could be found which could be used for injuring oneself and others. In one institution41 the department was overcrowded and, therefore, both the seclusion and observation room were used as an ordinary ward. Therefore, the safety of the restrained person was not ensured because the furniture in the room was not fastened and the room could not be fully observed. Moreover, there was a risk of the restrained patient getting in the range of vision of other patients. The observation room was a small, dark, windowless room which did not provide a calming environment and felt inhuman. The Chancellor continues to be of the opinion that the safety of the patient and the staff must be ensured in the course of restraining, including on the way to the seclusion or observation room. The room intended for restraining should have a safe and calming environment in which persons cannot injure themselves. Therefore, the Chancellor still believes that the use of a restraining room as an ordinary ward endangers the safety of the patients.42 It should also be taken into account that restraining should not be visible to other patients. On this basis, the Chancellor recommended to the institutions to ensure the existence of an appropriate and safe observation and seclusion room, and use these rooms only for the intended purpose and ensure the safety of restraining. The Chancellor also recommended to ensure that restraining takes place outside the range of vision of other patients and that the route to the observation or seclusion room is safe both for the patient and the staff. 6.2. Threat to human dignity As one of the major problems among the providers of involuntary emergency psychiatric care inspected during the reporting year, the issue of ensuring human dignity of the patients arose. During two inspection visits43 it was found that the patients were not given sufficient explanations about the treatment, in one institution44 the wards lacked any furnishing besides the bed, in one institution45 the right to wear personal clothing was not ensured and in two institutions46 there were problems with free time activities and ensuring the opportunity of outdoor exercise. Section 10 of the Constitution gives rise to the principle of human dignity, which is one of the fundamental principles enshrined in the Constitution.47 The answer to the question when is a person’s dignity degraded in a manner which could amount to ill-treatment, i.e. when is the prohibition of degrading treatment under § 18 of the Constitution violated, depends to a large extent on the particular circumstances.48 41 Narva Hospital. See also the Chancellor’s 2013 Overview, p 31. 43 Wismari Hospital, Narva Hospital. 44 Tartu University Hospital. 45 North Estonia Medical Centre. 46 North Estonia Medical Centre, Narva Hospital. 47 The principle of human dignity gives rise to the requirement to treat people as subjects regardless of their current situation. This means that people should be treated with respect and they should be seen as autonomous subjects with their own will. Persons may not be seen or treated as a thing. Similarly, they may not be forced into conditions which debase their dignity as humans. 48 The duration of the treatment, its impact on the person (both physical and mental), the person’s gender, age and health, the combination of different conditions and the situation of the particular person also have to be taken into account. 42 34

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