Situations and risk factors in psychiatric institutions Several rights are affected by placement and involuntary treatment in psychiatric institutions. This chapter first examines the use of measures such as seclusion and restraint, which pose the greatest risks to physical and mental well-being. It then tackles other measures, such as various restrictions the individuals are subjected to as part of their daily life in the institution and that violate their dignity and privacy. Finally, it will deal with the risks of overmedication. Seclusion and means of restraints Placing someone in seclusion is understood here to be confining someone in an enclosed space that the person cannot leave at his/her own free will, whether this be his/her own room or any other room used for this purpose. Restraint aims to limit the person’s mobility and can take several forms: physical or mechanical restraint (straitjacket, fasteners, including restraint on a bed with straps on four or five fixation points) and chemical restraint (injecting medication, often with the aim of sedating the person). Other means of restraint include the use of cage beds, including in Europe, and shackles, which have been reported in traditional healing centres in Africa and Asia.12 The participants described the situation in various parts of the world and expressed huge concerns about the use of practices that constitute a “deprivation of liberty within deprivation of liberty”. The CPT in particular has underlined a trend towards an increase in the use of seclusion and restraint in various European countries, both in terms of duration and frequency, as well as the danger of combining 12 See the recent report by Human Rights Watch on the use of shackles in Indonesia: Living in Hell, Abuses against People with Psychosocial Disabilities in Indonesia, https://www.hrw.org/news/2016/03/20/living-hell-people-mental-healthconditions-indonesia. Other reports that document the situation in other countries are available here: https://www.hrw.org/topic/disability-rights. See also the reports of Disability Rights International: http://www.driadvocacy.org/mediagallery/our-reports-publications/ 23