health care • The ward had resorted to involuntary medication in acute situations on a patient’s arrival or in a more systematic manner, when a patient had been in treatment for a longer period of time and was refusing medication. The Ombudsman stressed that a patient in involuntary care or under observation may be administered medication against their will only if the failure to provide medication seriously endangers the health and safety of themselves or others. The Ombudsman referred to the guidelines issued by THL on reducing the use of coercion. According to the guidelines, involuntary medication refers to medication (injection, tablet, oral solution, etc.) that the patient refuses to take, as well as a situation in which the patient is told that if they refuse to take medication orally, they will be administered the medicine involuntarily by injection. Restrictive measures aimed at a child • Children were mainly in voluntary care in the paediatric psychiatric unit, and when the children exhibited aggressive behaviour, they would be manually restrained (forcible holding). The Ombudsman referred to his previous praxis and stated that the Mental Health Act is applicable in the case of manual restraint of a patient under inpatient care. However, the restrictions provided for in the Mental Health Act, such as manual restraint, cannot be applied to children in voluntary care. The Ombudsman recognises that the violent behaviour of a child requires intervention using appropriate means, to prevent them from harming themselves and others. In an emergency situation, means that are in proportion to the behaviour of the child can be used. If the child is held tightly for the purpose of calming them down, the conduct must be considered as a method of upbringing and nurturing, and not as a restrictive measure. The Ombudsman considered it necessary that guidelines for restraining situations should be drawn up to make sure that staff have a clear understanding of the limits of competence. Restrictive measures with no basis in the Mental Health Act • Several wards in a hospital had a policy of preventing patients from accessing their rooms in the morning and afternoon by locking the doors. The Ombudsman took the initiative to investigate the appropriateness of the method. 85