National Preventive Mechanism The experts from the commissions could not exclude the existence of medication-based measures that restrict freedom also in relation to PRN medication. The term “restless” as the most frequently used description of the requirement is too imprecise. In such cases, nursing staff are provided with a broad range of discretion that is not permitted. Although the Nursing and Residential Homes Residence Act has been applicable since 2005, in the view of the NPM medication-based treatments are not sufficiently queried with regard to their effect of restricting freedom. Considerable tensions remain between the protection of personal freedom provided for by (constitutional) law and the reality of insufficient resources. XX The operators of homes must raise staff awareness in order to ensure the reasonable usage of mechanical, electronic and medication-based restrictions of freedom. This requires appropriate training and cooperation with the representatives of the residents. XX The aim of medication-based treatment must in all cases be to achieve or increase well- being. Treatment with psychotropic medication may only be started if somatic, psycho-social and environmental causes of “problematic” behaviour can be excluded and non-medication- based nursing measures have been unsuccessful. Regular visits by specialist doctors are desirable. XX In order to assess potential effects of psychotropic medication that may restrict freedom, it is necessary not only to follow medical recommendations precisely, but also to document explicitly the goal of the therapy or the target symptom being treated. XX Regular attempts must be made to reduce doses and wean patients off the medication. The effects of sedatives must be evaluated regularly with reference to the target symptom. 118