Every competent patient, whether voluntary or involuntary, should be fully informed about the treatment which is going to be prescribed and should be given the opportunity to refuse treatment or any other medical intervention. Any derogation from this fundamental principle should relate only to clearly and strictly defned exceptional circumstances.14 Consent to treatment can only be qualified as free and informed if it is based on full and accurate information about the patient’s condition and the treatment which is proposed. All patients should be provided systematically with information about their condition and the treatment prescribed for them. The use of PRN (pro re nata, “as needed”) medication should be exceptional; the doctor should be immediately notifed whenever PRN medication is admin‑ istered so that he/she verifes the conditions in which it was administered.15 Use of restraints in psychiatric units Guidance for the use of restraints in psychiatric units can be found in the sub‑ stantive section of the 16th General Report of the CPT.16 A mentally disturbed (and possibly violent) patient should be treated through close supervision and nursing support, combined, if considered appropriate, with medication. Every psychiatric unit should have a comprehensive policy on restraint. The involvement and support of both staf and management in developing the policy is essential. Such a policy should make clear which means of restraint may be used, under what circumstances they may be applied, the practical means of their application, the supervision required and the action to be taken once the measure is terminated. The policy should also contain sections on other important issues such as staf training, complaints policy, internal and external reporting mechanisms and debriefng. There are various methods of controlling agitated or violent patients and they can be used separately or in combination: X shadowing, which means a staf member is constantly at the side of a patient and intervenes in his/her activities when necessary, X manual control, 14. CPT/Inf (2008)29, CPT/Inf (2012)11, CPT/Inf (2007)40. 15. CPT/Inf (2012)34. 16. CPT/Inf (2006)35. Prison health care and medical ethics Page 36