CHANCELLOR OF JUSTICE AS THE PREVENTIVE MECHANISM VIII. PROVIDERS OF INVOLUNTARY EMERGENCY PSYCHIATRIC CARE AND COERCIVE TREATMENT 1. General outline In 2010, the Chancellor of Justice visited seven health care providers applying involuntary treatment of persons: psychiatric clinic of Tartu University Hospital Foundation (Inspection visit to the psychiatric clinic of Tartu University Hospital, case No 7-9/100203), psychiatric clinic of Viljandi Hospital Foundation (Inspection visit to Jämejala psychiatric clinic of Viljandi Hospital Foundation, case No 7-9/100537), psychiatric department of Lääne County Hospital Foundation (Inspection visit to the psychiatric department of Lääne County Hospital Foundation, case No 7-9/101095), department No 5 of the psychiatric clinic of the North-Estonian Regional Hospital Foundation (Inspection visit to department No 5 of the psychiatric clinic of the North-Estonian Regional Hospital Foundation, case No 7-9/101070), psychiatric department of Rapla County Hospital Foundation (Inspection visit to the psychiatric department of Rapla County Hospital, case No 7-9/101220), psychiatric clinic of Pärnu Hospital Foundation (Inspection visit to Pärnu Hospital, case No 7-9/101750), and psychiatric department of Narva Hospital Foundation (Inspection visit to the psychiatric department of Narva Hospital Foundation, case No 7-9/101714). Three of the inspection visits were announced and four unannounced. In two inspections, experts (psychiatrist, child psychiatrist, general practitioner, patient representative) were also involved in addition to officials. Six of the inspected establishments provide involuntary treatment under the procedure and bases established in Chapter 3 of the Mental Health Act, and one establishment provides coercive treatment under the procedure and bases established in § 86 of the Penal Code and Chapter 16 of the Code of Criminal Procedure. The choice of the inspected establishments was based first and foremost on the needs to carry out follow-up inspection of the implementation of the recommendations made by the Chancellor as a result of his previous visits to the same establishments. The Chancellor also wanted to pay special attention to the practice of applying means of restraint by providers of health services.23 On this basis, unannounced visits to the establishments were also organised late in the evening and early morning when the number of staff in the establishments is smaller and thus the risk of restricting the freedom of patients for purposes other than treatment is higher. Regardless of the fact that the inspected establishments were different by the profile of services provided, the number of patient places, as well as the infrastructure, some general issues can be highlighted which were common for most service providers. Thus, for example, unfortunately there are still shortcomings in informing the patients about their rights during the treatment, as well as about the procedure for submitting complaints and other feedback, and available external complaint mechanisms. Homepages of several service providers lacked information on the results of patient satisfaction surveys.24 In addition, despite the Chancellor’s previous recommendations and the instructions for compliance issued by the Health Care Board within the project for the verification of the use of means of restraint carried out in 2010, the majority of the inspected psychiatric care providers had not created a proper register of the use of means of restraint,25 and the rooms used for applying means of restraint did not always conform to the requirements26. Larger service providers have concluded contracts for the provision of personal protection services with private security companies. Despite the fact 23 In addition to the regulation of the use of means of restraint in § 14 of the Mental Health Act, the Health Care Board has drawn up guidance material “The procedure for applying means of restraint during the provision of in-patient psychiatric care” for psychiatric care providers. 24 Under § 6(6) of the Minister of Social Affairs Regulation No 128 of 15 December 2004 “Requirements for the provision of health services”, the providers of health services must draw up a summary, analysis and discussion of patient satisfaction surveys and complaints together with the recording of the results at least once a year. The results of the patient satisfaction analysis are made public at the place of business of the health service provider or on the website in case the provider has a website. 54 25 16th general report of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT/Inf (2006) 35), para 37. Available online: http://www.cpt.coe.int/en/annual/rep-16.pdf. See also the Health Care Board guidance material “The procedure for applying means of restraint during the provision of in-patient psychiatric care” clause 5.13. 26 Ibid, para 48 and 50.