npm annual report 2016 / observations and recommendations The psychiatric wards of South Karelia Central Hospital The NPM visited the psychiatric wards of South Karelia Central Hospital in late 2016. The NPM also visited the hospital’s outpatient and assessment clinic for mental health patients, which provides detoxification and opioid replacement therapy. A psychiatric nurse participated in the visit to psychiatric wards as an external expert. The hospital was informed in advance of a two-month period during which the visit would take place. This made it possible to obtain documents from the hospital and peruse them in advance. Before the visit, the NPM also contacted the patient ombudsman and the Regional State Administrative Agency, from whom a lot of useful information was obtained on aspects to which special attention should be paid on the visit. • In particular, the visit focused on the fact that, even if the hospital has managed to clearly reduce the use of different restrictive measures, an increase can be seen in the statistics since 2014. In the final discussion, this question was addressed, noting that the stalling of positive development may partly have taken place because the issue has not been actively brought up. • The unit did not have a plan for reducing the use of coercion in which quantitative and qualitative targets would be set for restrictive measures. The NPM noted that the unit should prepare such a plan. • Instructions for special situations had been prepared for the unit. The NPM suggested that the instructions should be turned into a user-friendly manual for the wards. This would promote consistent action by all nurses and, for example, help them understand how soon the doctors should come and check a patient. Comment: The chief physician explained that the doctors on call had been given instructions on this matter, but the nurses did not seem to know what they can expect of the doctors. • The NPM drew the unit’s attention to the fact that the ward could have several patients in the same room, while other rooms were vacant. The NPM pointed out that in the interest of the patients’ recovery it could be considered an appropriate goal to spread the patients into the rooms evenly. 63