their duty to treat and protect on one hand and the existing treatment possibilities and available resources on the other, more reflection and open discourse is needed about perspectives and requirements of psychiatric treatments that give as much room as possible to – or even expand – the autonomy and freedom of persons with mental disorders. Solely adequate numbers of well trained and confident staff can if not prevent then at least reduce the development of aggression within a system and deal professionally and competently (while applying techniques to de-escalate tensions) with agitated and aggressive patients and protect themselves at the same time. Much too little is being invested in Austria in the development, research and use of preventive measures and alternatives to coercive treatment. Operators of hospitals and psychiatric institutions must ensure – as far as personnel, concept and organisation are concerned – that there be as many graduated response possibilities with regard to intervention intensity as possible before coercive measures are used. The guiding criteria for professional action must be the principles of voluntary action, (assisted) self-determination, participative decision-making as well as intensive care and occupational activity – if necessary during acute crises at a ratio of 1:1. This requires resources, patience and personal attention, equal footing between staff and patient, respectful attitude vis-à-vis individual life patterns, as well as ongoing qualification of staff in dealing with crisis situations, violence and aggression. De-escalation can take place at various different levels. It begins with prevention of aggression, in a conversation that seeks to calm an agitated patient and then ranging from conflict resolution without losers to restraints, which must be used with the least invasive impact on the patient while maintaining the patient’s dignity. This is what the principle of proportionality under the Federal Constitution requires, according to which sovereign acts by the state in order to achieve an overriding goal in the public interest must be suitable, necessary and reasonable for those impacted by them. Any coercive measure is excessive if a milder directive that is just as suitable is sufficient to achieve the desired level of success. Interference with the right to personal freedom and other personal rights may not be more dramatic than is necessary with regard to substance, space, time and personnel. Multi-dimensional prevention of violence neglected The fact that criticisms with reference to human rights have up to now not been systematically taken as an opportunity by operators of hospitals and medical facilities to implement a number of relevant recommendations by the CPT, which the NPM has repeatedly pointed out, is cause for concern and must remain on the NPM’s radar. In dayto-day psychiatric care in most Austrian clinics, it is, for example, unfortunately not customary that patients be supervised 1:1 “constantly, directly and personally” after they have been restrained as the CPT has been demanding for years. This intensive care must not be understood as a purely supervisory measure because it also offers a high degree of therapeutic potential; video monitoring systems and frequent rounds CPT recommendations requiring more resources not implemented 39