fundamental and human rights �.� national preventive mechanism against torture pital has succeeded in halving the amount of seclusion and restraint in proportion to treatment days in the 2010s. Various methods have been developed to decrease the use of restrictive measures. These include the development of special observation (100% observation), facilitating access to occupational therapy, harmonising the practices and record of wards, developing the use of relaxation or sensory deprivation rooms, and replacing traditional violence management training with prevention-oriented training. The Deputy-Ombudsman commended the hospital’s work for decreasing the restrictive measures used on patients. She recommended offering a debriefing opportunity to patients after all restrictions of their right to self-determination, instead of just after seclusion and restraint situations. The Deputy-Ombudsman also commended the hospital’s work in reducing the use of seclusion. She nevertheless considered the still occurring long seclusion periods to be problematic. Seclusion is an extremely strong infringement on the patient’s personal freedom. The steering group for decreasing the use of coercion made reducing the use of mobility-restricting garments a focus area for 2018. The use of restrictive clothing is monitored in the hospital. In the last eighteen months, the garment has been used for six patients. At the time of the visit, it was only used for one patient. There are many instances of its use, however, (3,395 in 2017), because the patient is dressed in the garment whenever he moves in the ward’s common areas. The hospital has sought to develop alternatives to restrictive clothing (ponchos, muffs). Such clothing permits violent patients to spend time with the other patients. The Deputy-Ombudsman commended the hospital’s work for reducing the use of restrictive clothing (3712/2018). 124 Emergency units As in previous years, the Ombudsman felt it was important to visit the emergency care units of somatic hospitals, which use so-called secure rooms. Attention is also paid to the privacy of the patient in urgent-care facilities. Patients can be placed in the secure room because they are, for example, aggressive or confused and cannot be placed with other emergency patients. This situation is problematic because there is currently no legislation on seclusion in somatic health care. However, secluding a patient may sometimes be justified under emergency or self-defence provisions. Such situations tend to involve an emergency, during which it is necessary to restrict the patient’s freedom in order to protect either his or her own health or safety, or those of other persons. The Ombudsman has required that the legal provisions and ethical norms governing the actions of doctors and other health care professionals must also be taken into account in these situations, and, as a result, the application of two parallel sets of standards. Furthermore, the procedure may not violate the patient’s human dignity. Having appropriate equipment in the seclusion room is of major importance when assessing whether a patient’s seclusion has, as a whole, been implemented in a manner that qualifies as dignified treatment and high-quality health and medical care. The criteria laid down in the Mental Health Act for the seclusion of a psychiatric patient are also applicable as minimum requirements for secure rooms in somatic hospitals. A patient placed in a secure room must be continuously monitored. This means that the patient must be monitored by visiting the seclusion room in person and observing the patient through a video link with image and audio. Appropriate records must be kept of the monitoring at all times. The NPM visited the emergency care units of three hospitals in 2018. All visits were made unannounced and during the evening. An external expert participated in the visits. The visits paid attention to the fulfilment of the above-mentioned requirements.