X mechanical restraints such as straps, straitjackets or enclosed beds, X chemical restraint (medicating a patient against his/her will for the purpose of controlling behaviour), X seclusion (involuntary placement of a patient alone in a locked room). The method chosen for a particular patient should be the most propor‑ tionate among those available in the situation. Patients should only be restrained as a measure of last resort in order to prevent imminent injury or to reduce acute agitation and/or violence. The application of means of restraint in the correct manner and appropriate environment requires that a staf member provides direct, personal and continuous supervision. Every single case of resort to means of restraint should be authorised by a doctor or brought without delay to a doctor’s attention in order to seek approval for the measure. When the emergency situation resulting in the application of restraint ceases to exist, the patient should be released immediately. There can be no justifcation for the use of restraints for lengthy periods of time (days). Once the means of restraint have been removed, it is essential that a debrief‑ ing about the patient takes place. This provides an opportunity to explain the rationale behind the measure, thus reducing the psychological trauma related to that situation and restoring the doctor–patient relationship. The circumstances of the use of restraint should not aggravate the mental and physical health of the restrained patient. The place where a patient is restrained should be specially designed for that specifc purpose. It should be safe and have appropriate light and adequate heating, thereby promoting a calming environment. The restrained patient should be adequately clothed and not exposed to other patients. The means used to restrain the patient should be applied with skill and care in order not to endanger the health of the patient or cause pain. Vital functions, such as respiration, the ability to communicate, eat and drink must not be hampered. If a patient has a tendency to bite, suck or spit, potential damage should be averted in a manner other than by covering the mouth. A specifc register should be established to record all instances of recourse to means of restraint. This register should be in addition to the records in the patient’s personal medical fle. The entries in the register should include the time at which the measure began and ended, the circumstances of Psychiatric care and treatment plans Page 37