86 health care • It appeared that the hospital was adequately staffed to allow for the use of 100% special observation (so-called “rooming-in care”) as the main method of restriction, which allowed the nursing staff to concentrate on providing care to the patient under observation, as they remained next to the patient or at least within eye contact of the patient at all times. The Ombudsman found that the method of 100% observation was often used in a situation in which the other alternative would have been the seclusion of the patient. It was also evident from the list of restrictive measures that the adoption of 100% observation was successful in reducing the need for seclusion, which the Ombudsman found to be a highly satisfactory outcome. The Ombudsman further stated that this type of observation was not included in the restrictive measures referred to in the Mental Health Act, but considered it prudent that its use should be documented and transparent, and that its use should be documented in the record of restrictive measures if the patient objects to it. • One of the wards had a restrictive vest in use for aggressive patients, so that the patient did not need to be secluded. The geriatric psychiatric ward had back-zip overalls in use, albeit rarely. There were no guidelines on the use of restrictive clothing. The Ombudsman stated that if a hospital is using restrictive clothing, there must be guidelines, and the use of the garment must be duly recorded in the list of restrictive measures used. The Ombudsman encouraged the institution to consider completely discontinuing the use of restrictive garments, as they were rarely used. • A hospital had adopted the use of chest and crotch straps for various situations, and separate guidelines for their use had been provided. The Ombudsman pointed out that there are no provisions in the Mental Health Act that are directly applicable to the use of chest or crotch restraints, and restraining as it is understood in the law refers exclusively to the use of conventional bed restraints. Usually this type of restraint is used for patients who are not in involuntary treatment but whose movements need to be controlled for the sake of their own safety. The Ombudsman referred to the Valvira guidelines on the use of restrictive safety equipment and the principles on the restriction of movement of a person in voluntary care. The Ombudsman emphasised that a separate assessment should be made of the use of restrictive equipment, and alternative applicable safety measures should be considered. The Ombudsman recommended that the hospital review its guidelines regarding the use of chest or crotch restraints for patients in involuntary care. The Ombudsman also recommended that the guidelines include principles on the restriction of movement applied to patients in voluntary care, as based on Valvira guidelines, unless the matter is not governed by law.