IMPLEMENTATION UNDER NATIONAL LAW NPM further witnessed that fixation straps were not removed after their requirement but instead stayed there to restrain the person during sleep. It also found that the documentation of restraint measures (including the use of fixation straps, isolation, etc.) was not complete or only vaguely referred to the danger for the person or others.230 The CPT recently recommended keeping a register of measures such as fixation or isolation, as especially with regard to the prevention of inhuman treatment, meticulous documentation is of utmost importance.231 In Bulgaria, the CPT has highlighted that mechanical restraint continues illegally in social care institutions and in psychiatric hospitals, which does not conform with international guidelines and is often recorded fraudulently or not at all.232 In 2018, the German Federal Constitutional Court assumed that mechanical restraints as a special security measure to avert danger to self or others resulting from an underlying medical condition are permissible in principle under strict conditions. The court further found that it has to be closely linked to the psychiatric treatment of the underlying medical condition taking place in detention.233According to the guidelines of the court, physical restraint is an interference with the fundamental right to freedom of the person concerned. In order to ensure the protection of the person affected by a restraint involving deprivation of liberty, a reservation of a judicial order and a daily judicial on-call service is required. In response to this decision, the Court's regulations were applied to the prison system and it was therefore assumed that mechanical restraint was actually permissible in this context. However, this cannot be deduced at all, as the regulations refer to a medical context. CPT has been recommending for years that the measure of restraint be abolished, but above all that it not be used in a non-medical context. In Germany, there is a comprehensive catalogue of disciplinary measures in prisons that can be imposed in a highly formalised procedure. In addition, there are similar measures that can be ordered as security 66 measures but do not require a formalised procedure. These measures are used on the basis of self-harm or perceived danger to others and are regularly imposed on detainees who are perceived as disruptive, often including detainees with psychosocial and/ or intellectual disabilities. This also applies to various forms of isolation, which can lead to severe deterioration in the person’s condition if support is not provided.234 2.6.4. ISOLATION One recurrent theme that has come up throughout the research both on national levels in the partner countries, as well as the regional consultations with regard to detention conditions, is isolation. In reality, according to experts, many persons with intellectual and/or psychosocial disabilities are confined in prisons or forensic psychiatric institutions without meaningful contact with other detained persons or the outside world. Isolation may be imposed for the protection of the person concerned, as a punishment or disciplinary measure or due to a lack of personnel and resources (see Section 2.6.6). For example, detainees who exhibit aggressive behaviour (to themselves or others) might be met with isolation measures, often in combination with fixation measures and medication, as reported in Bulgaria, Lithuania and Germany. It was also reported that in Austria, persons subject to the security measures or preventive detention frequently experience loneliness and desperation, which had been exacerbated due to COVID-19 prevention and control measures implemented in the facilities. Based on a visit in 2021, the CPT has noted that in one forensic unit at a prison, patients were locked in their cells for extensive periods of time, with the “night lock-up” starting at noon on some days.235 These conditions are often worse for persons in pre-trial detention where detainees may be locked in their cells for 23 hours per day, as has been reported in Austria, and even fewer services are available. Similarly, in Germany, detainees in forensic psychiatric detention who are in isolation are