health care iour, debriefing with the patient following seclusion or restraint, and the adoption of the Safewards model. In addition, the hospital’s own guidelines on the application of restrictive measures, Handbook on the options and coercive and restrictive measures under the Mental Health Act were, in the hospital’s opinion, compliant with the CPT recommendations. Guidelines and agreement on the use of restrictive measures • A hospital ward had adopted guidelines and practices that restricted the patients’ rights more than the law prescribes. As an example, the patients could be subjected to bodily searches and required to give blood or urine samples. The Ombudsman stressed that a patient’s rights cannot be restricted by a ward’s individual instructions, as any restrictions must be based on law, and they must be used on the basis of individual consideration. • The hospital aims to reach an agreement with the patient on their care, instead of resorting to restrictions on self-determination. The Ombudsman explained in his statement the general rules for consensual restriction of basic rights and what is required of the person giving consent. The Ombudsman stressed that any intervention in the physical integrity of a patient, or other care measures, must always be subject to voluntary and informed consent given by the patient. The patient must also have the right to withdraw his or her consent at any time. The Ombudsman stated that, for example, metal detectors can be used if the patient consents to the practice. Otherwise, the patient can be subjected to a bodily search if the criteria provided in the Mental Health Act are met. • A patient in involuntary treatment had given their consent on the care agreement form used by the hospital district on the restriction of their basic rights on entering a substance-free treatment period. The Ombudsman recommended that on the care agreement form, a section should be added in which the patient can cancel the agreement at their own discretion, including information on what the consequences of such cancellation may be. • A patient who was in involuntary care told the NPM that food that she had purchased was placed in a locked fridge in the ward and that she had access to it only on request. The Ombudsman stated that patients under involuntary treatment can also agree on the safekeeping of their personal belongings during treatment, in which case the safekeeping does not constitute the possession of personal property referred to in the Mental Health Act. The 83

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