8. Pharmaceutical chemicals 8.1. Pharmaceutical chemicals employed in torture and ill-treatment From 2012-2017, the CPT and Human Rights Watch have reported cases of non-consensual, non-therapeutic application of pharmaceutical chemicals (including sedatives, tranquilisers, anti-psychosis medication and other psychoactive chemicals) against patients in psychiatric institutions in Armenia,367 Italy368, the Russian Federation,369 and Serbia370. 8.1.1. Illustrative cases Italy Following its 2016 visit to the Castiglione delle Stiviere psychiatric establishment, the CPT delegation stated it was “very concerned” about the case of one young male patient who was visibly slowed down in both his movements and his speech (clearly as a side effect of the neuroleptic medication he had been prescribed), and who was made to sign an attendance sheet each hour. This patient had been in the establishment for a year and had tried to escape three times. Following the third attempt in early August 2015, his psychiatric medication had been modified and augmented. The delegation was told by the medical staff that “such medication had been prescribed with the express intention of rendering him physically incapable of attempting to escape, in particular through the psychomotor retardation caused by Fluphenazine, an older generation neuroleptic.” The CPT recognised the difficulties involved in managing escape risks, but it was unequivocal in stating that “such a use of psychotropic medication could be considered to be long-term chemical restraint, or even inhuman and degrading treatment. The CPT recommends that such practices be stopped.” 371 Serbia Following its visit in 2015 to the Veternik Residential Facility, the CPT delegation highlighted its “particular concern” that the majority of residents received various types of psychoactive medication, most often without having been diagnosed with a mental disorder. In many cases, anti-psychosis medication in combination with various tranquillising medicines was administered, including to juvenile residents. For instance, approximately half of the residents in one unit were on medication normally used to treat psychotic disorders such as schizophrenia, even though “only one resident in the whole establishment had been diagnosed with schizophrenia, and none with other types of psychotic illness”. Further, almost all the residents were taking at least one, if not several, types of sedative. Consequently the CPT delegation “was of the opinion that the widespread use of sedatives and anti-psychotic medication was an indication of the widespread use of chemical restraint as a tool to control disturbed behaviour among residents, rather than to treat symptoms of a psychiatric illness. The widespread and long-term use of chemical restraints has no medical justification; its deliberate use to subdue residents without therapeutic justification may amount to inhuman and degrading treatment.”372 367 HRW, HRW World Report 2015, Armenia entry. CPT (8 September 2017) op.cit. 369 Violence, Neglect, and Isolation for Children with Disabilities in Russian Orphanages, Human Rights Watch, 15 September 2014. 370 CPT (24 June 2016) op.cit. 371 CPT (8 September 2017) op.cit. 372 CPT (24 June 2016) op.cit. paragraph 190. 368 69