The prison had a range of modern, high-quality facilities for prisoners’ work, vocational
training, education and leisure-time activities. Work and vocational training was provided in a series
of workshops (metal-work, welding, car mechanics, fitting and assembly work, packaging work, etc.)
and in the establishment’s general services (laundry, kitchen, cleaning, gardening, etc.). There were
class and therapy rooms (including for alcohol and drug therapy), numerous premises to practice
arts, watch movies or attend religious services, several indoor and outdoor gyms and many well-
designed outdoor exercise yards. The prison’s extensive grounds also comprised a football pitch
(accessible to Category 3 prisoners).
71.
The situation was less favourable in the other prisons visited, with approximately a third of
the inmates being involved in work or education at the Western Prison (mostly in general services
and some in-cell work) and about half at Nyborg Prison (either in the large and modern printing,
graphic and assembly workshops or in general services).
Both aforementioned prisons accommodated some segregated
79
and high security
prisoners
80
(with limited association opportunities), as well as numerous remand prisoners (see
paragraph 60 above), and for those categories the regime was fairly impoverished with between 21
and 23 hours per day spent inside the cell watching television, listening to the radio, reading or
playing games.
81
The scarcity of organized activities was of particular concern given that segregated, high-
security and remand prisoners tended to stay on such impoverished regime for long periods, that is
for months and sometimes even years.
82
Furthermore, due to lack of spare capacity in
establishments for sentenced prisoners, many prisoners continued to be accommodated in remand
units even after their sentence had become final, being subjected to the same regime as remand
prisoners.
78
79
80
81
82
Including 43 gang members, five inmates on voluntary segregation and seven prisoners convicted of
sex offences segregated for their own safety. That said, it is important to add that not all segregated
prisoners were allowed to work.
There were some 120 segregated prisoners at the Western Prison (including approximately 90 gang
members and 30 inmates on voluntary segregation, most of them convicted of sex offences) and some
30 at Nyborg Prison. Segregated prisoners could associate with each other inside their unit (some the
whole day, some – especially gang members – for several hours per day) but had less work and
education opportunities. See also paragraphs 98 to 102 below.
High-security prisoners (22 at Western Prison, likewise 22 at Nyborg Prison and 12 at Enner Mark
Prison) were entitled to one hour of outdoor exercise, one hour of gym and between two and three
hours of association time every day, together with one other prisoner (selected by the prison
management but obviously with the approval of both inmates concerned). This usually took the form
of the two prisoners being allowed to meet inside one of the cells, sometimes also in the exercise yard.
They were rarely able to work (if at all, then it would be work inside the cell). See also paragraphs 100
and 101 below.
As for Police Square Prison, five out of the 23 inmates had a job (those inmates being free to move
around the detention area whole day) whilst the others could associate three hours per day.
See also paragraph 60 above and paragraph 101 below.
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The CPT reiterates its long-standing recommendation that the Danish authorities take
steps to develop adequate programmes of activities for remand prisoners and sentenced
prisoners obliged to remain in remand sections.
The aim should be to ensure that all prisoners, including those on remand, spend a
reasonable part of the day (i.e. eight hours or more) outside their cells engaged in purposeful
activities of a varied nature: work, preferably with vocational value; education; sport;
recreation/association. The longer the period for which remand prisoners are detained, the
more developed should be the regime offered to them. Steps should be taken to ensure that
prisoners, once sentenced, are transferred promptly from a remand prison (or unit) to an
establishment (or unit) for sentenced prisoners.
The Committee also reiterates its recommendation that measures be taken to offer
segregated and high-security prisoners structured programmes of constructive activities,
preferably outside the cells, based on individual projects intended to provide prisoners with
appropriate mental and physical stimulation. The implementation of these individual projects
should be overseen by a multi-disciplinary team and their aim should be to assist the
prisoners to transit out of the segregation/high-security unit into ordinary accommodation as
well as, in due course, reintegrating the community at large.
83
72.
Two systemic problems observed in all the prisons visited merit a particular mention. First,
inmates were not able to pursue distance education above the 9
th
grade (reportedly because of
online security concerns) which negatively impacted their social reintegration prospects. Second, no
organised activities (other than work and some language courses) were available to foreign national
prisoners sentenced to be deported after serving their prison sentence.
The CPT recommends that
steps be taken to address these issues, including as required through amending the relevant
legislation.
73.
As already mentioned in paragraph 65 above, all the establishments but especially Nyborg
and Western Prisons were confronted with shortages of custodial staff, which had an unavoidably
negative impact on the possibilities to offer association and organized activities to prisoners, in
particular those who had to be segregated from the others and those in high-security units (given
the requirement of at least two, sometimes three or four, prison officers being present each time the
prisoner was taken out of the cell).
The absence of in-cell toilets, referred to in paragraph 68 above meant that the modest staff
resources had to be additionally diverted to the tasks of escorting inmates to and from the communal
toilets, which left little time for prison staff to enable prisoners to engage in organized activities. In
this context,
reference is made to the remarks and recommendations in paragraphs 68 above
and 90 below.
83
See also the remarks and recommendation in paragraph 102 below.
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4.
Health-care services
74.
In all the prisons visited, inmates had access to health care, both primary and secondary.
Prisons were staffed with nurses,
84
general practitioners
85
and dentists,
86
and arrangements were in
place for regular visits by various specialists, as needed.
87
However, the presence of health-care
staff was not sufficient and, with the notable positive exception of the Western Prison, the delegation
gained the impression that health-care staff did not always act proactively enough, tending to wait
for prisoners to request to see them. Given that some prisoners (including those most vulnerable,
due e.g. to mental conditions or the language barrier) would not necessarily take the step to request
a consultation,
the CPT invites the Danish authorities to encourage health-care staff (nurses
and doctors) at Nyborg and Enner Mark Prison to develop a more proactive attitude and to
visit prisoners (especially those identified as vulnerable) on a regular and frequent basis.
Further,
the Committee recommends that efforts be made to increase the effective
presence of primary health-care professionals in the prisons visited. In particular, there
should be the equivalent of two full-time GPs at the Western Prison and at least the equivalent
of a full-time GP at Nyborg Prison. There should also be the equivalent of two additional full-
time nurses at the latter establishment.
75.
The CPT is concerned by the fact that, apart from the Western Prison,
88
none of the
penitentiary establishments benefited from a 24/7 health-care staff coverage, with no health-care
staff being present after 3 – 4 p.m. and on weekends. This was clearly problematic given the size
and characteristics of the prisoner populations in the larger establishments (i.e. Nyborg and Enner
Mark Prison). As already mentioned in paragraph … above [preliminary remarks], these prisons were
accommodating many remand prisoners for whom these establishments represented a point of entry
into the prison system.
The CPT wishes again to stress that establishments accommodating remand prisoners
should have health-care staff coverage seven days a week and rapid availability of health-care staff
at night time. As a minimum, a person competent to provide first aid should always be present in
such establishments, including at night and on weekends; preferably, this person should be a
qualified nurse.
The Committee reiterates its recommendation that steps be taken to ensure
such a permanent health-care coverage in all penitentiary establishments concerned.
84
85
86
87
88
The Western Prison (population 539) employed 18 full-time nurses, with six to nine being present each
day. A nurse was present each working day at the Police Square Prison. Nyborg Prison (population
349) had five full-time nurses and Enner Mark Prison (population 260) had six nurses.
A GP visited Nyborg Prison twice a week (and was on call the other working days) but if needed, any
of the other eight general practitioners employed at the regional level could also come to the prison;
further, procedure was ongoing for the recruitment of a second on-site GP. Police Square Prison was
visited by a GP once a week. As for the Western Prison and Enner Mark Prison, a GP was present
every working day.
A dentist held surgeries twice per week at the Western Prison and once per week at Nyborg Prison
and Enner Mark Prison. Police Square Prison had no dentist; inmates would be taken for consultation
to the Western Prison in case of need.
E.g. infectious diseases specialists, dermatologists, radiologists, orthopaedists, etc. Teleconsultations
(using a video link) were also available.
Where there always was a nurse on duty.
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76.
Another major issue of concern was the impact of custodial staff shortages (see paragraph
87 below) on the provision of health care. In particular, scheduled appointments with doctors (both
inside and outside the prison) had to sometimes be cancelled because there was not enough
custodial staff on duty to provide escorts; this could have a negative impact on prisoners’ health and
even life. At the Western Prison, nurses told the delegation that they were no longer able to go to
the detention blocks every evening and check on inmates identified as requiring particular attention
by health-care professionals, because there were not enough custodial officers on duty especially
as regards inmates whose security category required the presence of two or more custodial staff
every time their cell door was opened. The low custodial staff presence, in particular on evening
shifts, also resulted in certain prescribed medication (including sleep medicines) being administered
too early (e.g. 7 p.m.) which reduced its efficacy.
In this context, reference is made to the remarks and recommendation in paragraph 90
below. In addition,
the CPT recommends that the Danish authorities reflect on whether
(pending the recruitment of additional custodial staff) it would be possible to reorganize the
shifts so as to at least partly alleviate the negative impact of custodial staff shortages on
prisoners’ access to health care.
77.
The delegation further observed that prisoners’ access to mental health care was inadequate.
Although positive efforts had been made in recent years to recruit prison psychologists
89
and to
secure the presence of psychiatrists, at least a few hours weekly,
90
the fact remained that this was
insufficient to provide for the needs of numerous mentally ill prisoners.
91
Health care staff working in the prisons visited seemed generally well trained and appeared
to be doing their best to help their patients. The delegation witnessed, for example, an incident in
the course of which one of the nurses at the Western Prison succeeded in a most professional
manner to calm down an agitated mentally ill prisoner, without any recourse being made to means
of restraint.
However, where the system clearly failed was with respect to inmates whose psychiatric
condition was so severe that they would require hospitalisation.
92
The delegation was told in all the
prisons except for Police Square Prison (which did not receive inmates with known severe mental
health issues) that – although it was possible to transfer prisoners to “civil” psychiatric establishments
in case of emergency – the latter establishments tended to hospitalize prisoners not long enough for
their mental health condition to truly improve, with the result being that such prisoners would often
be transferred to the hospital and back to prison multiple times.
89
90
91
92
For example, two clinical psychologists had been hired to work at the Western Prison; they also went
to Police Square Prison whenever needed. At Nyborg Prison there was a visiting
psychologist/psychotherapist and another psychologist who however mostly worked with staff. As for
Enner Mark Prison, the delegation was told that there used to be a visiting psychologist (once a week)
but it was no more the case; the establishment had an agreement with an outside psychologist who
could be called if needed.
A psychiatrist came to the Western Prison once or twice per week and to Nyborg Prison once a week.
Enner Mark Prison had a contract with a psychiatrist who visited whenever called in.
For example, approximately half of all the inmates at Nyborg Prison were regularly taking psychiatric
medication.
There were several such prisoners in the establishments visited, e.g. 21 at the Western Prison
(accommodated in larger cells, measuring approximately 12 m², in the so-called Western Hospital
which was in fact not a hospital but a separate detention wing located closer to the offices of health-
care staff).
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The aforementioned situation resulted in a heavy workload and a serious psychological
pressure on (understaffed) custodial personnel, several of whom told the delegation that they would
benefit from more specialised training in dealing with mentally disturbed prisoners. Further, it had an
obvious impact on the extent of use of “observation cells, “security cells” and mechanical restraint
(fixation).
93
In one case the delegation was told about at Enner Mark Prison, a very agitated and
aggressive prisoner, diagnosed with a psychosis, had reportedly been sent to the psychiatric facility
whilst restrained and was still restrained when the hospital sent him back as he had not calmed down
sufficiently. Reportedly, such situations were due to the reluctancy of “civil” psychiatric hospitals to
admit prisoners considered to be potentially more “dangerous” for the staff and other patients there.
The delegation was told that, for any longer-term treatment of a mentally ill prisoner in a psychiatric
establishment, a court decision on placement in a forensic establishment (surrogat
fængsling)
was
required, normally for a specific period of time, e.g. 6 months.
94
However, the waiting time for such
a forensic placement could reportedly be long due to the lack of spare capacity in specialised
establishments.
The Committee recommends that serious efforts be made by the Danish authorities to
improve the access to mental health care in prisons. This should include recruiting more
mental health professionals and facilitating transfer to appropriate mental health care
facilities, for as long as needed on medical grounds, of prisoners whose condition so
requires. If necessary, suitable procedures need to be discussed and agreed with the Ministry
of Interior and Health. The CPT also recommends that custodial staff be provided with more
specialised training on dealing with mentally disturbed prisoners.
78.
Regarding prisoners’ access to health care, one particularly problematic issue was the legal
discrimination of foreign prisoners subjected to deportation (in addition to imprisonment). These
prisoners were as a rule only entitled to primary and emergency care. Any non-urgent medical
procedures, including specialist care and operations (even in case of serious illnesses, cancer for
example) would in principle be provided on a paid basis only. Admittedly, there was a degree of
discretion both for the prisons and the hospitals, and in practice health-care staff would often manage
to offer free-of-charge treatment to those prisoners, but the fact remains that this legal discrimination
resulted in a two-class health-care system for prisoners, which is potentially harmful to health and
thus totally unacceptable.
The CPT recommends that the aforementioned legal discrimination be abolished and
foreign prisoners be given the same free-of-charge access to both primary and secondary
health care as their fellow Danish inmates.
93
94
See paragraphs 104, 105, 108 and 109 below.
Prison doctors would provide the courts with their assessment of the state of health of the inmate,
although if the prisoner was already sentenced, the procedure required first a placement in an
observation ward in the “civil” psychiatric establishment, followed by a forensic psychiatric
assessment. As far as the delegation understood, it was easier to initiate the transfer when the inmate
was still on remand (the prison doctor could address the competent prosecutor directly).
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79.
Despite the recommendations reiterated by the Committee since its very first visit to Denmark
in 1990,
95
there was still no systematic and prompt medical screening of all newly-arrived prisoners,
including checking for the presence of injuries and transmissible diseases, in the prisons visited.
Newly-arrived prisoners were met by a nurse, usually within 24 to 72 hours, and were given
a medical questionnaire (the same model as that used in hospitals in the outside community). They
were also asked if they had any health-related complaints and whether they wanted to see a doctor.
However, this was on an entirely voluntary basis and the procedure did not involve a clinical
examination. Newly-arrived prisoners who did not express any health complaints and did not request
a medical consultation would not be seen by a GP.
80.
The CPT must stress, once again, that the initial medical screening of all persons admitted
to a prison should be obligatory, not an option offered to them.
96
Such systematic screening is
essential, in the interests of the prisoners and of the staff, in particular to identify special medical
needs (including mental health needs), prevent the spread of transmissible diseases, reduce the risk
of suicides and ensure the timely recording of any injuries. Save for exceptional circumstances, the
initial medical screening should be carried out on the day of admission, especially as regards the
prisoners entering the prison system.
The CPT calls upon the Danish authorities to take the necessary measures to ensure
that all prisoners are properly interviewed and physically examined by a medical doctor, or a
fully qualified nurse reporting to a doctor, within 24 hours of their admission to prison, and
preferably on the day of arrival at the establishment.
Further,
each prison health-care service should have in place a screening procedure
to enable them to properly assess the health-care needs of each newly-admitted prisoner,
including mental health needs. The procedure should also include symptomatic TB screening
and systematic voluntary testing for HIV and hepatitis B and C.
Regarding the recording of injuries, see paragraph 16 above. The Committee also
reiterates its long-standing recommendation that whenever injuries are recorded by a doctor
which are consistent with allegations of ill-treatment made by a prisoner (or which, even in
the absence of allegations, are indicative of ill-treatment), the record is immediately and
systematically brought to the attention of the relevant investigatory authorities. Health-care
staff should further advise prisoners that the forwarding of the report to the relevant
investigatory authorities is not a substitute for the lodging of a complaint in a proper form.
81.
As regards medical confidentiality, it appeared that, as a rule, health-care examinations took
place out of the hearing and out of the sight of custodial staff. However, similar to what had been
observed on previous visits, in order to see a member of the health-care service, prisoners had to
hand over a written application to a prison officer who passed it on to a nurse. The possibility of
placing the application in a sealed envelope existed but was rarely used; most of the prisoners
appeared to be unaware of this option.
95
96
See paragraph 48 of document CPT/Inf (91) 12.
See also Rule 42.1 of the European Prison Rules.
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The CPT recommends, once again, that steps be taken to ensure that prisoners have
confidential access to the health-care service in all the prisons in Denmark. In particular,
prisoners should not be obliged to state to prison officers the reason why they wish to see a
member of the health-care staff. Submitting request forms in sealed envelopes should
become a standard procedure; for this purpose, the forms should always be handed over to
prisoners together with envelopes.
82.
In all the establishments visited, the distribution of prescription medicines continued to be
carried out, as a rule, by prison officers (from dosage boxes prepared by nursing staff). As a result,
medication and its dosage were clearly visible to the custodial staff.
As stated by the CPT many times in the past, such a practice compromises medical
confidentiality requirements and does not contribute to the proper establishment of a doctor-patient
relationship. For both confidentiality and safety reasons, the preparation of prescription medicines
should always be entrusted to qualified staff (pharmacist, nurse, etc.) and medication should be
distributed by health-care staff.
The Committee reiterates its long-standing recommendation
that steps be taken to ensure that this is the case in all the prisons in Denmark.
97
83.
The health-care facilities and equipment varied from basic at Police Square Prison (which
did not even have a proper examination couch), to generally adequate at the Western and Nyborg
Prisons, and excellent at Enner Mark Prison. That said, there was no electrocardiography (ECG)
machine at Police Square and Nyborg Prisons, which meant that prisoners requiring an ECG had to
be transferred to the Western Prison (in the case of Police Square Prison) or to a local general
hospital (in Nyborg).
The CPT recommends that steps be taken to address these deficiencies.
84.
In all the prisons visited, but especially at the Western Prison and Nyborg and Enner Mark
Prisons, some inmates and members of health-care staff told the delegation – and the delegation
found other indications – that the use of intoxicating substances by inmates was a problem, in
particular as regards the use of opioids (also newer synthetic opioids, such as fentanyl). However,
the managements appeared not to be fully aware of the magnitude of this phenomenon, expressing
the view that the main substance used by prisoners was cannabis. Due
inter alia
to the absence of
a systematic screening upon admission, the main burden rested upon custodial staff who had to be
alert to, and bring to the attention of health-care staff, signs of possible drug dependence. In this
context,
reference is made to the recommendation in paragraph 80 above.
85.
Opioid agonist therapy (OAT) was available for prisoners who were dependent on opioids.
98
There was a drug free unit at the Western Prison and a “treatment unit” (for 30 inmates) at Enner
Mark Prison, with therapeutic activities provided by outside specialists. That said, as with respect to
other non-emergency medical treatments, foreign inmates sentenced to deportation in addition to
imprisonment were legally banned from access to such therapies, which means that nothing was
done to help them with their addiction problem. The CPT finds this very questionable and regrettable;
the recommendation in paragraph 78 above should be interpreted as applying to this aspect
of health care as well.
97
98
See, however, the exception referred to in paragraph 86 below.
OAT could be continued or initiated in prison. Patients were prescribed methadone (in the majority of
cases), buprenorphine or suboxone.
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86.
Another issue of serious concern is that easily administered life-saving medication (in case
of opioids overdose) such as naloxone in the form of nasal spray, was prohibited in prisons. The
delegation was told that the Patients’ Security Agency which oversees health care in prisons, and
the National Healthcare Authority opposed its use on the grounds that opioids used by prisoners
were not prescribed by doctors, and it would be incorrect to make medication such as antidotes
available as a response to the illegal use of drugs.
The Committee finds this reasoning surprising to say the least, and somewhat in denial of
the reality. Whether the substances were legally prescribed or not, prisoners did use opioids and
risked death from overdose. Providing staff (not only health-care staff but also custodial officers) with
naloxone, to be used only in case of emergency, could save prisoners’ lives.
The CPT recommends that steps be taken to make naloxone nasal spray available to
both health-care and custodial staff (and to train the latter in how to administer naloxone in
case of emergency).
5.
Other issues
a. prison staff
87.
As already stressed earlier in this report (see paragraphs 73 and 76), custodial staff
shortages remained one of the key challenges facing the Danish prison system at the time of the
2024 periodic visit. According to the information provided by the DPPA, while the average prison
population had increased from 3.974 at the beginning of 2019 to 4.191 at the beginning of 2024,
99
the actual number of custodial staff had continued declining (from 2.113 in 2019 to 1.874 in 2023),
with closed prisons being the most affected by this negative trend.
100
Despite measures taken since
2022 by the DPPA, in co-operation with staff unions, to recruit and retain prison officers, for example
by rewarding satisfactory performance with increased salaries, a considerable number of custodial
staff had left their jobs in search of better career opportunities.
101
88.
Custodial staff shortage was especially conspicuous at the Western Prison and Nyborg
Prison, as well as to a lesser extent at Police Square Prison.
102
Staffing levels were particularly low
at night and on weekends, with often as few as six custodial officers present in establishments
accommodating hundreds of inmates.
103
In the older prisons, such as the Western Prison and some
areas of Nyborg Prison, without in-cell sanitary annexes, custodial staff had to escort persons to the
toilets and showers in addition to performing their regular duties, which led to considerable delays in
some cases, especially at night.
104
99
100
101
102
103
104
See also paragraph 60 above.
Source: DPPA’s Management Information System (MIS), data as of 14 May 2024.
For example, 11 out of 13 newly recruited custodial staff left the Western Prison in 2023, which lacked
20% of its custodial staff complement at the time of the visit.
By contrast, staff shortage was not perceived as a major issue at Enner Mark Prison.
There were only 18 custodial staff on duty at night and on weekends for 504 prisoners at the Western
Prison; seven custodial staff (also involved in escorting prisoners to the toilet and back to their cells,
distributing medication and monitoring “observation” and “security” cells) at Nyborg Prison
(accommodating some 350 prisoners) and six for 260 prisoners at Enner Mark Prison.
Sometimes it reportedly amounted to a total lack of access to a toilet at night. See paragraph 68 above.
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More generally, as described by several prison officers and openly acknowledged by
Directors of the establishments concerned, the low (and diminishing) staff complement had a
negative impact on prisoners’ access to activities and visits.
105
89.
As stressed by the CPT many times in the past, low custodial staff complements reduce the
possibilities of direct contact between staff and prisoners, impeding the development of positive
relations and jeopardizing the effective maintenance of order and security as well as social
reintegration efforts. Significant amounts of overtime can then prove necessary to maintain a basic
level of security and regime delivery in the establishment. This can easily result in high levels of
stress in staff and their premature burnout, potentially leading to an increase of sick leaves,
106
which
is likely to exacerbate the tension inherent in any prison environment, leading to an insecure
environment for both staff and prisoners. The number of prison officers employed must therefore be
sufficient to guarantee safety and order in custody as well as the physical and mental integrity of
inmates.
107
90.
Whilst acknowledging steps being taken by the Danish authorities to recruit and retain staff,
the CPT recommends that more efforts be made to increase custodial staff complements and
times of presence in the prisons visited (especially at the Western Prison and Nyborg Prison),
in particular at night and on weekends. These efforts should include providing competitive
working conditions and supporting staff’s wellbeing through initiatives to improve their
mental, emotional, and physical health and to build their resilience and capacity to deal with
challenging situations.
91.
In this connection, several custodial officers with whom the delegation spoke expressed the
wish to receive additional on-the-job refresher training
108
on how to effectively manage prisoners with
mental health issues,
109
which according to them would help them reduce the extent of use of force
and means of restraint.
110
The Committee considers that staff who are working with challenging and vulnerable
prisoners, including violent and mentally ill persons, should be able to communicate with the inmates
in a supportive and non-threatening manner, in line with dynamic security approaches.
Miscommunication or poor communication can easily result in a breakdown in trust and tensions,
with severe consequences for the staff and prisoners in question, and eventually for other inmates.
105
106
107
108
109
110
The latter especially at the Western Prison, where there had sometimes been not enough staff present
to ensure all the required escorts to visiting premises.
As was particularly the case at Nyborg Prison, according to 2023/2024 data provided by the DPPA.
See e.g. the
CPT's 11th General Report
and paragraph 26 of the United Nations Prison Incident
Management Handbook,
www.un.org/ruleoflaw/blog/document/the-prison-incident-management-
handbook.
Unlike the initial training for newly-recruited custodial staff, which was reportedly satisfactory, there
apparently was a problem with the availability of ongoing training for older officers recruited several
years ago.
Of whom there were many in the prisons visited, see paragraph 77 above.
See paragraph 108 below.
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In the light of the above,
the CPT recommends that the Danish authorities improve
ongoing training for custodial staff in communication, conflict prevention and management
of mentally ill prisoners, including de-escalation techniques. The initiative, observed at Enner
Mark Prison, of involving a psychiatric nurse in training and mentoring custodial staff on the
special needs of mentally ill prisoners merits being positively highlighted in this context.
b. discipline
92.
Pursuant to amendments to the Criminal Code, the Criminal Enforcement Act and the
Administration of Justice Act dated 28 February 2023,
111
which entered into force on 4 September
2023, the maximum duration of solitary confinement as a disciplinary measure (strafcelle) in respect
of adult prisoners had been reduced to 14 days (from the previous 28 days). The CPT welcomes
these amendments which are in line with the Committee’s long-standing recommendation.
However, the law continues to permit the imposition of longer sanctions (up to 28 days) in
exceptional circumstances, such as in the case of serious repeated offences and where it is deemed
necessary to deal with particularly challenging, violent, or disruptive inmates. Further, the delegation
observed in the prisons visited that inmates were sometimes placed in disciplinary solitary
confinement for more than 14 days, on occasion up to 24 days and even longer for special categories
of prisoners (in particular, inmates who were known to be gang members and who were classified
as “negatively strong”)
112
and as a result of serving consecutively multiple sanctions without
interruption.
In the light of the above,
the CPT strongly reiterates its recommendation that
disciplinary solitary confinement should never be imposed for more than 14 days for a given
offence (and should preferably be shorter). Whenever an additional period of disciplinary
solitary confinement is imposed on a prisoner, there should be an interruption of several days
between the two placements in the
strafcelle.
93.
The aforementioned legal amendments continue to permit the placement of juvenile
prisoners in a
strafcelle,
for up to 7 days as a rule but exceptionally for up to 28 days in cases related
to violence against staff.
113
That said, guidelines on the implementation of those provisions stipulate
that juveniles aged 15 to 17 should in principle never be placed in disciplinary solitary confinement
for more than 3 days. Only in special cases, typically for repeated offences of a serious nature, the
duration may be longer (up to 7 days). Alternative sanctions, such as restricting association with
other inmates, should be considered for this category of prisoners.
114
Whilst appreciating the Danish authorities’ evident intention to reduce the duration of
disciplinary solitary confinement for juvenile prisoners, the CPT must stress once again that any form
of solitary confinement of juveniles is likely to have an even more detrimental effect on their physical
and/or mental well-being than in the case of adult prisoners. Consequently,
the Committee
reiterates its recommendation that solitary confinement as a disciplinary punishment for
juveniles be abolished in Denmark.
115
111
112
113
114
115
See Sections 67 to 72 of the Criminal Enforcement Act and Executive Order no. 1120 of 26 June 2023
on the new disciplinary punishment system.
See paragraph 98 below.
See Section 70 (1) and (2) of the Criminal Enforcement Act.
See also Executive Order on Disciplinary Cells, Interrogation Cells and the Examination of Disciplinary
Cases in State and Local Prisons, as latest amended on 17 August 2023.
See also Rule 45 (2) of the UN Standard Minimum Rules on the Treatment of Prisoners (Nelson
Mandela Rules) and Rule 67 of the UN Rules on Protection of Juveniles Deprived of Liberty (Havana
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94.
In a more positive vein, the CPT is pleased to note that the overall number of disciplinary
sanctions of solitary confinement has decreased, from 7,212 in 2019 to 4,855 in 2023, and the
delegation was told by senior officials of the DPPA that the policy was to continue reducing recourse
to this sanction. For example, first-time smuggling of a mobile telephone into the prison was no
longer to be sanctioned with solitary confinement, such a sanction only being imposed if a prisoner
attempted the same for a second time within the period of 12 months. Further, there was a practice
of increased replacement of disciplinary solitary confinement with pecuniary sanctions (fines).
116
95.
The amended provisions also introduced several improvements to the regime applied to
inmates placed in a
strafcelle,
such as allowing limited association with a selected other inmate,
requiring prison staff to visit the prisoner on a frequent and regular basis, and granting inmates in
disciplinary solitary confinement access to a telephone unless there were specific reasons to restrict
it. Further, prisoners placed in a
strafcelle
could now have a TV set in the cell, wear their own clothes
and could, under certain conditions, be permitted to work. The Committee welcomes these positive
developments.
96.
An examination of disciplinary proceedings in the prisons visited revealed that the safeguards
set out in the Criminal Enforcement Act, including prisoners’ right to be heard and to appeal
disciplinary decisions,
117
were complied with. Prisoners also had the right to be assisted by a fellow
inmate from the same unit who was not involved in the incident and were allowed to request to be
assisted by a lawyer, although this was rare in practice. If required, access to professional
interpretation could be provided, in person or by telephone.
However, as far as the delegation could ascertain, only at Enner Mark Prison were inmates
systematically given a written copy of the disciplinary decision; in other prisons this would be done
upon the prisoner’s request.
The CPT recommends that inmates in all prisons in Denmark be
systematically provided with a copy of the disciplinary decision, the receipt of which they
should be asked to acknowledge in writing.
Further, the delegation gained the impression that some prisoners did not properly
understand the new disciplinary system (with different sanctions that could be applied for the same
offence, depending on the circumstances of the case and of the person involved) and were not fully
aware of the applicable sanctions and the increased flexibility that the new system offered to staff.
In this context, the delegation noted that the management of the Western Prison had decided to
produce a leaflet explaining the new rules in a simple and clear manner, to be handed out to
prisoners. At the time of the visit, the Danish version of the leaflet was ready and translations into
several foreign languages were being prepared.
This is a positive initiative which merits to be
followed in other prisons in Denmark.
116
117
Rules).
For example, the recourse to fines had increased by 32% when comparing the periods from January-
April 2023 to January-April 2024 at the Western Prison. At Nyborg Prison the increase was of about
15% and at Enner Mark Prison of about 40% during the same period.
Prisoners could appeal disciplinary decisions internally to the prison’s Director within 2 months. If the
sanction amounted to more than 7 days of solitary confinement, they could also lodge an appeal to
the court within 4 weeks, in which case there was a right to compensation for the time spent in the
strafcelle
(half a day of sentence for each day spent in the disciplinary cell) if the appeal was
successful.
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Also on a positive note, the delegation observed that disciplinary registers were well kept in
the establishments visited, both in paper and electronic form. Case files and related protocols were
adequately documented, and investigations took place timely.
97.
As regards the role of health-care staff, the delegation was informed that the health-care
service was systematically informed of every placement and health-care staff (usually nurses) were
required to visit prisoners placed in
strafcelle
on a weekly basis. Doctors, psychiatrists or
psychologists could also visit them as they deemed necessary on a case-by-case basis. It would
however appear that access to psychiatrists was more limited in the establishments visited.
118
In the CPT’s view, health-care staff should visit prisoners placed in solitary confinement
immediately upon placement and regularly thereafter, at least once a day, to timely provide the
required medical care.
The Committee therefore calls upon the Danish authorities to reconsider
Denmark’s reservation to Rule 43.2 of the European Prison Rules and introduce the
necessary legislative changes to bring Chapter 11 of the Criminal Enforcement Act in
compliance with the aforementioned standard.
c. segregation on security grounds
98.
As already mentioned earlier in this report (see, in particular, paragraphs 60, 67 and 71),
three out of the four prisons visited (the Western Prison, Nyborg Prison and Enner Mark Prison)
accommodated a number of inmates segregated on security grounds, essentially prisoners known
to be gang members and those with a record of violent and/or otherwise challenging behaviour
(referred to as “negatively strong” prisoners).
Placement in a high security unit
119
(including a dedicated unit for gang members) was
decided by the establishment’s management (in consultation with the regional prison administration),
either upon admission or subsequently, and was based on operational information provided by the
police and on individual risk assessment performed inside the prison. The placement decision was
reviewed after one month and then every three months.
99.
In terms of procedural safeguards, the delegation observed at Enner Mark Prison that
inmates were systematically heard prior to the placement and given a copy of the placement decision
with stated grounds (albeit some details could be omitted for security reasons) and with information
about available avenues of complaint.
120
Further, they were able to attend the internal review
hearings and could present their views on their situation.
By contrast, at the Western Prison and Nyborg Prison, prisoners placed in high-security units
were, as a rule, informed orally of the placement decision and were only given a written copy upon
request.
The CPT recommends that the procedure followed in this respect at the Western
Prison and Nyborg Prison be aligned with that applied at Enner Mark Prison.
118
119
120
See paragraph 77 above.
There were four prisons in Denmark with such high-security units: in addition to the three above-
mentioned establishments, Storstrøm Prison had one.
It was possible to appeal the decision by the Director of the prison to place a prisoner in a high-security
unit to the Director of the DPPA. The appeal had no suspensive effect.
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100. Concerning the regime in high-security units, as already mentioned (see paragraph 71)
prisoners placed in them were generally allowed to associate with other prisoners of the same
category, at the very least with another inmate in their cells during 2 to 3 hours per day, but often for
several hours per day and in larger groups (within the confines of their unit). Moreover, following
individualized risk and needs assessment, some of the prisoners were permitted to work (either in
their cells, in small workshops inside the unit or in some cases also in main workshops, under staff
supervision) and study. Further, special programmes existed to assist gang members in leaving their
gangs and reintegrating the society.
The Committee would like to receive more detailed
information about these special programmes.
101. That said, the situation varied between different prisons visited. In particular, the regime was
more impoverished at the Western Prison, due to the characteristics of the establishment (the main
remand prison in Copenhagen, accommodating many gang members, see paragraphs 60 and 71
above) and the serious custodial staff shortage (see paragraph 88 above). Indeed, for certain
inmates (those who had been subjected to such an impoverished regime for many months if not
years), the conditions could on occasion be considered as amounting to inhuman and degrading
treatment.
102. The delegation observed (and this was corroborated by statements by the management, staff
and inmates, as well as the relevant medical documentation) that high-security units accommodated
a significant number of prisoners with diagnosed mental disorders whose condition was likely to
worsen due to segregation. Those prisoners were monitored on a weekly basis by health-care staff
(including mental health professionals) who could, if deemed necessary, recommend their release
from the high-security unit and/or their transfer to a mental health facility.
That said, in the light of the delegation’s findings regarding the quality of mental health care
in the prisons visited (see paragraph 77 above),
the Committee recommends that steps be taken
to strengthen the psycho-social support provided to prisoners segregated on security
grounds. More generally, such prisoners should be followed individually by multidisciplinary
teams involving the custodial, social and health-care staff, the objective being to assist the
prisoners concerned to gradually (re)integrate the mainstream prison population. Reference
is also made to the recommendation in paragraph 77 above.
d.
“observation cells”
103. Pursuant to Section 64 (1) of the Criminal Enforcement Act, placement of prisoners in an
“observation cell”
121
may take place to prevent acts of vandalism, to maintain public order and
security or for “special observation” (i.e. to prevent suicide and self-harm).
122
According to the available documentation examined by the delegation at the Western Prison,
inmates had mainly been placed in “observation cells” to maintain order and security, followed by
“special observation” needs and to prevent acts of vandalism. At Nyborg and Enner Mark Prisons,
most placements had been due to “special observation” needs, followed by the maintenance of order
and security, and preventing acts of vandalism.
121
122
“Observation cells” seen by the delegation in the prisons visited were equipped with a bed (with a
mattress and a blanket), a table and chairs/benches fixed to the floor, as well as a call system. A
window (in the wall or in the door) permitted surveillance by prison staff from outside the cell.
On this, see paragraph 106 below.
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104. As regards the nationwide frequency of prisoners’ placements in “observation cells”, there
had been an overall decrease, from 1.227 placements in 2019 to 994 in 2023.
123
This is particularly
noteworthy given that there had been an overall increase of the prison population in the same period
(see paragraph 60 above).
The delegation noted that the recourse to placements in “observation cells” had indeed
decreased at two of the establishments visited: from 388 placements in 2022 to 361 in 2023 at the
Western Prison, and from 27 placements from January-May 2023 to 12 from January-May 2024 at
Nyborg Prison. The number of placements in “observation cells” had, however, increased at Enner
Mark Prison, from 154 in 2022 to 193 in 2023.
124
The Committee would welcome the Danish
authorities’ observations on the possible reasons behind this increase.
105. In terms of duration of placement in “observation cells”, according to the records consulted
by the CPT’s delegation, the longest placement in an “observation cell” in 2024 (up until mid-May)
had been approximately 48 hours at the Western Prison,
125
some 20 hours at Nyborg Prison and
approximately 97 hours at Enner Mark Prison.
126
In this context, the Committee wishes to reiterate its view that placement of agitated or violent
prisoners in an “observation cell” should only last until the person calms down, whereupon they
should be placed in an ordinary cell and, if appropriate managed through disciplinary processes or
the provisions regulating removal from association under Section 63 of the Criminal Enforcement
Act.
The CPT calls upon the Danish authorities to limit the duration of prisoners’ placements
in “observation cells” to the time strictly necessary for the inmate concerned to calm down.
106. As had been the case during the 2019 visit, the delegation saw several prisoners with mental
health-related conditions who had been placed in “observation cells” for “special observation”
reasons (to prevent suicide and self-harming).
Unlike on the aforementioned visit, the delegation noted that nurses were as a rule involved
in timely assessing inmates’ condition upon their placement in “observation cells”, and either a nurse
or the duty doctor regularly (at least daily) monitored their condition during the placement. However,
despite the Committee’s previous recommendation, placements in “observation cells” for the
purpose of preventing suicide or self-harm (as well as their continuation) were still decided by
custodial staff and were not immediately brought to the attention of health-care staff, which is
unacceptable.
The CPT recommends that the relevant provisions be amended so that placement in
“observation” cells for “special observation” (i.e. to prevent suicide and self-harming by a
prisoner with a mental-health related condition) is only decided as a last resort and
immediately brought to the attention of health-care staff who should visit the prisoner without
delay; the same should apply to any prolongation of the measure. Any prisoner whose
condition requires “special observation” in excess of 24 hours should be transferred to an
appropriate mental health facility (see the remarks and recommendation in paragraph 77
above).
123
124
125
126
Source: DPPA Management Information System, information as of 27 May 2024.
Police Square Prison did not possess “observation cells” (prisoners requiring placement in such a cell
would be transferred to the Western Prison).
There had also been 3 placements lasting more than 30 hours, 6 lasting more than 20 hours, and 17
lasting more than 10 hours.
There had also been a placement lasting some 44 hours, one of over 30 hours and 5 lasting longer
than 20 hours.
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e.
“security cells” and mechanical restraint
107. The placement of prisoners in “security cells”
127
and the application of mechanical restraints
(fixation belts) to immobilize them is regulated in Section 66 of the Criminal Enforcement Act and in
the Executive Order on the placement in security cells and use of means of restraint.
128
According to the aforementioned provisions, the purpose of fixation is to avoid imminent
violence, bring prisoners under control and prevent suicides and self-harming. There must be
proportionality between the aim of fixation and the loss of dignity and discomfort that it may cause,
a doctor must be promptly requested to visit the inmate (which can only happen at the doctor’s
discretion)
129
and fixation must be carried out with as much tact and consideration as the
circumstances allow. Whenever an inmate is placed in a “security cell” and fixated, a custodial officer
(placed in an adjacent room) must visually monitor the prisoner through a glass window in the wall
and record his/her observations on the inmate’s behavior and condition at least every 15 minutes.
The delegation’s findings from the three prisons possessing “security cells” (that is the
Western Prison and Nyborg and Enner Mark Prisons)
130
suggest that the above-mentioned rules
were duly applied in practice.
At the Western Prison the delegation was informed that a nurse had to regularly check the
fixated inmate’s condition and that debriefings had to take place with the prisoner during and after
fixation. Further, whenever the period of fixation exceeded 24 hours, a doctor was required to visit
the prisoner once per day. The delegation was not able to ascertain whether analogous procedures
were applied at Nyborg and Enner Mark Prison.
The CPT would like to receive clarification of
this point from the Danish authorities.
108. As regards the frequency of placements in “security cells” and application of mechanical
restraint, according to the data provided by the DPPA, the number of placements had decreased at
Nyborg Prison, from 106 in 2019 to 78 in 2023. Not all placements in the “security cell” were
accompanied by fixation, and the number of instances where the belts had been used was also on
the decline (from 59 instances in 2019 to 31 in 2023).
Likewise, at the Western Prison, the recourse to placement in “security cells” had decreased
in recent years, from 41 placements in 2022 (14 times to prevent suicide and 27 to bring under
control violent prisoners), out of which 27 with mechanical fixation, to 18 placements in 2023 (8 times
to prevent suicide and 10 to deal with violent resistance), out of which 10 with mechanical fixation.
By contrast, the number of placements had increased at Enner Mark Prison, from 42 in 2022
(all accompanied by fixation) to 70 in 2023 (out of which 69 with fixation). However, when comparing
the periods January-May in 2022, 2023, and 2024, the number had increased from 14 to 33 and
then again decreased to 25.
127
128
129
130
That is, cells equipped only with a bed bolted to the floor, a mattress and five-point fixation belts
attached to the bed.
No. 1111 of 17 August 2016.
In addition, a doctor must be called if requested by the inmate and if there is a suspicion of any illness
and/or injury.
If a prisoner accommodated at Police Square Prison required placement in a “security cell”, he would
be transferred to the Western Prison.
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109. The CPT remains concerned regarding the excessive duration of fixation in prisons.
According to the data provided by the DPPA, during the period between 1 January and 31 May 2024,
the average duration of fixation had ranged from 15 to 20 hours, depending on the establishment.
The longest instance (in respect of an inmate who had been fixated on two subsequent occasions
in May 2024) was over 140 hours.
At Enner Mark Prison, the delegation interviewed a young prisoner (19 years old) who had
been fixated for 19 hours, and an older male inmate who had been subjected to fixation for 24 hours.
The delegation also found, in the relevant documentation, cases where fixation had repeatedly been
applied vis-à-vis the same inmate, for example to prevent suicide,
131
or due to violent behaviour.
132
110. The Committee also continues having serious misgivings about the recourse to fixation in
respect of prisoners with mental health issues, which constituted the majority of cases at the
establishments visited.
For example, at Nyborg Prison the delegation interviewed a prisoner diagnosed with a mental
health condition who had attempted to commit suicide and harm himself several times, and who had
been placed in a “security cell” and fixated for 12 hours given his agitated state. Reportedly,
according to the doctor who assessed the inmate after fixation, the inmate was mostly frustrated and
angry and kept requesting to see a psychiatrist while being fixated. The same inmate was fixated
again after having been transferred to Enner Mark Prison, this time for approximately 19 hours. This
could be considered as amounting to inhuman and degrading treatment.
111.
In the light of the aforementioned findings of the 2024 visit, the CPT must stress once again
that agitated prisoners who pose a serious danger to themselves or to others may be temporarily
isolated in a calming down cell until they restore behavioural control, only as a last resort when all
other reasonable options (such as talking to the prisoners in question) have failed to satisfactorily
contain these risks. As regards prisoners displaying severe mental health issues, they should be
transferred to a psychiatric facility where they can receive the necessary care.
The Committee reiterates the recommendation that the Danish authorities abolish the
practice of fixation of prisoners for security reasons and develop alternative approaches; the
CPT would like to be provided with a detailed plan to achieve this objective. Pending this, the
Danish authorities must ensure that the following minimum safeguards are strictly applied in
all prisons resorting to fixation:
-
fixation may only be used as a measure of last resort, when all other reasonable
options have failed satisfactorily to deescalate violence; previous (unsuccessful)
measures should be clearly indicated either in the decision to apply fixation or in
dedicated register;
any fixation may only be of a very short duration (minutes rather than hours);
fixation may only be resorted to in a medical setting, namely as expressly ordered
by a doctor or immediately brought to the doctor’s attention. The doctor should
proactively visit fixated prisoners immediately upon fixation to document and treat
any injuries, review the prisoners’ health condition as well as assess the necessity
to continue applying the measure;
-
-
131
132
14 hours followed by 13 hours two days later.
51 minutes and 19 hours five days later.
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-
fixated inmates should be under continuous, personal and direct supervision by
prison staff physically present in the “security cell”; observing patients through a
window is not sufficient.
Further,
the CPT recommends that steps be taken to ensure that debriefing sessions
involving the prisoners concerned and custodial and health-care staff are organized following
each measure of fixation, for oversight and learning purposes. In this context, the
establishment of a “Violence and Threats Committee” at Enner Mark Prison,
133
assessing
individual cases with a view to identify tools and techniques to deescalate violence and
reduce the use of mechanical restraints, draw lessons learned and compile statistics, is to
be considered as a good practice worthy of applying in all other prisons equipped with
“security cells”. The Committee also recommends that appropriate initial and refresher
training be provided to staff regarding the use of fixation and de-escalation techniques.
Lastly,
the CPT would like to receive statistics on the application of the measure of
fixation in prisons countrywide in 2023 and 2024, broken down by prison establishment,
gender, duration, reason for applying the measure and whether the inmates in question had
a mental illness and/or had recently self-harmed or attempted to commit suicide.
112. Several prisoners interviewed at the Western Prison and Nyborg Prison told the delegation
that they had been placed in a “security cell” and fixated whilst naked. If true, such a practice would
be unacceptable. In this context,
reference is made to the comments and recommendation in
paragraph 52 above, which apply
mutatis mutandis
also in the prison context.
134
f.
use of force including “special means”
113. As far as the CPT’s delegation could ascertain in the prisons visited, recourse to the use of
physical force (holding) and “special means” (including handcuffs, truncheons, pepper spray and
shields) typically occurred in the context of staff trying to bring agitated prisoners under control,
placing them in “observation” and “security” cells and/or applying mechanical restraint inside the
“security cells”.
114. As regards the frequency of use of force,
135
the total number of cases had decreased at the
Western Prison from 2022 to 2023, from 427 to 372 instances. At Nyborg Prison, the total number
of instances had increased slightly from 2022 to 2023, from 108 to 112 incidents. Lastly, at Enner
Mark Prison the number of instances had clearly increased from 2022 to 2023, from 127 to 181.
136
133
134
135
136
Involving representatives from the prison management, the staff union, health care and security
services in cooperation with the psychiatric union and the DPPA.
See also paragraph 66 of the report on the 2014 visit, document CPT/Inf (2014) 25.
A generic term in the Danish legislation including instances of use of physical force and various
“special means”.
As far as the delegation could ascertain there had been no cases at the Police Square Prison which
only received prisoners with a good record of behaviour and no serious mental health conditions.
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The Committee would welcome the Danish authorities’ observations on the possible
reasons behind this significant increase at Enner Mark Prison (and the decrease at the
Western Prison). The CPT would also like to be provided with the corresponding data in
respect of the year 2024.
115. As regards, more specifically, the use of pepper spray, the relevant Danish provisions
137
stipulate that pepper spray should only be used in confined areas if the deployment of other means
does not seem sufficient to secure the desired outcome. Further, prisoners should receive a warning
that pepper spray will be used if they fail to comply with the instructions of staff and should receive
adequate assistance after the use of pepper spray.
In the prisons visited, the delegation noted that there had been a general tendency to reduce
the recourse to pepper spray inside prisoner accommodation areas (including cells); the only
exception to this positive trend was – again – Enner Mark Prison, where the number of instances of
use of pepper spray had increased between 2022 and 2023.
The Committee would like to receive
observations by the Danish authorities on the possible reasons behind this increase.
Reference is also made here to the comment in paragraph 111 above and the request for
information in paragraph 114 above.
g.
strip searches
116. In accordance with Sections 60 (1), (4) and (5) of the Criminal Enforcement Act, prisoners
must be fully undressed during searches carried out for reasons of order and security. Such strip
searches must otherwise be carried out as gently as the circumstances allow and only if the
discomfort that they may cause is proportionate to their justification. Further, the imposition of strip
searches is conditional on the prison administration carrying out a prior individual risk assessment
of the prisoner concerned.
117. Despite the above-mentioned requirement, the delegation gained the impression that strip
searches were imposed in the prisons visited in an excessive manner,
quasi
systematically, in
particular whenever inmates returned from the outside (court hearings, leaves, etc.). Furthermore,
strip searches were often carried out when prisoners were brought back to their unit after having
been taken elsewhere inside the establishment (e.g. workshops, classrooms, visiting area, etc.). In
addition, the strip search procedure did not follow the two-step (first top half, then bottom half) rule
recommended by the CPT. In some instances, naked prisoners also had to go through an X-ray
metal detector, squat and cough.
137
See Section 62 of the Criminal Enforcement Act and the Executive Order by the Minister of Justice
No.1026 of 15 July 2023.
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118. As stated many times in the past, the Committee is of the view that strip searches are very
invasive measures that must therefore be proportionate and duly justified. They should only be
carried out when there are reasonable grounds to suspect that prisoners may have hidden on
themselves items that may be used to harm themselves or others or in the case where there may
be evidence of a crime (e.g. smuggling in prohibited items) and a more in-depth search is necessary.
In the light of the above,
the CPT recommends that the Danish authorities ensure that
the decision to impose a strip search on a prisoner is indeed always based on an individual
risk assessment. As concerns the procedure, the Committee reiterates its recommendation
that prisoners who are subjected to a strip search be allowed to remove clothing above the
waist and redress before removing further clothing.
Further,
when prisoners are instructed to pass through a metal detector, they should
in principle be allowed to keep their clothes (at least the underwear). As for instructing
inmates to squat and cough, this should only be done if the X-ray machine detects the
presence of a suspicious object inside the prisoner’s body cavities.
h.
contact with the outside world
119. As had been the case in the past, sentenced prisoners were offered reasonably good
opportunities to maintain contact with the outside world. In particular, they could receive visits from
their relatives at least once per week, lasting a minimum an hour (but often longer in practice).
Additional visits (up to two per week) could be granted upon request, subject to the availability of
both short-term and long-term
138
visiting premises (which were of a good standard in every prison
but of an especially high standard at Enner Mark Prison). Further, sentenced prisoners were allowed
to accumulate visiting periods, in particular if their relatives lived far away.
As for access to a telephone, sentenced prisoners could make telephone calls for up to 30
minutes per week.
The Committee invites the Danish authorities to increase this entitlement.
120. However, although this was not the case at the time of the visit, the delegation was informed
by the management and staff at the Western Prison that in the recent past (i.e. in 2023) staff
shortages
139
had prevented prisoners from making full use of their visit and telephone call
entitlements (in the case of the latter, the entitlement had been temporarily reduced to one call per
10 days). In addition, overcrowding at the Western Prison had obliged the management to
provisionally transform some of the long-term visit premises into accommodation for prisoners,
additionally restricting inmates’ access to visits.
Luckily that unfavourable situation had been overcome (inter
alia
through reopening the
Police Square Prison,
140
which had been closed for some time previously); however,
the CPT
recommends that continuous efforts be made by the Danish authorities to ensure that
sentenced inmates at the Western Prison benefit from their full entitlement to visits and
telephone calls.
138
139
140
Long-term (conjugal or family) visits could last up to 47 hours at a time (the final, 48
th
, hour being
reserved for cleaning the premises).
See paragraph 88 above.
See paragraphs 60 and 67 above.
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121. As regards remand prisoners, they were in principle entitled to one visit lasting an hour per
week and could make telephone calls with the same frequency and duration as sentenced inmates.
However, the Committee remains seriously concerned by the continuous widespread
practice of the police and/or prosecutors imposing restrictions on visits and other forms of
communication (telephone calls and correspondence) on remand prisoners (the so-called “B&B”),
141
at least during the initial period of remand imprisonment (usually up to 3 months).
In the prisons visited, up to 50% of all remand prisoners were subjected to “B&B” at any given
time, the impact of which being all the greater given the high percentage of remand prisoners among
the overall inmate population.
142
Admittedly, “B&B” never resulted in a total ban on visits (visits by close family members were
never prohibited) and correspondence,
143
but as a rule remand prisoners subjected to “B&B” could
not make telephone calls
144
; further, visits had to be monitored by custodial staff which often resulted
in visits being postponed or shortened (given the limited staff availability). In addition, several foreign
prisoners on “B&B” complained that they were often
de facto
unable to receive visitors as no
interpretation (required for the prison staff to be able to monitor the conversations) could be ensured.
In the light of the above remarks,
the CPT reiterates its recommendation that the legal,
regulatory and practical framework governing remand prisoners’ contact with the outside
world be reviewed, particularly as concerns the “B&B” provisions. Steps must be taken that
all remand prisoners, without exception, effectively benefit from the entitlement of at least
one visit lasting one hour every week. Regarding access to a telephone, this must be granted
as a rule; if there is a risk of collusion, calls to a particular person could be restricted by a
prosecutor for a certain amount of time but, in any event, the privileged option should be that
particular telephone calls could be monitored (rather than prohibited). Further, efforts should
be made to ensure that letters sent by and addressed to remand prisoners on “B&B”
restrictions are forwarded without undue delay.
More generally,
the Committee recommends that any restrictions on remand prisoners’
contact with the outside world be subjected to a prior authorization by a body unconnected
with the case at hand (e.g. a judge) and be applied for a specified period of time (for example,
two weeks or a month), with reasons stated in writing. The relevant decision should be made
available to the prisoner concerned and (if the inmate has one) the prisoner’s lawyer.
122. The delegation was informed at the outset of the visit that prisoners in Denmark were not
allowed to make video calls using the Voice over Internet Protocol (VoIP) technology (such as
Skype), reportedly for both security and technical reasons. In the prisons visited, the absence of
such a possibility was resented by inmates, in particular those whose families resided far away from
the prison (including the numerous foreign prisoners).
The Committee acknowledges the technological and security-related challenges related with
offering access to VoIP to prisoners. It notes, however, that such access exists in many Council of
Europe Member States, apparently without causing any major concerns.
The CPT encourages the
Danish authorities to explore ways to facilitate prisoners’ communications through modern
technologies (such as VoiP), with due regard to necessary security requirements.
141
142
143
144
“Brev-og besøgsforbud”.
See paragraph 60 above.
Although both outgoing and incoming letters were controlled (not censored) by the police, reportedly
resulting in delays in the delivery of correspondence.
Remand prisoners subjected to “B&B” were only allowed to make telephone calls in exceptional
justified cases, such as family emergencies.
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i.
information for prisoners and complaints procedures
123. Danish legislation foresees that prisoners should be informed orally (and, upon their request,
in writing) about the establishment’s house rules and about their rights (including the avenues of
complaint) within 24 hours after admission.
145
As far as the delegation could ascertain, this was
indeed done in the prisons visited. In particular, ongoing efforts by the management of the Western
Prison to devise simplified versions of the house rules in a variety of languages (including in
pictograms) merit to be highlighted as a positive practice, to be expanded to all prisons in Denmark.
Written information, in the form of brochures translated into several languages, also existed in the
other prisons visited (e.g. in 18 languages at Nyborg Prison); however, not all of the interviewed
prisoners were apparently aware of the existence of those brochures.
In the light of the above,
the CPT reiterates its recommendation that written information
on house rules and prisoners’ rights be systematically distributed to all prisoners upon
admission.
124. Prisoners were able to confidentially lodge complaints addressed to external bodies,
including the Parliamentary Ombudsman.
146
As for internal complaints (addressed to the prison’s
Director or to the DPPA), the procedure was to carry out a preliminary internal inquiry (which could
involve interviewing the complainant(s) and/or the prison officer(s) concerned) and attempt to solve
the problem internally. If the complaint could not be satisfied, the prisoner would be informed of the
possibility of appealing to the court (although not every administrative decision by the Director and
DPPA was appealable under the Danish law). If the Director and/or DPPA concluded that the subject-
matter of the complaint fell under police jurisdiction, the complaint was referred to the police for
further investigation.
125. Upon examination of a number of complaint files (and after discussions with lawyers dealing
with complaints in the prisons visited),
147
the delegation concluded that the receipt of internal
complaints was usually not acknowledged in writing and prisoners were as a rule not informed about
their outcome. Further, there were still no centralized and categorized complaint registers in the
prisons visited.
The Committee reiterates its recommendation that the Danish authorities take steps
to improve internal complaint mechanisms by ensuring that prisoners are timely informed of
the action taken to address their concerns or of the reasons for considering the complaint
unjustified.
Further,
dedicated complaints registers should be set up in each prison, which would
assist the management in assessing the functioning of the complaints system and identifying
areas of discontent to be addressed at local, regional or national level.
145
146
147
See Section 31 (1) of the Criminal Enforcement Act, Section 7 (1) of the Executive Order No. 399 of 9
April 2015 and Circular No. 9741 of 28 June 2022.
Information on the addresses, telephone numbers and e-mail addresses of these external bodies was
available to prisoners.
Those lawyers were part of a nationwide pool established by the DPPA to provide legal advice to the
Directors of prisons and to review prisoners’ complaints with a view to speeding up the processing of
those.
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D.
Psychiatric establishments
1.
Preliminary remarks
126. The delegation visited the Psychiatric Departments of Aarhus University Hospital in order to
examine the situation of “civil” psychiatric patients - including young persons at the hospital’s Child
and Adolescent Psychiatry Department - and forensic patients. In addition, the delegation paid a
targeted visit to Glostrup Psychiatric Centre with a focus on recourse to means of restraint and the
legal procedures and safeguards in the context of involuntary treatment of (“civil” and forensic) adult
patients.
127. The Psychiatric Departments of Aarhus University Hospital (hereafter Aarhus University
Hospital) are part of the Midtjylland Region Psychiatric Hospital. They are located in the large, multi-
storey University Hospital complex built in 2018, in the outskirts of the city of Aarhus on the Jutland
peninsula. They comprise three departments
148
for “civil” and forensic adult inpatients as well as one
inpatient Child and Adolescent Psychiatry Department, with a total capacity of 271 beds on 16 mixed-
gender wards. In addition, there are several outpatient clinics. The four departments receive about
4000 inpatients per year, including about 400 to 500 patients in the Child and Adolescent Psychiatry
Department.
149
At the time of the visit, the four Departments were accommodating 244 patients, of whom
128 were men, 96 women and 20 were minors
150
(14 girls and 6 boys). The Forensic Department
was accommodating, at the time of the visit, 64 patients; further, 16 forensic patients were
accommodated in the “civil” psychiatry Departments. A total of 17 patients were involuntary “civil”
patients hospitalised pursuant to the Mental Health Act (MHA).
151
The median length of stay was
said to be about 3 months
152
but two patients had stayed at Aarhus University Hospital for 11 and
16 years respectively.
128. Glostrup Psychiatric Centre is part of the Capital Region Psychiatric Hospital, situated at five
different addresses within the municipality of Glostrup, on the western outskirts of Copenhagen. It
has a total capacity of 189 beds and comprises 13 inpatient wards (seven of them closed) for “civil”
and forensic adult psychiatric patients. In addition, there are seven outpatient units and an
emergency department. The delegation visited the seven closed wards (two acute emergency wards,
three intensive wards for longer term patients, one forensic ward and one ward for elderly psychiatric
patients). These mixed-gender wards, located in large one-storey buildings constructed in the 1960s,
had an overall capacity of 95 places and received about 2500 patients per year.
At the time of the visit, 87 patients were accommodated on closed wards (29 women and 58
men). Among them, 39 were “civil” involuntary patients and 11 were forensic patients accommodated
on the forensic ward; further, a number of other forensic patients were accommodated on the “civil”
psychiatric wards. Most patients had stayed at the establishment for some weeks to several months
and none had been there for more than 2.5 years.
148
149
150
151
152
Department for Depression and Anxiety, Department for Psychoses and Forensic Department.
Patients accommodated at the Child and Adolescent Psychiatry Department were between 9 and 25
years old.
Under 18 years of age.
LBK No. 1045 of 18 September 2024.
With much shorter median stays of about a week at the Department for Depression and Anxiety and
much longer median stays of several years notably at the Forensic Department.
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129. From the outset, the CPT wishes to stress that its delegation gained a very positive
impression of the quality of care provided to patients in both psychiatric establishments visited. The
two establishments appeared to be well-managed and offered a calm and caring environment for
the patients.
2.
Ill-treatment
130. It should be underlined that no allegations of physical ill-treatment by staff were heard from
the patients interviewed by the delegation at either of the psychiatric establishments visited. On the
contrary, the vast majority of the interviewed patients spoke very positively about the staff and the
delegation observed for itself that many staff members displayed a caring and professional attitude
vis-à-vis the patients, as well as a high level of professional commitment.
That said, at two Departments of Aarhus University Hospital, the delegation heard several
reasonably detailed allegations according to which some staff members had made remarks of a
xenophobic character towards certain patients. After the delegation had mentioned this to the
management of the Departments concerned, assurances were given that the importance of staff
using respectful language vis-à-vis patients was in the management’s constant focus and that the
delegation’s observations would be duly followed up. The Committee welcomes this quick and
positive reaction to the delegation’s observations.
131. As for inter-patient violence, it did not appear to be frequent in the two psychiatric
establishments visited, and staff seemed to react quickly and appropriately whenever any such
violence occurred.
3.
Living conditions
132. The delegation was positively impressed by the excellent living conditions at Aarhus
University Hospital,
153
an establishment which had clearly been thoughtfully designed and which
provided a positive therapeutic milieu for the patients.
154
This applied in particular to the Forensic
Department, where patients were accommodated in a secure yet non-carceral environment.
133. Patients usually lived in large, bright and clean single rooms (measuring approximately 18
m² each) with integrated bathrooms (measuring an additional 10 m²).
155
Particular attention had been
paid to ensuring that the rooms and bathrooms were free of ligature points.
156
Each room was
appropriately equipped with a bed, a desk, a chair, a cupboard and a TV-set. Patients could decorate
and otherwise personalise their rooms and wore their own clothes.
153
154
155
156
As mentioned in paragraph 126 above, the visit to Glostrup Psychiatric Centre was a targeted one,
and the delegation did not examine in detail the living conditions offered to patients there.
For instance, there was a dedicated ward for patients from Greenland, which was designed to provide
a cultural-sensitive environment with murals of Greenlandic landscapes.
In exceptional cases, two patients shared a room.
For example, showerheads were slanting downwards and hooks had been designed in a such a
manner as to break off under heavy weight.
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134. The wards had pleasantly furnished communal areas with sofas, armchairs, TV sets and
large windows giving to staff offices (fostering staff’s accessibility to patients). In addition, each ward
had access to an inner garden equipped with tables, chairs, benches, a barbecue and a shelter
against inclement weather.
157
4.
Therapeutic staff and treatments available
135. The therapeutic staff complement at the Psychiatric Departments of Aarhus University
Hospital
158
could be assessed as being fully adequate (and even generous). On weekdays, two to
four doctors were usually on duty during the day shifts on each ward (accommodating up to 24
patients). During the evenings, at nights and on weekends, four doctors were usually in charge of
the three adult psychiatry departments together, and two doctors were on call for the Child and
Adolescent Psychiatry Department. As for ward-based staff (nurses, orderlies and therapists), six to
eight were present in each ward during the day (including on weekends), five to seven during the
evenings and three to four during night shifts.
136. As far as the delegation could ascertain, based on interviews with patients and health-care
staff and examination of relevant medical documentation, patients at Aarhus University Hospital were
offered adequate pharmacotherapy. Further, the delegation was impressed by the excellent range
of individual and group therapeutic activities, some of which were also offered during weekends.
These included, for example, cognitive-behavioural therapy, a better-life group focussing on
substance abuse treatment, physiotherapy and ergotherapy. Patients could engage in sensory
stimulating activities (e.g. massage chair, sensory chairs, pressure massage, ear acupuncture), in
life skills training or social activities (e.g. barbecues, puzzles, board games). There were also several
cooking groups and various sports activities (e.g. access to a large gym or exercise rooms, football,
hockey, table tennis, table football, walks and bicycle tours) on offer. Further, patients at the Forensic
Department had access to its own large and well equipped “activity centre” which comprised
amongst others several arts and crafts workshops, music and sports rooms and an educational
kitchen.
137. Upon a patient’s admission, a comprehensive individual treatment plan was drawn up which
usually also included a part on the patient’s own views and in particular their consent to (or refusal
of) the proposed treatment.
159
Patients could consult the plan online as they had access to their
medical records in the national health system’s electronic database. Most patients had received a
printout of their plan and its updated versions, as foreseen by the law. The treatment plans were
regularly reviewed (at least every 3 months) with the participation of the patient and other staff
working with the patient. That said, some patients had apparently not (always) received printouts of
their (updated) plans and some plans lacked mention of the patients’ views on the proposed
treatment.
The CPT trusts that these shortcomings will be remedied.
157
158
159
Several of the involuntary patients (both “civil” and forensic) could also leave the establishment,
following assessment by health-care staff, and go for walks in the surrounding nature or visit the city
for a few hours per day.
The delegation did not focus on staffing issues during its targeted visit to Glostrup Psychiatric Centre
(see paragraph 126 above).
As stipulated in Section 3 (3) of the MHA and Chapter 3 of the “Guideline on the Use of Coercion in
Psychiatry”, VEJ no. 9257 of 19 March 2023.
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138. Every patient had at least one contact person amongst the staff members. Patients received
cards with the names and contact phone numbers of their contact staff members so that they could
easily call them even when they were not present on the ward. Another measure to enable positive
staff-patient relations were wall boards placed inside patient accommodation areas, showing
photographs of the staff members on duty during the different shifts. The Committee welcomes these
positive practices.
5.
Means of restraint
a.
nationwide efforts to reduce recourse to means of restraint in psychiatry
139. For many years, a major concern for the CPT and other relevant international and national
bodies
160
has been the high frequency of recourse to and long duration of measures of restraint,
including mechanical restraint (fixation) in Danish psychiatric establishments. In particular, the
European Court of Human Rights found in 2020 that Denmark had violated Article 3 of the European
Convention on Human Rights in a case of a patient who had been fixated (the “Aggerholm case”).
161
140. The CPT acknowledges considerable efforts made by the Danish authorities over the recent
years to reduce recourse to means of restraint and notably fixation, in particular through increased
managerial oversight, recruitment of additional health-care staff and improved staff training.
As regards national restraint statistics, it is indeed commendable that the number of instances
of prolonged fixation (that is, for longer than 48 hours) has been reduced significantly, from an annual
average of 777 in the period 2011-2013 to 340 in 2022. Further, the number of fixated patients has
decreased (from over 2.000 per year in 2011-2013 to 1.177 in 2022 and 1097 in 2023).
However, while also the total number of instances of fixation has decreased over several
years, available statistics show that there has again been an increase in the number of instances
between 2020 and 2022. In the period between 2011 and 2013, 5.680 cases of use of fixation were
registered per year, 3.712 cases in 2020, 4.537 cases in 2021 and 4.904 cases in 2022. It is positive
though that in 2023, the number has decreased again, with 4208 instances of fixation.
162
141. At the outset of the 2024 visit, senior officials from the Ministry of the Interior and Health
assured the delegation of the Danish authorities’ ongoing determination to further reduce the
recourse to means of restraint in psychiatric establishments.
160
161
162
Including the European Court of Human Rights and various other stakeholders such as the UN
Committee against Torture (CAT), the Council of Europe’s Human Rights Commissioner, the Danish
National Audit Office, Danish courts and many Danish non-governmental organisations.
Application No. 45439/18, judgment of 15 September 2020. The case concerned a patient with
paranoid schizophrenia who had been placed against his will in a psychiatric establishment. While the
Court found that the initial decision to restrain the patient had been justified, the continuation of the
measure was not deemed strictly necessary and its duration was considered to be excessive.
The delegation was told that these statistics were at least partly influenced by a change of recording
practice in 2020 whereby short restraint instances including fixation used in connection with other
interventions (such as forced nutrition or somatic surgeries when a patient had swallowed a dangerous
item) were henceforth to be recorded as “psychiatric restraint” while this had not necessarily been the
case in the past.
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Among other things, they informed the delegation that, within the framework of the current
10-year Action Plan for Psychiatry, a political agreement had been reached between the Government
and the parties represented in the Folketing (the Danish Parliament) in November 2023, according
to which the recourse to the most intrusive restraint measures, in particular fixation and chemical
restraint, should be reduced by at least 30% and up to 40% until 2030, with a special focus on
children and juveniles. A national task force for psychiatry, set up by the Ministry of the Interior and
Health in 2014, continued to follow developments regarding the use of means of restraint and it was
hoped that it would
inter alia
improve the sharing of relevant experience and the dissemination of
best practices.
Acknowledging the progress already made,
the CPT reiterates its recommendation that
the Danish authorities place continued focus on preventing and reducing recourse to means
of restraint in psychiatric hospitals, and instances of fixation in particular. This obviously
implies that a reduction in recourse to fixation should not be substituted by an increased use
of other, similarly or even more intrusive/coercive means of restraint (e.g. chemical restraint).
b.
recourse to means of restraint in the psychiatric establishments visited
142. In both psychiatric establishments visited, patients in a state of acute agitation could be
subject to manual restraint (holding the patient with professional grips), mechanical restraint (fixation)
and chemical restraint (administration of rapid acting tranquillisers).
163
The MHA and accompanying
official guidelines regulated the application of these measures in detail. Seclusion of patients was
not resorted to in the establishments visited as it could only be applied in Denmark’s sole high-
security psychiatric establishment, namely the Secure Department of Slagelse Psychiatric
Hospital.
164
143. At Aarhus University Hospital (with about 4000 admissions per year), adult patients had been
subjected to fixation
165
on 1.167 occasions in 2022, 569 occasions in 2023 and 239 occasions during
the first five months of 2024. In most cases, patients had been fixated for periods ranging from
several minutes to 8 hours. On a few occasions, fixation was applied for more than 48 hours (in 33
out of 569 cases in 2023 and in 17 cases out of 239 until the end of May 2024). The longest instances
of fixation since the beginning of 2023 were of 16, 13 and 8 days. Further, chemical restraint had
been administered on 914 occasions in 2023 and on 482 occasions during the first five months of
2024.
163
164
165
Patients who behaved in a manner representing a serious threat to fellow patients (or who were acutely
suicidal or otherwise exposing themselves to a significant harm) could also be subjected to the
measure of “personal shielding” (pursuant to Section 18d of the MHA) whereby one or more staff
members remained constantly in the patient’s immediate vicinity.
“Locking of patients” in either their own or in a seclusion room (as well as the application of “walking
restraint”) at the Secure Department of Slagelse Psychiatric Hospital is regulated in Sections 18a and
18b of the MHA. For further details on these measures see the report on the CPT’s 2019 visit to
Denmark, CPT/Inf (2019) 35, paragraphs 168 to 178.
The equipment used were textile belts for up to five-point restraint. On all “civil” wards, fixation was
applied in the patients’ (single) rooms. On the forensic wards, fixation restraint was applied in a
dedicated “observation room”.
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144. At Glostrup Psychiatric Centre (with about 2500 admissions per year), fixation
166
had been
resorted to on 138 occasions in 2022, on 66 occasions in 2023 and on 31 occasions during the first
five months of 2024. The longest instances had lasted 10, 8 and 5 days (in 2024). In addition,
chemical restraint had been applied 753 times in 2022 and 380 times in 2023. In the first five months
of 2024, patients had been subject to chemical restraint on 211 occasions.
145. As highlighted many times in the past, frequent and prolonged fixation, lasting for hours or
even days, is a matter of serious concern for the CPT. According to the medical documentation
examined in the two psychiatric establishments visited, patients involved had indeed displayed
extremely challenging behaviour, seriously endangering themselves or others. In many cases,
fixation had been applied shortly after the patient’s admission when the patient was acutely psychotic
or in an otherwise acute mental condition.
In this context, the delegation observed that preventing excessive recourse to fixation (and
other means of restraint) was indeed a clear and permanent focus for the committed management
and staff in the psychiatric establishments visited, a task also facilitated by adequate staffing levels
(see paragraph 135 above). The delegation observed several positive practices such as the
managements making clear to staff (on an ongoing basis) the crucial importance of fostering good
staff-patient relations, mandatory regular initial and ongoing training for staff in de-escalation
techniques, systematic debriefings for staff after each instance of restraint,
167
appointing
experienced nurses and therapists (on a rotation basis) as “prevention instructors”
168
and employing
so-called “acute physiotherapists”.
169
The delegation was also informed that health-care staff used certain elements of the so-
called “Safewards” model
170
and were advised to actively seek to recognize patients’ personal
triggers for agitation and discuss with patients in advance what kind of support they would like to be
offered when approaching an acute state (e.g. a walk, tranquilizing medicine, talking with a person
of trust, using a massage chair, etc.). A respective “crisis intervention plan”, which also specified the
patient’s preferences in case restraint had to be resorted to,
171
was subsequently drawn up for every
patient - as a rule with the patient’s participation - and made accessible to the patient. Another
positive practice were regular meetings of hospital staff and police aimed at reducing the use of force
upon involuntary admissions, described in paragraph 150 below. Whenever a patient was fixated,
health-care staff attempted from the very outset to come to an agreement with the patient to stop the
measure. Trials, e.g. for going to the toilet, were made as early as possible and repeated later if they
had failed. It was also positive in this connection that the “observation rooms” used on some wards
for fixation had a sofa, a TV and even a terrasse (e.g. for smoking) which allowed to gradually phase-
out the measure before the patient was ready to rejoin the general accommodation.
While welcoming all the aforementioned efforts, given how intrusive fixation is,
the
Committee strongly encourages the managements of Aarhus University Hospital and
Glostrup Psychiatric Centre to pursue their efforts to reduce the length and the frequency of
fixation and other forms of restraint.
166
167
168
169
170
171
The equipment used were either textile or leather belts for up to five-point restraint. Fixation was either
applied in a dedicated “observation room” or in the patient’s own room.
Seeking ways to better respond to similar situations in the future.
Who could be called by ward-based staff in acute situations for support and advice.
Trained to intervene and possibly calm down agitated patients.
‘Safewards’ is a program that provides practical guidance for reducing resort to means of restraint on
psychiatric wards, as well as preventing conflicts between patients and staff. See
https://www.safewards.net.
E.g. holding, fixation or chemical restraint.
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146. As far as the delegation could ascertain, after the end of the fixation measure a debriefing
was usually held with the patient (in addition to the above-mentioned regular debriefings amongst
staff, see paragraph 145 above). The software which was used to record instances of fixation
automatically reminded health-care staff that a debriefing had to be carried out.
172
That said, in many
cases such debriefing had not been recorded in the system at Aarhus University Hospital (which,
naturally, did not necessarily mean that it had not taken place).
The CPT recommends that steps
be taken at Aarhus University Hospital to ensure that a debriefing with the patient takes place
after the end of each episode of fixation, and that this fact is systematically recorded.
147. At the Department for Child and Adolescent Psychiatry of Aarhus University Hospital (with
up to 500 admissions per year), the delegation observed that fixation (the same method as used for
adult patients) could sometimes be applied to juvenile patients. For example, in the period between
the beginning of January 2023 and the end of May 2024, 18 such patients (aged 14 to 17) had been
fixated on 237 occasions.
173
However, it is important to note that the majority of these instances (179
out of 237) – including both cases of patients younger than 15 – had concerned situations when
fixation had been resorted to for short periods, in order to enable forced nutrition of juveniles suffering
from eating disorders in a situation where their life or their health was at serious risk, and when
manual holding was not sufficient to contain the patient.
174
In some cases, this had apparently been
necessary several times a week over a longer period.
175
According to the information provided by
health-care staff and corroborated by relevant documentation, these instances had lasted only as
long as needed for the nutrition, usually 10 to 30 minutes.
In the remaining 58 instances, 13 juvenile patients had been fixated for periods of 10 minutes
up to several hours and in one case for more than a day, usually due to their extreme agitation or to
prevent an imminent risk of suicide. The delegation was particularly concerned by the fact that four
of those patients – aged 15 to 17 – had been fixated for prolonged periods, from 20 to 34 hours.
Juveniles were sometimes also administered chemical restraint. This had occurred on 26
occasions in 2023 and on 12 occasions during the first five months of 2024.
148. Although it was clear – from the examination of patients’ medical files and discussions with
personnel – that staff made constant efforts to use fixation of juveniles as little and for as short as
possible, the CPT must reiterate its view that, in light of the particular vulnerability of underage
patients, it has serious misgivings about the application of mechanical and chemical restraint in
respect of them. Both means should only be used, if at all, as a measure of absolute last resort and
any fixation should be terminated as soon as possible. In some cases, when manual restraint
(holding) is not sufficient to calm down agitated juveniles, they might be contained in unlocked “time-
out” rooms with staff present.
172
173
174
175
The debriefing was obligatory according to Chapter 7 of the “Guidelines on the Use of Coercion in
Psychiatry” (see footnote 159 above).
The “Guideline on the Use of Coercion in Psychiatry” (see footnote 159 above) stipulates in Chapter
9.1. that whenever considering coercion of a juvenile patient, the patient’s age must be taken into
account and that “serious interventions, such as forced immobilisation should generally not be used
on patients under the age of 15”.
According to Section 7 of the “Executive Order on the Use of Coercion other than Deprivation of Liberty
in Psychiatric Wards” (BEK No. 1075 of 27 October 2019), only involuntary patients can be subjected
to forced nutrition and only when necessary to save the patient’s life or when failure to nourish the
patient would result in a serious risk to patient’s life or health.
For example, 121 of these instances had concerned one particular patient who had had to be forcefully
nourished several times a week over a period of six months.
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The Committee recommends that steps be taken to fully implement these precepts at
the Department for Child and Adolescent Psychiatry of Aarhus University Hospital and, more
generally, in all other psychiatric establishments accommodating juvenile patients in
Denmark.
149. As already mentioned in paragraph 10 above, the delegation observed in both psychiatric
establishments visited that police officers occasionally remained present during agitated patients’
psychiatric admission examination and/or while the patients were subjected to a strip search (usually
upon their admission). Moreover, on rare occasions (approximately once a month), the police could
be called by health-care staff (or asked to remain present after an admission) to support ward-based
staff in restraining particularly agitated patients. The delegation was told that often the police’s mere
presence was sufficient to bring the situation under control. However, police could sometimes also
be actively involved “hands-on” in fixating a patient or when staff administered chemical restraint.
Further, upon involuntary admissions, patients were occasionally accompanied by the police on the
ward while still being handcuffed.
150. It was clear from the delegation’s conversations with the management and staff in the two
psychiatric establishments that the involvement of the police was considered as a very exceptional
measure of last resort.
176
Whenever it happened, the incident was afterwards analysed at the regular
staff meetings. In addition, two or three times a year, meetings were held with the police to discuss
how to better collaborate and deescalate in violent admission situations, and some police officers
participated in the establishments’ in-service de-escalation training.
These are all commendable practices which, however, do not dissipate the Committee’s
serious reservations about the presence of police officers inside psychiatric establishments. The
CPT does acknowledge that, in exceptional situations (i.e. when weapons or hostage taking are
involved), the assistance of the police may be unavoidable. However, health-care staff should
generally be sufficient in number and able to handle violent situations without recourse to the police.
The Committee recommends that steps be taken at Aarhus University Hospital and
Glostrup Psychiatric Centre (and in all other psychiatric establishments in Denmark, as
applicable) to limit any presence of police officers to absolutely exceptional situations.
The CPT further recommends that if, very exceptionally, it is considered necessary by
the healthcare professional involved that police officers remain present upon an agitated
patient’s admission, the medical examination must be conducted out of their hearing and, if
possible, also out of their sight.
“Special means” (including handcuffs) should never be used in a psychiatric setting
to handle agitated patients, including during a patient’s admission.
151. In both psychiatric establishments visited, health-care staff spoke very positively about a
practice under which, when the police brought a patient to the establishment, a nurse would be called
to accompany the patient already in the police car and to advise police officers on how to interact
with the patient. Staff told the delegation that the presence of the nurse often had a deescalating
effect and frequently prevented the use of force by the police and upon the person’s admission to
the hospital. Unfortunately, the aforementioned practice had reportedly been discontinued shortly
before the CPT’s visit.
The Committee would welcome the Danish authorities’ observations on
this subject.
176
Usually, when a patient could not be contained by the staff present, an efficient alarm system was
used, at least at Aarhus University Hospital, to quickly call additional staff from other wards.
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c.
procedural safeguards in the context of resort to means of restraint
152. In addition to the efforts made on the national and local level to reduce recourse to means of
restraint, described in paragraphs 140, 141, 145 and 148 above, the delegation gained a generally
positive impression of the implementation, in both psychiatric establishments visited, of the relevant
procedural safeguards, especially as regards fixation.
153. The decision to apply fixation could only be taken by a doctor after an individual assessment
and was subsequently approved “as soon as possible” by a senior psychiatrist (overlaege).
177
The
measure was then subjected to a medical review
178
at least three times a day at specified intervals
(at least 4 hours after the initiation of fixation and subsequently at evenly spread intervals of 10 hours
maximum).
179
If fixation lasted longer than 24 hours, additional reviews were carried out by a second
psychiatrist from a different hospital ward after 24 hours, 48 hours, 4 days and 7 days after the
initiation of the measure, and thereafter once a week.
154. During the application of the measure of fixation, patients had to be under permanent
supervision by health-care staff.
180
In practice, the delegation observed in both psychiatric
establishments visited that a staff member was usually permanently present inside the room.
However, it appeared that patients fixated on forensic wards were sometimes only supervised by a
staff member through a window from an adjacent room.
By email of 13 September 2024, the CPT was informed by the management of the Forensic
Department of Aarhus University Hospital that exceptions from the rule of permanent presence of
health-care staff members inside the rooms where patients were fixated were only allowed when
deemed necessary in individual cases (i.e. if requested by the patient, if required by the patient’s
mental state or if the patient displayed seriously distressing/threatening behaviour). It was further
stated that, this notwithstanding, staff had to enter the rooms and directly check the patient’s
condition at least every 30 minutes.
181
The Committee takes note of this additional information.
155. In accordance with Section 16 of the MHA and a recently adopted specific guideline,
182
supervising health-care staff were required to document fixated patients’ condition at least every 15
minutes in a dedicated logbook. The CPT welcomes the introduction of this new procedural
safeguard.
177
178
179
180
181
182
See Section 15 of the MHA.
See Section 21 (4) of the MHA.
The intervals could be disregarded if the patient was asleep and waking the patient would be harmful.
Pursuant to the “Guideline on the Use of Coercion in Psychiatry” (see footnote 159 above), ward-
based health-care staff should in such cases call a doctor as soon as the patient wakes up, in order
for the doctor to assess if restraint is still necessary.
See Section 16 of the MHA and Chapter 4 of the “Guideline on the Use of Coercion in Psychiatry”.
The CPT was also informed that it was planned to put in place an obligation for health-care staff to
record in writing the reasons for any such exceptions, and to discuss them at the debriefing meetings
amongst staff and with the patient.
Chapter 2 of the “Guideline on the Supervising Staff’s Duty to take Notes during Belt Restraint”, VEJ
No. 9285, 4 March 2022.
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156. Another important safeguard was that patients subjected to any means of restraint
183
were
automatically and immediately provided with specially appointed and trained patient advisors
184
whose task was to guide the patients and assist them with any complaints or appeals, including
against restraint measures. Patient advisors were independent of the psychiatric establishments and
bound by the duty to respect medical confidentiality. Patients indeed regularly filed complaints about
recourse to coercive measures to the independent Patient Complaints Board
185
and subsequently to
the Patient Appeals Board
186
(and eventually further to a court). Easy-to-use forms were available to
them and made this safeguard effective.
157. As regards the specific safeguards for juvenile patients subjected to any means of restraint,
recently introduced legal provisions
187
stipulated that such measures
188
applied to patients younger
than 15 were to be considered as coercion, irrespective of whether their parents (or guardians) had
(or had not) expressed their consent to them. As a result, all the aforementioned safeguards,
including the appointment of patient advisors, the right to complain
189
and to have one’s case tried
in court
190
apply now to all patients regardless of their age. These new provisions are to be
welcomed.
158. The delegation was informed at Aarhus University Hospital that whenever voluntary patients
became agitated or acutely suicidal and were subjected to fixation, they were asked after one or two
hours or at the latest after the end of the fixation measure whether they agreed to remain voluntarily
in the establishment. If they did not agree, and the doctors considered that continuous hospitalisation
was necessary, the involuntary hospitalisation procedure was immediately initiated.
191
In this context,
the Committee reiterates its recommendation that if voluntary patients
are considered to be in need of fixation, their legal status as “voluntary” should be reviewed
immediately, with the aim of providing them with all legal safeguards accorded to involuntary
patients. The review of their legal status should not be delayed until after release from
fixation.
183
184
185
186
187
188
189
190
191
As well as involuntary hospitalization and treatment, see paragraph 159 below.
Pursuant to Sections 24 to 30 of the MHA.
Patient Complaints Board consists of a Chairperson (the Director of Danish Appeals Boards Authority
or an employee appointed by him/her) and two members, appointed by the Minister of Interior and
Health upon recommendation of the Danish Medical Association and the Danish Handicap
Organisation (see Section 34 of the MHA).
Patient Appeals Board consists of the Chairperson who is a judge, two psychiatrists and two members
from the Danish Handicap Organisation (see Section 38a of the MHA).
See the new Section 1 (4) of the MHA.
As well as involuntary hospitalization and treatment, see paragraph 159 below.
See Section 35 of the MHA.
See Section 37 of the MHA.
See paragraph 159 below.
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6.
Legal safeguards in the context of involuntary hospitalisation and treatment
159. It is recalled that in Denmark, “civil” involuntary hospitalisation may be decided if a person is
considered “insane” (or in a comparable state) and when, at the same time, hospitalisation is
considered indispensable for a decisive improvement of their condition, or if the persons concerned
represent an imminent and significant danger to themselves or to others.
192
The decision on such hospitalisation must be taken by a senior psychiatrist from the admitting
hospital, based on a medical certificate drawn up by a doctor independent of the establishment
(usually a general practitioner).
193
Patients may appeal against the decision (or the decision to
continue the involuntary hospitalisation) to the Patient Complaints Board and subsequently to the
Patient Appeals Board and to a court in the same way as against the application of means of restraint
(see paragraph 156 above). As mentioned in the aforementioned paragraph, patients subjected to
“civil” involuntary hospitalization have an independent patient adviser appointed
ex officio
as from
the very outset of their placement. However, the delegation was not in a position to ascertain whether
such patients also have access to
ex officio
legal assistance (in the manner that forensic patients
do, see paragraph 163 below).
The CPT would like to receive clarification of this point from the
Danish authorities.
160. From the examination of patients’ files and interviews with patients and staff in the two
psychiatric establishments visited it transpired that the aforementioned procedures were, as a rule,
duly implemented in practice. In particular, decisions on “civil” involuntary hospitalisation were well
reasoned and documented, and patients were provided with written copies of the decisions
concerning them, together with information on the avenues of complaint, drawn up in an easily
understandable manner. Patient advisors were indeed immediately informed of every involuntary
hospitalisation decision and usually quickly came to see the patients concerned on the wards.
161. The legally required internal reviews of the need for continued involuntary “civil”
hospitalisation were carried out by senior psychiatrists 3, 10, 20 and 30 days after admission, and
thereafter every 4 weeks. That said, despite the CPT’s previous recommendations, the procedure
still did not require the involvement of a psychiatrist independent of the department where the patient
was involuntarily hospitalised.
The CPT reiterates its recommendation that steps be taken, including at a legislative
level, to ensure that the internal review of “civil” involuntary hospitalisation require the
opinion of a doctor independent of the psychiatric department accommodating the patient
concerned. The Committee further invites the Danish authorities to introduce an effective
mechanism for independent external reviews of patients’ involuntary hospitalisation, at
reasonable intervals.
162. The delegation was informed by health-care staff at Aarhus University Hospital that “civil”
voluntary patients requesting release were usually asked to wait for up to two hours for the doctor’s
assessment and decision. Thereafter they could either leave the hospital or the involuntary
hospitalisation procedure was initiated.
192
193
See Sections 6 (3) and 5 of the MHA.
See Sections 7 and 9 of the MHA.
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However, the fact that Section 10 (3) of the MHA still provides that voluntary patients’
requests for discharge must be responded to by a senior psychiatrist only “as soon as possible and
at least within 24 hours” is a matter of concern.
The CPT recommends that the aforementioned
legal provision be amended. Voluntary patients who no longer wish to remain hospitalised
should be discharged without any delay.
Further, a “civil” patient’s voluntary stay in hospital may be transformed into involuntary
hospitalisation upon the decision of a senior psychiatrist. Despite the recommendations made by the
Committee in its previous reports, such transformation of a voluntary hospitalisation into an
involuntary one still does not require the involvement of another doctor independent of the
department accommodating the patient concerned. In the CPT’s view, patients concerned should
benefit from the same safeguards as other “civil” involuntary patients.
The Committee recommends
that the MHA be amended accordingly.
163. As regards forensic patients hospitalised in psychiatric establishments by court order in the
context of criminal proceedings, the Danish law allows them to request a judicial review of their
placement every six months. Patients must be informed about this right in writing when receiving the
court’s compulsory hospitalisation decision.
194
Apart from that, the competent prosecutor is required
by law to assess the need for continued compulsory hospitalisation (on the basis of the treating
psychiatrist’s opinion and, if required by the case, of a statement from the DPPA) at least once a
year and may, in this connection, initiate a judicial review. Unless the case has been submitted to
the court within the last two years, a court review takes usually place at least five years after the
beginning of compulsory hospitalisation and thereafter every second year.
195
During the court review,
the patient is heard in person and represented by a lawyer free of charge.
In this context, the CPT must stress that, in its view, the aforementioned intervals for
ex officio
court reviews are too long. More frequent automatic reviews are necessary because forensic patients
may not always be able and/or willing to themselves request such reviews of their compulsory
hospitalization. Furthermore, commissioning, at reasonable intervals, in the context of these reviews,
a psychological or psychiatric expert opinion (as appropriate) which is independent of the psychiatric
establishment in which the patient is accommodated, would offer an important additional safeguard.
The Committee therefore recommends that the frequency of
ex officio
judicial reviews
be increased for patients detained under a forensic placement decision, to once per year for
example. The CPT also recommends that the current legislation be amended so as to
introduce the requirement of obtaining an external psychological or psychiatric opinion in
the context of such judicial review.
164. The MHA and the respective Executive Order
196
provide for a number of safeguards in the
context of involuntary treatment of patients hospitalised in psychiatric establishments. In particular,
patients may only be involuntarily treated if the conditions for their “civil” involuntary or forensic
hospitalisation are met. Further, involuntary treatment can only take place as a measure of last resort
if non-treatment would put the patient’s life or health in serious danger.
194
195
196
See Section 72 (2) of the Criminal Code.
See Section 68a of the Criminal Code.
See Sections 12 and 13 of the MHA and Chapter 1 of the “Executive Order on the Use of Coercion
other than Deprivation of Liberty in Psychiatric Wards”.
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Prior to the beginning of such involuntary treatment, several attempts must be made to
explain the necessity of the treatment to the patient (except if delayed treatment would endanger the
patient’s life or health). The patient must further be fully informed about the purpose and possible
side effects of the proposed treatment, must have the opportunity to discuss the matter with the
patient advisor and is entitled to “appropriate reflection time” of up to 3 days. Further, the decision to
start such involuntary treatment must be taken by a senior psychiatrist and a doctor must always be
present during the treatment. As with other coercive measures, patients can file a complaint against
involuntary treatment to the Patient Complaints Board and later appeal the Board’s decision (see
paragraph …below). Such complaints can, in some cases, have suspensive effect.
165. The examination of the relevant medical documentation and interviews with patients and
health-care staff led the delegation to the conclusion that the aforementioned safeguards were
implemented in practice in both psychiatric establishments visited, including in respect of forensic
patients and minors. As regards, in particular, the decision-taking by a doctor, the delegation was
pleased to note that, in practice, two doctors were as a rule involved in the decision to treat patients
against their will.
197
To sum up, the practice in this respect was satisfactory.
7.
Contact with the outside world
166. The delegation observed in both psychiatric establishments visited that patients could receive
visits every day for up to several hours. Further, parents visiting patients at the Child and Adolescent
Psychiatry Department of Aarhus University Hospital could stay there overnight, sleeping on
mattresses placed for this purpose inside their children’s rooms.
There were no restrictions on outgoing and incoming correspondence and patients had
usually access to the Internet. Patients in both establishments could also make frequent telephone
calls, usually with their own mobile phones which the majority of them was allowed to keep.
198
That
said, the delegation noted that some patients could not use their mobile phones.
The CPT would
like to be informed of the rules in force and criteria applied to restrict patients’ use of their
own mobile phones.
197
198
Firstly, the treating doctors discussed the need for a specific treatment with the patients and tried to
convince them to give consent to the treatment, and secondly, if this could not be achieved and
involuntary treatment was indeed considered necessary, senior psychiatrists took the final decision.
If necessary, patients who had no mobile phone would also be allowed to make telephone calls, using
the establishment’s phones.
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APPENDIX I
LIST OF ESTABLISHMENTS VISTED BY THE CPT’S DELEGATION
Police establishments
-
-
-
-
-
Aarhus Police Headquarters
Albertslund Police Headquarters
Bellahøj Police Station (Copenhagen)
Horsens Police Headquarters
Odense Police Headquarters
Establishments for foreign nationals detained pursuant to aliens’ legislation
-
Ellebæk Centre for Foreigners
Prisons
-
-
-
-
Western Prison, Copenhagen
Police Square Prison (Polititorvets Arrest), Copenhagen
Nyborg Prison
Enner Mark Prison, Horsens
Psychiatric establishments
-
-
Midtjylland Psychiatric Hospital
Psychiatric Centre Glostrup
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APPENDIX II
LIST OF THE NATIONAL AUTHORITIES, OTHER BODIES
AND NON-GOVERNMENTAL ORGANISATIONS
WITH WHICH THE CPT’S DELEGATION HELD CONSULTATIONS
A.
National authorities
Ministry of Justice
Carsten Madsen
Maria Hanna Carlsson
Jakob Hüttel
Anders Just Christensen
Tage Jehn
Birgitte Buch
Maria Bislev
Marjun Jogvansdottir
Henrik Alstrup-Andersen
Thomas Jørn Rasmussen
Camilla Marta Giordano
Nikolaj Mielcke Siekstele
Goran Kreso
Sarah Juul Ekknud
Rikke Ekholm Møllgaard
Maja Sass Nielsen
Christian Høygaard
Christine Berg
Emma Dencker Steenberg
Deputy Permanent Secretary
Head of Police Division
Deputy Head of Police Division
Head of Section, Police Division
Chief Superintendent, Center for Crisis Management, Danish National
Police
Head of Sector, Legal Department, Uniformed Policing and
Emergency Preparedness, Danish National Police
Head of Sector of the Policing Division, Center for Policing
Governance, Danish National Police
Police Assessor
Police Commissioner
Acting Head of Criminal Enforcement Division
Deputy Head of Criminal Enforcement Division
Head of Section, Criminal Enforcement Division
Head of Client Management and Processing, Centre for Sentence
Enforcement, Department of Prisons and Probation
Acting Head of Client Supervision and Control, Centre for Sentence
Enforcement, Department of Prisons and Probation
Acting Manager in the Rehabilitation Unit, Centre for Sentence
Enforcement, Department of Prisons and Probation
Head of the Practical Implementation of the Danish prison in Kosovo,
Centre for Building and Property, Department of Prisons and Probation
Director of the Prisons and Probation Service in Greenland
Deputy Head of International Division
Head of Section, International Division
Ministry of Interior and Health
Andreas Jull Sørensen
Carlo V. Andersen
Nina Fjord Fromberg
Christian Ulrich Eriksen
Deputy Permanent Secretary
Head of Unit, Psychiatry and Substance Abuse
Senior Advisor, Psychiatry and Substance Abuse
Special Advisor, Global Health Unit
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Ministry of Immigration and Integration
Christina Fløystrup
Bjørn Bruun Østergaard
Christoffer Buchhave
Birgit Enevoldsen
Birgitte Krohn Madsen
Head of Division for Return and Readmission
Deputy Head of Division for Return and Readmission
Deputy Head of Division for Return and Readmission
Head of Section, Division for Return and Readmission
Senior Consultant, Legal Department, Section for Public Law
Ministry of Foreign Affairs
Ulf Melgaard
Hélène Fester
Director of International Law and Human Rights
Special Advisor, International Law and Human Rights
B.
Other bodies
Director of Public Prosecutions
Iren Mirmojtahedi Hagen
Stig Fleischer
Stine Kok Nissen
Assistant Deputy Director of Public Prosecutions
Senior Specialist Prosecutor
Prosecutor
ParliamentaryOmbudsman/National Preventive Mechanism
Niels Fenger
Lisbeth Adserballe
Louise Christophersen
Ann Thagård Gregersen
Morten Engberg
Parliamentary Ombudsman
Senior Head of Department
Senior Head of Division
Deputy Head of Department
Chief Legal Advisor
C.
Non-governmental organisations
Amnesty International
Association of Aliens’ Lawyers
Better Psychiatry
Danish Refugee Council
Dignity
Forsete, Legal and Criminal Policy Think Tank
International Rehabilitation Council for Torture Victims (IRCT)
Refugees Welcome