National Preventive Mechanism 5.2 Hospitals and psychiatric institutions and facilities 5.2.1 Introduction In the year under review, the NPM commissions visited 41 medical facilities, including 31 psychiatric and 10 somatic clinics or wards. In the course of these visits, the commissions observed that the intercultural care of patients is becoming increasingly difficult throughout the country. This is partly attributable to the movement of refugees among other things. Language barriers in particular cause communication problems, which can have a negative effect on the care situation and the medical treatment of the patients. For this reason, video interpreting systems have been installed in some medical facilities in order to professionalise the basic framework for interviews and facilitate translation in several languages. The deployment of interpreters is of key importance especially in hospitals where addressing intercultural differences requires a sensitive approach. Special training is required for this. The NPM recommends the continuous expansion of video interpreting services in hospitals. Intercultural treatment becomes increasingly important The principle of patient autonomy, i.e. that treatment may only be carried out after the consent of the informed patient, also applies to psychiatry. Restrictions to the freedom of movement through involuntary placement in a psychiatric hospital, restraint and/or isolation and medication-based treatment without or against the will of the patient are thus only allowed in certain conditions. These restrictions must be commensurate and may only be applied if persons not in full possession of their faculties place their own health and life or that of other people at real and considerable risk, and this cannot be prevented through other measures. The demographic development in Austria indicates that the incidence of gerontopsychiatric illness is set to increase. For this reason alone, improvements in the research on coercive measures, in particular from the patient perspective, are necessary, as are the development and testing of measures to reduce coercive treatment. The NPM considers clear changes in prioritisation in the health care system such as better alignment of the inpatient and outpatient areas, the promotion of local psychiatric care structures, health care research and, above all, the qualitatively and quantitatively suitable availability of personnel in psychiatric institutions to be indispensable. It is a fact that psychiatric care is insufficient in some regions in Austria. Restraint as a last resort Patients often behave aggressively and violently during inpatient psychiatric treatment. This happens most frequently in acute and admission wards during the first few days of involuntary hospital stays. Avoidance of coercive measures in all forms has to be top priority in treatment procedures. This is followed by carrying out coercive measures as gently as possible, thus reducing invasive and traumatic effects to a minimum when they prove to be unavoidable. The “therapeutic milieu” is of utmost importance for good clinical practice when dealing with coercive measures and treatment. This includes, in particular, the „Therapeutic milieu“ and de-escalation 119