Poročilo Varuha človekovih pravic Republike Slovenije o izvajanju nalog državnega preventivnega mehanizma za leto 2011 Obiski psihiatričnih bolnišnic Splošno V letu 2011 smo obiskali dve psihiatrični bolnišnici, in sicer 27. 1. 2011 Psihiatrično bolnišnico Begunje (PB Begunje) in 18. 4. 2011 Psihiatrično bolnišnico Ormož (PB Ormož). Glavni namen teh obiskov je bil preveriti razmere na oddelkih pod posebnim nadzorom in ravnanje z osebami, nastanjenimi na teh oddelkih, da bi odpravili morebitne pomanjkljivosti, ugotovljene ob samem obisku. Visits to psychiatric hospitals General In 2011, we visited two psychiatric hospitals, Begunje Psychiatric Hospital (PB Begunje) on 27 January 2011 and Ormož Psychiatric Hospital (PB Ormož) on 18 April 2011. The main purpose of these visits was to monitor the situation in secure wards and how persons accommodated in these wards were treated, with the aim of eliminating any potential irregularities established during the visit. Na poslani poročili smo prejeli odziva obeh bolnišnic, ki pa sta se odzvali le na manjši del pripomb in priporočil. Zato lahko upamo, da sta druga priporočila upoštevali. To bomo preverili pri naslednjem obisku. S končnim poročilom o obisku smo seznanili tudi Ministrstvo za zdravje in Razširjeni strokovni kolegij za psihiatrijo pri Ministrstvu za zdravje. Both hospitals responded to the reports we sent to them, but only to a small number of comments and recommendations. We can only hope that they have implemented the other recommendations, which will be monitored during our next visit. The final report on the visit was also submitted to the Ministry of Health and to the Expanded Professional Board of Psychiatry at the Ministry of Health. Prostorske razmere Spatial conditions PB Begunje ima dva oddelka pod posebnim nadzorom, in sicer moški (C1) in ženski oddelek (D). V sklopu zadnjega je oblikovan polodprti ženski oddelek (D1). Na vsakega od oddelkov pod posebnim nadzorom je mogoče namestiti po dvoje ležišč, namenjenih začasni namestitvi pacientov. PB Begunje has two secure wards, a male ward (C1) and a female ward (D). A semiopen female ward (D1) is organised within the latter. Two beds intended for the temporary accommodation of patients can be placed in each secure ward. Ob obisku oddelkov pod posebnim nadzorom v PB Begunje smo ugotovili, da postelje, namenjene začasni namestitvi pacientov na teh oddelkih, sicer niso povsem enakovredne drugim posteljam na oddelku, vendar ustrezajo začasni namestitvi. Bolj nas je (predvsem na moškem oddelku pod posebnim nadzorom), presenetilo, da sta postelji nameščeni tako rekoč na hodniku. Tako ne omogočata nobene zasebnosti, čeprav le začasno nameščenima pacientoma. Kljub vidni prostorski stiski smo predlagali, da PB Begunje poskuša najti primernejšo rešitev za začasno namestitev pacientov. Prekoračitev zmogljivosti oddelka ne pomeni zgolj slabše kakovosti bivanja za druge paciente, ampak je še posebej neprijetna za ravnokar sprejetega pacienta, ki je tako še bolj izpostavljen. Odziva PB Begunje na te ugotovitve nismo prejeli. Prostori na oddelkih pod posebnim nadzorom PB Begunje so bili čisti, obnovljeni, oprema je v dobrem stanju. Vendar so sobe na moškem oddelku pod posebnim nadzorom delovale pusto, skoraj sterilno, saj ni bilo opaziti nobenih slik ali osebnih predmetov. Osebje je takšno stanje opravičevalo z bojaznijo, da bi bile slike (npr. fotografije, izdelki delovne terapije) lahko nevarne, če so na oddelku psihotični pacienti. Res je, da so pacienti na oddelku pod posebnim nadzorom nameščeni praviloma krajši čas. Zato je razumljivo, da pacienti sobe, v kateri prebivajo, ne okrasijo z lastnimi osebnimi predmeti. Vendar pa smo poudarili, da bi lahko bolnišnica poskrbela, da bi se skupni prostori in praviloma tudi sobe polepšale z izdelki npr. delovne terapije. Tako okrasitev smo že videli v nekaterih drugih obiskanih bolnišnicah, pa tudi v PB Begunje na ženskem oddelku pod posebnim nadzorom. Do zdaj tudi še nismo bili seznanjeni z morebitnimi težavami, ki bi jih takšna okrasitev povzročala glede na zdravstveno stanje nekaterih pacientov. Tako smo predlagali, da bolnišnica sobe in skupne prostore opremi z izdelki delovne terapije, hkrati pa paciente tudi spodbudi, da prostor ob svoji postelji – če to seveda želijo, opremijo s svojimi osebnimi predmeti (fotografije in podobno). Tudi v tem delu se na ugotovitve oziroma predloge DPM bolnišnica ni odzvala. 32 Implementation of the Duties and Powers of the National Preventive Mechanism in 2011 Državni preventivni mehanizem v Republiki Sloveniji po Opcijskem protokolu h Konvenciji OZN proti mučenju in drugim krutim, nečloveškim ali poniževalnim kaznim ali ravnanju During the visit to the secure wards in PB Begunje, we observed that beds intended for the temporary accommodation of patients to these wards are not the same as the other beds in the ward, but that they are suitable for temporary accommodation. We were more surprised by the fact that (particularly in the male secure ward) the beds were placed almost in the hallway. They do not provide any privacy for the patients, regardless of whether they are just temporarily accommodated. Despite the obvious overcrowding, we suggested that PB Begunje try to find a more appropriate solution for the temporary accommodation of patients. Exceeding the capacity of the ward not only leads to poorer living quality for other patients, but is particularly unpleasant for a patient who has just been admitted, and makes the patient even more exposed. PB Begunje has not responded to these findings. Rooms in the secure wards in PB Begunje were clean and renovated, and the equipment is in good order. Nevertheless, the rooms in the male ward have a bleak, almost sterile atmosphere, as there were no pictures or personal items. The personnel made exuses for the situation, saying that pictures (e.g. photos, items made during occupational therapy) could be dangerous when psychotic patients are present in the ward. It is true that the time the patients spend in the secure ward is usually short, so it is understandable that they do not use their own personal items to decorate the room in which they are accommodated. However, we pointed out that the hospital could provide for the decoration of common rooms and accommodation rooms with items made, for example, during occupational therapy. We have seen such decoration in some other hospitals, even in the female secure ward of PB Begunje. We have never been informed of any problems associated with the health condition of certain patients caused by such decoration. We therefore proposed that the hospital decorate accommodation rooms and common rooms with items made during occupational therapy, and encourage patients, if they wish, to place some personal items (photos and similar) next to their beds. Again, the hospital did not respond to these findings or the proposals of the DPM. National Preventive Mechanism in the Republic of Slovenia under the Optional Protocol to the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment 33