CAT/OP/C/57/4 64. Even measures that appear to be protective can often operate to the detriment of individuals. Authorities routinely rely on prolonged periods of protective custody, isolation or solitary confinement as default forms of protection, 22 but those measures are extremely taxing on the person and restrict access to education, work and programme opportunities that affect time off for good behaviour and parole. As a result, lesbian, gay, bisexual and transgender persons are not only likely to serve their sentences in isolation, but also more likely to serve longer time. 65. The Subcommittee has noted with particular concern the situation of complete abandonment of transgender women and men in detention. At the outset, the absence of adequate policies and methods of identification, registration and detention has severe consequences: obtaining precise individual information as to gender identity is vital to determining proper treatment, including hormone and other treatment associated with gender transition. In the absence of mechanisms to obtain such information, grave health consequences ensue. 66. The lack of institutional policies and methods to adequately address selfidentification, classification, risk assessment and placement leads in some cases to transgender women being placed in male-only prisons, where they are exposed to a high risk of rape, often with the complicity of prison personnel. During its visits, the Subcommittee has learned that transgender persons deprived of their liberty are often beaten and forced to enact sex scenes in front of fellow inmates, practices that are often sponsored by guards who charge for viewings. They are also required to shower in the presence of persons of the opposite gender, are patted down by officers of the opposite gender, and are sometimes groped with the sole purpose of determining the nature of their genitalia. The Subcommittee has learned of deaths of transgender women in custody, including an occurrence of death after anal penetration with a club (see CAT/OP/PRY/1, para. 214). 67. Those concerns are also present when deprivation of liberty occurs in other contexts. For instance, lesbian, gay, bisexual, transgender and intersex migrants often suffer serious mental health effects of ill-treatment in their country of origin. As mental health treatment is virtually non-existent in migration facilities, symptoms are often aggravated and retraumatization often occurs. Those concerns extend to ill-treatment (see A/HRC/19/61/Add.4, para. 172) and violation of the principle of non-refoulement. 68. In health-care settings, ill-treatment and torture include denial of gender-appropriate medical treatment, verbal abuse and public humiliation, psychiatric evaluations, sterilization, and hormone therapy and genital-normalizing surgeries under the guise of socalled “reparative therapies”. Identifying ill-treatment and discrimination in health-care settings is particularly important since homosexuality is still treated as a pathology by some medical professionals, despite the World Health Organization having removed it from the International Classification of Diseases (ICD-10) in 1992. To date, transgender and intersex persons continue to be pathologized in medical settings based on medical classifications. 69. The Committee on the Elimination of Discrimination against Women and the Special Rapporteur on torture have expressed concern about lesbian, bisexual, transgender and intersex women as victims of abuse and mistreatment by health-service providers (see A/HRC/19/41, para. 56). That includes so-called “normalization therapies”, in pursuit of which members of sexual minorities are said to have been involuntarily confined to medical institutions and allegedly subjected to forced treatment, including electric shock therapy 22 14 See, for example, European Court of Human Rights, Case of X v. Turkey, application No. 24626/09, final judgement adopted on 25 May 2013, para. 53.