- 19 36. The CPT’s delegation noted that chemical restraint was frequently used. However, with the exception of the Psychiatric Unit at Sotiria Hospital, the application of chemical restraint was not generally acknowledged or recorded as such, and therefore was not surrounded by the necessary safeguards (monitoring, recording, etc.). Moreover, many patients, particularly during the initial phase of hospitalisation at both Dromokaiteio Psychiatric Hospital and Athina Psychiatric Clinic, were administered neuroleptics by injection without their consent, for the purpose of rapid tranquillisation, often in combination with mechanical restraint applied for long periods of days or even weeks. 37. Limited resort was had to seclusion, in two special rooms with sanitary annexes at the Aiya Markella (acute) ward at Dromokaiteio Psychiatric Hospital, either to prevent patients – including ostensibly voluntary ones – from escaping, or to punish them for having attempted to escape. One patient interviewed by the CPT’s delegation had been in seclusion for a day, ever since she had been returned to the Hospital after escaping for one week. The other seclusion room at the ward was occupied by a forensic patient prone to impulsive acts of violence; staff informed the CPT’s delegation that he had been secluded for uninterrupted periods of weeks. At the Unit at Evangelismos Hospital, patients were also very occasionally, and for brief periods of a few hours, according to both patients and staff, confined to a locked hospital room. No formal record was kept of any of the above-mentioned instances of seclusion. 38. At most establishments visited, staff were not aware of the ministry-endorsed policy18 on restraints. Internal regulations implementing that policy were absent at Athina Psychiatric Clinic, and staff were insufficiently aware of the implementing regulations at Dromokaiteio Psychiatric Hospital. 39. In response to the CPT delegation’s preliminary observations about the use of restraints, the Greek Ministry of Health informed the CPT, by letter of 7 June 2018, that it had issued instructions to all public psychiatric establishments on the exceptional use of mechanical restraint, with a view to: (a) clarifying the very specific criteria according to which it is acceptable to apply mechanical restraint (immediate risk of harm to self or others, and only after de-escalation attempts have failed); (b) integrating the CPT’s standards on this issue into the practice, as well as the policy, in Greece; (c) ensuring that any change in practice does not result in a departure from the open regime conditions, and that on the contrary, time spent outdoors, home leave and therapeutic activities are to be promoted as decreasing tension and preventing the need to resort to restraints; and (d) ensuring that patients are treated with respect and their needs and particularities are taken into account. Establishments were further required to keep a specific register on the use of means of restraint as well as to submit regular quantitative reports to the Health Ministry, the Special Committee for the Protection of the Rights of Persons with Mental Health Disorders and the 18 Special Committee on the Rights of Patients with Mental Illnesses, Guidelines on the Use of Restraints, 30 January 2008