National Preventive Mechanism representatives of residents. In some cases, however, there has been a lack of structured approach and a more fundamental examination of potential measures that restrict freedom. They were not even recognised as such measures. These cases involved both electronic measures (body pressure alarm systems or video monitoring) as well as mechanical measures, such as inclined bed side guards, bed exit sensors, tightened wheelchair brakes and bed side guards used in low-profile beds. The NPM welcomes the fact that the facilities that have been subject to criticism have subsequently introduced improvements to documentation, carried out staff training and also liaised with the representatives of the residents. The relevant suggestions made by NPM experts have as a rule been received as a positive impulse and implemented constructively. Restrictions of freedom through psychotropic medication are a particularly sensitive issue. The problem that arises here is the need to distinguish carefully between medication that is recommended as part of treatment (with side effects) and aspects involving restrictions of freedom. Provided that clearly defined indications are complied with and subject to continuous supervision, psychotropic medication is at times indispensable in treating symptoms and re-establishing quality of life. However, there is a high risk that inappropriate medication which restricts freedom may be used in nursing homes. Mediaction-based measures that restrict freedom Nursing staff (and not only nursing staff) often perceive any questioning of the administration of medication that may potentially have the effect of restricting freedom as a personal affront and claim that it is a necessary part of residents’ treatment. However, upon closer examination it becomes apparent that it is more the structures in which nursing care is provided that lead to problems within everyday nursing and make the usage of measures that restrict freedom appear to be a reasonable solution. Although the prescription of medication falls exclusively under the competence of doctors, in practice the initiative is frequently taken by nursing care staff. As there is not enough time for individual attention, nursing staff see medication as an opportunity to eliminate troublesome “disturbances” in the operation of the home and to ensure that homes are run in an orderly fashion. It is thus clear that psychotropic medication may be recommended less following conscious consideration of restrictions of freedom and more as a way of getting by with limited resources. However, if the usage of a medication is instructed primarily “in order to suppress movement” (where the symptoms of mental illness include excessive movement), this will constitute a medication-based restriction of freedom and must be reported to the representative(s) of the residents. It is therefore necessary to assess whether a situation involves a restriction of freedom or merely medical treatment with reference to the direct reason for the administration of medication. If it is necessary to respond to a specific hazard, any additional therapeutic considerations that are made 115