have a role in caring for the prisoner, including when he/she is transferred to another establishment. Dealing with persons at suicide risk A person identifed as being at risk of suicide should, for as long as necessary, be kept under a special observation scheme. Further, such persons should not have easy access to means for committing suicide (cell window bars, broken glass, belts or ties). All persons identifed as presenting a suicide risk should beneft from counselling, support and appropriate association. A prisoner showing severe signs of suicidal or (auto)‑aggressive behaviour should be immediately transferred to an acute mental health unit. Should the person remain in prison, the treatment and care should be overseen by medical staf and be subject to regular medical visits and follow‑up.23 2.6 Other mental health problems in prison Prisoners with self‑harming behaviour Acts of self‑harm frequently refect problems and conditions of a psychological or psychiatric nature and should be approached from a therapeutic rather than a punitive standpoint. Isolation of the prisoners concerned (even if it is not considered as a disciplinary measure) is likely to exacerbate their psychological or psychiatric problems. All cases of self‑harm should be assessed medically, immediately after the incident, in order to evaluate the extent of lesions and to assess the psychological state of the prisoner.24 Medical management of hunger strikers in prison The management of hunger strikers in prison is a controversial issue. Both CM Recommendation No. R (1998) 7 on the ethical and organisational aspects of health care in prison and the WMA Declaration on Hunger Strikers, adopted in Malta on 1991, leave to the physician the discretion to act in a situation where a hunger strike becomes life‑threatening for the prisoner.25 The ten‑ sion between the duty to secure the right of a prisoner to life and the duty to 23. CPT/Inf (2011)5. 24. CPT/Inf (2009)35. 25. CM: The ethical and organisational aspects of health care in prison. Recommendation R (1998) 7; WMA: Declaration of Malta on Hunger Strikers (2006). Prison health care and medical ethics Page 40