1.3 Obiski psihiatričnih bolnišnic 1.3 Visits to psychiatric hospitals To pojasnilo PB Begunje nas je presenetilo. Do prekoračitve kapacitete posameznega oddelka seveda lahko pride zaradi velikega števila pacientov, ki jih je treba urgentno namestiti na oddelek pod posebnim nadzorom. Ker pa bolnišnica nameščanje na postelje v skupnem prostoru opravičuje (tudi) z razlogom varnosti pacientov, smo poudarili, da samo dejstvo o novih namestitvah še ne more biti zadostno opravičilo za namestitev paciente v prostor, kjer so stalno na očeh drugih pacientov in tudi osebja. V nekaterih primerih pa naj bi namestitev na te postelje zahteval razlog varnosti. Tako je bil tudi ob obisku DPM en pacient nameščen na tej začasni postelji, čeprav so bile še vedno proste kapacitete v sobah. Prvič smo se v slovenskih psihiatričnih bolnišnicah srečali s takšnim načinom zagotavljanja »varnosti«. Čeprav bo na vprašanje o ustreznosti takšne namestitve vsekakor morala odgovoriti stroka, pa se nam postavlja vprašanje, ali je primer, ko se (ne)varni pacient izpostavi stalnemu pogledu in morebitno drugim dražljajem s strani drugih pacientov, brez možnosti, da se ta umakne v »svojo« sobo, hkrati pa se tudi ne izvaja stalen nadzor s strani osebja, res najbolj primeren. We were surprised by this clarification from Begunje Psychiatric Hospital. The large number of patients who require urgent accommodation on the secure ward may exceed the capacities of individual wards. Because the hospital justified the installation of beds in a common living area (also) with the safety of patients, we stressed that new accommodation could not be a sufficient justification for accommodating patients in an area where they were constantly being watched by other patients and staff. In some cases, safety could be a reason for accommodating patients in this area. Thus, one patient was accommodated in a provisional bed at the time of the NPM visit, although, there were free capacities in rooms. This was the first time we had encountered this manner of ensuring “safety” in Slovenian psychiatric hospitals. Experts will nevertheless need to address the suitability of such accommodation; but we wonder about the suitability of exposing a (dangerous) patient to continuous observation or any other stimuli from other patients without the possibility of retreating to their own room, whereby continuous supervision by the staff is also not being implemented. Oddelek za psihiatrijo pa je pojasnil, da so doslej problem prezasedenosti že reševali, in sicer z nameščanjem v drugo ustanovo, če je bilo to mogoče. V primeru prezasedenosti tudi v drugih podobnih ustanovah pa bodo še naprej nameščali začasne postelje. It was explained by the Department of Psychiatry that they had resolved the issue of overcrowding by transferring patients to another institution if possible. In the case of overcrowding in other similar institutions, they would still accommodate patients in provisional beds. Predlagamo, da bolnišnice dajo večji poudarek opremi sob pacientov, vsekakor pa predvsem tudi okrasitvi hodnikov in drugih skupnih prostorov z izdelki pacientov, ki imajo estetsko (pa tudi optimistično) vrednost. Ob tem pozdravljamo prizadevanja, da bi se stene oddelkov prebarvale v tople, pastelne barve. We propose that hospitals pay more attention to decorating patient rooms and particularly corridors and other common areas with patients’ handicrafts because this has an aesthetic (and also positive) value. We also commend the efforts to paint walls in warm pastel colours. PB Begunje je pojasnila, da bi bila namestitev slik ali določenih drugih predmetov za posamezne paciente lahko nevarna, nameščanje okrasnih tapet ali stenskih poslikav pa ni mogoče zaradi higienskih norm, ki jih morajo kot bolnišnica izpolnjevati, pa tudi zaradi požarne varnosti. Slednje so ob akreditaciji izpostavili tudi mednarodni presojevalci. Begunje Psychiatric Hospital clarified that the installation of pictures or other objects could be dangerous to certain patients, while the installation of decorative wallpaper or painting was not possible due to hygienic norms which the hospital had to meet, and also due to fire safety. The latter was also highlighted by the international evaluators. Strinjali smo se s pojasnilom PB Begunje, da je vsekakor treba ob izbiri okrasnih predmetov, s katerimi bi se polepšali skupni prostori in tudi sobe pacientov, v prvi vrsti upoštevati vidik varnosti. Vendar že namestitev slik na ženskem oddelku pod posebnim nadzorom kaže, da je ustrezna okrasitev z nekaj truda in razmisleka možna. Zato prizadevanja za pacientom čim bolj prijazno bivalno okolje podpiramo. We agreed with the clarification of Begunje Psychiatric Hospital that the safety aspect must be observed first in the selection of decorative objects which would enliven common areas and patient rooms. However, the arrangement of pictures in the female section of the secure ward proved that decoration was possible with a little effort and careful consideration. We thus support the efforts to create as patient-friendly a living environment as possible. Oddelek za psihiatrijo pa je pojasnil, da so hodnike in deloma sobe v enoti D dodatno opremili z izdelki pacientov in namestili znake na vrata sob pacientov; v sprejemnih enotah (enoti A1 in A2) pa še iščejo rešitev za namestitev opreme, ki mora biti tudi varna – nesnemljiva, brez steklenih delov. Predlagamo, da bolnišnice pacientom tudi na oddelkih pod povečanim nadzorom omogočijo nošenje dnevnih oblačil (bodisi lastnih bodisi takšnih, ki jih zagotavlja bolnišnica) in jih v čim večji meri seznanjajo z možnostjo nošenja takšnih oblačil ter jih pri tem spodbujajo, razen tedaj, ko to otežujejo ali celo onemogočajo posebnosti zdravstvenega stanja posameznega pacienta. PB Begunje je pojasnila, da se nočna oblačila (pižame) uporabljajo na oddelkih pod posebnim nadzorom predvsem zaradi higienskih razlogov v skladu s priporočili Komisije za obvladovanje bolnišničnih okužb. Bolnišnica je pojasnila, da so začeli s projek za uvedbo oziroma nabavo ustreznih materialov za paciente, ki jih bodo nosili prek dneva tudi na intenzivnih oddelkih. Odločitev o nošenju teh oblačil bo prepuščena pacientom, kar pomeni, da se bodo svobodno odločili, kaj bodo želeli imeti oblečeno v času hospitalizacije. Že sedaj pa se pacientom, če jim je omogočen kratek izhod za osebni opravek, glede na vremenske pogoje, zagotavljajo ustrezna obutev in lastna oblačila. Bolnišnica je poudarila, da je ob nošenju pižame pri pacientih bistveno lažje vzdrževati higieno pacientov, predvsem pa naj bi bil poudarek na varnosti, saj naj bi bil v primeru nošenja pižame vnos nevarnih predmetov na oddelek otežen. 86 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 The Department of Psychiatry explained that corridors and some rooms in Unit D were additionally decorated with patients’ work, and labels were installed on room doors; they were still exploring solutions for installing equipment in admissions units (units A1 and A2) which must also be safe, nonremovable and without glass parts. We suggest that hospitals also enable patients in secure wards to wear day-time clothes (their own or provided by the hospital) and inform them of the possibility of wearing such clothes and encourage them to wear such clothes, except when the patient’s medical conditions aggravate or even prevent this. Begunje Psychiatric Hospital explained that night clothes (pyjamas) were used in secure wards for reasons of hygiene in compliance with the recommendation of the Commission for the control of hospital infections. The hospital explained that a project to implement or purchase suitable materials for patients to be worn during the day also in intensive care departments had already begun. Patients would be free to decide what clothes they want to wear during hospitalisation. Suitable footwear and their own clothes were already being provided to patients who go on personal errands, depending on weather conditions. The hospital emphasised that by wearing their pyjamas the patients maintain hygiene much more easily and safety is also better, since they cannot bring hazardous objects to the ward so easily if they are wearing pyjamas. 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 87