IMPLEMENTATION UNDER NATIONAL LAW pre-trial detention facilities. In Austria, other facilities are available, but persons with intellectual and/or psychosocial disabilities usually do not receive the necessary treatment when serving pre-trial detention, whether they are deemed to possess criminal legal capacity and detained in (ordinary) pre-trial detention facilities or considered to be without criminal legal capacity and committed to a public hospital where they receive treatment primarily in the form of medication.253 Another finding throughout the research concerns the overuse of medication and pharmaceutical treatment in prisons as well as in psychiatric institutions. Calming and psychotropic medication may be dispensed at disproportionate levels in the absence of other treatment options (eg psychotherapy). For example, the CPT has stated during its 2020 visit to Bulgaria that treatment was predominantly pharmacotherapeutic.254 In Italy, the Sestante case has brought to the forefront routine administration of “abnormal and exaggerated doses” of psychotropic drugs in mental health units in prison.255 This case concerns a young man named Sestante who exhibited severe psychiatric symptoms and was detained in the Turin prison in the ATSM section (Articolazioni per la tutela della salute mentale; special mental health units in prisons). In this special section for persons with intellectual and/or psychosocial disabilities, the detention conditions have been reported to be very poor, with crumbling and dirty environments and a total lack of meaningful human contact, total absence of activities, and frequent administration of psychotropic drugs. For example, the medical file of the man in question contained “abnormal and exaggerated doses” of psychotropic drugs, as one study found. There was no communication with the person with regard to his condition and the therapy administered. The light had been kept on at all times during the young man’s ten months in that section. In the middle of winter, the young man found himself with a broken window, which meant he had to stay close to the radiator and in his dazed condition due to high doses of drugs, he acquired a burn on his back. The ‘Sestante’ Section (ATSM) of the Turin prison was later 70 closed following an official complaint to the public prosecutor's office filed by Antigone.256 A significant problem that has been raised throughout the research is a lack of continuity of care. When detainees are transferred from one facility to another or moved from inpatient to outpatient treatment, or released, in most countries there are no adequate mechanisms in place to ensure that essential and confidential medical information, as well as other relevant information about the person concerned, is shared with service providers. For example in Bulgaria, there are databases recording psychiatric patients’ information, but other medical institutions or facilities that these patients might be transferred to, would not have access to the database.257 2.6.8.2. CONSENT IN TREATMENT Together with the availability and accessibility of appropriate treatment also comes the issue of non-consensual treatment, as was raised by the experts consulted in this project. This is of particular relevance, as the refusal of accepting medication is often interpreted as “non-compliance” and can consequently lead to a prolongation of detention. International standards, including the UNCRPD, require free and informed consent, including through supported decision making mechanisms, prior to any medical treatment, and the UNCRPD views involuntary treatment on the basis of disability as a violation of the right of persons with disabilities to be free from cruel, inhuman or degrading treatment.258 Experts have noted that it can be very difficult to ensure informed consent to treatment with regard to detainees with intellectual and/or psychosocial disabilities and not enough attention is paid to ensure that treatment is not coercive. A person might sign something without fully understanding the ramifications and the right to withdraw consent at any point and refuse treatment. In fact, involuntary treatment has been observed throughout all the partner countries. Especially in psychiatric facilities, consent for treatment is frequently not sought, and compulsory treatment is applied. This has been reported by experts from Lithuania and Slovenia.