fundamental and human rights �.� national preventive mechanism against torture Quality of care and care culture The Ombudsman recommended that the rehabilitation ward should be made more comfortable to better support rehabilitation. Excrement-resistant furniture suitable for such purposes is available. The Ombudsman felt the shortcomings in the rehabilitation ward’s care environment to be significant and urged the ward to take measures to bring the environment up to the required standard. In the opinion of the Ombudsman, it was not possible to wait for the rectification of the situation with the completion of the new hospital building in 2021 (727/2018). According to the observations made by the NPM, the treatment times of patients in the rehabilitation ward were long, and many patients appeared to be more in need of nursing and care than rehabilitative treatment. The NPM got the impression that a large portion of the ward’s patients were not in a correct or appropriate place of care. The offering of rehabilitative activities was sparse. The Ombudsman issued a serious recommendation to the ward to take measures to bring the conditions and treatment of the patients up to the required standard. The Ombudsman considered it necessary to evaluate the suitability of the place of care individually for each patient (727/2018). According to the observations made by the NPM, not many nurses could be seen in the rehabilitation ward’s common areas or among the patients. If the patients wanted to talk to the nurses, they knocked on the door of the office. The nurses seemed to spend a disproportionate amount of time in the office instead of working with the patients. The nurses’ working methods also appeared task-oriented. According to the NPM’s observations and patients’ accounts, the nurses did not actively initiate contact with the patients. The Ombudsman recommended that the ward should continue assessing its care culture and opportunities to lessen the nursing staff ’s focus on the office. The Ombudsman urged the ward to consider the implementation of visibility between the office and ward so that the patients could see into 122 the office and the nurses out of it, without compromising confidentiality (727/2018). According to the authority, it is part of the ward’s care culture that the staff should be as available as possible to the patients. This has been discussed with the staff to an even greater extent. Only the necessary work should be done in the office behind closed doors. Whenever possible, work should be arranged so that one or more staff members are always in the ward and available to the patients. For example, care meetings and other meetings should be arranged in a staggered manner, so that a majority of the staff would not be unavailable at any one time. Work for decreasing the use of coercion in a state forensic psychiatric hospital Niuvanniemi Hospital treats patients who have not been convicted due to their mental state (forensic psychiatric patients) and performs psychiatric examinations. The hospital also treats dangerous and/or difficult psychiatric patients. At the end of 2017, the average treatment time of forensic psychiatric patients was 6 years and 8 months (the longest being 35 years and 7 months). The corresponding figures for patients admitted due to difficult conditions was 4 years and 5 months (the longest period being 26 years and 1 month). All of the patients being treated in the hospital had been committed to the hospital against their will. Thus, their right to self-determination can be restricted subject to the conditions provided for in chapter 4a of the Mental Health Act. However, the Act states that a patient’s right to self-determination and other fundamental rights may only by restricted to the extent required by the treatment of their condition, the safety of themselves or others, or the safeguarding of other interests provided for in chapter 4a. In 2011 and 2015, the hospital drew up proposals for plans to decrease the use of coercion, and a steering group for decreasing the use of coercion operates in the hospital. The hospital is committed to decreasing the use of coercive measures on patients. According to the steering group, the hos-