National Preventive Mechanism Multimodal therapy concepts Guiding principles such as normalisation, integration and self-determination also depend on the behaviour and interest of the social environment, which has to change if psychosocial disorders are to be reduced or eliminated. Multimodal therapy concepts thus require the alignment of pedagogical, therapeutic and medication-based therapy with the respective clients. The NPM is of the opinion that the existence of a pedagogical framework, within which the professional treatment and therapeutic support take place, is a condition for the use of psychotropic medication in persons with disabilities. It must become clear – in close cooperation with the attending professional medical experts – how the effects of medication should be used to improve the pedagogical social strategies in everyday life and the curative pedagogical and psychological primary therapies. This implies determining which routine pedagogical, curative pedagogical and psychological social strategies can be applied as support. PRN medication Commissions repeatedly describe problems with PRN medication that potentially restricts freedom without sufficient medical description of the indication. The use of neuroleptics appears to be particularly problematic when they should only be administered “symptom-oriented” to allay “disruptive” behaviour (e.g. “anxiety”, “restless activity”, etc.). The risk of inappropriate use and misuse is evident. The staff of residential groups assume a responsibility that they are not permitted to in these cases. The management of facilities is obliged to request the correction of the inadequate medical prescriptions from doctors accordingly. A further indication of the legally highly questionable assumption of responsibility is displayed in the way the refusal to take medication is treated. Doctors are rarely contacted in these cases. If nothing else works and “persuasion is to no avail”, the medication is ground and mixed with the food. From the NPM’s point of view, it can certainly be assumed that in many cases external factors and not only behaviour, which could potentially harm the client or others, are causal in perceiving which alternatives there are to restricting freedom. Risk factors 158 The following risk factors for measures that restrict freedom are named by the commissions: staff shortages and/or high personnel fluctuation, the size of facilities, lack of support for the pedagogical personnel through additional professional services or expertise, precarious structural conditions, few possibilities to retreat, lack of supply with adequate aids, missing psychiatric diagnosis of behavioural disorders, outdated or non-individualised treatment concepts, lack of occupational and therapeutic possibilities as well as lack of communication. Sometimes it is also irritations such as the departure of the familiar care giver, new residents, a change of room or somatic complaints that contribute to behavioural disorders and culminate in aggression. The justification that measures that restrict freedom are only applied for the protection of those affected sometimes prevent awareness of the fact that