40 are removed (which they enter immediately upon removing the restraints), the reasons for applying this measure, the name of the physician who ordered or approved the measure, a description of any injuries caused to patients or staff and any other relevant circumstances.113 Patients are not physically restrained in rooms where other, unrestrained patients stay. In accordance with the recommendation of the NPM, physical restraint is performed by binding one limb only. Hospitals have improved their arrangements for informing patients of their treatment at the hospital and their rights by providing brochures which are distributed to patients and their families and/or guardians immediately upon admission. Patients who are not capable of understanding the brochure are given assistance by appropriate means in order to introduce them to the content of the brochure to the extent that their intellectual capacities allow. An encouraging development is the organisation of training and professional advancement sessions for the medical staff of the hospitals. However, the staff of psychiatric wards of General Hospitals also needs to undergo training. The length of patients’ stay at hospitals for non-medical reasons in itself constitutes inhuman treatment. As there are no appropriate community-based mental health services that would be capable of caring for patients after their hospital treatment, there is no continuity of care and proper psychosocial rehabilitation is lacking. This can lead to an aggravation of the underlying disorder and may contribute to rapid deterioration of personality. Cooperation between psychiatric hospitals and centres for social work in connection with community-based care for the patients who have been institutionalised for years, many of them due to social considerations, remains unsatisfactory. Upon examination of several medical histories, we found that hospitals tend to ask centres for social work to arrange for the transfer of such patients to social welfare homes, as the patients allegedly did not have any relatives who were willing to take care of them upon their discharge from the hospital. With a view to improving the position of patients, it will be necessary to step up the efforts towards introducing community-based mental health care. Support should be provided to the families who are willing to take in the patients upon their discharge. An encouraging development is the plan to open a Community-based Mental Health Care Centre in Kikinda, which would be staffed by physicians of the Special Psychiatric Hospital “Sveti Vračevi”. A crucial issue faced by psychiatric hospitals is the lack of medical staff and occupational therapists. Due to the insufficient human resources, employees are not able to fully meet patients’ needs. Hospitals have applied to the Ministry of Health for staff increases on many occasions, but this issue remains unresolved. Cooperation between psychiatric hospitals and general hospitals is unacceptably poor. General hospitals do not accept clinical evidence for patients referred to them from psychiatric hospitals, even if the conditions are life-threatening. Patients with severe conditions are sometimes sent from general hospitals to special psychiatric hospitals simply because they were once treated in one of those special hospitals, even if their mental health is not a primary consideration at the given moment. General recommendations for remedying the identified shortcomings The Ministry of Health should without any further delay implement all necessary activities aimed at rationalization of services in secondary and tertiary psychiatric institutions, focusing on day hospitals and out-patient treatment and should initiate intensive activities on the introduction of the services of community-based mental health protection. 113 Special Psychiatric Hospital Kovin, No. 71-73/13, and Special Psychiatric Hospital “Sveti Vračevi”, No. 71-15/14.