During this visit, we again pointed out cases in which a patient withdraws (in any way) their consent to be accommodated in a secure ward. In such an event, the hospital must immediately discharge the patient from the secure ward or instigate a procedure anticipated by the ZDZdr for the admission in cases of emergency. We established that the staff are informed about the fact that patients may withdraw their consent regarding the accommodation at any time and in any way, e.g. by knocking on the door, opening the door and similar. In such cases, the staff enable the patient to consult with the doctor, who assesses whether the discharge is possible, or the patient changes their mind after the consultation. Based on the clarification received, we informed the hospital that although the doctor may explain to the patient reasons why it would be sensible to continue treatment in the secure ward, which is completely acceptable, they may not influence the patient’s free will or persuade them to remain in the ward on the basis of their consent. If the patient withdraws their consent, the hospital must discharge them immediately or, if the patient agrees, accommodate them in one of the hospital’s open wards. If the doctor assesses that the patient’s condition poses a serious risk either to themselves or other people, the patient may be detained in the ward, but according to the provisions of the ZDZdr in cases of emergency admission. During the 2018 visit, we also advised the hospital to promptly find a suitable solution for both admission wards so that SPM could be implemented without the presence of other patients or within their sight and only in the presence of a staff member who would implement continuous supervision as per the ZDZdr. We were pleased to find on the occasion of this visit that there were some eighty per cent less SPM implemented in the year before the visit, particularly due to the emphasis on de-escalation techniques. Unfortunately, we had to repeat the recommendation from 2018 based on the discovered conditions. In 2018, we proposed that the hospital supplement the form regarding the record of using SPM of physical restriction (belts, bed rails) with suitable sections where the staff may enter measures implemented before the use of SPM (entry in an empty field or a selection of proposed measures), and a field for data concerning who held an explanatory discussion with the patient after the measure ended. With regard to the established situation, we highlighted the importance of the explanatory discussion after the completion of the measure from two aspects in particular: the establishment of a possibly broken trust between the patient and the person who ordered/implemented SPM, and the verification of consent 41 2.2 VISITS TO PSYCHIATRIC HOSPITALS When visiting in 2018, we recommended that the hospital ensure that female patients have enough daytime clothes at their disposal as the fact that a female patient has no daytime clothes because of the hospital’s insufficient stock is not acceptable. As per the opinion of the Expanded Professional Board for Psychiatry, we recommended that the hospital ensure the availability of daytime clothes for all patients with the exception of those with whom this is unsuitable due to somatic reasons. We were pleased to observe that male and female patients in their respective secure wards usually wore hospital tracksuits. Unfortunately, patients in the gerontopsychiatric ward were still in pyjamas despite the hospital’s assurance that it agreed with the NPM’s recommendation.