system. Finally, psychiatric units can be used for the placement of persons on remand in custody for the purpose of assessing their mental state. It is not uncommon to fnd that, in the absence of a specialised psychiatric unit in the prison system, prisons have established secure areas or levels for more vulnerable prisoners, including the ones with mental disorders. General principles of care in a prison psychiatric unit The care and custody of persons subject to placement in a penitentiary mental health‑care facility as a security measure should be based on treatment and rehabilitation, while taking account of the necessary security considerations. This approach should be refected in the living conditions and other facilities ofered to this particular patient population, as well as in their treatment and activities. Such establishments should be stafed by suitably trained health‑care personnel who are able to develop positive relations with the patients by entering into direct contact with them.7 Staf resources should be adequate in terms of numbers, categories (psychiatrists, general practitioners, nurses, psychologists, occupational therapists, social workers, etc.), experience and training. Defciencies in staf resources can lead to high‑risk situations for patients, notwithstanding the good intentions and genuine eforts of the staf. The CPT has on many occasions commented on the living conditions of people placed in psychiatric institutions.8 This applies, inter alia, also to psychiatric units within the prison system. A psychiatric unit should ofer material con‑ ditions which are conducive to the treatment and welfare of the patients and, in psychiatric terms, a positive therapeutic environment. Creating a positive therapeutic environment involves, frst of all, providing sufcient living space per patient as well as adequate lighting, heating and ventilation, maintain‑ ing the establishment in a satisfactory state of repair and meeting hygiene requirements. Provision of accommodation based on small groups is a crucial factor in preserving patients’ dignity, and is also a key element in any policy for the psychological and social rehabilitation of patients. Such accommodation also facilitates the allocation of patients to relevant categories for therapeutic purposes. Sanitary facilities should allow patients some privacy. Further, the needs of elderly or handicapped patients in this respect should be given due consideration; for example, lavatories of a design which do not allow the user to sit are not suitable for such patients. Similarly, basic hospital equipment 7. CPT/Inf (2007)28. 8. The CPT Standards 2002 (rev. 2011). Prison health care and medical ethics Page 32