JUSTICE FOR ALL frequently prohibited from having contact with relatives on the outside, as well as with other detainees.236 In the framework of the consultation workshops, it was reported from experts that in the Czech Republic, patients are not able to leave their cells and are not allowed to leave the premises or get fresh air while in forensic treatment. 2.6.5. PURPOSEFUL ACTIVITIES, PRIVACY AND PRIVILEGES Isolation and loneliness might also be felt more viscerally in the absence of purposeful activities. Purposeful activities, such as work or recreation, can have a positive impact on detainees. In Slovenia, the NPM has recommended enhancing opportunities for work and meaningful activities for convicted prisoners.237 Surveillance in private rooms is another security measure which has raised concern, infringing on the detainees’ privacy. In Germany, detainees in forensic psychiatric detention may be detained in rooms with camera surveillance without the possibility to blur the sanitary area for privacy.238 Video surveillance in private rooms has also been observed in Croatia (purportedly for security reasons) and in some prisons in Italy in units for persons with mental disabilities, where, in addition, lights are on for 24 hours a day. Concern was voiced that the reasons for such surveillance are not primarily security-based but because it might ease demands on staff. Detainees in psychiatric institutions may find themselves in similarly “total” institutions as prisons and are often prohibited from leaving the facility for special occasions, such as for family bereavement, as was reported in Italy and raised by an expert from Romania in a consultation workshop. Often, the assessment of dangerousness, which is a grounds for detention in a psychiatric institution, precludes any possibilities for temporary leave. However, conversely, successful leaves can serve to demonstrate that dangerousness is not exhibited anymore and the person concerned may qualify for a conditional release (see Section 2.7.3). In Germany, compared to the prison system, forensic psychiatric detention offers more possibility for leaves and such measures that are part of the reintegration process toward the end of one’s detention. Within the framework of leaves and similar measures, inpatient confinement is lifted, converted into ambulatory controls and finally removed.239 Using a stage model, it is intended to be able to react to changes in individual behaviour. The stages can be categorised as follows: (i) reduction of inpatient controls with accompanying staff; (ii) reduction of institutional controls through the increase in informal control structures; and (iii) removal of formal controls with independent leaves without supervision. This system exists because detention in a psychiatric hospital is indefinite. Nevertheless, these leave measures do not exist in preventive detention and they can also lead to detention being prolonged, due to potentially long outpatient care.240 In Slovenia, the Forensic Psychiatry Unit in Maribor currently has a semi-open ward, where patients are included in the available (limited) rehabilitation activities (see the case study in Annex 6). The patients in this ward have supervised exits to the city and weekend exits.241 In Italy, there is the option of granting leave from prisons during the day and going to work, returning to prison at night, but this option is not available to persons serving a form of security measure. In Austria, the interruption of the security measure/preventive detention is often used (i.e., living in an extra mural facility for a trial period to assess the situation and condition of the persons).242 The interruption may only be allowed if it is expected that the person will not commit further offences during the interruption and after 90 days, the extra-mural facility has to determine whether the interruption was successful, additional time is needed and conditional release is recommended. Research shows that this privilege has been used increasingly over the past years and has become an essential requirement for conditional release in many cases.243 67