13 Physical confinement7 in psychiatric treatment, when properly used, aims at preventing any harm that the patient may cause to himself/herself or to third parties. Causing harm to the patient with the excuse of controlling his/her emotions is a clear indicator of the personnel’s inadequate training in the use of correct confinement methods. In the case of Ximenes-Lopes there is no evidence indicating that he was an imminent danger for himself or third parties. The attempt to use a less aggressive method to control a potentially violent incident was not proved. Therefore, the use of any form of physical strength in this case was illegal. Once Damião Ximenes-Lopes was restrained, with his hands tied on the back, the State had the supreme duty to protect him due to his extreme condition of vulnerability. The excessive use of physical strength and the beating constituted a violation of his right to humanitarian assistance. There are other alternatives that may be resorted to before making use of strength or deciding a patient’s isolation. Mental health programs should strive to maintain a caring environment and culture which minimizes the use of such methods. The unjustified and excessive use of strength in this case constitutes a cruel practice and a degrading treatment. When isolation and strength are used as punishment or coercion methods or with improper objectives, violation of human rights is even more serious. Where use of strength with improper purposes has caused great pain or physical or mental suffering, it may constitute torture. Hitting a psychiatric patient or causing him/her any kind of harm or suffering is always unnecessary. The fact that Ximenes-Lopes was unarmed while held under the custody of the State shows that such an action was not proportional to the potential threat he could pose. Given the extreme vulnerability of individuals undergoing psychiatric crises, State authorities should have greater responsibility in their protection. The beating suffered by Damião Ximenes-Lopes – and his subsequent death – could have been avoided had the State complied with its obligation to provide an institution with officers qualified to treat his mental illness. B) TESTIMONIAL AND EXPERT EVIDENCE 47. On November 30 and December 1, 2005, the Court held a public hearing where the witnesses proposed by the Inter-American Commission, by the representatives and the State gave testimony and the expert witness proposed by the representatives submitted the corresponding expert report ( supra para. 24). The following is a summary of the relevant part of said testimonies and expert report: 1. Testimony of witnesses for the Commission a) Irene Ximenes-Lopes-Miranda, sister of Damião Ximenes-Lopes Damião Ximenes-Lopes had been admitted to hospital in 1995, and he was admitted again in 1998. During the last hospitalization term, this witness noticed that his brother had cuts and injuries in his ankles and knees, and for this reason she asked Confinement is a form of restraint, i.e. ‘any word of action interfering with a patient’s capacity to make decisions or restricting his/her freedom of movement.’ For the purposes of the instant Judgment, the Court will use the term ‘confinement’ to designate the physical restraint to which Damião Ximenes-Lopes was subject. 7