Report of the CHR on the Activities of the National Preventive Mechanism in Poland 5) Direct coercive measures Like in the previous years, the visiting staff observed irregularities in using direct coercive measures. It must be emphasized that, like last year, problems in this area were observed in practically all visited institutions145. Many hospitals do not use isolation as a direct coercive measure, they reach for a more acute coercive measure, by immobilizing with belts. There is no doubt that there are multiple cases where it is justified, yet attention must be drawn to the fact that the lack of rooms for isolation is very common, which clearly affects the discussed practice. Moreover, in the significant number of facilities patients are bound to their beds on the eyes of other persons in general rooms, on the corridors, and even at the canteen146, frequently without obscuring them with screens even for hygienic purposes147. The representatives of the NPM emphasize that coercive measure of immobilization should, as a rule, be imposed in a one-patient room, which is indicated in Article 7(1) of the Ordinance on direct coercive measures. In line with (2) of the specified article, if it is not possible to place a person with mental disorders in a one-patient room, the coercive measure of immobilization shall be applied in the manner that allows for separating that person from other persons staying in the same room and for respecting their dignity and intimacy, in particular by performing care routine without the presence of other people. Also, other irregularities in the area of imposing direct coercive measures: failure to partially mobilize the patient after 4 hours since applying the measure, if the behaviour of the patient allowed it, failure to allow the patients to use the bathroom (frequently persons who wanted to use the bathroom were provided with a urinal or nappies)148, using another patient (instead of hospital staff member) to help with an immobilized patient149, applying excessive physical force150, failure to check on the patient151, using extensions in improper time periods152. Several visited facilities apply immobilization for extended periods of time, e.g. 20 hours or several days153. It is doubtful whether such extended immobilization periods are actually necessary not only compared with the practice of other facilities but also compared with the laconic or general reasons for applying or extending them (e.g. active aggression or the reasons did not cease). It is difficult to believe in aggression behaviour that lasts 8 days, if the patient is able to access their medical records and draws up written requests while being mobilized154. 148 149 150 151 152 153 154 145 146 147 58 The commendable exception in this area is the Hospital in Kłodzko. Hospital in Gorzów Wlkp. Hospital in: Kraków, warsaw, Andrychów, Sochaczew, Rzeszów, Żurawica, Nowy Sącz, Wrocław. Hospital in: Sochaczew, Warszawa, Andrychów, Gorzów Wlkp., Rzeszów, Kraków, Suwałki, Żurawica. Hospital in: Gorzów Wlkp., Frombork, Aleksandrów Kujawski. Hospital in Warsaw. Hospital in Rzeszów. Hospital in Warsaw. Hospital in: Gorzów Wlkp., Rzeszów, Kraków. Hospital in Kraków.