JUSTICE FOR ALL In contrast, within the Austrian system, the converse is possible, and persons who are declared criminally responsible may receive a (regular) sentence in addition to their (potentially unlimited) preventive detention. In this case, the preventive measures should be applied first, and the prison sentence after. The time they spend in preventive detention counts towards the sentence. If they are released from the preventive detention before the end of their sentence (if they have received one), they are transferred into the “ordinary” prison.183 In practice, however, preventive detention very often exceeds the prison sentence. One of the reasons for this extended stay is that during the preventive detention, the person concerned often does not receive the therapy needed in order to demonstrate an improvement in their condition and qualify for release, or therapies start very late (see Section 2.6.8.1).184 All six partner countries provide for a specific measure to respond to a detainee in prison who is experiencing an acute mental health condition, either because a pre-existing condition worsens or because they develop a severe mental health condition while imprisoned. In three countries (Italy, Bulgaria and sometimes in Germany), there is the option of providing psychiatric care for detainees with acute mental health issues in a specialised unit within an ordinary prison, as well as the option of either postponing the sentence for care in the community or transferring detainees to psychiatric facilities in the community for treatment. Special mental health units in prisons, such as the ATSMs (Articolazioni per la tutela della salute mentale) in Italy, have been criticised for their lack of a precise legal framework and little therapeutic efficacy due to a lack of treatment options and insufficient personnel.185 Another issue with such specialised units is that they only exist in selected prison facilities. For example, in Bulgaria, only in Sofia and Lovech are there are specialised hospitals for active treatment of prisoners at the prisons.186 In some countries (Austria, some states in Germany) it is possible to transfer detainees with acute mental health conditions to psychiatric departments of public hospitals or use the inpatient structures of the civic care system. However, in practice, arranging such transfers is not without difficulties due to a lack of capacity of prison hospitals, the lack of willingness of public hospitals or need for further security staff for the transfer/placement in a public hospital. Moreover, in five of the partner countries (Slovenia, Lithuania, Bulgaria, Austria, and Germany) detainees who exhibit acute mental health conditions may also be (temporarily) transferred from prisons to psychiatric institutions or places where compulsory treatment measures are usually executed and where persons who are determined to not be criminally responsible are placed. In other words, it is still possible for detainees with disabilities who are serving a sentence of imprisonment in an ordinary prison (because they have been determined to have full or diminished criminal responsibility) to (temporarily) come under a regime belonging to the “second track” and under the purview of a security measure. Thereby, the distinction between persons who are deemed dangerous based on intellectual and/or psychosocial disability, and therefore without criminal legal capacity, and persons who are deemed to have criminal legal capacity but develop an acute “condition”, becomes blurred. Such referrals to other institutions for (compulsory) treatment are often short and, according to experts, the quality of treatment and care provided is often low, as the facilities may lack the necessary resources. Afterwards, the person is then transferred back to the prison, and it can happen, as reported in Austria and Slovenia, that the same prisoners can be transferred back and forth between the prison and the forensic psychiatry unit several times.187 57