63 On the use of restraint in general 37. As a matter of principle, hospitals should be safe places for both patients and staff. Psychiatric patients should be treated with respect and dignity, and in a safe, humane manner that respects their choices and self-determination. The absence of violence and abuse, of patients by staff or between patients, constitutes a minimum requirement. That said, on occasion the use of physical force against a patient may be unavoidable in order to ensure the safety of staff and patients alike. Creating and maintaining good living conditions for patients, as well as a proper therapeutic climate - a primary task for hospital staff - presupposes an absence of aggression and violence amongst patients and against staff. For this reason, it is essential that staff be provided with the appropriate training and leadership to be capable of meeting in an ethically appropriate manner the challenge posed by an agitated and/or violent patient. 38. The line separating proportional physical force to control a patient from acts of violence can be a fine one. When that line is crossed, it is often due to inadvertence or unpreparedness rather than a result of malevolent intention. In many cases staff are simply not properly equipped to intervene when confronted with agitated and/or violent patients. It should also be emphasised that CPT delegations have found that an active and alert role by management with respect to resort to means of restraint in a given establishment has usually resulted in a steady decline in their use. Types of restraint in use 39. The CPT has come across various methods of controlling agitated and/or violent patients, which may be used separately or in combination: shadowing (when a staff member is constantly at the side of a patient and intervenes in his/her activities when necessary), manual control, mechanical restraints such as straps, straitjackets or enclosed beds, chemical restraint (medicating a patient against his/her will for the purpose of controlling behaviour) and seclusion (involuntary placement of a patient alone in a locked room). As a general rule, the method chosen in respect of a particular patient should be the most proportionate (among those available) to the situation encountered; for example, automatic resort to mechanical or chemical restraint is not called for in cases when a brief period of manual control combined with the use of psychological means of calming the person down would suffice. As one might expect, using oral persuasion (i.e. talking to the patient to calm him/her down) would be the CPT’s preferred technique but, at times, it may be necessary to resort to other means directly limiting the patient’s freedom of movement.