Given their intrusive nature and the potential for abuse and ill-treatment, the CPT has always paid
particular attention to the use of various types of restraint vis-à-vis psychiatric patients.
At the outset, the CPT wishes to stress that the ultimate goal should always be to prevent the use
of means of restraint by limiting as far as possible their frequency and duration. To this end, it is of
paramount importance that the relevant health authorities and the management of psychiatric
establishments develop a strategy and take a panoply of proactive steps, which should inter alia
include the provision of a safe and secure material environment (including in the open air),
the employment of a sufficient number of health-care staff, adequate initial and ongoing training
of the staff involved in the restraint of patients, and the promotion of the development of alternative
measures (including de-escalation techniques).
In most countries visited by the CPT, one or more of the following types of restraint may be used:
physical restraint (i.e. staff holding or immobilising a patient by using physical force –
mechanical restraint (i.e. applying instruments of restraint, such as straps, to immobilise
chemical restraint (i.e. forcible administration of medication for the purpose of controlling
a patient’s behaviour);
seclusion (i.e. involuntary placement of a patient alone in a locked room).
The restraint of violent psychiatric patients who represent a danger to themselves or others
may exceptionally be necessary.2
Means of restraint should always be applied in accordance with the principles of legality,
necessity, proportionality and accountability.
All types of restraint and the criteria for their use should be regulated by law.
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 are security measures and have no therapeutic justification.
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.
See also Article 27 of Recommendation Rec(2004)10 of the Committee of Ministers to member
States concerning the protection of the human rights and dignity of persons with mental disorder, as
well as the judgments of the European Court of Human Rights in Bureš v. the Czech Republic
(18 October 2012; application no. 37679/08; paragraph 86) and M.S. v. Croatia (19 February 2015;
application no. 75450/12; paragraph 97).