- 21 Similarly, the use of chemical restraint must also be surrounded by appropriate safeguards, in particular as regards its comprehensive recording in a dedicated register as well as in the patient’s medical file, and the circumstances and manner in which chemical restraint may be used in combination with mechanical restraint.20 The CPT recommends that steps be taken to ensure that the principles outlined above in respect of the use of seclusion and of chemical restraint are rigorously followed. 6. Safeguards 42. Involuntary placement in a psychiatric establishment, whether under civil or criminal law, must be surrounded by appropriate safeguards. 43. In Greece, the formal decision to place a person in a psychiatric hospital is always based on the opinion of two psychiatrists.21 However, in all of the cases examined by the CPT’s delegation, both psychiatrists were from the same institution in which placement was sought and they conducted their assessment jointly, producing one opinion, not two as prescribed by law. Moreover, at Dromokaiteio Psychiatric Hospital, for example, one of the psychiatrists was typically in training, mentored by his or her licenced colleague. Further, with the exception of assessments made by the Psychiatric Unit at Sotiria General Hospital, the opinions examined by the delegation contained little if any reasoned, diagnostic information (see also paragraph 34). The CPT recommends that the Greek authorities ensure that involuntary placement procedures offer guarantees of independence and impartiality as well as of objective medical expertise. In particular, the psychiatric opinions provided should include reasoned diagnostic information (description of state of mind, appearance, attitude, behaviour, etc.), and two separate opinions should be provided, as prescribed by the Greek legislation. 44. An examination of patients’ files showed that the placement of long-term patients was not the subject of systematic, periodic reviews beyond the first 6-month review.22 The CPT recommends that the law be amended so that this periodic review is explicitly required, and that steps be taken in order to ensure that such a review is undertaken in practice. 20 21 22 See CPT/Inf (2017) 6. See Section 96.2 of Law 2071/1992, which allows for one of the two doctors to be specialised in another related field. See also the CPT’s 2005 visit report (CPT/Inf (2006) 41), paragraph 147.