CAT/OP/TGO/1 49. The Subcommittee reminds the Government of Togo that it must ensure access to medical services by detained persons, in accordance with the Standard Minimum Rules for the Treatment of Prisoners. It recommends that the State party take the necessary measures to ensure that every prison has regular access to the services of a qualified medical doctor, who should examine each prisoner as soon as possible after his or her admission and monitor the physical and mental health of prisoners, in particular by creating medical files for each of them. 50. The Subcommittee recommends that the Cabano Unit be fully renovated, that the total number of beds be adapted to need, that beds be specifically reserved for women and minors and that prisoners with contagious diseases be effectively isolated. In addition, the Subcommittee recommends increasing the medical presence in the Cabano Unit by assigning a full-time medical doctor to it. 51. The Subcommittee recommends that the State party ensure access to medical care for all prisoners, including indigent ones. It urges the State party to consider incorporating medical care for the prison population into the health-care reform under way, and in particular to consider broadening the social protection scheme to include prisons. Zébé Psychiatric Hospital 52. The Subcommittee visited Zébé Psychiatric Hospital, the only psychiatric hospital in the country. The hospital was overcrowded (166 patients for 136 beds on the day of the visit), but the physical conditions were acceptable in terms of cleanliness, the maintenance of the premises and available space. The Subcommittee also noted with satisfaction that the hospital administration and the head doctor were working on diversifying services by creating an ambulatory consultation and treatment clinic — a welcome alternative to hospitalization — in the city centre of Lomé. That said, the number of psychiatrists (one) and medical assistants (three) was clearly inadequate. 53. The Subcommittee notes that no allegations of ill-treatment were heard during the interviews and that visits from families were encouraged. 54. The Subcommittee nevertheless points out that most of the patients were hospitalized without their consent: at the time of the visit, fewer than a dozen were there at their own request. Most patients had been hospitalized at the request of their families, while around 15 were there by order of the State prosecutor for breaches of the peace or because a judge had decreed that detention was not appropriate. 55. The Subcommittee also notes that solitary confinement (sometimes coupled with forcible administration of medication) is frequent and not adequately monitored or documented; it is imposed without guidelines and is not recorded in a special register or systematically noted in the individual’s medical file. 56. A relatively broad range of services is provided, including individual- and groupbased care. The Subcommittee is nevertheless concerned that 60 per cent of patients are disadvantaged persons who cannot pay for medical care. Although the hospital covers their costs, causing a structural budgetary deficit, it can provide them with only a very limited range of basic medical treatment. 57. The Subcommittee is concerned about the lack of legal safeguards, in particular the lack of a periodic review of involuntary hospitalizations, the absence of appeal mechanisms and complaint procedures and the lack of a regular inspection of the premises by the judicial or administrative authorities. 58. The Subcommittee requests that the State party ensure that the legislative reform under way will include a review of involuntary hospitalization measures and that it reconsider the legal status of persons who have committed a criminal offence and were suffering from mental problems at different stages of the criminal proceedings. 59. The Subcommittee also recommends allocating sufficient human and financial resources to the mental health sector, recruiting more psychiatrists, adopting a mental GE.17-06858 9