64 npm annual report 2016 /observations and recommendations • Other patients in the ward called at the nurse’s station, which had a direct visual link with the seclusion room through the security camera monitor. The NPM focused attention on the risk of compromising the privacy of patients placed in the seclusion room. The emergency care units of somatic hospitals As in previous years, the Ombudsman felt it was important to visit the emergency care units of somatic hospitals, which use so-called secure rooms. These rooms are used for patients brought to emergency care services who, for example because they are aggressive or confused, cannot be placed among other emergency patients. This situation is a problem because there are no legislation on seclusion in somatic health care. However, secluding a patient may sometimes be justified under emergency or self-defence provisions. Usually, these situations involve an emergency where it is necessary to restrict the patient’s freedom to protect either his or her own or other persons’ health or safety. In his legal practice, the Ombudsman’ has also required that the legal provisions and ethical norms that guide the actions of doctors and other health care professionals (so-called double standard requirement) must be taken into account in these situations. Additionally, the procedure may not violate the patient’s human dignity. Having appropriate equipment in the seclusion room is of major importance when assessing if a patient’s seclusion has, as a whole, been implemented in a manner that qualifies as dignified treatment and high-quality health and medical care. As minimum requirements that a secure room must fulfil can be regarded the conditions laid down in the Mental Health Act for the seclusion of a psychiatric patient. A patient placed in a secure room must be monitored continuously. This means that the patient must be monitored by visiting the seclusion room in person and observing the patient through a video link with image and audio. Different emergency care units have numerous security rooms, and they are used regularly. Regardless of this, patients rarely complain to the Ombudsman about their placement in a secure room or their treatment while in there. In 2016, the NPM visited the emergency care units of two university hospitals. Both visits were unannounced and took place in the evening time. In the case of the emergency care services of Turku University Hospital, the NPM were satisfied that the secure room was not used in breach of the principles described above. On the other hand, there was scope for improvement in cooperation between various authorities. • The observations made during the visit indicated that the emergency care unit personnel did not have a clear idea of how other authorities (such as the police and the detoxification centre) operate, even if their customers are partly the same. The Deputy-Ombudsman pointed out that by increasing cooperation between the authorities, limited resources could be used more efficiently and appropriately.