general observations in connection with inspections 41 Conclusions regarding compulsory psychiatric care Inspections during the period 2015–2017 show that there is a great need for care providers to work on issues concerning coercive measures and for the Parliamentary Ombudsmen to monitor these issues. This involves ensuring that there are clear procedures for using such measures. Care providers must also ensure that the personnel have the training necessary in order to be able to apply the procedures correctly. If these basic requirements are not fulfilled, there is an immediate risk of patients being subject to measures for which there is no legal basis. During the period, it emerged that it is still difficult to get an idea of how many places there are for compulsory psychiatric care in Sweden. This is troublesome from several aspects. The Health and Social Care Inspectorate has the task of keeping an automated register of hospital establishments and units where care can be provided, in accordance with LPT and LRV, and of units for forensic psychiatric examinations. The Parliamentary Ombudsmen has previously investigated the issue within the framework of an enquiry after the OPCAT unit noted that some elements of details in the Health and Social Care Inspectorate’s register were out of date.65 In a decision in May 2016, the Parliamentary Ombudsmen expressed criticism of the Health and Social Care Inspectorate not having updated the register. This question has subsequently also been illustrated in the report, In the Child’s Best Interests? (SOU 2017:111). The investigation also emphasised that having total control over which clinics conduct compulsory care of children is of great importance for the implementation of the suggestions presented.66 It was not part of the remit of the investigation to provide suggestions regarding this. There is therefore no reason for the Parliamentary Ombudsmen to return to this issue. There are also grounds for the Parliamentary Ombudsmen to continue to monitor how to ensure, within compulsory psychiatric care, that patients are not subjected to more extensive measures than absolutely necessary. This element may require clinics to bring in external experts to a greater extent, to assess what care to provide (so-called second opinions). This is to avoid long periods of care, with static assessments. Finally, the question of care in environment lacking stimuli and the opportunity to spend time outdoors on a daily basis should continue to be prioritised in the inspection activity in the coming years. Giving patients the opportunity spend time outdoors and get fresh air should be seen as an important element in the provision of care. The OPCAT unit’s inspections show that psychiatric clinics relatively frequently lack access to exercise yards that enable even extremely ill patients to spend time in a controlled outdoor environment. The 65 Ref. no. 733-2015. 66 See SOU 2017: 11 p. 279. During the period, it emerged that it is still difficult to get an idea of the number of places that exist for compulsory psychiatric care.

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