Hospitals and psychiatric institutions this recommendation should also be implemented with the next amendment to the Hospital and Convalescent Homes Act. However, the NPM would like to emphasise that in addition to formal legal requirements, a comprehensive preventive concept for avoiding sexual assault is necessary. This includes basic and further training to increase the awareness of clinic staff with respect to dealing with “sexuality”. These training sessions should emphasise that patients can perceive suggestive remarks for example or even an imprudent, fleeting physical touch as a violation of personal integrity. It has regularly come to the knowledge of the NPM that security organs, in rural areas in particular, are forced to judge whether the conditions for necessary hospitalisation pursuant to the Hospitalisation of Mentally Ill Persons Act are given in the event of imminent danger. Police officers are thus often left alone when having to decide whether a person displaying behavioural disorders is suffering from an illness, which due to acute and considerable harm to themselves or others justifies the involuntary placement in a psychiatric hospital. These decisions are extremely stressful for people without a medical background and foster misjudgement and the insufficient description of situations in states of emergency. As a consequence, doctors in psychiatric wards may not think that the conditions for hospitalisation are fulfilled, and those affected are left alone in what is still a difficult situation, sometimes far from home even at night. Hospitalisation without medical certificate The NPM thus suggested that emergency doctors as well as office-based psychiatric specialists be legally authorised to issue certificates pursuant to the Hospitalisation Act. The former Federal Ministry of Health and Women’s Affairs indicated to the NPM that the topic is being taken seriously and different solutions are being discussed, for which a formal legal solution is also being sought. It was outlined in previous reports (see NPM Report 2015, p. 53 et seq.) that even in the area of application of the Hospitalisation Act pursuant to the jurisdiction of the Supreme Court, the administration of psychotropic medication can constitute a restriction of the freedom of movement in certain conditions. This should, contrary to current practice, be specially documented as a medication-based restriction of freedom and reported to the patient advocacy pursuant to Section 33 Hospitalisation Act. The Supreme Court substantiated this by explaining that it is not critical “within the meaning of restrictions of the freedom of movement” whether a restriction of freedom is effected by physical coercive measures or by pharmacological intervention. The observations made by the NPM during the period under review, however, give reason to believe that in psychiatric hospitals the opinion still prevails that every medication-based therapy is indicated and thus an indispensable component of psychiatric medical treatment. From the NPM’s point of view, it is still essential that potential medication-based restrictions of freedom in Medication-based restriction of freedom 43