- 18 5. Means of restraint 35. One of the most serious findings during the visit concerned the use of mechanical restraint. The CPT’s delegation observed a lack of appropriate training on, and strict criteria for, the use of restraints in line with internationally accepted guidelines. These factors, combined with very low staffing levels, have resulted in a widespread practice of excessive, inappropriate use of mechanical restraint. The CPT’s delegation observed that the criteria followed for the use of mechanical restraint were often unclear. Allegations were heard about the use of restraints as a punishment (e.g. two hours for “stepping on a mop” (at the Athina Clinic)) or as a means, during the initial period of hospitalisation, to prevent escape. Even at the Psychiatric Unit of Sotiria Hospital, where restraints were resorted to less frequently than at the other establishments visited and were subject to adequate monitoring and recording, the CPT’s delegation found records of the prolonged use of mechanical restraint, for days, on subdued patients who were described by staff as “calm, polite and compliant”, evidently presenting no imminent risk of harm to themselves or others. At Dromokaiteio Psychiatric Hospital, advance authorisations were found for mechanical restraint, for example, at the geriatric unit, or at the Singrio ward, where a doctor had ordered restraint in case the patient went to another room. Certain files examined, and interviews held with staff, also indicated a “therapeutic” use of restraints. Quite a number of files consulted by the CPT’s delegation and/or interviews held with patients or staff attested to an excessively long duration of mechanical restraint being applied. For example, at Dromokaiteio Psychiatric Hospital, one formally voluntary patient found in restraints at the Kundirijotio ward during the CPT delegation’s visit on 12 April had been restrained since 3 April and beforehand between 8 March and 1 April 2018; and at the Berisarios ward one patient, who had been hospitalised for many years, was constantly restrained on a long-term basis and released only during visits from her mother, who would stroll with her in the gardens. Two patients at the Gennimatas Hospital Psychiatric Unit were subject to long-term restraints: one, who suffered from autism and had been at the hospital for two years, was restrained for lengthy periods; the other was restrained constantly and only released during the daytime visits of additional support staff. The CPT’s delegation also encountered instances, as well as numerous consistent reports, of inappropriate restraint methods. For example, restraints were usually applied in hospital rooms – or, at Evangelismos, in the Unit’s corridor – in full view of other patients. At Dromokaiteio Psychiatric Hospital, in particular, restrained patients were often obliged to use a bedpan or in some instances soiled themselves in front of other patients. Restraints were often applied just to one lower limb; and padlocks were in use at the Psychiatric Unit of Gennimatas Hospital and at the Aiya Markella ward at Dromokaiteio Psychiatric Hospital. Nowhere was there a reliable system in place ensuring the immediate release of a restrained patient in the event of an emergency. The CPT’s delegation also noted that patients were restrained without appropriate approval and/or supervision by a doctor, in particular wherever no dedicated restraints register was in use, namely at the Athina Clinic and at all wards at Dromokaiteio Psychiatric Hospital except the Singrio ward. It is certainly positive that dedicated restraints registers were in use at the Singrio ward and at the Psychiatric Units of the three General Hospitals. That said, those registers should be kept more thoroughly.