JUSTICE FOR ALL 2.6.8. TREATMENT 2.6.8.1. ADEQUACY OF TREATMENT The research has revealed that adequate and evidence-based psychosocial and/or psychiatric treatment, based on free and informed consent, is rarely offered to detainees with intellectual and/or psychosocial disabilities, whether they are detained in an ordinary prison, special prison units or (forensic) psychiatric institutions. For detainees in pre-trial detention, such treatment is often non-existent. Generally, when it comes to prisons, all partner countries follow some form of admission procedure that includes the medical assessment of any health needs, including a psychological assessment of mental health needs. However, most prisons do not offer sufficient psychiatric or psychotherapeutic services and there is a lack of qualified staff (see Section 2.6.6). A lack of continuous care and treatment options while serving a prison sentence can lead to a deterioration of health conditions and the isolation of the persons concerned. Individuals with intellectual and/or psychosocial disabilities may struggle to adapt to the prison environment and participate in programs. Research in Germany has shown that if a transfer to a psychiatric department, within or outside the correctional system, is not possible, detainees with intellectual and/ or psychosocial disabilities who demonstrate specific needs may be moved to observation and/or highly secured cells, thus isolating them from other detainees. Particularly, individuals whose disability has not been diagnosed may be perceived as "troublemakers" and are more likely to face security and disciplinary measures, often being isolated. Due to a lack of alternatives, individuals with psychotic disorders, self-harm tendencies and suicidal thoughts may be housed in these conditions for months. However, their health condition usually does not improve with this type of isolated placement. The correctional system is often unable to provide the necessary medical and psychological treatment, close supervision and hygiene standards. Consequently, the persons concerned end up living in deplorable conditions, contribut- ing significantly to the deterioration of their health. Furthermore, due to their health status, further measures such as privileges and releases are often discontinued.249 Although (forensic) psychiatric institutions embody the express purpose of providing treatment, the research has shown that the availability and quality of psychiatric treatment is lacking in many countries. In Germany, on average, only 30% of the detainees in preventive detention are in therapy, although the proportion of persons affected with mental health conditions requiring treatment is significantly higher at 79.3%.250 In Austria, multiple experts from different fields (including representatives of NPMs, lawyers, medical doctors and probation officers) have pointed out that persons who are subjected to preventive detention very often do not receive the necessary treatment and support they need. There have been multiple accounts of persons not receiving the treatment (particularly therapeutic treatment) they need for multiple months.251 A lack of adequate treatment is not simply problematic because it can lead to deterioration of a person’s mental and physical wellbeing, but also because it can have repercussions on the length of detention. Successful treatment – and improvement of a person’s condition – are often linked to conditional release prospects. In Austria, persons who are subjected to preventive detention are often detained in ordinary prisons (or specialised departments within ordinary prisons) that simply do not offer the treatment/therapy that is necessary, impacting the possibilities for conditional release – which is often dependent on a demonstration of active participation in therapeutic services and improvement of one’s condition – and leading to overlong stays in preventive detention.252 A lack of adequate treatment is especially prevalent for persons in pre-trial detention, where services are generally even scarcer and there are generally no special regimes in place to ensure the provision of treatment and special medical care for persons with intellectual and/or psychosocial disabilities in ordinary 69