- 23 47. Patients are entitled to legal assistance in placement proceedings. They can also be represented by someone acting in their interests. However, neither of these formal rights is effectively enjoyed in practice. In general only the very few persons who availed themselves of the right to be present were also legally represented at placement hearings before the Athens Court of 1st instance. The CPT recommends that the Greek authorities ensure that patients enjoy effective access to legal representation. Such assistance should be made available to indigent patients free of charge. 48. As explained above (see paragraph 11), a provisional placement measure is subject to a time limitation of 10 days from the moment the psychiatric assessment recommending placement for treatment is communicated to the district court.26 However, it was clear from interviews with patients, staff, non-governmental organisations and the Office of the Ombudsman, as well as from the CPT delegation’s consultation of patients’ files, that this limit is often not respected. Such situations could possibly amount to unlawful deprivation of liberty.27 The CPT recommends that the Greek authorities review, as a matter of urgency, the practice applied to involuntary placements, and take the necessary steps to ensure that the statutory time limitations are respected. 49. There is no distinction in Greek law between the procedure for involuntary placement in a psychiatric institution and the procedure for involuntary psychiatric treatment. Indeed the term used in the Greek legislation, signifying both concepts, is “involuntary hospitalisation”28. As a result, no safeguards were in place in the establishments visited as regards forced medication/treatment. In particular, due to the lack of properly kept documentation (see paragraph 34), it was difficult to establish the policy and frequency of applications of forced treatment.29 The CPT recommends that the Greek law be amended in order to ensure that placement and treatment (where involuntary) are two separate decisions, and that each is surrounded by appropriate safeguards. 50. In none of the establishments visited were patients – who were formally voluntary – required to sign a form on admission attesting to their voluntary status. That said, it was not uncommon for the institutions visited to initiate a procedure to change the status of a patient from voluntary to involuntary. However, it was unclear how systematically this procedure was initiated. The CPT recommends that all voluntary patients be required to sign a form, on admission, attesting to their voluntary status. This form should expressly state that voluntary patients are free to leave the establishment and to refuse treatment they do not wish to take. Further, patients who are not able to give valid consent to their hospitalisation should be assessed in order to establish whether they fulfil the criteria for involuntary admission. 26 27 28 29 See Section 96.6 of Law 2071/1992. See European Court of Human Rights (ECtHR), Venios v. Greece, application no. 33055/08, 5 July 2011. “Involuntary hospitalisation consists of a patient’s admission against his/her will to, and his/her placement for therapy in, an appropriate Mental Health Unit” (Section 95.1 of Law 2071/1992, “Ακούσια νοσηλεία είναι η χωρίς τη συγκατάθεση ασθενή εισαγωγή και η παραμονή του, για θεραπεία, σε κατάλληλη Mονάδα Ψυχικής Υγείας (MΨΥ).”). On this issue, see also the CPT’s 2005 visit report (CPT/Inf (2006) 41), paragraph 148.