–2–
Nevertheless, the CPT's own on-site observations and reports received from other sources
indicate that the deliberate ill-treatment of patients in psychiatric establishments does occur from
time to time. A number of questions will be addressed subsequently which are closely-linked to the
issue of the prevention of ill-treatment (e.g. means of restraint; complaints procedures; contact with
the outside world; external supervision). However, some remarks should be made at this stage as
regards the choice of staff and staff supervision.
28.
Working with the mentally ill and mentally handicapped will always be a difficult task for
all categories of staff involved. In this connection it should be noted that health-care staff in
psychiatric establishments are frequently assisted in their day-to-day work by orderlies; further, in
some establishments a considerable number of personnel are assigned to security-related tasks. The
information at the CPT's disposal suggests that when deliberate ill-treatment by staff in psychiatric
establishments does occur, such auxiliary staff rather than medical or qualified nursing staff are
often the persons at fault.
Bearing in mind the challenging nature of their work, it is of crucial importance that
auxiliary staff be carefully selected and that they receive both appropriate training before taking up
their duties and in-service courses. Further, during the performance of their tasks, they should be
closely supervised by - and be subject to the authority of - qualified health-care staff.
29.
In some countries, the CPT has encountered the practice of using certain patients, or inmates
from neighbouring prison establishments, as auxiliary staff in psychiatric facilities. The Committee
has serious misgivings about this approach, which should be seen as a measure of last resort. If such
appointments are unavoidable, the activities of the persons concerned should be supervised on an
on-going basis by qualified health-care staff.
30.
It is also essential that appropriate procedures be in place in order to protect certain
psychiatric patients from other patients who might cause them harm. This requires inter alia an
adequate staff presence at all times, including at night and weekends. Further, specific arrangements
should be made for particularly vulnerable patients; for example, mentally handicapped and/or
mentally disturbed adolescents should not be accommodated together with adult patients.
31.
Proper managerial control of all categories of staff can also contribute significantly to the
prevention of ill-treatment. Obviously, the clear message must be given that the physical or
psychological ill-treatment of patients is not acceptable and will be dealt with severely. More
generally, management should ensure that the therapeutic role of staff in psychiatric establishments
does not come to be considered as secondary to security considerations.
Similarly, rules and practices capable of generating a climate of tension between staff and
patients should be revised accordingly. The imposition of fines on staff in the event of an escape by
a patient is precisely the kind of measure which can have a negative effect on the ethos within a
psychiatric establishment.
C.
Patients’ living conditions and treatment
32.
The CPT closely examines patients' living conditions and treatment; inadequacies in these
areas can rapidly lead to situations falling within the scope of the term “inhuman and degrading
treatment”. The aim should be to offer material conditions which are conducive to the treatment and
welfare of patients; in psychiatric terms, a positive therapeutic environment. This is of importance
not only for patients but also for staff working in psychiatric establishments. Further, adequate
treatment and care, both psychiatric and somatic, must be provided to patients; having regard to the
principle of the equivalence of care, the medical treatment and nursing care received by persons
who are placed involuntarily in a psychiatric establishment should be comparable to that enjoyed by
voluntary psychiatric patients.