The laws that regulate health care in prison in Slovenia are:

Health care in the prison system is organised in collaboration by the Ministry of Justice, Ministry of Health, Ministry of Finance and The Health Insurance Institute. Since 2009, the prison health care system has been part of the public health care system and it functions in line with the basic health care insurance. Before that date, the health care of prisoners was solely organised by the Ministry of Justice (direct contracts were made between prisons and individual doctors), which was more problematic in terms of financing and providing the same quality of care and insurance benefits than for the general population.

The situation has improved significantly since the new arrangements have been put in place. Health insurance benefits are now available both for the inmates on remand, who do not have any other medical insurance, and for convicted prisoners, including juvenile prisoners, and for those in re-education facilities and in obligatory psychiatric or addiction treatments. Furthermore, imprisoned foreigners have the same rights. The prison administration (Ministry of Justice) covers the costs of basic health care insurance, and the Ministry of Health covers the potentially higher costs of additional health care.

Inmates essentially have the same rights regarding health care as other citizens. They are entitled to the health care according to the Health Care Law, with the exceptions mentioned in the 58th article of the Law on Enforcement of Penal Sentences. These are the rights that cannot be fulfilled during the time of imprisonment. E.g., inmates have limited options in choosing their personal GPs as the prison GP becomes their personal GP. Prisoners also do not have the right of treatment at home, treatment abroad, treatment at a health resort, sick-leave (even though they work within the prison), health care for family members, funeral expenses or travel reimbursements for medical treatment reasons.

The prison healthcare network includes 11 prison outpatient clinics, but does not have prison hospitals or wards. Local health care facilities are responsible for providing primary health care for prisons, as prison outpatient clinics are part of the public health care network. They have a team of GPs, a psychiatrist, dentist and gynaecologist responsible for the local prison facilities. The prison does not have any direct contracts with doctors, but still employs nurses. General practitioners work from one to three times per week in the prison setting (depending on the prison size). They are under the control of the Ministry of Health and members of a public network of outpatient clinics in Slovenia.

There were 45,139 examinations done in 2009 within the prison outpatient clinics. Usually there are no delays or waiting lists for GP visits. There were 5,584 examinations by psychiatrists, 3,810 by dentists, 1,162 lab tests, and 730 examinations by gynaecologists (in women’s prison), dermatologists and others. There was a decrease of psychiatric and dental examinations in comparison to 2008 and there were also fewer treatments done outside the prison (Annual Report 2009).

In cases of intensive care needs, prisoners are referred with an official order to external services, such as specialist clinics or specialised hospitals, all part of the general health care system. Health care personnel in prison assess the urgency of the referrals and manage the appointments. Waiting times for the prisoners are usually of the same duration as for the general population. Emergency cases are immediately transferred to the nearest general hospital or an emergency ambulance is called.

According to the Annual Report 2009, there were 5,632 external examinations done in that year, which is a 10 % decrease compared to 2008. Male prisoners had 5,328 appointments, mostly in diagnostic labs for X-rays, computed tomography (CT), electroencephalography (EEG), ultrasound (1,179), as well as attending trauma clinics (839), internal medicine clinics (646), dentists (669), or others. Female prisoners had 194 specialised examinations outside the prison system, most of them in internal medicine clinics (56) followed by diagnostic labs to do X-rays, CT, EEG (20), optical clinics (14), trauma clinics (51), etc. Juvenile inmates had 110 examinations, most of them in trauma, psychiatric, otorhinolaryngology clinics, and optics.

In 2009 there was a 3 % decrease in inmate hospitalisations. One hundred and eighty three prisoners were hospitalised; 106 were escorted during that time and 77 were not. Most of the hospitalised persons were male (with escort 104, without escort 69) and the other eight were female (two escorted). Only two juvenile inmates were hospitalised, both without escort. The majority of hospitalisations was in general hospitals (66) and the rest in psychiatric facilities (35). Sixty-one hospitalisations occurred in the University Clinical Centre Ljubljana.

In 2009, there were 11,986 days of sick leave, a 24 % increase from 2008. Out of this number, 10,616 (males: 10,602, females: 0, juvenile: 14) were spent within the prisons and 1,370 (males: 1,320, females: 32, juvenile: 18) within the external hospitals.

For the purpose of providing mental health care, every prison in Slovenia, in addition to general nurses and doctors, also employs mental health professionals. In total, there are 13 psychiatrists, who are part of the public health care system, as well as institutional staff such as psychologists, teachers/educators and social workers. All psychiatric inpatient care is provided by public psychiatric hospitals, as there are no forensic departments, hospitals or special medical settings for prisoners in Slovenia.

Mental health professionals are available from 8–12 h daily (from Monday to Friday), but their presence depends on job specifications. Psychiatrists are available from once weekly to once per month and psychologists, nurses or educators every day. In cases of psychiatric emergencies, if no mental health professionals are available, emergency services responsible for the general public are called.

Other institutions outside the prison system play an important part in the mental health care of prisoners. There are different ways of initiating this collaboration: prison GPs, psychiatrists or other prison staff might refer the prisoner to institutions outside. Alternately, the prisoner might express a wish to seek additional help in other institutions. For example, there is an established practice of good cooperation between the prison system and the Centre for Treatment of Drug Addiction (in Ljubljana), a governmental organisation. Other frequent options for treatment are psychiatric clinics, local outpatient clinics for alcohol addiction (AA), local AA groups, self-help alcoholic clubs and other centres for the treatment of substance abuse. The NGO network in this field is also quite developed and their counselling and support staff might deliver their service (e.g. individual therapy/treatment) even within prison wards. There are cases when prisoners continue these treatments even after serving their prison sentence.

As other citizens, prisoners are covered by basic health insurance and given a valid insurance card. With this card, a prisoner can visit any health care facility during periods of leave or holidays. They can also visit private health care providers if they pay privately, similar to the general population. Prisoners who are not permitted leave may visit health care providers with escorts.

When entering the prison system, personnel perform an initial assessment of the inmate’s needs. Usually, no psychiatric diagnosis is made in this phase, as time-limitations do not allow that. Prison personnel also assess background history, suicidality, social network contacts, current mental health and social status, and behaviour and criminal history. Within 24 h the prisoner has an appointment with a general practitioner, who makes the decision as to whether the inmate is fit to serve his/her punishment in the prison. Prisoners are not given access to mental health professionals automatically, but the option to receive psychiatric help is presented to them as appropriate.

Almost all prisoners see a psychologist during their imprisonment. The majority of psychologists’ work in prison consists of counselling (40.56 %) or debriefing (25.54 %) as well as informative interviews (20.66 %). Other work demands, such as introductory interviews (10.89 %) and crisis interventions (2.34 %) are also carried out (Annual Report 2009). Crisis interventions are implemented in situations of acute personal distresses, suicidal ideations, self-inflicted injuries, depressive mood and acute emotional strain.

The form of help and its content depend on the inmates’ problems, motivation and the professional background of the psychologist (e.g. CBT orientation). Psychologists mainly offer help to inmates with regards to violent behaviour, alcohol addiction, illegal drug addiction, self-harm behaviour, distress, etc. The work of the psychologists is carried out in individual and group settings.

In 2009, there were 4,186 sessions performed by prison psychologists in total. There were 256 continuing sessions, which lasted on average of 6.6 sessions. That number increased despite a 14 % annual decrease of persons receiving psychological help (in 2009 there were 1,009 persons involved). During the same time there were 5,584 psychiatric sessions carried out. Besides the work described above, psychologists and psychiatrists were involved in collaboration with other institutions. Treatment for drug addiction includes methadone therapy in collaboration with local drug addiction specialists.