1.3 Obiski psihiatričnih bolnišnic 1.3 Visits to psychiatric hospitals Vsekakor pozdravljamo prizadevanja PB Begunje, da bi se izdelala nova (dnevna) oblačila, za katere bi se pacienti lahko odločili. Menimo namreč, da razlogi, s katerimi PB Begunje opravičuje nošenje nočnih oblačil (pižam) tudi v dnevnem času, niso utemeljeni. Higienski razlogi so sicer nedvomno pomembni, vendar pa kažejo predvsem na zmanjšano obremenjenost ali celo komoditeto osebja kot na utemeljen razlog. DPM namreč ob obiskih drugih psihiatričnih bolnišnic, predvsem pa posebnih socialnovarstvenih zavodov in domov starejših, ugotavlja, da so pri zagotavljanju ustrezne higiene pacienti in oskrbovanci brez večjih težav v dnevnem času v svojih oblačilih ali oblačilih, ki jih zagotavlja sam zavod. Tudi razlog varnosti verjetno ne more biti odločilni element ob pojasnilu bolnišnice, da se pacientu, ki mu je omogočen (samostojen) izhod, zagotovi obutev in dnevno oblačilo in da torej prehaja z oddelka in se nanj vrača v takšnem oblačilu in ne pižami. We commend the efforts of Begunje Psychiatric Hospital to supply new (day-time) clothes which the patients could choose to wear. We believe that the reason for wearing night-time clothes (pyjamas) also during daytime was not founded. Reasons of hygiene are important, but they suggest reduced burdening or even convenience of the staff. When visiting other psychiatric hospitals and particularly special social care institutions and retirement homes, the NPM established that patients and residents wear their clothes or clothes provided by the institution during daytime without any major difficulties and while being provided sufficient hygiene. The safety reason can certainly not be the deciding factor in the hospital’s clarification that a patient who is allowed (independent) exit is provided with footwear and daytime clothes and that they are thus leaving and returning to the ward in such clothes and not in their pyjamas. Oddelek za psihiatrijo pa je pojasnil, da so upoštevali predlog DPM glede nošenja dnevnih oblačil – paciente namreč še dodatno spodbujajo pri nošenju dnevnih oblačil. The Department of Psychiatry clarified that they had observed the NPM recommendation on daytime clothes and now additionally encourage their patients to wear daytime clothes. Predlagamo, da bolnišnice zdravnike, ki PVU odrejajo, posebej opozorijo, da je PVU skrajni ukrep in da mora biti iz medicinske dokumentacije vedno razvidno, če in kateri milejši ukrepi so bili izvedeni pred uvedbo PVU. Predlagamo tudi, da bolnišnice temu primerno prilagodijo tudi obrazce, ki se izpolnjujejo ob uvedbi PVU. Obrazec bi bilo smiselno dopolniti z rubriko o izvedenih ukrepih pred uvedbo PVU (npr. pogovor, tehnike deeskalacije, dodatna medikamentozna terapija ...). Smiselno bi bilo dodati seznam tehnik na obrazec in ob izpolnjevanju obrazca le označiti, katere tehnike so bile uporabljene pred uvedbo PVU. Predvsem pa predlagamo, da bolnišnice zagotovijo, da ne prihaja do primerov, ko bi zdravnik dajal vnaprejšnjo odreditev uvedbe PVU – torej »po potrebi«. We propose that hospitals inform physicians who order special protection measures that these are a last resort, and that it must always be evident from the medical documentation if, and which, more lenient measures have been implemented before ordering special protection measures. We also propose that hospitals accordingly adjust the forms which are completed when implementing special protection measures. A section about measures implemented before the application of special protection measures should be added (e.g. discussion, de-escalation techniques, additional medicament therapy etc.). It would be advisable to add a list of techniques used before the application of special protection measures which could only be marked when completing the form. In particular, we propose that hospitals ensure that cases in which a physician orders the implementation of special protection measures in advance, i.e. “when needed” no longer occur. PB Begunje kljub našim predlogom ne vidi razloga za spremembo obrazca. Meni namreč, da dokumentiranje v pretiranem obsegu pomeni zmanjševanje časa, ki ga zdravnik in drugo osebje posvečajo neposredno pacientu. Vse, kar predlaga DPM, pa je, kot navajajo, zavedeno v poročilu zdravstvene nege na listu posebnega varovalnega ukrepa in na terapevtskem listu. Oddelek za psihiatrijo je pojasnil, da so intenzivirali sicer že utečeno izobraževanje osebja o uporabi PVU kot zadnjemu ukrepu obvladovanja agresivnega vedenja. V istem času so začeli z dodatno edukacijo deeskalacijskih tehnik, sprva za specializante in specialiste, za ostalo osebje ZN pa bodo edukacijo teh tehnik nadaljevali jeseni, ko bodo educirali tudi novosprejeti kader za potrebe Enote za forenzično psihiatrijo. Ko bodo opravili izobraževanje celotnega osebja z navedenim, bodo na obrazec za PVU (po ZDZdr) dodali tudi beleženje uporabe teh tehnik pred uporabo PVU. Predlagamo, da bolnišnice zdravnike neprestano opozarjajo na roke, ki jih tako glede trajanja PVU kot tudi glede obveščanja posameznih oseb določa ZDZdr. Pomisleki glede smiselnosti določenih rokov ali njihove dolžine so lahko razlog za aktivno vključitev ob pripravi sprememb ZDZdr, ne pa za izogibanje svojim dolžnostim ali celo ravnanje v nasprotju z zakonom. PB Begunje je pojasnila, da je v zakonu urejen postopek obveščanja sodišča še eden od primerov nerealnosti zakona. Obveščanje je v času, ko sodišče ne dela praktično nemogoče v zakonskih rokih. Meni, da bo to vprašanje prvenstveno moral rešiti zakonodajalec. Oddelek za psihiatrijo pa je pojasnil, da v zadnje pol leta ne opažajo zamud pri pošiljanju oziroma obveščanju oseb po ZDZdr. Despite our proposals, Begunje Psychiatric Hospital noted no need to change the form. It believed that excessive documentation reduced the time the physician and staff dedicate directly to patients. In their opinion, everything proposed by the NPM was already included in the medical care report of the list of special protection measures and on the therapeutic list. The Department of Psychiatry explained that they had intensified the regular training of their staff on the use of special protection measures as the last way of restraining aggressive behaviour. They also started additional training in de-escalation techniques, firstly for registrars and specialists. The training of these techniques would continue in autumn for other staff when newly employed staff for the needs of the Unit for Forensic Psychiatry will also be trained. Following the training, the form for special protection measures (as per the ZDZdr) would be adjusted to enable noting the application of these techniques before the use of special protection measures. We further suggest that physicians be constantly warned about the deadlines stipulated by the ZDZdr relating to the duration of special protection measures and informing individual persons. Concern about certain deadlines or their duration may be a reason for active participation in the preparation of amendments to the ZDZdr and not for the avoidance of duties or even practices contrary to the Act. Begunje Psychiatric Hospital explained that the procedure of informing the court regulated by the Act was yet another example of the unrealistic nature of the Act. Informing within determined deadlines was practically impossible at times when the court was not working. The hospital believed that this question would have to be resolved by the legislator. The Department of Psychiatry noted that no delays had been observed in the previous six months when informing persons as per the ZDZdr. 88 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 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 89