On the day of the visit, the chief officer was supported by only one deputy chief officer and four custodial officers. This meant that only one officer was present on the first and second floors, where the more unwell patients were accommodated, while no officer was stationed on the third floor which held a mix of 40 patients and 24 prisoner workers. Moreover, while the prison officers had developed on-the-job experience and knowledge of working with mentally ill prisoners, they had received no formal training. This is not professional. The CPT recommends that the Greek authorities increase the number of prison officers providing security in the Hospital. Further, all prison officers assigned to the Hospital should be offered specific training on how to work and interact with mentally ill patients. e. seclusion and other means of restraint 32. The delegation found that there was minimal recourse to any type of means of restraint in the Hospital. There were no allegations or indications of staff resorting to the immobilisation of patients to a bed or the use of other mechanical means of restraint. 33. A measure of separation may be imposed on a patient if he becomes agitated or commits an act of self-harm or is assessed as being at risk of attempting to commit suicide. In such cases, the chief officer will authorise the placement of the patient in the admission room on the ground floor, which is under CCTV coverage, while instructions are sought from the duty doctor and psychiatrist. Upon written authorisation of the psychiatrist, the patient will be re-located to the ground floor separation unit which consists of five recently renovated cells. The cells are furnished with metal framed bunk beds. However, they cannot be considered as safer cells as they contain multiple ligature points and sharp edges. According to interviews with patients and staff and an examination of the registers, patients may be held in these cells for a couple of weeks together with one or two other patients. These patients are afforded the same regime as other patients and may access a small courtyard. However, no staff member is permanently present on the unit to interact with the patients, and it would be left to the patients to alert the staff (via a cell call bell or shouting) should there be a need to intervene. This is not appropriate. A person assessed as being at risk of aggression or self-harm must always be placed under close supervision by staff. The length of time a patient remained on this unit was at the discretion of the treating psychiatrist. Patients who were extremely agitated or acutely unwell would be transferred to a civil psychiatric hospital in the community. 34. In its report on the 2018 visit to Greece, the CPT highlighted the importance for every psychiatric establishment to have a comprehensive, carefully developed policy on seclusion and other means of restraint. The involvement and support of both staff and management in elaborating the policy is essential. Such a policy should be aimed at preventing as far as possible the resort to means of restraint and should make clear which means of restraint may be used, under what circumstances they may be applied, the practical means of their application, the supervision required and the action to be taken once the measure is terminated. The policy should also contain sections on other important issues such as: staff training; recording; internal and external reporting mechanisms; debriefing; and complaints procedures. Further, patients should be provided with relevant information on the establishment’s restraint policy. 12