fundamental and human rights �.� national preventive mechanism against torture of the patient or others. In his decision dated 15 March 2018, (1496/2017) the Ombudsman commented on the medication of a patient against their will. Restraint bed in an isolation room at the central hospital in Kajaani. records inspected gave the impression of a low threshold for the use of restraints in certain cases. As an example, one patient had been permitted to go for a cigarette and go to the sauna in the middle of restraint and seclusion. The Ombudsman stressed that, according to the Mental Health Act, seclusion without mechanical restraints is the primary alternative and restraints can only be employed when other measures are insufficient (727/2018). During the visit, the NPM noted that patients were transported outside the seclusion rooms with the restraints still attached to their limbs. This could be the case when taking the patient to the toilet or for a cigarette, for example. In the Ombudsman’s opinion, moving a patient with the restraints still attached can be considered humiliating for the patient. It can also cause anxiety in other patients. In the Ombudsman’s opinion, this practice should be avoided, particularly in the ward’s common areas (727/2018). Involuntary medication The Ombudsman recommended that, from now on, decisions on involuntary medication should be justified with regard to the requirements of the Mental Health Act. He stressed that psychosis cannot be considered to constitute sufficient grounds for involuntary medication, because all patients under observation and ordered to treatment suffer from psychosis. The patient records should also indicate how the patient was consulted on the medication or why consultation was not possible (5338/2017). The authority reported that the physician in charge of the psychiatric hospital had started clarifying the guidelines with the objective of assessing the use of restrictive measures in more detail and recording the reasons for employing restrictive measures more systematically. Particular attention will be paid to the use of involuntary medication and recording seclusion situations. The patient records indicated that involuntary medication was administered in the psychiatric ward. The medication had been justified as ”necessary”, but the entry in the patient records lacked a detailed assessment of whether the requirements for involuntary medication specified in the Mental Health Act were met (failure to medicate would seriously endanger the safety or health of the patient or others). The Ombudsman recommended that, in the future, involuntary medication should be assessed in the manner required by the Mental Health Act, and that the fulfilment of the conditions be recorded in the patient records (727/2018). The authority reported that the staff was instructed to accurately document everything related to the administration of involuntary medication. If a patient in involuntary care or under observation refuses to take the medication prescribed for them, the medication may be administered against their will only if the failure to provide medication would seriously endanger the health and safety 121