16 44. What can be done to prevent the misuse or overuse of means of restraint? First of all, experience has shown that in many psychiatric establishments the use of, in particular, mechanical restraint can be substantially reduced. Programmes set up in some countries for that purpose seem to have been successful, without this having led to an increased resort to chemical restraint or manual control. The question therefore arises whether complete (or almost complete) eradication of mechanical restraint might not be a realistic goal in the longer term. It is imperative that every single case of resort to means of restraint be authorised by a doctor or, at least, brought without delay to a doctor’s attention in order to seek approval for the measure. In the CPT’s experience, means of restraint tend to be applied more frequently when prior blanket consent is given by the doctor, instead of decisions being taken on a case by case (situation by situation) basis. 45. When the emergency situation resulting in the application of restraint ceases to exist, the patient should be released immediately. On occasion, the CPT encounters patients to whom mechanical restraints have been applied for days on end. There can be no justification for such a practice, which in the CPT’s view amounts to ill-treatment. One of the main reasons why such practices linger on is that very few psychiatric establishments have developed clear rules on the duration of periods of restraint. Psychiatric establishments should consider adopting a rule whereby the authorisation of the use of a mechanical restraint lapses after a certain period of time, unless explicitly extended by a doctor. For a doctor, the existence of such a rule will act as a powerful incentive to visit the restrained patient in person and thus verify his/her state of mental and physical well-being. 46. Once means of restraint have been removed, it is essential that a debriefing of the patient take place. For the doctor, this will provide an opportunity to explain the rationale behind the measure, and thus reduce the psychological trauma of the experience as well as restore the doctor-patient relationship. For the patient, such a debriefing is an occasion to explain his/her emotions prior to the restraint, which may improve both the patient’s own and the staff’s understanding of his/her behaviour. The patient and staff together can try to find alternative means for the patient to maintain control over himself/herself, thereby possibly preventing future eruptions of violence and subsequent restraint. CPT: 16TH GENERAL REPORT How restraint should be used 47. Over the years, many patients have talked to CPT delegations about their experiences of being restrained. Patients have repeatedly said that they felt the whole ordeal to be humiliating, a feeling at times exacerbated by the manner in which the restraint was applied. For the staff of a psychiatric hospital, it should be of the utmost concern that the conditions and circumstances surrounding the use of restraint do not aggravate the mental and physical health of the restrained patient. This implies, inter alia, that previously prescribed therapeutic treatment should, as far as possible, not be interrupted and that substancedependent patients should receive adequate treatment for withdrawal symptoms. Whether these symptoms are caused by deprivation of illegal drugs, nicotine or other substances should not make any difference. 48. In general, the place where a patient is restrained should be specially designed for that specific purpose. It should be safe (e.g. without broken glass or tiles), and enjoy appropriate light and adequate heating, thereby promoting a calming environment for the patient. Further, a restrained patient should be adequately clothed and not exposed to other patients, unless he/she explicitly requests otherwise or when the patient is known to have a preference for company. It must be guaranteed in all circumstances that patients subject to means of restraint are not harmed by other patients. Of course, staff should not be assisted by other patients when applying means of restraint to a patient. When recourse is had to restraint, the means should be applied with skill and care in order not to endanger the health of the patient or cause pain. Vital functions of the patient, such as respiration, and 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.