National Preventive Mechanism will not change any aspect of the existence of medication-based restrictions of freedom. The administration of sedatives such as sleeping pills, neuroleptics or other psychotropic medication must be regarded as a restriction of freedom not only if residents are thereby prevented from leaving the facility, but also if they are ordered with the aim of establishing peace and quiet in the ward or home. However, the short-term effect of this medication is often considered as the goal of treatment without any reflection – and without sufficient awareness of the detrimental consequences for the individuals involved. Especially where multiple psychotropic medication is used – or where psychotropic medication is administered alongside other medication – without pharmacological expertise the interactions are not only difficult to estimate, but also difficult to control. A medication-based measure that restricts freedom is also in place in particular if sleeping patterns are not considered prior to arrival in the home and sleep is induced pharmacologically at a certain time of day. The same applies if the duration of sleep is extended by medication without any medical necessity beyond the individual requirement. Precisely in view of the increasing numbers of persons with dementia in long-term nursing homes, it is desirable for the well-being of such persons to deploy larger numbers of staff in a targeted manner during the evening and to ensure a more fluid transition for each individual from daytime to night-time. The Nursing and Residential Homes Residence Act requires that all nursing options and non-pharmacological measures be exhausted before psychotropic medication is administered. A way of improving the current situation is to ensure comprehensive and ongoing support from specialist doctors, because general practitioners cannot be automatically assumed to have specialist gerontopsychiatric knowledge concerning the effects and side effects of psychotropic medication and those that have effects on the central nervous system. High need for protection when prescribing psychotropic medication 116 The experts from the NPM have observed also in this reporting year that there is often a lack of awareness in retirement and nursing homes that sedatives could potentially represent measures that restrict freedom. In many cases, the particular need for protection of residents is overlooked. For instance, nursing staff may regard Psychopax drops as particularly suitable medication for individual restless or disruptive residents. However, there is only a moderate awareness of the long half-life and disruptive side effects of this medication, in particular for the very elderly. Due to the hangover effect, the risk of falling on the following day can be significantly higher. Although there are a variety of other factors that lead to falls, which have been thoroughly investigated, such medication should only be prescribed after very careful consideration, taking account of the complications arising from side effects.