fundamental and human rights �.� national preventive mechanism against torture budsman felt that the changes required by him could not wait that long (727/2018). The authority reported that it had started renovating the seclusion premises. The wall surfaces had been painted and sharp grooves removed. New, soft and excrement-resistant furniture had been ordered. A film had been installed on the glass pane in the door of one seclusion room to protect the occupant’s privacy. An alarm bell system had been acquired for the rooms. A dedicated wheeled table had been ordered for serving meals in the seclusion rooms so that the patients are not required to eat on their beds. Every patient in seclusion is permitted to use the toilet next to the seclusion premises in the presence of a nurse/nurses. Efforts will be made to protect the privacy of patients when safe and possible. The staff will actively offer the opportunity to use the toilet. Patients who wish to use the toilet can ask the staff or ring the bell. Treatment of patients in seclusion The Ombudsman stated that the dignified treatment of an secluded patient and good health-care standards require that the patient has access to a toilet. Access to the toilet should also be actively offered to patients without waiting for a specific request. For this reason as well, patients in seclusion should always be able to contact the care staff without delay. In his opinions, the Ombudsman has stated that it is inhumane and humiliating if the patient’s only means of communicating with nursing staff is to bang on the door or yell. Patients must also be supplied with adequate and humane clothing. The Ombudsman issued a serious recommendation to the authority to take measures to bring the conditions and treatment of patients in seclusion up to the required standard. The Ombudsman recommended that the guidelines on treatment should more clearly communicate the objective of providing humane treatment for patients in seclusion. At the very least, this means that staff should be instructed to ensure that patient has the opportunity to use the toilet. The implementation of personal surveillance could also be expressed more clearly in the guidelines. Specific examples of how nurses can assist patients during meals and ensure that they do not take their meals sitting or standing on the floor and eating with their hands. Guidelines alone will not suffice, however, and the management must ensure that everyone participating in the treatment of a patient in seclusion are aware of the guidelines and comply with them (5338/2017). The authority reported that it had updated its seclusion guidelines as recommended by the Ombudsman. By the end of August 2018, the authority intended to draw up a proposal for increasing the staff ’s level of training and awareness of these and other guidelines and legislation. The proposed methods for this include reading materials and an electronic exam, which everyone working in the wards would be required to pass. The Ombudsman was satisfied with the measures and plans reported by the authority for bringing the seclusion premises up to an appropriate standard. The Ombudsman commended the fact that more attention will be paid to the staff ’s and management’s knowledge of legislation, guidelines and national recommendations. Clear instructions and dedicated training programmes are methods that can consolidate the staff ’s capabilities for encountering challenging patients. The guidelines gave the impression that patients will not necessarily be visited in the room, but supervision can be performed from ”behind the door”. The Ombudsman did not find such supervision consistent with the supervision required for patients in seclusion. Neither can such supervision, or event two-way voice communications, replace contact between the patient and staff. Patients should have the opportunity to talk with nurses face-to-face (5338/2017). The Ombudsman did not deem it sufficient that patients can contact staff by waving to the surveillance camera or banging on the door and shouting. A minimum requirement in this regard would be a call button in the seclusion room. A system enabling two-way communication would be an appropriate way of arranging contact (727/2018). 119