6 – PSYCHIATRIC CLINICS In 2018, the National Agency visited a total of five psychiatric clinics in Bavaria, Hesse, Lower Saxony and Schleswig-Holstein. The visits comprised three forensic psychiatric clinics, one clinic for general psychiatry and one for child and youth psychiatry. In the visited child and youth psychiatric clinic, individual patients were assigned primary nurses and therapists, while therapeutic continuity was ensured even when patients were transferred to additional wards. This is viewed as sensible, as a change of therapist can potentially interrupt the treatment process and ultimately delay the therapy’s success. 6.1 – POSITIVE EXAMPLES The National Agency also welcomed the spacious premises and ample outdoor area where patients are able to move around. Furthermore, the grounds of one forensic psychiatric clinic were secured via a hedge, which was visually inconspicuous. As the razor-wire security fence is hidden by bushes, the structural security measures were barely noticeable to patients. The National Agency highlighted several positive examples during its visits. All of the visited facilities offer internal and interdisciplinary training courses on the topics of de-escalation, non-violent communication and dealing with aggression. By dealing with these topics intensively and carrying out practical exercises on patient-friendly flight and defence techniques, it is possible to increase the confidence of staff when dealing with crisis situations. This can help to prevent assaults and reduce the application of physical restraints. On the wards of one general psychiatric clinic, there were many possibilities for submitting a complaint – including the option of complaining anonymously. The details of various contact persons were put up on display. In addition, a complaints box was available so that complaints could be submitted at any time – even on the closed ward. During an inspection of the files at a child and youth psychiatric clinic, the National Agency observed that the forms for ordering and documenting coercive measures included empty text boxes for describing the current situation, the patient’s risk of self-harm or harm to others, and the measures that had already been taken to de-escalate the situation. The National Agency welcomes this approach, as it requires that an order to apply physical restraints must be carefully considered and justified, as opposed to simply ticking a box containing a predetermined reason. In addition, a record is kept of when and by whom a reflective discussion was held with the person concerned. 6.2 – FINDINGS AND RECOMMENDATIONS The visited facilities were given recommendations on the following main topics: 6.2.1 – Possibilities for complaint On some wards, the National Agency repeatedly found that there was no way for patients to submit a complaint anonymously. At one facility there was no central record of complaints, which made it impossible to provide information on the number of complaints or their content. On the wards of the forensic psychiatric clinics visited by the National Agency, patients were not locked up at night. This was viewed positively, as night lock-up would prevent continuous treatment and could interrupt the 92 therapeutic process. None of the facilities expressed any security concerns. Mentally ill patients on closed wards in particular may encounter huge difficulties when trying to contact a complaints body. A patient advocate can act as an intermediary in such situations. Publishing the contact details of patient advocates or an ombudsman can make it possible for patients to lodge a complaint. It could also be useful to offer regular consulting 92 Bulla/Hoffmann, “Der Nachteinschluss – eine Methode des modernen Maßregelvollzugs? Forensische Psychiatrie und Psychotherapie”, Vol. 19, 2012, p. 204-216 71