- 62 4. Restraints 145. In Corfu Psychiatric Hospital agitated or violent patients were restrained by strapping them to a bed in one of the two rooms adjacent to the staff room, or in the patient's own bed. The fixated patient would be visited by a staff member every ten minutes during the day, but only once an hour at night, which is insufficient. Patients who are fixated should always be subject to continuous, direct personal supervision by a member of staff. During the period of fixation a patient could receive visits from other patients. Such visits should only take place with the express permission of the restrained patient. The delegation noted that in Corfu Psychiatric Hospital mechanical restraints were only applied with approval of a doctor and with proper registration, contrary to findings on earlier CPT visits to Greek psychiatric institutions in 1993 and 1997. Nevertheless, the register highlighted two main concerns. Firstly, there was frequent recourse to fixation and, at times, for long periods. Secondly, restraints were not only applied for controlling agitated patients but apparently for purposes of punishment as well; for example, according to the relevant register, one patient was strapped to a bed for “throwing ice cubes at another patient”. 146. If recourse is had to instruments of physical restraint, they should be removed at the earliest opportunity; they should never be applied, or their application prolonged, as a punishment. Furthermore, the restraint of patients should be the subject of a clearly-defined policy. That policy should make clear that initial attempts to restrain agitated or violent patients should, as far as possible, be non-physical (e.g. verbal instruction) and that where physical restraint is necessary, it should in principle be limited to manual control. The complete absence of such a restraint policy in the form of a protocol or guidelines in Corfu Psychiatric Hospital was at least a contributing factor to their occasional misuse. The CPT understands that a protocol was under consideration; its delegation was also informed that a recent study at Chania Psychiatric Hospital showed that the introduction of a protocol on restraints was instrumental in a significant reduction in their use. The CPT recommends that the Greek authorities introduce a protocol or guidelines on the use of restraints in Corfu Psychiatric Hospital, taking into account the above remarks.