55
36.
The CPT also wishes to make clear its support for the trend observed in several
countries towards the closure of large-capacity dormitories in psychiatric establishments; such
facilities are scarcely compatible with the norms of modern psychiatry. Provision of
accommodation structures based on small groups is a crucial factor in preserving/restoring
patients' dignity, and also a key element of any policy for the psychological and social
rehabilitation of patients. Structures of this type also facilitate the allocation of patients to
relevant categories for therapeutic purposes.
Similarly, the CPT favours the approach increasingly being adopted of allowing
patients who so wish to have access to their room during the day, rather than being obliged to
remain assembled together with other patients in communal areas.
treatment
37.
Psychiatric treatment should be based on an individualised approach, which implies
the drawing up of a treatment plan for each patient. It should involve a wide range of
rehabilitative and therapeutic activities, including access to occupational therapy, group therapy,
individual psychotherapy, art, drama, music and sports. Patients should have regular access to
suitably-equipped recreation rooms and have the possibility to take outdoor exercise on a daily
basis; it is also desirable for them to be offered education and suitable work.
The CPT all too often finds that these fundamental components of effective psychosocial rehabilitative treatment are underdeveloped or even totally lacking, and that the treatment
provided to patients consists essentially of pharmacotherapy. This situation can be the result of
the absence of suitably qualified staff and appropriate facilities or of a lingering philosophy
based on the custody of patients.
38.
Of course, psychopharmacologic medication often forms a necessary part of the
treatment given to patients with mental disorders. Procedures must be in place to ensure that
medication prescribed is in fact provided, and that a regular supply of appropriate medicines is
guaranteed. The CPT will also be on the look-out for any indications of the misuse of
medication.
39.
Electroconvulsive therapy (ECT) is a recognised form of treatment for psychiatric
patients suffering from some particular disorders. However, care should be taken that ECT fits
into the patient's treatment plan, and its administration must be accompanied by appropriate
safeguards.
The CPT is particularly concerned when it encounters the administration of ECT in its
unmodified form (i.e. without anaesthetic and muscle relaxants); this method can no longer be
considered as acceptable in modern psychiatric practice. Apart from the risk of fractures and
other untoward medical consequences, the process as such is degrading for both the patients and
the staff concerned. Consequently, ECT should always be administered in a modified form.
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