1.3 Obiski psihiatričnih bolnišnic 1.3 Visits to psychiatric hospitals 1.3 Obiski psihiatričnih bolnišnic 1.3 Visits to psychiatric hospitals Splošno General DPM je v letu 2014 obiskal Psihiatrično bolnišnico Begunje (PB Begunje), Psihiatrično bolnišnico Ormož (PB Ormož) in UKC Maribor, Oddelek za psihiatrijo (Oddelek za psihiatrijo), ločeno pa tudi enoto tega oddelka za forenzično psihiatrijo (Enota za forenzično psihiatrijo). Pri slednji je šlo za prvi obisk, preostale ustanove pa je DPM obiskal že v preteklosti, in sicer zadnjič PB Begunje in PB Ormož leta 2011, Oddelek za psihiatrijo pa leta 2010. Vsi obiski so bili osredotočeni na oddelke pod posebnim nadzorom, opravljeni so bili brez predhodne napovedi ob sodelovanju predstavnikov nevladnih organizacij in zunanjega izvedenca psihiatrične stroke, ki je o svojih ugotovitvah pripravil izvedensko mnenje. Tudi v tem letu smo na podlagi obiska pripravili najprej predhodno poročilo. Po odzivu PB Begunje in Oddelka za psihiatrijo smo pripravili še končno poročilo, ki je bilo (oziroma bo) posredovano tudi Ministrstvu za zdravje RS in Republiškemu strokovnemu kolegiju za psihiatrijo pri tem ministrstvu. Ker sta bila obiska PB Ormož in Enote za forenzično psihiatrijo opravljena v drugi polovici leta, na odgovor PB Ormož na predhodno poročilo v času priprave tega poročila še čakamo, poročilo o obisku Enote za forenzično psihiatrijo pa je še v pripravi. In 2014, the NPM visited Begunje Psychiatric Hospital, Ormož Psychiatric Hospital, and Department of Psychiatry of Maribor University Medical Centre, and additionally also a unit of this department, i.e. Unit for Forensic Psychiatry. The latter was visited for the first time, while the NPM had already visited other institutions in the past, i.e. Begunje and Ormož psychiatric hospitals in 2011 and the Department of Psychiatry in 2010. The visits focused on secure wards, and were unannounced and implemented in cooperation with the representatives of NGOs and an external expert of psychiatry, who prepared an expert report on their findings. In 2014, we first prepared a preliminary report on the basis of the visit. Following the response of Begunje Psychiatric Hospital and the Department of Psychiatry, we drafted a final report which was (or will be) submitted to the Ministry of Health of the Republic of Slovenia and the Psychiatric expert council of Republic Slovenia at the above Ministry. Because Ormož Psychiatric Hospital and the Unit for Forensic Psychiatry were visited in the second half of the year, we were still waiting for a reply from Ormož Psychiatric Hospital to our preliminary report during the preparation of this report, while the report on the visit to the Unit for Forensic Psychiatry was still in preparation. Namen obiska DPM je bil, da na krajih odvzema prostosti (kot so opredeljeni v 4. členu Zakona o ratifikaciji Opcijskega protokola h Konvenciji proti mučenju in drugim krutim, nečloveškim ali poniževalnim kaznim ali ravnanju – MOPPM) preveri ravnanje z osebami, ki jim je bila odvzeta prostost, da bi se okrepilo njihovo varstvo pred mučenjem in drugimi oblikami okrutnega, nečloveškega ali poniževalnega ravnanja ali kaznovanja. Če je treba, daje priporočila ustreznim organom, da bi izboljšali razmere in ravnanje z osebami, ki jim je bila odvzeta prostost. DPM lahko predloži tudi predloge in pripombe k veljavnim ali predlaganim zakonom. Glavni namen obiskov psihiatričnih bolnišnic pa je bil ponovno preveriti ravnanje z osebami, nastanjenimi na oddelkih pod posebnim nadzorom, in pregled uresničitev naših predlogov v zvezi s prejšnjimi obiski DPM. The purpose of the NPM visits was to review the treatment of persons deprived of liberty in places of deprivation of liberty (as defined in Article 4 of the Act ratifying the Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment – MOPPM) in order to enhance their protection from torture and other forms of cruel, inhuman or degrading treatment or punishment. If necessary, recommendations are submitted to suitable bodies in order to improve the conditions and treatment of persons deprived of liberty. In this regard, the NPM may also submit proposals and comments to applicable or draft acts. The main purpose of the visits to psychiatric hospitals was to re-examine the treatment of persons accommodated in secure wards and to review the realisation of our proposals relating to previous NPM visits. (Ne)izpolnitev bistvenih priporočil DPM, podanih ob preteklih obiskih (Non-)fulfilment of key NPM recommendations provided during previous visits V PB Begunje smo ob tokratnem obisku pozdravili namestitev nekaj večjih slik na ženskem oddelku pod posebnim nadzorom, a hkrati opozorili, da so hodniki in drugi skupni prostori, v največji meri pa tudi sobe, še vedno sterilno beli. Na moškem sprejemnem oddelku sta bili ob našem obisku še vedno dve zasilni postelji nameščeni na hodniku, torej brez možne zasebnosti, kar je še posebej skrb zbujajoče, če se uporabljajo tudi za primer povečanega nadzora nad posameznim pacientom. Na obeh oddelkih pod posebnim nadzorom so pacienti še vedno v pižamah, čeprav je DPM že ob prejšnjem obisku opozarjal na neprimernost takšnega načina oblačenja. Bolnišnica nam je zagotovila, da tudi na podlagi opozorila DPM ob prejšnjem obisku spoštuje zahtevo Zakona o duševnem zdravju (ZDZdr) o obveščanju zastopnika v roku štirih ur od sprejema pacienta. Na oddelkih so obešena pojasnila o tem, kakšna je vloga zastopnika in kako lahko pomaga pacientu, vključno z navedbo zastopnikov za območje bolnišnice in njihovimi kontaktnimi podatki. Tudi ob tokratnem obisku smo ugotovili, da oznake na nabiralnikih za pritožbe ostajajo enake, zato še vedno obstaja možnost, da se pacient pri oddaji zmoti. We commended the installation of more pictures in the female secure ward in Begunje Psychiatric Hospital, but we also noted that corridors and other common areas, including the majority of rooms, were still sterile white. Two provisional beds were still situated in the corridor of the admissions ward for men, which offered no privacy, and this is particularly worrying if they are used also in the case of increased supervision of a certain patient. The patients in both secure wards were still in their pyjamas, although the NPM had already pointed to the unsuitability of such clothes during the previous visit. The hospital assured us that, on the basis of the NPM’s last warning during the previous visit, it was complying with the requirement of the Mental Health Act (ZDZdr) on notifying a representative within four hours of the admission of a patient. Clarifications were provided on wards about the role of the representative and how they could help patients, including the provision of representatives for the area of the relevant hospital and their contact data. During this visit, we also established that the labels on collection boxes for comments and complaints were the same and there was still the possibility that a patient might make a mistake when submitting their complaint. Na Oddelku za psihiatrijo smo znova ugotovili, da razpoložljive posteljne kapacitete in tudi drugi prostori oddelkov pod posebnim nadzorom bolnišnice pacientom nudijo zadosten bivalni prostor zgolj v primeru, če v posamezni sobi ni nameščene zasilne postelje. Z njo se namreč utesnjenost v sobi poveča, prostor, ki ga ima posamezen pacient, pa močno skrči. Tudi ob tokratnem obisku smo na oddelkih pod posebnim nadzorom pri pacientih opazili različno prakso nošenja dnevnih oblačil. Tako so bili vsi pacienti v gerontopsihiatrični enoti v spalnih oblačilih oziroma bolniškem perilu (pižamah); pacienti so bili delno v spalnih oblačilih tudi v moški sprejemni enoti. Tudi v tem primeru smo (znova) opozorili na neprimernost takšnega načina oblačenja. Ob zadnjem obisku smo opozorili, da bi bila za preprečevanje padcev z invalidskega vozička bolj kot uporaba improviziranih sredstev primerna namenska sredstva (npr. pettočkovni pasovi ali posebni predpasniki), vendar smo tokrat znova opazili pacientko, pri kateri je bilo varovanje izvedeno s kosom oblačila. 78 poročilo o izvajanju nalog DPM v letu 2014 DržavnI preventivnI mehanizEm po Opcijskem protokolu h Konvenciji OZN proti mučenju in drugim krutim, nečloveškim ali poniževalnim kaznim ali ravnanju At the Department of Psychiatry, we again discovered that the available accommodation capacities and other premises of secure wards provided only sufficient living space for patients when no provisional beds were installed in individual rooms. These increased the claustrophobia in the room and space available for every patient had thus shrunk. On the occasion of this visit, we also noticed that patients in secure wards wear different day-time clothes. The patients in the geronto-psychiatric unit were in pyjamas and patients in the admissions unit for men were also partly in pyjamas. In this case, we (again) highlighted the unsuitability of such clothes. During our last visit, we pointed out that special purpose devices (e.g. five-point straps or special aprons) would be more suitable for the prevention of falls from wheelchairs than the application of improvised means; however, we again noticed a female patient who was protected with a piece of clothing. IMPLEMENTATION OF THE DUTIES AND POWERS OF THE NPM IN 2014 National Preventive Mechanism under the Optional Protocol to the UN Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment 79