CHANCELLOR OF JUSTICE AS NATIONAL PREVENTIVE MECHANISM PART III PART II PART I 2. Providers of involuntary emergency psychiatric care During the reporting year, the Chancellor inspected six establishments providing involuntary emergency psychiatric care: – Inspection visit to Rapla County Hospital Foundation (case No 7-9/130273); – Inspection visit to the North Estonian Regional Hospital Foundation16 (case No 7-9/130325); – Inspection visit to Tallinn Children’s Hospital Foundation (case No 7-9/130324); – Inspection visit to Wismari Hospital Ltd (case No 7-9/130246); – Inspection visit to Pärnu Hospital Foundation (case No 7-9/130275); – Inspection visit to Viljandi Hospital Foundation17 (case No 7-9/130296). The choice of the inspected establishments was based first and foremost on the results of the Chancellor’s visits in the previous years and the need to ensure consistent and regular supervision of involuntary emergency psychiatric care activities which may seriously interfere with fundamental rights of individuals. All the inspection visits were carried out without advance notice and without involving any experts. In the above establishments the Chancellor verified primarily the application of means of restraint. The Chancellor found problems mostly in the use of seclusion rooms and insufficient registration of the use of means of restraint. The following subdivision contains a more detailed overview of the shortcomings and the Chancellor’s proposals for eliminating them. 2.1. Seclusion of individuals The main problem with the seclusion of individuals in three of the inspected establishments was related to the conditions of seclusion which did not always necessarily ensure the safety of the persons. For example, in one of the establishments18 a regular ward was used for secluding persons, while the door of the ward was simply locked in case of need of seclusion. However, the room which was designed for daily occupation was not furnished in a way as to ensure the safety of persons secluded in the ward. In two of the establishments19 there were problems with safety of the special seclusion rooms used for seclusion (and application of other means of restraint), as there were items in the rooms with which persons could easily injure themselves (e.g. unfixed bed, a screw extending from the wall, fractured door glass). The Chancellor proposed to isolate persons only in a safe room specifically fitted for seclusion, so that persons cannot injure themselves. 2.2. Registration of the applied means of restraint Another most frequent problem was still20 related to maintaining a register providing a quick 8 16 The Chancellor inspected units No 5 and 7 in the psychiatric clinic of the North Estonian Regional Hospital Foundation. 17 The Chancellor inspected the acute psychiatry, tuberculosis treatment, coercive treatment, psychiatric longterm treatment and child psychiatry units of the psychiatric clinic of Viljandi Hospital Foundation. 18 See also the summary of inspection visit to Viljandi Hospital Foundation: http://oiguskantsler.ee/sites/default/ files/IMCE/inspection_of_viljandi_hospital_2012.pdf. 19 See also the summary of inspection visit to Rapla County Hospital Foundation: http://oiguskantsler.ee/sites/ default/files/IMCE/inspection_of_rapla_county_hospital_2012.pdf; and the summary of inspection visit to Wismari Hospital Ltd: http://oiguskantsler.ee/sites/default/files/IMCE/inspection_of_wismari_hospital_2012. pdf. 20 See the Chancellor’s 2011 Overview, Part II, subdivision 4.2. Available online: http://oiguskantsler.ee/sites/ default/files/annual_report_2011_.pdf.