CAT/OP/KAZ/1 all the institutions the delegation visited the physical conditions were satisfactory, although they did not allow for any privacy, decorations or private storage space. 135. In the medical centre for mental health in Astana there are involuntary patients (those who present a danger for themselves or surroundings) and five patients under court order. The same form is used to obtain consent for hospitalization and for treatment. If a patient refuses treatment, a hospital commission decides whether to administer the treatment, but the patient can complain through lawyers and can have access to a patient support service. Mechanical restraints are used only on a doctor’s order, in rare cases, but there is no specific register for such use. The Prosecutor’s Office conducts daily inspections. 136. The Subcommittee recommends that consent for hospitalization be requested separately from consent for treatment and that an independent commission be established to deal with complaints. A special register for the use of restraint measures should be introduced, and should include all necessary data, for example, who ordered the restraints, for what reason, for how long and the supervision provided, and the approach to treatment should be individualized. The medical centre for mental health in Astana should also facilitate privacy and decorations in patients’ rooms. 137. The Subcommittee also visited the rehabilitation centre in Astana for alcoholics and drug users, who can be placed in the centre involuntarily on the basis of a court order. The maximum duration of treatment is 12 months. According to the detainees, there is no effective appeal procedure, although article 132 of the Code on public health and healthcare system (Law No. 193-IV) provides that a decision to identify someone as an abuser of alcohol, drugs or other substances can be appealed to a higher health care facility or a court. In accordance with article 133 of the Code, a drug addict or his or her legal representative has the right to refuse medical and social rehabilitation at any stage. Such a refusal must be signed by the patient or his or her legal representative and the medical doctor. 138. In practice, detainees at the centres reported that there were no avenues for them to reverse decisions identifying them as substance abusers. The Subcommittee recommends that an effective appeals procedure that complies with international law be put in place. 21