CAT/OP/PRT/1 such delays in access to specialist treatment can lead to worsening of the medical condition of inmates who are not free to make medical arrangements themselves. Such neglect may in certain circumstances amount to ill-treatment under international law. 99. The Subcommittee recommends that the State party improve the access of inmates to medical care, including specialized medical care, through better coordination, with the aim of reducing the waiting time for medical assistance for persons deprived of liberty. 100. The Subcommittee is further concerned that the standards of mental health care seem low. The problem of overmedicalization has been raised already and in some prisons, for example Porto Prison, it was reported by the prisoners that everyone was obliged to take tranquilizers at night. 101. The Subcommittee recommends that the State party ensure that tranquilizers are not administered without the prior, free and informed consent of prisoners. 102. The Subcommittee noted with concern the lack of consistent application of therapy for drug users in some prisons, for example Coimbra Prison. In a particularly worrying case, a heavy drug user reported to the delegation that he had not been provided with any drug substitution therapy, which caused serious sleep problems, aggressive impulses and a state of severe mental imbalance. This situation resulted in the prisoner’s transfer to a high security isolation cell, where he had remained for almost two years by the time of the delegation’s visit. 103. The Subcommittee recommends that substitution therapy for drug users be made available to all who need it and that it be administered in a proactive manner. D. Forensic units 104. The delegation wants to draw the State party’s attention to the situation in Pavilion 16 of the psychiatric hospital of Coimbra, which is seriously understaffed. All the work appears to be done by nurses, whereas the doctors only formally authorize treatments and medications and most of the time are not present in the clinic. Article 35 of the 1998 Mental Health Act requires a review of the detained patient’s situation two months following the beginning of the detention and two months after each decision to extend the detention. The delegation was informed that that mandatory review did not always take place. The medical files at the hospital were not updated and, based on a review by the delegation, they did not seem to meet the necessary standards. The delegation encountered a case of overmedication with severe side effects that had been examined by an external neurologist. Nevertheless, according to the documentation that the delegation was able to review, the psychiatrist responsible for the medication seemed unwilling to adjust the medication despite the obvious side effects. The delegation is particularly concerned about a case of a young female inmate who has been kept in detention in this forensic unit without any medical reevaluation. Furthermore, she was kept in the unit even after the court decided to release her, because “she had no other place to go”. The delegation considers that this is an example of arbitrary detention, as the deprivation of liberty has been extended beyond the period ordered by the court. 105. The Subcommittee urges the State party to ensure that Pavilion 16 of the psychiatric hospital of Coimbra has adequate staffing, maintains detailed and regularly updated medical records and adheres to all provisions stipulated in law, including providing alternative care for patients formally released from the hospital. E. Psychiatric units 106. The delegation observed a general lack of non-medical treatment in psychiatric units, that is, different recreational and creative activities. There was also a lack of psychological care and, in most places, a lack of occupational therapy. The Subcommittee considers that the implementation of the procedure for individual risk assessment as a basis of admission to psychiatric care under court order is inadequate. In the cases reviewed by the delegation, 17