Hospitals and psychiatric institutions 2.2 Hospitals and psychiatric institutions 2.2.1 Introduction In the year under review, the commissions visited 34 medical facilities including 19 psychiatric and 15 somatic clinics or departments. 33 visits were unannounced. Mental health just as important as physical health As depicted in the NPM reports in previous years, there is no nationwide clinical-psychological treatment programme in Austria which is provided by office-based doctors and covered by state health insurance. There is a huge gap in health care provision, in rural areas in particular. This must be rectified quickly from the NPM’s point of view. Sustainable investment in building up structures where health care is provided outside hospitals by office-based doctors ensure that local, professional and rapid support in mental crises reduces the strain for those affected and their relatives, thus taking pressure off the health care system in the medium term. The development and expansion of places in the state health insurance system for clinical psychologists, child and adolescent psychiatrists as well as psychotherapists could counter the chronification of mental disorders in children and adolescents and should therefore be given priority in all Laender. Lack of availability of public medical officers Relatives, residential facilities (nursing homes, residential groups in homes, shared accommodations etc.) or psychosocial services usually make the first steps towards forced placement when they can no longer deal with persons entrusted to them who have a suspected or diagnosed mental illness, and see no other alternative. These are usually persons who pose enormous challenges for themselves and their surroundings (unaware that they are ill, aggressive, unpredictable, threatening and, at the same time, not knowing that their own health is at risk, sometimes in a state of physical and hygienic neglect). The Hospitalisation of Mentally Ill Persons Act (Unterbringungsgesetz) stipulates that a medical examination and certificate pursuant to Section 8 of the Hospitalisation Act are necessary before a person can be hospitalised against their will (involuntary hospitalisation). In cases of imminent danger, the police can, however, bring the affected person to a psychiatric department without examination and certificate (Section 9 of the Hospitalisation Act). As in recent years, the NPM observed that public medical officers are not available quickly enough or at all in rural areas in particular, which is often why medical examinations by them are dropped. This means that the medical examination before involuntary hospitalisation set forth in hospitalisation law can only be performed in some cases. Protection against impermissible admissions to psychiatric wards is thus not sufficiently guaranteed. The NPM recognises structural maladministration here that can only be jointly rectified with the regional governments, as the implementation of Section 8 of the Hospitalisation Act is the responsibility of the Laender. In Vienna, police medical officers can be called on through the Land control centre. As 43