- 20 Ombudsman’s Office, on the use of mechanical restraint and seclusion. The Ministry also called upon establishments to arrange for the necessary staff training to ensure that these instructions would be correctly implemented. In addition, the authorities informed the CPT that they would be sending to all private psychiatric institutions a separate document prohibiting the use of any means of restraint in those establishments. 40. The CPT welcomes the authorities’ thorough and constructive response and would like to be provided with detailed information on the implementation of the steps envisaged and on progress achieved, in practice, to strengthen the protection of psychiatric patients from the excessive and inappropriate use of restraints, in accordance with the CPT’s standards on the use of means of restraint in psychiatric establishments for adults.19 In particular: - - mechanical restraints are a security measure which can never have a therapeutic purpose; it is unacceptable for doctors to give blanket advance instructions to nurses to apply restraints at their discretion; the use of mechanical restraint should never take place in front of other patients; restrained patients should never be placed in a position where, in order to comply with the needs of nature, they are obliged to soil themselves or defecate or urinate in view of other patients; patients should never be restrained by the use of padlocks; patients under mechanical restraint should be continuously monitored by staff; a reliable system must be in place to ensure the immediate release of a restrained patient in the event of an emergency; and patients should be properly debriefed after a restraint episode. Further, each establishment should introduce clearly defined restraint guidelines and procedures, explaining that restraints are to be used as a means of last resort, to control aggressive or auto-aggressive behaviour; and they should never be used to prevent escape or make up for the shortage of staff. Finally, both at ministerial policy level and at the local establishment level, a clear strategy should be drawn up on how to lower the incidence of the use of restraints, with a particular focus on eradicating long episodes of the use of mechanical restraint. Staff should receive training on the use of restraints, but primarily on the use of verbal de-escalation techniques in order to avoid having to resort to the use of restraints. 41. Seclusion should only ever be used within a psychiatric institution for the prevention of imminent harm, for the shortest time necessary, and subject to constant staff supervision and systematic recording in a dedicated register. As with any other means of restraint, seclusion should never be used as a form of punishment. Guidelines to this effect were issued in 2008 by the Special Committee for the Protection of the Rights of Persons with Mental Health Disorders and endorsed by the Ministry of Health. 19 See the CPT’s standards on “Means of restraint in psychiatric establishments for adults”, CPT/Inf (2017) 6.