- 16 4. Staff, treatment and documentation 31. The two larger establishments visited by the CPT’s delegation were clearly understaffed, especially as regards the nursing complement, psychologists and occupational therapists. At both Dromokaiteio Psychiatric Hospital and Athina Clinic every ward was affected by understaffing. According to official figures, out of 382 nurses (of different categories) foreseen in the establishment table at Dromokaiteio Psychiatric Hospital, only 172 were employed for all the services under its responsibility. At any one time only one or at most two nurses were on duty at wards accommodating up to 36 patients. The staff-to-patient ratio was certainly better at the smaller psychiatric units of the three general hospitals visited. Nevertheless, additional staff would be needed to engage in activities with patients especially at the Evangelismos Psychiatric Unit, and to bring the new annex at Gennimatas Hospital’s Psychiatric Unit into service. The CPT’s delegation saw clear signs of a caring attitude among staff and an admirable level of motivation, in spite of the obvious strain they were under due to overcrowding and understaffing. The Committee understands that the current staffing crisis must be seen in the context of strict austerity measures combined with lengthy recruitment procedures. Nevertheless, the CPT recommends that urgent steps be taken to address the staff shortages, as essential frontline services, in direct contact with vulnerable patients, cannot be taken care of properly and safely, given the current low staffing levels. 32. As regards treatment, the pharmacotherapy provided to patients at the units of the three General Hospitals visited does not call for particular comment. Some psychotherapeutic activities, including group therapy, were also provided there, which is positive. By contrast, at Dromokaiteio Psychiatric Hospital and Athina Psychiatric Clinic there was an over-reliance on pharmacotherapy and very limited psychosocial activities on offer. A clear pattern was observed of high dosage, intra-muscular anti-psychotic injections during the first days after patients’ admission to Dromokaiteio Hospital. At the Athina Clinic, mainly 1st-generation antipsychotic drugs were in use in relatively high doses,17 with several patients clearly displaying symptoms of overmedication (blurred speech, extra-pyramidal symptoms). The CPT recommends that treatment at both establishments be the subject of a thorough evaluation, aimed at bringing medication in line with modern medical standards, preventing overmedication, and diversifying the treatment on offer; at all psychiatric establishments, patients should be offered a range of treatment options, including counselling, psychotherapy and psychosocial rehabilitation. It is especially important, in the Committee’s view, that long-term and forensic patients be offered suitable occupational and vocational therapy, in order to counter the risks of institutionalisation; and, as regards forensic patients, in order to foster their re-integration into society. 17 Up to 60mg/day of Haloperidol for several patients, whereas many were receiving 50mg/day over uninterrupted periods of months or even years.