Hospitals and psychiatric institutions Aggression and violence must be taken seriously The guideline-based way of dealing with aggression and violence as well as the effect on the safety, health and well-being of both the staff and the patients must be the focus of any psychiatric work. A growing number of psychiatric institutions is achieving this with training programmes in de-escalation and aggression management because they have recognised that optimising the way in which agitated or aggressive behaviour is dealt with is a key quality criterion. In order to be able to define adequate measures for the prevention of aggressive events, each ward also has to identify the factors that foster increased agitated behaviour in the direction of aggression or violence. Documentation and follow-up of aggressive events Ultimately, documenting aggressive events (by means of a standardised form) and searching for causes is critical for the structured analysis of the mentioned phenomena and suitable prevention work. What is important is including such events in an effective follow-up because dedicated countermeasures can be implemented on the basis of such documentation. Results flow into NPM recommenations The results of the nationwide documentation are evaluated and used to formulate recommendations by the NPM to the decision-makers. Continued misplacement of persons with psychiatric diseases in large institutions The situation for persons with chronic mental illnesses in nursing homes in Styria remains problematic. The NPM repeatedly criticised – most recently based on the observation of a case of structural maladministration (see NPM Report 2019, p. 58 et seq.) – the continued misplacement of young persons with psychiatric illnesses, in particular, in private medical facilities and nursing homes and the financing of such structures with the so-called psychiatry supplement. In this context, it was recommended to quickly develop a phased financing plan for building up adequate, small housing units and care structures (including disorder-specific activity concepts). No disorder-specific activity The patients who have often been living in the respective institutions for years or decades are not offered any adequate disorder-specific activity programmes. Generally speaking, the day is defined by the mealtimes with little other activity. Preventive disorder-specific intervention was not evident. A monitoring visit by Commission 3 showed that the majority of the (predominantly young) patients is very overweight and suffers from diabetes mellitus, which reinforced the impression of mere “custody”. What is missing is a multidisciplinary approach in the sense of disorder-specific motivation of the affected persons to lose weight, change medication (psychotropic medication) and take part in a sports programme. Insufficient psychiological care For persons with chronic mental illnesses, in particular, continuous care with the appropriate amount of time is of great importance. In the opinion of Commission 3, this is not guaranteed in the visited institutions because of the limited amount of time the clinical psychologist spends there. Inadequate psychiatric training of staff Ultimately, the medical and nursing care is still suffering from the inadequate training of the – always very motivated and eager – employees and from a 45