- 68 209. The CPT is concerned by the very meagre nursing staff resources in the establishments visited and, more particularly in the Leros establishments, by the shortage of psychiatrists. This situation is all the more striking given that the resources of other categories of staff not directly involved in the provision of care (secretarial staff, technicians, ancillary staff, etc.) were relatively speaking less weak. The Attica State Mental Hospital for children seemed to form an exception in this respect; the ratio of slightly more than 1 nursing staff member per patient was far closer to a level which could be considered as adequate. However, as stated above, the hospital also administered external child guidance centres and the delegation was unable to gain an exact idea of the proportion of staff assigned to such activities rather than to care of hospital patients. The CPT would like to receive information on this point. 210. It is also clear from the foregoing paragraphs, that most of the nursing staff in post had received either insufficient training or none at all. This is apparently a nationwide problem (according to information received, Greece has only some 60 qualified psychiatric nurses). In this connection, the CPT is concerned about the fact that despite steps taken to train nursing staff (opening of colleges), the prospects for both basic and further training are still not at all commensurate with requirements. The CPT saw no evidence of incentives or assistance being provided to encourage staff to undergo training. Furthermore, mainly administrative duties had unfortunately to be assigned to the few qualified nurses. 211. The observed deficiencies in staff resources and training had, for example, the result that two unqualified nursing staff members might be responsible for 40 or even 50 patients, many of them bedridden or seriously handicapped. This creates a situation of high risk for patients, despite the good intentions and genuine efforts of the staff. 212. The CPT recommends the Greek authorities to take the necessary measures to ensure that: - the nursing staff/patient ratio is both significantly increased and adapted to the type of patients; - a significant proportion of the nursing staff is made up of qualified nurses (i.e. at least threeyears training). Training should include specialised instruction covering the types of care to be administered; - qualified nursing staff are relieved, as far as possible, of secondary administrative duties and involved more in activities relating to the care of patients and supervision of staff members who have received little training; - a permanent training budget is allocated to each establishment and a staff member put in charge of co-ordinating training work; - the psychiatrist/patient ratio is improved, particularly in the Leros Public Health Establishments; - during their on-going training and the exercise of their duties, psychiatrists receive constant support from the appropriate professional associations and academic bodies.