to be in open air and to ensure for each child in the centre who so wishes an opportunity to spend time in open air every day. 6. Providers of involuntary emergency psychiatric care During the reporting year, the Chancellor inspected four institutions providing involuntary emergency psychiatric care: - Tartu University Hospital Foundation (case No 7-9/140630) - Wismari Hospital Ltd (case No 7-9/141043) - North Estonia Medical Centre Foundation (case No 7-9/141289) - Narva Hospital Foundation (case No 7-9/150158) The inspection visits to providers of involuntary psychiatric care were unannounced. The Chancellor involved a psychiatrist as an expert in the visit to the North Estonia Medical Centre. The expert did not find any signs of ill-treatment of the patients and concluded that the psychiatric care in general complied to the requirements. However, upon assessment of the circumstances in aggregate the expert reached an opinion that psychiatric care was provided in an outdated building not suitable for the provision of modern intensive psychiatric care. In all the four inspected institutions problems with the appropriateness of the rooms used for restraining and with ensuring human dignity of the patients were found. In addition, the Chancellor identified once again shortcomings with regard to the lack of privacy35 and insufficient documentation of the use of means of restraint36. In the following part, the main above shortcomings and the Chancellor’s recommendations for remedying them are described in more detail. The inspected institutions have taken steps to remedy most of the problems pointed out by the Chancellor. 6.1. Appropriateness of the observation and seclusion room During the reporting year, there were still problems with the conformity of the rooms used for restraining by the providers of involuntary emergency psychiatric care. In case of three institutions, there was a suspicion that a restrained patient could remain in the range of vision of other patients.37 Two institutions lacked a seclusion room.38 In one of them, patients were secluded in the observation room which had beds and radiators attached to the wall, and therefore the safety of seclusion could not be ensured. In one hospital39 both the restrained patients and patients under supervision who were not restrained stayed in the observation room; in another hospital40 the route of taking patients to the observation room was not sufficiently safe in the opinion of the Chancellor, as it involved movement through several rooms (including a narrow corridor) where, inter alia, loose objects Tartu University Hospital, North Estonia Medical Centre, Narva Hospital. See also the Chancellor’s 2013 Overview, p 31. 36 Tartu University Hospital, Wismari Hospital, Narva Hospital. 37 Wismari Hospital, Narva Hospital, North Estonia Medical Centre. 38 Tartu University Hospital, North Estonia Medical Centre. 39 Wismari Hospital. 40 North Estonia Medical Centre. 35 33