–3–
33.
The quality of patients' living conditions and treatment inevitably depends to a considerable
extent on available resources. The CPT recognises that in times of grave economic difficulties,
sacrifices may have to be made, including in health establishments. However, in the light of the
facts found during some visits, the Committee wishes to stress that the provision of certain basic
necessities of life must always be guaranteed in institutions where the State has persons under its
care and/or custody. These include adequate food, heating and clothing as well as - in health
establishments - appropriate medication.
living conditions
34.
Creating a positive therapeutic environment involves, first of all, providing sufficient living
space per patient as well as adequate lighting, heating and ventilation, maintaining the
establishment in a satisfactory state of repair and meeting hospital hygiene requirements.
Particular attention should be given to the decoration of both patients' rooms and recreation
areas, in order to give patients visual stimulation. The provision of bedside tables and wardrobes is
highly desirable, and patients should be allowed to keep certain personal belongings (photographs,
books, etc). The importance of providing patients with lockable space in which they can keep their
belongings should also be underlined; the failure to provide such a facility can impinge upon a
patient's sense of security and autonomy.
Sanitary facilities should allow patients some privacy. Further, the needs of elderly and/or
handicapped patients in this respect should be given due consideration; for example, lavatories of a
design which do not allow the user to sit are not suitable for such patients. Similarly, basic hospital
equipment enabling staff to provide adequate care (including personal hygiene) to bedridden
patients must be made available; the absence of such equipment can lead to wretched conditions.
It should also be noted that the practice observed in some psychiatric establishments of
continuously dressing patients in pyjamas/nightgowns is not conducive to strengthening personal
identity and self-esteem; individualisation of clothing should form part of the therapeutic process.
35.
Patients' food is another aspect of their living conditions which is of particular concern to
the CPT. Food must be not only adequate from the standpoints of quantity and quality, but also
provided to patients under satisfactory conditions. The necessary equipment should exist enabling
food to be served at the correct temperature. Further, eating arrangements should be decent; in this
regard it should be stressed that enabling patients to accomplish acts of daily life - such as eating
with proper utensils whilst seated at a table - represents an integral part of programmes for the
psycho-social rehabilitation of patients. Similarly, food presentation is a factor which should not be
overlooked.
The particular needs of disabled persons in relation to catering arrangements should also be
taken into account.
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.