National Preventive Mechanism However, there are still long-term nursing facilities that - as a matter of principle - do not notify the representatives of the residents of medication-based measures that restrict freedom. Already during an initial discussion visiting one retirement and nursing home in Vienna, the medical Head of the facility explained to Commission 5 that every use of psychotropic medication was medically recommended and did therefore not constitute a potential measure that restrict freedom. The fact that even medical treatment that is carried out according to proper professional standards may constitute a measure that restricts freedom was completely disregarded, in spite of the requirements laid down by the Nursing and Residential Homes Residence Act. A specific objection in this facility was that medication was administered to residents in “tense situations”; if consent was withheld they were flavoured and mixed in with Nutella. Commissions 1 and 2 in Tyrol and Salzburg and Commission 3 in Carinthia also encountered facilities in which, despite the higher number of persons needing nursing care with suspected psychiatric diagnoses, not one single report on measures that restrict freedom had been made. Medical treatment according to proper professional standards does not exclude measures that restrict freedom One retirement and nursing home in Tyrol presented the following picture: after consulting all 74 medication sheets, it became apparent that benzodiazepines had been prescribed in 34 cases, frequently along with anti-psychotic medication. Regarding the suitability of these prescriptions, Commission 1 was only able to consult the diagnosis sheets annexed to the lists of medication, as there was no comprehensive psychiatric clinical description of the condition. The diagnosis most frequently indicated for a medication containing the active ingredient benzodiazepine was “dementia”. However, that is entirely insufficient for the purpose of assessing any related measure that restricts freedom and the then required notification duties. When assessing the potential restrictions of freedom resulting from psychotropic medication, the NPM stresses the importance that a doctor defines an explicit symptom that is to be treated using sedatives. It is necessary to provide a clear description of the concrete goals of therapy, to reach agreement on success criteria and to carry out regular assessments of the effects of the substances administered. Only if it is evident that the attenuation or restriction of movement is an “unavoidable side effect” of treatment of an underlying mental illness, such as depression, anxiety or productive psychosis, the representatives of the residents do not have to be notified. However, after the symptoms have abated, it must be considered whether it is necessary to continue with the medication. Psychotropic medication should only be administered for as long as it is absolutely necessary. In order to prevent the administration of medication that is potentially unsuitable, regular attempts should be made to reduce doses and wean patients off the medication. It is a fact that frequently no attempts are made to reduce doses and wean patients off medication. It often occurs in practice that once a psychotropic medication has been prescribed, it is rarely removed again. 117