MONITORING PSYCHIATRIC INSTITUTIONS Several participants underlined the fact that medication often has no clear therapeutic purpose and that it is used for disciplinary and punitive purposes. To prevent abuse where possible, it is essential that individuals give their consent to treatment, that they are duly involved in the choice of medication and that they understand its possible side effects. This requires informing them and presenting alternatives, including a drug-free therapeutic option. Monitoring bodies often face the difficulty of evaluating the merit of a medical treatment. When they do not have medical expertise, some are occasionally powerless as they feel neither qualified nor entitled to judge the therapeutic value of a particular treatment. NPMs vary in their opinions on their capacity and legitimacy to challenge the relevance and content of treatments. Some believe it is their responsibility to evaluate each treatment systematically and question certain overmedication practices, which are often the result of insufficient or poorly trained staff. It is advisable to consider the content and duration of the treatment, whether or not alternatives have been suggested and the institution’s resources, including whether or not they propose alternative therapies without any medication. “The issue of medicine in the hospital is: what is it used for? Very rarely is it used for treatment, much more often it is used for discipline, sedation and punishment. And this is what I believe the role of the NPM is: to observe and decide whether these medicines are not being used for their purpose, which means they are not being used for treatment.” Vladimir Jovic, NPM, Serbia The NPMs must also be trained to be able to identify signs of potential overmedication from the presence of side effects (such as drowsiness) which can easily be identified, but also to evaluate the potential effects of interaction between various medicinal products and the use of substances for disciplinary purposes. The institution’s death rate should also be monitored to identify the causes. To be able to implement this aspect of their mandate, it is essential that NPM (including any non-medical staff) and SPT members have 29