80 health care • The seclusion facilities lacked an alarm button, a security camera, and means for the patient and staff to communicate. In the concluding discussion, the hospital staff pointed out that they considered special observation to be a more effective alternative than camera observation. The staff saw the patient every 30 minutes. The Ombudsman referred to the THL (the National Institute for Health and Welfare) guidelines to reduce the use of coercive measures, citing, for example, that the monitoring space for seclusion rooms must be one from where there is uninterrupted visual and audio contact with the patient. The Ombudsman noted that security cameras can never replace personal communication, but can be a welcome additional device adding to patient safety. According to Valvira (the National Supervisory Authority for Welfare and Health), it is not good practice to arrange monitoring exclusively by means of security cameras without the possibility for the patient to speak to the staff in person. The Ombudsman recommended that all seclusion facilities are immediately fitted with an alarm bell or a similar system so that the patients can contact a staff member without delay. The Ombudsman recommended that the seclusion facilities be furnished with fixtures that the patients cannot use to harm themselves. Follow-up: The hospital reported that it had acquired a bed-like mattress for the seclusion rooms on two wards, which already had a table and a stool. Technical communication systems will be installed in 2017. The hospital also responded that the new hospital currently under construction would have special architectural features that promote the reduction of seclusion as a care method. Other facilities • Some of the patients shared their room with one or two other patients. The Ombudsman stated that, when taking into consideration the long treatment periods of forensic psychiatric patients (average time 8 years 17 days), it should be the general goal to allocate patients to single-occupancy rooms.

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