general observations in connection with inspections
38
were forced to carry the patients to another floor and through common areas,
if the need to strap someone down arose.
The Parliamentary Ombudsmen holds that this kind of procedure is problematic in several respects. It is, e.g., unclear whether any assessment is done of
the risks that such measures pose, in the individual case, and whether there
is still a need for strapping down a patient, once the patient has been taken to
the area in question. In addition to this, the Parliamentary Ombudsmen states
that the patient is exposed to an offence when being carried through common
areas. The Parliamentary Ombudsmen questioned this method and urged
the clinic to take action as soon as possible to ensure that the use of force, deemed necessary, can be exercised in such a way as to not jeopardise a patients’
integrity and safety.52
At some clinics, so-called limitations apply, which, in brief, can mean that a
patient voluntarily comes to an agreement with the staff to, for example, stay
in his or her room. This is not a question of isolation, which is a coercive measure. The Parliamentary Ombudsmen states that the word limitation should
not be used since it could be confused with the coercive measure of isolation.
In order for the procedure of agreements on limitations to be acceptable, this
must, in the opinion of the Parliamentary Ombudsmen, be voluntary and
kept strictly separate from coercive measures. It is of great importance that it is
entirely clear to both patients and staff and that the documentation is clear.53
According to the Parliamentary
Ombudsmen, there is a need to
review the peremptory law, to clarify which coercive measures may
be used to perform compulsory
psychiatric care.
As regards to compulsory medication, it emerged that one clinic had procedures that meant that a patient kept securely could be given “an opportunity
to voluntarily accept the injection”. If the patient refuses this, the injection is
given by force. The nurse informed the patient that the injection had been
prescribed by a doctor. One employee also stated that a patient could be
strapped to a bed for preventive purposes prior to a compulsory injection and
that the patient was then often led to the isolation room. As a result of these
reports, the Parliamentary Ombudsmen emphasised the need for a review of
the compulsory care legislation. This is to clarify what compulsory measures a
senior physician should decide on, which coercive measures are required and
that the supervisory authority should be informed of the decision.54 Following
a later inspection, the Parliamentary Ombudsmen has decided that there are
grounds for monitoring this issue.55
Finally, in several cases, it has been established, that clinics are applying
provisions that make it possible to search patients at a general entrance area.
Such a check may only take place in inpatient-care establishments with an
elevated security classification and pursuant to a separate decision. In other
52 Ref. no. 2945-2017.
53 Ref. nos. 1350-2015 and 2222-2016.
54 Ref. no. 2222-2016.
55 Ref. no. 3416-2017.
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