officially approved procedures of the mental health facility and only when it is the only means available to prevent immediate or imminent harm to the patient or others. It shall not be prolonged beyond the period which is strictly necessary for this purpose… A patient who is restrained or secluded shall be kept under humane conditions and be under the care and close and regular supervision of qualified members of the staff’ (Principle 11). More recently the CPT (2017), in their Revised Standards for the Means of Restraint in Psychiatric Establishments for Adults have stressed that ‘means of restraint should always be applied in accordance with the principles of legality, necessity, proportionality and accountability... Patients should only be restrained as a measure of last resort (ultimo ratio) to prevent imminent harm to themselves or others and restraints should always be used for the shortest possible time. When the emergency situation resulting in the application of restraint ceases to exist, the patient should be released immediately…. Means of restraint should never be used as punishment, for the mere convenience of staff, because of staff shortages or to replace proper care or treatment’. The CPT Standards (2017: 4) also state that ‘preference should be given to the least restrictive and least dangerous restraint measure. When choosing among available restraint measures, factors such as the patient’s opinion (including any preferences expressed in advance) and previous experience should as far as possible be taken into account’. It should also be noted that the Nelson Mandela Rules (Rule 48) prohibit the use of instruments of restraints on ‘women during labour, during childbirth and immediately after childbirth’. Which restraints may be considered for application: The UNODC/OHCHR Resource book notes that ‘metal limb restraints, such as leg cuffs or chains that connect the limbs with chains to handcuffs and belts, should be avoided. Soft restraints should always be preferred’. Similarly, the CPT Standards for the Means of Restraint in Psychiatric Establishments for Adults note that, ‘for the purpose of mechanical restraint, only equipment designed to limit harmful effects (preferably, padded cloth straps) should be used in order to minimise the risk of the patient sustaining injury and/or suffering pain. Handcuffs or chains should never be used to immobilise a patient. Patients under restraint should always be face up with the arms positioned down. Straps must not be too tight and should be applied in a manner that allows for the maximum safe movement of the arms and legs. The vital functions of the patient, such as respiration and the ability to communicate, must not be hampered’. Checklist for detention monitors: the use of restraints Prohibited uses of restraints: When and what kind of restraints are applied: Are restraints used in circumstances other than i) during transfer (as a precaution against escape), ii) in order to prevent an individual harming themselves or others, iii) in order to prevent the individual damaging property? 6) Are metal or soft / fabric / padded restraints used? 7) Are the number and type of restraints applied the least intrusive option (that is reasonably available, and in light of the particular risks posed)? 2) Is the use of restraints routine, rather than an exceptional measure? 8) Is the detainee kept under constant and adequate supervision? 3) Are restraints ever used in circumstances where the incident could have been resolved without their use (i.e. where lesser forms of control could have been used instead)? 9) Are they removed as soon as possible, once their use is no longer necessary? 1) 4) Are restraints ever applied as a punishment, or on women during labour, during childbirth, or immediately after? 5) Are restraints used to hog-tie individuals? 10) Are they removed when the prisoner appears before a judicial or administrative authority? 11) Are qualified health-care professionals and higher administrative authorities informed? (Please see the next section for more details). 19