Nos. 2, 3 and 8, management of critical cases is limited to placement of prisoners in the de-escalation room, which is often repetitive and permanent. In case of severe psychotic condition, the prisoner is taken to the psychiatric unit of Establishment No. 18 as an urgent case, however, the transfer may be delayed due to the lack of availability of beds in Establishment No. 18.175 According to the reply received from the Special Penitentiary Service, a "crisis management" framework document176 has been developed with the support of the Council of Europe. It is important to develop crisis management guidelines in a timely manner and to train staff of the penitentiary facilities in the management of critical cases, as well as in the use of verbal de-escalation methods. Due to the lack of relevant services, psychiatric cases are not properly managed, which is why prisoners are often placed in the de-escalation room when their mental health problems get complicated.177 The environment in de-escalation rooms is not therapeutic and placement there is often perceived as a punishment by prisoners. It is important for the facilities to maintain statistics on prisoners with mental health problems, identify their needs and develop psychosocial rehabilitation programmes based on the above, which in turn may reduce the frequency of placement of these prisoners in the de-escalation room. Penitentiary staff should be able to identify triggers178 and warning signs to avoid aggravation of the situation. Monitoring of main and side effects of medicines Penitentiary facilities do not provide clinical-laboratory examinations or doctor-specialists’ consultations in order to manage the side effects of antipsychotic drug treatment. The Special Preventive Group considers that particular attention should be paid to the use of Zopin179 (active substance Clozapine) in combination with other antipsychotic drugs or psychotropic drugs of This case is a clear example of the fact that the medical staff of penitentiary facilities are not prepared for emergencies. 175 For example, transfer from Establishment No. 8 to the psychiatric ward of Establishment No. 18 may take 11.5 months in some cases. 176 In addition, with the support of the Council of Europe, a three-stage training was provided for trainers on the following theme: „Crisis Management in the Penitentiary System". 40 staff members were retrained within the framework of the training. 177 See the chapter on misuse of security measures. 178 “Situations or stimuli that cause suffering, frustration, anger and agitation, which in turn may turn into a potentially tense and challenging situation”. For details, see the WHO Course Guide: Creating mental health and related services free from coercion, violence and abuse, p. 34. 179 Treatment with Clozapine requires adherence to the prescription procedure and management of side effects. During treatment with Clozapine, it is not recommended to prescribe 12.5 mg as an initial dose and to increase the dose gradually. The drug should be prescribed in the doses of 50, 100 or 300 mg from the very beginning of treatment. For example, one of the patients was prescribed 50 mg of Zopin (Clozapine) twice a day in combination with Pzysin (Trifluoperazine). Another patient was prescribed 0.3 mg of Zopin in combination with with 30 mg of Haloperidol three times a day. 63