1.3 Obiski psihiatričnih bolnišnic 1.3 Visits to psychiatric hospitals Tudi ob obisku PB Ormož v letu 2014 smo ugotovili, da osebje paciente na psihogeriatričnem oddelku, ki želijo oddelek zapustiti, še vedno ustavi in napoti nazaj. Zato smo znova opozorili, da je v takšnem primeru treba postopati po določilih ZDZdr glede nameščanja pacientov na oddelku pod posebnim nadzorom. Znova smo tudi ugotovili, da bolnišnica opravlja nadzor nad oviranim pacientom skozi vrata, ki so odprta na hodnik, kar smo že v poročilih DPM ob prejšnjih obiskih izpostavili kot neprimerno. Tudi ob tokratnem obisku smo ugotovili, da (še vedno) prihaja do prekoračitev najdaljšega, z zakonom določenega časa telesnega oviranja. When visiting Ormož Psychiatric Hospital in 2014, we noticed that patients in the psychogeriatric unit who wanted to leave the unit were stopped and directed back. We thus warned them again that the provisions of the ZDZdr must be observed in such cases about accommodating patients in secure wards. We determined again that supervision of a disabled patient was being implemented through a door which opens onto the corridor, which was noted as unsuitable in previous NPM reports. On this occasion, we also established that the longest legally determined time for physical restraint was (still) being exceeded. Nekatere najpomembnejše ugotovitve DPM na podlagi obiskov Some of the most important NPM findings on the basis of the visits Prostori psihiatričnih bolnišnic, ki smo jih obiskali, so bili (tako hodniki, sobe in pomožni prostori) praviloma čisti, lepo urejeni, brez neprijetnih vonjav. Še vedno pa opažamo, da so stene oddelkov pod posebnim nadzorom pobarvane največkrat z belo barvo, zidovi delujejo pusto in so brez okrasitve, razstavljenih izdelkov delovne terapije ali slik. Bolnišnice sicer velikokrat opozarjajo na varnostni vidik in tudi higienske razloge, ki so ovira za okrasitev. Kljub temu menimo, da bi lahko z nekaj omejitvami prostore naredili pacientom prijetnejše in prijaznejše. Tako bi se lahko na stene namestile papirnate slike, v okviru delovne terapije bi se lahko slikalo neposredno na steno, uporabile bi se lahko fototapete, namestile slike ali drugi predmeti višje na steno, da bi bili tako težje dosegljivi. Predvsem pa bi se lahko oddelki pod posebnim nadzorom prebarvali v pastelne barve. Takšna sprememba bi imela tako estetsko kot tudi optimistično vrednost. Dekoracija prostora namreč za paciente predstavlja tudi določeno vizualno stimulacijo, ki naredi prostor bolj domač in tako pacientu prijazen. The premises of psychiatric hospitals which we visited were (corridors, rooms and auxiliary premises) as a rule clean, tidy and free of unpleasant odours. However, we noticed that the walls in secure wards were mostly painted white. The walls looked bare, without decoration, or adorned with handicraft products or pictures made at occupational therapy. The hospitals frequently highlighted safety aspect and the reasons of hygiene which hinder decoration. We nevertheless believe that with some limitations the premises could be more patient-friendly and congenial. Pictures on paper could be hung on the walls; direct painting on the wall could be included in occupational therapy; photo wallpaper could be installed; pictures or other items could be hung out of reach on the walls. Above all, the secure wards could be painted in pastel colours. Such changes could have an aesthetic and optimistic value. Room decoration is also a visual stimulus for patients, making the place more homely and patient-friendly. Še vedno v nekaterih bolnišnicah ugotavljamo dokaj striktno ali celo zapovedano uporabo nočnih oblačil (pižam) tudi v dnevnem času. V bolnišnicah, kjer so na podlagi opozoril DPM ob preteklih obiskih zapoved umaknili iz hišnega reda, smo ugotavljali, da se ravnanje v praksi ni spremenilo. Razlogi, s katerimi bolnišnice opravičujejo takšno prakso, so različni, predvsem pa so higienske narave, saj naj bi se osebe na teh oddelkih večkrat umazale. Nekatere bolnišnice so izpostavljale tudi varnostni vidik, saj naj bi okoliški prebivalci v primeru pobega iz bolnišnice takšno osebo takoj opazili, in socialni vidik, saj naj bi pižame onemogočale neugoden položaj socialno šibkejših pacientov zaradi neprimernih oblačil. Vsekakor je pomembno tudi dejstvo, da so pižame najcenejši kos oblačila in so tako z ekonomskega vidika za bolnišnico najbolj sprejemljive. Vendar praksa, ki jo lahko ugotavljamo v socialnovarstvenih zavodih (tako posebnih kot domovih starejših), pa tudi v nekaterih bolnišnicah (npr. na psihiatrični kliniki v Ljubljani), kaže, da so vsi izgovori bolnišnic, kjer pri nošenju pižam vztrajajo brez izjeme, neutemeljeni. Izkušnje kažejo, da je večini pacientov možno ponuditi drugo vrsto oblačil (npr. športna oblačila oziroma trenirke), saj jim omogočajo vzpostavitev njihove pozitivne samopodobe in krepitev osebnega dostojanstva. Naj ob tem opozorimo, da je Evropski odbor za preprečevanje mučenja in nečloveškega ali ponižujočega ravnanja ali kaznovanja (CPT) v svojem poročilu o obisku OPM v letu 2012 kritiziral uporabo pižame/spalne srajce ali uniforme in opozoril, da to ne prispeva k oblikovanju osebne identitete in samozavesti. Hkrati je poudaril, da je individualizacija oblačenja del terapevtskega procesa. Nedvomno so pacientovi stiki z zunanjim svetom lahko izjemno pomembni (odvisno vsekakor od vrste duševne bolezni oziroma motnje). V večini obiskanih bolnišnic je bila uporaba mobilnih telefonov prepovedana ali vsaj omejena. V bolnišnicah, kjer ima telefone pacientov shranjeno osebje, jim te ob primernem času izročijo. Včasih zgolj, da preverijo telefonsko številko, drugič tudi za to, da jih uporabijo za telefonski klic. Vendar smo opozorili na neprimernost prakse, kjer se zaradi strahu, da pacient s klicanjem na npr. neprimerne številke ne bi škodoval sebi, dovoli uporaba mobilnega telefona zgolj v ambulanti, ob prisotnosti osebja. Posamezniku bi bilo namreč treba med stiki z bližnjimi zagotoviti zasebnost, kar v ambulanti ni zagotovljeno. Ob tem običajno na oddelkih pod posebnim nadzorom opažamo tudi pomanjkanje prostorov, kjer bi se lahko pacienti srečali s svojimi obiskovalci – torej svojci, prijatelji, znanci – in se z njimi pogovorili brez prisotnosti ali motenja osebja in drugih pacientov. Običajno se tako obiski opravijo pri pacientih, kjer izhodi s spremstvom (še) niso dopustni, na hodniku ali v skupnem prostoru, kar ni najbolj primerno. 80 poročilo o izvajanju nalog DPM v letu 2014 DržavnI preventivnI mehanizEm po Opcijskem protokolu h Konvenciji OZN proti mučenju in drugim krutim, nečloveškim ali poniževalnim kaznim ali ravnanju In some hospitals, we still noticed rather strict or even required use of night clothes (pyjamas) also during the day. In hospitals which have removed this requirement from the house rules on the basis of the NPM warnings, it was discovered that such conduct had not changed in practice. The hospitals justify this in different ways, but most are of a hygienic nature, because the people in these wards would often get dirty. Some hospitals also cited the safety aspect, because the neighbouring residents would immediately notice such people if they escaped from the hospital, and a social aspect since pyjamas prevented uncomfortable situations for socially weak patients due to unsuitable clothes. The fact that pyjamas are the most cost-efficient item of clothing is also important and they are thus the most acceptable for the hospitals from the economic point of view. However, the practice established in social care institutions (special care institutions and retirement homes) and in some hospitals (e.g. Ljubljana Psychiatric Hospital) shows that none of the excuses of the hospitals which insist on wearing pyjamas are reasonable. Experience shows that the majority of patients could be offered other types of clothes (e.g. sports clothes or tracksuits) because they enable them to establish a positive self-image and enhance their personal dignity. At this point, we should mention that the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) in its report on the visit to Department of Psychiatry of Maribor University Medical Centre in 2012 criticised the use of pyjamas/ nightgowns or uniforms and stressed that these did not contribute to the formation of personal identity and self-esteem. It further emphasised that individualisation of clothing was part of the therapeutic process. The patients’ contacts with the outside world may be of the utmost importance (depending on the type of mental disease or disorder). The use of mobile phones was prohibited or at least limited in the majority of visited hospitals. In hospitals, where the staff kept patients’ phones, these were given to them at suitable times, sometimes to merely check their calls, and at other times to also use them. However, we pointed out the unsuitability of this practice, where the use of a mobile phone is only permitted in the consulting room in the presence of staff due to the fear that patients might harm themselves by calling, for example, inappropriate numbers. When contacting their families and friends, patients should have privacy, which is not provided in the consulting room. We also noticed the lack of rooms on secure wards where patients could meet visitors, i.e. relatives and friends, and talk to them without the presence of, or disturbance by, staff or other patients. Thus visits take place in the patient room for patients who are not (yet) permitted to go out without an escort or in the common area, which is not the most suitable. IMPLEMENTATION OF THE DUTIES AND POWERS OF THE NPM IN 2014 National Preventive Mechanism under the Optional Protocol to the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment 81