1.5 Obiski posebnih socialnovarstvenih zavodov 1.5 Visits to special social care institutions Varovani oddelki in priporočila DPM Secure wards and the NPM recommendations Zavod Dom Lukavci ima dva VO, in sicer oddelek za osebe z motnjo v duševnem razvoju in oddelek za osebe z demenco. Oddelka (še) nista verificirana skladno s Pravilnikom o kadrovskih, tehničnih in prostorskih pogojih za izvajanje nalog na področju duševnega zdravja za izvajalce institucionalnega varstva ter centre za socialno delo ter o postopku njihove verifikacije. Zavod namreč prostorsko nima možnosti, da bi izpolnil vse zahteve omenjenega pravilnika, zato se boji, da bo s potekom roka za verifikacijo moral (vsaj) enega od oddelkov odpreti. Zavod pa je v fazi investicije v nov (tretji) VO, ki bo izpolnjeval pogoje za verifikacijo. Novi oddelek bo tudi omogočil sprejemanje oseb z duševno boleznijo na podlagi odločbe sodišča. Zaradi tovrstnih namestitev pa ima vrsto težav. Prihajalo je tudi do preseganja kapacitete dosedanjih VO. Na podlagi priporočil DPM s preteklih obiskov smo tako ponovno ugotavljali, da se še vedno ponavljajo težave ob nameščanju stanovalcev na VO s sklepom sodišča, na kar smo opozarjali tudi v letnih poročilih Varuha za leta 2011, 2012 in 2013 (na to problematiko opozarjamo tudi v poročilu Varuha za leto 2014). Osebe, ki so sprejete v socialnovarstvene zavode, namreč ostanejo v njih praviloma več let, zato lahko vodijo tovrstni sprejemi, ki ne upoštevajo prostorskih zmogljivosti zavoda, tudi v dolgotrajno poslabšanje bivalnih razmer in oskrbe vseh stanovalcev VO. Ob tem je še posebej nesprejemljivo, da je lahko upravičenec do enake storitve sprejet v zavod mimo liste čakajočih za sprejem, čeprav za to morda ni (zakonsko) utemeljenega razloga. Žal ob tem DPM ugotavlja, da se po večletnih opozorilih, ki so bila posredovana tudi na pristojna ministrstva, obiskani zavod še vedno srečuje s podobnimi težavami in stisko. Do sprememb ZDZdr (še) ni prišlo, zato (neustrezna) veljavna ureditev sprejemov na varovane oddelke, brez privolitve na podlagi sklepa sodišča, ostaja enaka. Dom Lukavci Special Social Care Institution has two secure wards, i.e. a ward for persons with mental disorders, and a ward for persons with dementia. The wards had not been verified in accordance with the Rules on staff, technical and premises requirements for institutional care providers and Social Work Centres providing mental health services, and on the verification procedure thereof. The institution has no spatial capacities to meet all the requirements of the above rules, and it is feared that with the expiry of the deadline for verification (at least) one ward would have to become open. The institution was in the phase of investing in a new (third) secure ward which would meet all the verification conditions. The new ward will also accept persons with mental disorders on the basis of a court order. The institution was experiencing many problems with such accommodation. The capacities of the current secure wards have also been exceeded. On the basis of NPM recommendations from previous visits, we thus again established that problems in accommodating residents in secure wards as per court orders were still occurring, which was pointed out also in the Ombudsman’s annual reports in 2011, 2012 and 2013 (we also highlight these issues in the 2014 Ombudsman’s annual report). Persons admitted to social care institutions remain there for several years, which is why admissions which fail to comply with the spatial capacities of the institution lead to the long-term worsening of living conditions of, and care for, all residents in secure wards. It is particularly unacceptable that a beneficiary of the same service may be admitted to the institution irrespective of the waiting list for admission when no (legally) founded reason exists for this. Unfortunately, the NPM further established that despite several years’ warnings, which were also submitted to the competent ministries, the visited institution was still encountering similar issues. The amendments to the ZDZdr have not been implemented (yet), and the (unsuitable) applicable arrangement of admission to secure wards without consent and on the basis of a court order remains in force. Skrb zbujajoče so bile tudi navedbe zavoda, da glede sprejemov na podlagi odločitve sodišča ne le, da ni prišlo do večjih sprememb, temveč, da glede na podatke, s katerimi zavod razpolaga, Dom Lukavci še vedno ostaja zavod, kjer prihaja do največ namestitev oseb z odločitvijo sodišča. To kaže, da prizadevanja MDDSZ, da se vzpostavi mreža varovanih oddelkov v posebnih socialnovarstvenih zavodih, ki bo enakomerno pokrila celotno območje Republike Slovenije in hkrati zagotovila zadostno število kapacitet za namestitev oseb s težavami v duševnem zdravju brez privolitve na podlagi sklepa sodišča, še niso (bila) uspešna. DPM meni, da bo MDDSZ s svojimi prizadevanji vsekakor moralo nadaljevati, dokler ne bo zagotovljeno, da bo posameznika možno namestiti v poseben socialnovarstveni zavod, kjer mu bo zagotovljena vsa potrebna oskrba glede na njegovo zdravstveno stanje in ob tem tudi ne bo prihajalo do prekoračitve najvišje kapacitete zavoda oziroma posameznega oddelka. Ob tokratnem obisku smo ugotovili, da zavod ni upošteval priporočila, ki smo ga podali že ob zadnjem obisku leta 2011, in sicer da naj prouči možnost, da se ob postelje na varovanih oddelkih stanovalcev namestijo novi klicni zvonci (sedanja stikala so poškodovana in nefunkcionalna), s katerimi bodo stanovalci lahko v stiski na varen način poklicali osebje. Zato je DPM ponovno predlagal, da se zagotovi sistem, s katerim bodo varovanci na varen način lahko poklicali osebje. Izvedenec je pri tem podal mnenje, da je možna rešitev namestitev novih stikal na steno ob varovančevi postelji, in sicer stikal, ki bi bila manj nevarna v primeru, da bi se pri varovancu pojavilo avtoagresivno vedenje, in ki bi bila manj dostopna poškodovanju ob neustrezni uporabi. Nezaželeni dogodki (incidenti) na varovanih oddelkih in priporočila DPM DPM je ob obisku ugotovil, da je bilo v letu 2013 zabeleženih 92 incidentov. Od navedenih je bilo 21 takih, pri katerih so bile opažene vidne poškodbe. Če pride do neželenih dogodkov, jih osebje opiše na posebnem obrazcu. Po mnenju izvedenca je obrazec dobro zasnovan in omogoča polstrukturirano zbiranje podatkov o neželenem dogodku. Ob posameznih kategorijah so podane črte, ki omogočajo vpis. Le pri posameznih kategorijah tako ni povsem jasno, ali se jih le izbere ali pa dopiše tudi opažanja. Če je treba le izbrati kategorijo, bi bilo zato bolje namesto črte uporabiti kvadratek. Pri tem je DPM ob podanem mnenju izvedenca zavodu predlagal ločeno spremljanje tistih incidentov, ki pomenijo večje ogrožanje varovančevega zdravja in bi bila potrebna pozornost zdravstvenega osebja z napotitvijo v drugo ustanovo, in ločeno spremljanje tistih incidentov, ki so povzročili manjše tveganje za varovančevo zdravje in prav tako ni bila potrebna napotitev na zdravljenje v drugo ustanovo. 116 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 It is worrying that no major changes occurred relating to admissions on the basis of court orders, and what is even more, on the basis of data available to the institution, Dom Lukavci Special Social Care Institution still remains the institution with the majority of accommodations based on court orders. This clearly shows that the efforts of the Ministry of Labour, Family, Social Affairs and Equal Opportunities to establish a network of secure wards in special social care institutions which would equally cover the entire Republic of Slovenia, and also provide sufficient capacities for accommodation of persons with mental disorders without consent and on the basis of a court order, have not been successful (yet). The NPM believes that Ministry of Labour, Family, Social Affairs and Equal Opportunities should continue its efforts until it is ensured that each individual can be accommodated in a special social care institution where they will receive all necessary care relating to their medical condition, and the maximum capacities of institutions or individual units will not be exceeded. On the occasion of this visit, we established that the institution had not observed the recommendation made during the last visit in 2011, i.e. to examine the possibility of installing new call bells next to beds in secure wards (the current switches were damaged and non-functional), by means of which residents would be able to safely call staff when in distress. The NPM again proposed to provide a system enabling residents to safely call staff. The expert suggested the installation of new switches on the wall by the resident’s bed, i.e. switches which would be less dangerous in the case of autoaggressive behaviour, and which would be more damage-resistant if used incorrectly. Adverse events (incidents) in secure wards and the NPM recommendations Upon the visit, the NPM established that 92 incidents had been recorded in 2013. From these, 21 resulted in visible injury. Adverse events were recorded by the staff on a special form. According to the expert, the form was well designed and enabled semi-structured collection of data on the event. In certain sections, lines were provided enabling description. In some sections, it was not fully clear whether they were to be selected or if descriptions should be written down. If sections are to be selected, it would be better to use squares instead of lines. In addition to the expert’s opinion, the NPM suggested separate monitoring of incidents which pose a greater risk to residents’ health and require the attention of medical staff or referral to another institution, and incidents which pose a minor risk for residents’ health and for which referral to another institution is not necessary. 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 117