JUSTICE FOR ALL During its 2020 visit to Germany, the CPT criticised the fact that the forcible administration of rapid-acting tranquillisers, also known as chemical restraint, was only documented as "emergency medication" and not as a restraint measure in patients' medical records.259 In 2021, the Federal Constitutional Court imposed constraints on the coercive treatment of detainees in a psychiatric hospital. In Germany, the Federal Constitutional Court stated that the facility may not ignore the rejection of coercive medical treatment if this rejection was made in a state of mental capacity with a patient decree.260 However, this is limited to coercive treatment designed to protect the person concerned. The state's obligation to protect the fundamental rights of other persons who come into contact with the person concerned and be at risk of harm remains unchanged. The patient's autonomous decision can only extend as far as their own rights are affected. In Austria, if persons subjected to security measures or preventive detention refuse to participate in a medical examination/treatment which is absolutely necessary under the circumstances, they may be subjected to these measures by force, provided this does not involve a risk to life and is otherwise reasonable for them.261 Unless there is imminent danger, the approval of the Ministry of Justice must be obtained before any compulsory examination or treatment is ordered. In practice, experts have raised concern that consent is not always obtained, and persons concerned are not properly informed of their medication. Approvals from the Ministry are sometimes simply obtained by phone, without further documentation. Experts have also raised concerns regarding the consequences of refusing to take medication, where persons are perceived as non-cooperative, which may negatively influence their annual review and chances of receiving privileges.262 Similarly, in Germany, treatment in forensic psychiatric detention, as in other hospitals, is based on a contract with the patient. Due to the special situation in forensic psychiatric detention, some measures go beyond this contract, such as compulsory medication, accommodation in certain residential groups or similar. Nevertheless, it should not be overlooked that this measure has a coercive context and often goes against the will of the persons concerned.263 The persons concerned are also indirectly forced to cooperate, to participate in any treatment they are offered, and even talk about themselves and their offences the way they are expected to by the institution. Otherwise, they have no realistic chance of release. This was also expressed as a problem in Austria, where lack of consent or refusal to take medication without further information can be seen as opposition and reluctance to cooperate and accept responsibility.264 Due to the fusion of treatment and control and the constantly perceived dangerousness of the person concerned, treatment evolves into "total therapy".265 All activities in the hospital are characterised by the therapeutic mission. However, a concept of treatment that encompasses all measures makes it impossible to separate specific measures of security and order and the provision of a dignified quality of life. In other words, the boundaries between therapy, care and discipline become blurred.266 In Italy, compulsory medical treatment is only possible in specialised health facilities and not in prison. Theoretically, and generally in practice, if compulsory treatment of a detainee is considered necessary, the person has to be transferred to one of these facilities. 2.6.9. CONCLUSIONS AND RECOMMENDATIONS The research revealed multiple concerns related to the treatment of persons with intellectual and/or psychosocial disabilities in all places of deprivation of liberty, including prisons, (forensic) psychiatric hospitals, preventive detention and other institutions for compulsory treatment. Although separate psychiatric facilities should not exist for persons with disabilities, according to the UNCRPD (see Section 1.2.3), experts have noted that faced with unsuitable environments in prison, such facilities may be preferable in some cases. Considering the rather poor conditions and treatment options in prisons and psychiatric facilities 71