Observation rooms (rooms for mechanical restraint) in some hospitals still do not
comply with requirements. The observation rooms at Wismari Hospital and Tartu
University Hospital psychiatric clinic were not safe and the privacy of restrained
persons was not ensured. Access by unrestrained patients to mechanically
restrained patients should be avoided, and restraint should not take place in the
sight of other patients. A member of the medical staff should always be present
beside a mechanically restrained patient.
Records of instances of applying means of restraint should always contain a fairly
detailed description of reasons for applying the measure, as well as the
circumstances that justify continued restraint. A brief note that a patient was
restless or aggressive is not sufficient, because this does not indicate what exactly
it was that presented a danger. In addition, chemical restraint should always be
properly recorded.
2.
Institutions providing a 24-hour special care service
During the reporting period, the Chancellor also inspected two special care
institutions: Valkla Home (where 100 clients were receiving a 24-hour special care
service under court authorisation) and Sõmera Home (where 356 clients were
receiving a 24-hour special care service, including 42 clients with profound
multiple disability).
The twenty-four-hour special care service financed from the state budget is
intended for those in need of daily guidance, counselling, assistance, and
supervision due to their mental health condition. Referral to the service of persons
diagnosed with a mental disorder, severe or profound disability and incapacity for
work in addition to the above needs is based on a rehabilitation plan.
Use of the 24-hour special care service is voluntary, but those who could pose a
danger to themselves or others due to their mental health are involuntarily
consigned to the service in a closed institution under a court ruling. There the
individual is under the constant supervision of the service provider and is not free
to leave the grounds of the institution. A twenty-four-hour special care service
under a court ruling is provided to minors in three locations and to adults in one
location (Valkla Home). Estonia has a total of 47 24-hour special care service
institutions, with 2699 residents as at the end of 2016 (including 110 persons
referred to a closed institution under a court ruling).
During inspection of special care institutions this year, the Chancellor reviewed
whether the freedom of movement of residents was restricted (e.g. by locking
them in rooms, securing them to their beds) and how means of restraint were
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