a room with other patients. Since the situation remained the same in the male and female admission
ward, we repeated this recommendation also on the occasion of this visit.
In their response to the preliminary report, the management of Ljubljana University Psychiatric Hospital
stated that they took care of the personal dignity of all patients, including those subject to SPM. The
management was of the opinion that rooms could not be divided architecturally in a way that the
rooms for supervision of SPM would be completely separated from the hallway. For this purpose,
it was also impossible to install curtains or blinds (risk of suicide). But the management would
nevertheless re-evaluate other possibilities.
The Ministry of Health agreed with the NPM’s opinion that the use of SPM in a living room and/or in
the presence of other patients was not appropriate. Regarding the application of SPM, the Ministry
has informed all psychiatric hospitals about its correct implementation several times; most recently
in letter no. 010- 27/2014/5 of 26 March 2015. In spite of these warnings, errors have continued. By the
end of 2016, the Expanded Professional Board of Psychiatry was to adopt new expert guidelines on the
application of SPM. It was expected that a uniform document for reporting on SPM would become an
integral part of the guidelines, and that the adoption of new expert guidelines would help eliminate
established deficiencies and errors in the use of SPM in psychiatric hospitals.
We repeated the earlier recommendation to Ljubljana University Psychiatric Hospital that the physical
restriction (SPM) of female patients in the living room, i.e. in the presence of other patients, may be
permitted only if this is requested by the patient.
In their response to the preliminary report, the management of Ljubljana University Psychiatric Hospital
claimed that SPM were applied in living rooms only occasionally (fixation on a lounger for patients
who gave their consent, for patients for whom sensory, social and functional stimulation was useful,
for patients who fall off chairs etc.) and to patients who consented after the staff had spoken to them.
The management thought that the complete isolation of patients in a room for SPM was not always
recommended or appropriate. Other patients frequently proved themselves to be very caring towards
restricted patients.
Exceeding time limits for informing of relatives is not permissible and is contrary to the ZDZdr; however,
according to the examined records these were not very frequent. We thus proposed that the management
of Idrija Psychiatric Hospital inform the staff about being meticulous in keeping records and timely
informing all relevant persons as determined by the Act.
In their response to the preliminary report, the management of Idrija Psychiatric Hospital stated that it
would dedicate special care to managing and keeping records related to the ZDZdr, and would regularly
remind staff of the urgency and need to keep records promptly and diligently.
Distribution of medication or therapy
The expert proposed that Idrija Psychiatric Hospital use combinations of psychotropic medications which
may lead to serious complications outside official indications and contrary to the recommendations
provided in fundamental characteristics of medications only when reasons exist for the use of such
combinations and that these reasons be carefully recorded and justified in medical documentation
together with the patient’s consent.
In their response to the preliminary report, the management of Idrija Psychiatric Hospital wrote that
during the visit the expert highlighted the comment by a person who mentioned the administration of
medication by intramuscular injection without his consent. The expert believed that the field had to be
arranged legally, and anticipated the possibility that a person was not able to understand a clarification
on receiving psychopharmacotherapy and provide their consent for the administration of the therapy.
There was a need for a systemic arrangement of the field. The management believed that a different
recommendation was described in the summary of the NPM’s findings and recommendations, which
did not comply with the initial complaint and content. The problem of prescribing combinations of
psychotropic medications outside official indications and the non-compliance with recommendations
86
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
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