   Structural deficits (too few resources, time pressure for staff and out-dated structural environment) impede care significantly. De-escalation management and multi-dimensional violence and fall prevention work help to prevent measures that restrict freedom. Central register to record measures that restrict freedom must be implemented seamlessly. 2.2.2 System-related problem areas 2.2.2.1 Evaluation of conditions for restrictions of freedom Restraints and isolation are not therapeutic interventions but purely security measures that are used when a therapeutic approach is temporarily impossible. If their use appears to be unavoidable, it is necessary to maintain human dignity and guarantee legal certainty. Interventions must be kept as short and as non-intrusive as possible; psychological or physical trauma must be avoided. How such coercive measures are carried out with regard to safety aspects and the supervision during these measures should be regulated through binding rules and should be the subject of regular training. Restraints and isolation The frequency and the environment, in which restraints are used, are important indicators for sensitive treatment of patients and the protection of their fundamental personal rights. As previously set out in the NPM Report 2013 (pp. 35 et seq.), the commissions found serious deficits with regard to this monitoring priority. The frequency of restrictions of freedom varies not only by region but also among various wards of a hospital. This suggests that if sensitisation has changed the basic attitude and the available resources are deployed in a targeted way, the extent of measures that restrict freedom can be reduced to an absolutely necessary level. To this end, however, it would also be necessary to focus attention in and outside of psychiatric wards on the use and acquisition of alternative measures (e.g. low-profile beds, sensor floor mats, etc.). In the opinion of the NPM, there is significant room for improvement in many places. Such auxiliary resources that have proven successful in retirement and nursing homes are used less often in hospitals. Alternatives to measures that restrict freedom The configuration of the space and the organisational procedures in psychiatric institutions can contribute significantly to the prevention of violence and aggression. Aspects such as communication, information and transparency of action while maintaining privacy and selfdetermination are highly important, especially vis-à-vis people who are ill. Gender-specific issues and vulnerabilities always require particular attention. The commissions frequently found that patients were cared for in beds set up in hallways and were sometimes restrained there; this is an absolutely unacceptable violation of their human dignity and their fundamental personal rights. The reasons for this, however, can be 42 Restraints used under degrading conditions