Case study: Extreme Custody: a report by HM Chief Inspector of Prisons for England & Wales. In 2006 HMCIP carried out a thematic review of all the segregation units in the High Security Estate (HSE) and of the Close Supervision System (CSC) designed to manage disruptive prisoners. These were the units where prisoners were held in isolation in the most restricted and controlled environments with the most potential for prisoner damage. The thematic review followed previous criticisms of the approach of staff in high security segregation units from coroners and others. The report charted the progress that had been made – some of it innovative, particularly in integrating mental health approaches with custodial care – but also pointed out the distance still to travel. The inspection exposed a hard core of long stay prisoners in segregation units who had complex needs and who could not be managed safely elsewhere. Though there was some psychiatric and therapeutic support in the units, it was not enough, and many prisoners were deteriorating further in lengthy solitary confinement. HMCIP recommended individual, multidisciplinary and properly resourced care plans to ensure that prisoners’ health was supported and that opportunities for mental and social stimulation and time out of cell were provided. The inspection team examined records and interviewed both prisoners and staff. It made 17 recommendations for improvements in the CSC and 21 in the HSE segregation units, and identified 17 areas of good practice. Only one recommendation was rejected. This review illustrates the constructive role that an independent inspectorate can have, opening up to scrutiny an otherwise hidden part of a closed prison system where the potential for over-control by staff and of consequent prisoner deterioration is high. Where the prison system is also a mature user of inspection and makes good use of the findings, the process can result in positive outcomes for prisoners. Prison inspections may also be carried out by regional bodies. In Europe, for example, the Committee for the Prevention of Torture (CPT), whose reports we have referred to throughout the Sourcebook, may visit any place of detention within the jurisdiction of Member States. International bodies charged with inspecting and monitoring places of detention include the International Committee of the Red Cross (ICRC), which is mandated to visit any place of detention in situations of armed conflict, and the UN Special Rapporteur on Torture and other Cruel, Inhuman or Degrading Treatment or Punishment. The Optional Protocol to the UN Conventions Against Torture (OPCAT) establishes both an international body of experts to conduct preventative visits to any place of deprivation of liberty in State parties (see above), and a National Preventative Mechanism, which is an independent body tasked with regular and ongoing preventative visits to any place of deprivation of liberty in that country. Sourcebook on solitary confinement: Monitoring and inspecting solitary confinement units 71