The expert proposed that Idrija Psychiatric Hospital amend the form on the record on the use of SPM with an abdominal safety belt with perineal band. A section about measures implemented before the application of special protection measures should be added (e.g. discussion, de-escalation techniques, additional medicament therapy etc.). It would be advisable to add a list of techniques used before the application of special protection measures which could simply be marked when completing the form. The role of a doctor ordering SPM (name and surname) should also be defined in more detail. Until this field is systemically arranged, it would be sensible to use the same forms which are used to implement special protection measures. According to the NPM, the implementation of SPM in an armchair in the living room is not suitable, since it fails to ensure suitable privacy and safety for the patient being restricted. If Idrija Psychiatric Hospital implements restriction in an armchair as a SPM, we ask that it immediately cease this practice (unless the relevant patient agrees to the presence of other patients) and implements SPM only in rooms that are used for such purposes (on a bed or armchair) under constant supervision. The response of Idrija Psychiatric Hospital is presented under the following recommendation. The NPM believes that physically restricting a patient in a lounger is an SPM, and all provisions of Article 29 of the ZDZdr must thus be observed and acted on accordingly. We suggested that the management of Idrija Psychiatric Hospital inform its staff thereof and also provide effective control of the implementation of SPM and the observance of statutory provisions. In their response to the preliminary report, the management of Idrija Psychiatric Hospital claimed that their position regarding the placement of older people in the armchair in the living room, which was stated during the Ombudsman’s (actually the NPM’s) last visit in 2013, remained unchanged. They firmly insisted on their position, and would further advocate and defend it with their expert authority. They highlighted that patients with delirium conditions and severe dementia with psychological and behavioural disorders were accommodated in the intensive section of the geriatric ward. The worsening of conditions and the need for hospitalisation are usually displayed with simultaneous infectious diseases or conditions after injuries or surgery. According to Idrija Psychiatric Hospital, a dementia patient in a geriatric ward thus requires suitable somatic and psychiatric diagnostics and treatment. Accompanying measures ensure optimum conditions for persons who in their current state usually require constant care and help with all activities. Disorders in balance and motor skills are particularly problematic with dementia patients, and seen in the increased possibility of falls, and frequently also in the inability to walk. Due to poor understanding of the disorder and the severe decline of cognitive abilities, patients are usually uncritical of their condition and exposed to frequent falls and injury. Damage to the skeleton or brain haemorrhages are proven to significantly increase the mortality of dementia patients. As per the fundamental characteristics of the dementia patient’s condition and subsequent disability, the management of Idrija Psychiatric Hospital believes that the nature of protection measures is also specific with regard to patients not suffering from dementia. The patients usually need assistance with all essential activities (hygiene, eating, moving). In order to avoid falls, protection measures are applied in a wheelchair or lounger. The management claims that the same protection measures are used by other medical and social care institutions for the same reasons for older people due to the same or similar conditions, particularly when organic mental disorders and/or psychotic conditions are combined with somatic complications, and the nature of these measures is not subject to the same monitoring standards. The fact that such a protection measure is considered a special protection measure only when an elderly person is being treated in a psychiatric institution, and that once they are transferred to a somatic hospital or a social care institution this is no longer the case, does not stand up to serious expert scrutiny and additionally stigmatises the psychiatric hospital. According to the management of Idrija Psychiatric Hospital, a special protection measure as per Article 29 of the ZDZdr is an emergency measure used in order to enable the medical treatment of a person or in order to eliminate or control dangerous behaviour in cases when their life or the life of others is endangered, when their health or the health of others is grossly endangered or when the person’s behaviour is causing a serious physical damage to themselves or others and the endangerment cannot be prevented by other, milder measures. The management believes that a prescriptive standard for introducing SPM is clear, and the key elements for implementing it include the urgency of implementation (ultimate measure), justification for implementation and the existence of an objective danger to the life and health of an individual or property. In their opinion, the measure of restricting someone in a lounger (or e.g. in a bed with rails) as implemented by hospitals, including psychiatric ones and social care institutions, to prevent possible IMPLEMENTATION OF THE DUTIES AND POWERS OF THE NPM IN 2016 NATIONAL PREVENTIVE MECHANISM UNDER THE OPTIONAL PROTOCOL TO THE UN CONVENTION AGAINST TORTURE AND OTHER CRUEL, INHUMAN OR DEGRADING TREATMENT OR PUNISHMENT 83