possibility to have a court review the 100 permissibility of the restraint procedure. Furthermore, the measures should be discussed with the person concerned afterwards, as this can lead to a reduction in the frequency and duration of measures involving deprivation of 101 liberty. requirements of the Federal Institute for Drugs 103 and Medical Devices (BfArM) are met. 6.2.4 – Privacy Occupancy of patient rooms The rooms in one forensic psychiatric clinic were occupied by up to four patients. At another forensic psychiatric clinic, three individuals occupied a room with a floor space of around 17.6 square metres. In addition, the guidelines of the German Society for Psychiatry, Psychotherapy and Nervous Diseases [Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde e.V., DGPPN] call for one-onone supervision of patients under physical restraint, as well as the possibility for personal contact throughout the entire duration of the 102 measure. Confining three or more mentally ill patients to a single room can cause issues with the therapy process – even if the room is of sufficient size. This is because the lack of privacy can trigger aggressive behaviour and provoke incidents. For this reason, the protection of patients’ privacy should be guaranteed. In the course of renovations or new construction projects, the rooms should be geared towards a lower number of patients. The documents submitted by one forensic psychiatric clinic indicated that, in some cases, physical restraints were applied for a long period of time. In one instance, the duration of physical restraint was listed as 803 hours. It was not clear whether less severe measures had already been tried and, if so, why these were insufficient. There are serious doubts as to whether a physical restraint applied over such a long period of time can ever be proportionate. The causes of lengthy periods of physical restraint should be investigated, as it must be ensured that the application of physical restraint is limited to the shortest possible period of time. Furthermore, direct supervision is also required in order to identify the earliest possible point at which the application of physical restraint can be terminated. There should be documentation stating which less restrictive measures had already been tried and why these failed. Corridor beds In some facilities, patients were placed in “corridor beds” when over-occupancy occurred. When patients are placed in beds in the corridor of a ward, they no longer have the option of spending time alone. The privacy of the individuals concerned is severely compromised as a result. For this reason, facilities should refrain from accommodating patients in the corridor. Where the use of corridor beds is unavoidable due to a large number of new arrivals, a partition wall must be used at the very least so that the bed is not directly visible to others. This type of accommodation should be limited to the shortest possible period of time. In one instance, the belt restraint system was not applied correctly. The bed did not have fulllength side rails. In order to avoid accidents, it should be ensured that the manufacturer’s safety instructions and warnings are taken into account when using a belt restraint system, and that the Visibility of toilets In the forensic psychiatric clinics, the observation rooms for crisis situations – e.g. for patients at acute risk of suicide – were all fitted 100 Ibid., margin no. 85 DGPPN [German Society for Psychiatry and Psychotherapy] (2018): “S3-Leitlinie: Verhinderung von Zwang: Prävention und Therapie aggressiven Verhaltens bei Erwachsenen.” URL: https://www.dgppn.de/_Resources/Persistent/154528053e2d1 464d9788c0b2d298ee4a9d1cca3/S3%20LL%20Verhinderung %20von%20Zwang%20LANG%2BLITERATUR%20FIN AL%2010.9.2018.pdf (last retrieved on 27/02/2019) 102 Ibid. 101 103 BfArM (2003): “Informationen zu Fixierungssystemen”. URL: (retrieved on 07/03/2019); BfArm (2013): “Information zu Sicherheitsrisiken von Patienten-Fixiersystemen”. URL: https://www.bfarm.de/SharedDocs/Downloads/DE/Medizin produkte/risikoerfassung/empfehlungen/PatientenFixiersystem.pdf?__blob=publicationFile&v=2 (retrieved on 07/03/2019) 73