National Preventive Mechanism number and training of the personnel as well as their disposition, attitudes and response strategy when dealing with violence and aggression. Unfavourable environmental factors caused by hyper-stimulation, noise, little private sphere and possibility to retreat, rigid ward regulations, constantly changing contact persons and humiliation brought about by a manner perceived as authoritarian, too expectant or indifferent can provoke pressure, fear, tension or disorientation in highly stressed patients. This encourages aggressive outbursts. Regular analyses of risk behaviour and risk situations, dedicated and standardised verbal and non-verbal de-escalation techniques through the provision of space, time, interviews, opportunities to move, physical relaxation, etc. create possibilities for reducing aggression and are measures which have been proven in practice. Central recording of measures that restrict freedom Only analysis of the context in which coercive measures are set makes it possible to identify the opportunities and limits of reducing violence. It is not currently possible to compare the involuntary hospitalisation or forced intervention on a national level due to a lack of the relevant data and research. The NPM is of the opinion that the introduction of benchmarking for coercive measures in psychiatric clinics would improve transparency considerably in this area and would be of key importance in both quality management in hospitals and in terms of safeguarding human dignity and the legal status of the patients. The NPM has thus, in line with the permanent recommendations of the CPT, repeatedly pointed out that an anonymised central register for recording measures that restrict freedom is the condition for an effective and systematic prevention strategy aimed at reducing such measures. Only in this way can routines in dealing with measures that restrict freedom be measurable and comparable from clinic to clinic. The commissions determined again in the reporting year 2016 that central registers were still not extensively in place in the medical facilities. In view of this standstill and in spite of the efforts made to date, the NPM considers that it is necessary to compel the hospitals by legislative changes to set up relevant registers within a reasonable period of time. The NPM will thus again approach the Federal Ministry of Health and Women’s Affairs with this topic and point out the necessity for a change in the law. Discussion about coercive measures with patients 120 A further fundamental aspect in the successful treatment of mentally ill patients is the establishing of a stable therapeutic relationship. This requires actively interacting with the patient including informing and involving them in the decision making processes. This increases the patients’ willingness to receive treatment, fosters their personal responsibility and social skills and makes post-hospital re-socialisation easier. From the professional and human rights perspective, more attention should be paid to the processing and debriefing of experiences with severe measures that restrict freedom (e.g. restraints, single room restrictions, medication) in the team, but above all with directly affected patients. This should be established as a standard in all Austrian clinics.

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