OVERVIEW OF RELEVANT STANDARDS detainees who have “been shown to have serious mental problems and suicidal tendencies”. In these cases, the Court requires special measures to ensure that this condition is compatible with the requirements of humane treatment, irrespective of the gravity of the acts for which he has been convicted or is suspected of having committed.86 The ECtHR has noted in several instances that, with regard to forms of coercive and non-consensual measures against patients with psychological or intellectual disabilities in hospitals and all other places of deprivation of liberty, measures should be employed as a matter of last resort, when their application is the only means available to prevent immediate or imminent harm to the patient or others, that sufficient procedural safeguards are provided and that every use of restraint must be properly recorded.87 The CPT has issued several standards and recommendations regarding the institutionalisation and treatment of persons with intellectual and/or psychosocial disabilities, including for example: • ensure institutional and functional separation between mental health facilities (forensic hospitals) and prisons;88 • ensure adequate living conditions, including sufficient living space per patient, adequate lighting, heating and ventilation, maintaining the establishment in a satisfactory state of repair and meeting general hygiene requirements, allowing persons to keep certain personal belongings and providing a lockable space for them;89 • ensure medical treatment, which should consist of an assessment of the clinical needs as well as a risk assessment based on structured professional judgement and the identification of treatment targets in consultation with the patient and a multi-disciplinary approach;90 • ensure that all categories of psychiatric patients (i.e., voluntary or involuntary, civil or forensic, with legal capacity or legally incapacitated) be placed in a position to give 32 their free and informed consent to treatment. Consent to treatment can only be qualified as free and informed if it is based on full, accurate and comprehensible information about the patient’s condition, the treatment being proposed and its possible side-effects, as well as about the possibility to withdraw consent. Any derogation from this fundamental principle should be based in law and only relate to clearly and strictly defined exceptional circumstances. It should also be accompanied by appropriate safeguards; • ensure access to purposeful activities, including a range of therapeutic options (i.e., group therapy, individual psychotherapy and creative therapies such as art, drama and music, as well as sporting activities) and involvement in clinically appropriate rehabilitative psychosocial activities, recreational activities suited to their needs and unrestricted daily access to the open air;91 • ensure the application of safeguards with regard to medical restraints, including: using restraints as a measure of last resort to prevent imminent harm to themselves or others and applying them for the shortest possible time; never using restraints as punishment, for convenience, because of staff shortages or to replace proper care or treatment; ensuring that restraints must be expressly ordered by a doctor after an individual assessment, or immediately brought to the attention of a doctor with a view to seeking his/her approval; making sure that every patient who is subjected to mechanical restraint or seclusion is subjected to continuous supervision; and ensuring that a specific central register is established to record all instances of recourse to means of restraint for the management to be able to monitor their use;92 and • ensure adequate staffing levels to enable the provision of adequate treatment and care to all residents, as well as psycho-social rehabilitation activities.