CHANCELLOR OF JUSTICE AS NATIONAL PREVENTIVE MECHANISM PART IV PART III PART II PART I In the following part, the above shortcomings and the Chancellor’s proposals for remedying them are described in more detail. Most of the problems pointed out by the Chancellor were eliminated by the inspected institutions during the reporting year. 6.1. Availability of a psychiatrist The most important shortcoming in organising involuntary treatment is related to the fact that not in all the hospitals a psychiatrist is available all the time. In two of the inspected institutions53 round-the-clock availability of a psychiatrist for making decisions concerning involuntary treatment was not ensured and, therefore, a decision could be made by a person not competent for this. In particular, on weekends and public holidays decisions concerning involuntary treatment could be made by a duty doctor who was not a psychiatrist. In one of the institutions54 the Chancellor had a suspicion that it might not be ensured that a person admitted for involuntary treatment without a court authorisation is indeed also examined by another psychiatrist within the required time. The Chancellor found that the availability of a psychiatrist at the psychiatric department of a hospital is inevitably necessary for making decisions concerning involuntary treatment. Also, for review of involuntary treatment, under § 13(3) of the Mental Health Act a psychiatrist other than the one having made the decision to apply involuntary treatment must carry out a medical examination of a person admitted for involuntary treatment within twenty-four hours after commencement of in-patient treatment. Therefore, the Chancellor proposed to both institutions to ensure that decisions of involuntary treatment are made by a psychiatrist at the psychiatric department. The psychiatrist must do this upon the admission of a person to the psychiatric department or, in case of a person receiving voluntary in-patient treatment at the hospital, immediately after the medical examination when the need to apply involuntary treatment appeared. Furthermore, the Chancellor pointed out that a provider of involuntary emergency psychiatric treatment must ensure that every time a person is admitted for involuntary psychiatric treatment without a court authorisation they are examined by another psychiatrist within 24 hours as of the commencement of involuntary treatment. It was also found that in one of the institutions55 at night the decision to apply means of restraint is taken by the duty nurse of the psychiatric department, and the doctor may grant the authorisation by telephone without having seen the patient. If the doctor makes the decision to apply means of restraint without having personally assessed the patient’s condition, the circumstances necessitating the application of restraint have not been directly assessed by a designated professional. The Chancellor reached the opinion that this may constitute an unlawful interference with a patient’s fundamental right to liberty and inviolability of person. In applying means of restraint, the requirement of a personal and direct assessment of a patient’s condition by a doctor must be complied with. As an obstacle to a 24-hour availability of a psychiatrist, the above-mentioned psychiatric hospital pointed to the lack of resources and suggested a video consultation as a possible solution. 6.2. Conditions of restraint The main problems in the restraining of patients were related to inappropriateness of the physical conditions for restraint. In two institutions56 the Chancellor had a suspicion that 30 53 See the inspection visits to South Estonian Hospital Ltd (case No 7-9/130245) and Narva Hospital Foundation (case No 7-9/130436). 54 See the inspection visit to South Estonian Hospital Ltd (case No 7-9/130245). 55 See the inspection visit to Narva Hospital Foundation (case No 7-9/130436). 56 See the inspection visits to Tartu University Clinic Foundation (case No 7-9/130434) and Ahtme Hospital Foundation (case No 7-9/130612).