National Preventive Mechanism up. Despite the smell of putrefaction, which permeated the area, no one supposedly noticed that the prisoner was rotting away for months. Physical decay as a sign of emotional neglect The man had been bandaged at the Stein medical facility some time earlier, but the bandages had never been changed. Some of the totally filthy bandages had adhered to the skin. In addition, the man was wearing a pair of trousers, which he did not remove when washing. He apparently had not felt that his feet belonged to his body for some time and had abandoned them to decay. The man had consistently refused care for quite some time and had become more and more withdrawn. The prison administration did not respond until the smell of rot emanating from the single cell became unbearable. After the incident became known, the Federal Minister of Justice was deeply moved and announced reform of the detention of mentally ill offenders. Enhancement of care of long-time inmates Personal hygiene is a problem for older prisoners with lengthy prison terms. The NPM needs to clarify how a minimum standard of hygiene can be guaranteed for persons who are unable to look after themselves (which should include oral hygiene as well as personal hygiene). Signs of deterioration in inmates must be prevented from reaching the stage of illness. Threat of hospitalisation and deprivation The NPM sees an urgent need to expand nursing care and medical examinations for groups of persons who are at particular risk. Inmates must be strongly encouraged to maintain a minimum standard of personal hygiene, and adequate support is to be provided, if necessary. In addition, inmates who belong to an at-risk group should be screened at regular intervals by a general practitioner and a psychiatrist, since a physical decline can be accompanied by a process of mental deterioration and/or emotional neglect. Screenings The Federal Ministry of Justice acted on the NPM’s suggestions to establish minimum standards of hygiene and intensify the use of medical examinations. At the present time, the medical superintendent at the prison administration conducts screenings of inmates over the age of 65 in all correctional institutions and of persons being held in detention for mentally ill offenders in order to determine which steps should be taken to establish minimum standards of hygiene and what standards should be implemented for medical (specialist) examinations at regular intervals. Minimum standards in the area of hygiene Minimum standards in the hygiene area are to be established by the spring of 2015. Qualitatively, they should conform to the 2014 Hygiene Regulation and the Organisation and Strategy for Hospital Hygiene issued by the Federal Ministry of Health. Preliminary discussions have been initiated on the requisite training measures for staff in the hygiene area. There will be a hygiene manager in every correctional institution. Possibility to report rejection of medical exams The NPM was also able to push through its request for a control or warning system for inmates who repeatedly reject medical treatment. Any such repeated rejection of a medical examination will be recorded in the integrated 138