fundamental and human rights �.� national preventive mechanism against torture of time. This permits the NPM to request materials from the unit in advance. For example, psychiatric units have been requested to deliver lists of basic patient information, such as the date of admittance, legal status, psychiatric diagnoses and significant somatic diagnoses, for each ward. The list permits the NPM to form an overall picture of the ward’s patients in a short time. The information also helps with choosing patients for interviews – e.g. the patient last admitted to the ward, or the patient who has spent the longest time in the ward. The care staff play a major role in the prevention of mistreatment. For this reason, the inspection visits pay a great deal of attention on procedures, the forms used and the orientation and instruction of employees. A draft of the visit report, containing the Ombudsman’s preliminary opinions and recommendations, is sent to the visited facility, which has the opportunity to comment on the draft. In many cases, the health care unit reports on the measures it has taken on the basis of the Ombudsman’s preliminary recommendations already at this stage. The Ombudsman welcomes this development as an indication of constructive dialogue. The NPM made a total of ten visits to healthcare units. The visits to VTH were announced in advance. The other visits were made with the limited announcement described above or were completely unannounced. Visits to the larger units lasted 2–3 days. The NPM made visits to the following units (the opinions and responses of the units also include the visit to the psychiatric unit of the Päijät-Häme Joint Authority for Health and Wellbeing, 5338/2017): The sites visited were: – VTH outpatient clinic in Kerava, 30 January 2018, (450/2018) – Psychiatric unit of Kainuu Central Hospital, 19–20 March 2018, 50 beds (727/2018) – Kainuu Central Hospital emergency clinic, 19 March 2018 (729/2018) – Psychiatric unit of North Karelia Central Hospital, 22–24 May 2018, 97 beds (1600/2018) – North Karelia Central Hospital emergency clinic, 23 May 2018 (1601/2018) – Niuvanniemi Hospital, 25–27 September 2018, 297 beds (3712/2018) – Niuvanniemi Hospital’s research and treatment unit for underage children, the NEVA Unit, 25 September 2018, 13 beds (3713/2018) – KYS joint emergency clinic, 26 September 2018 (4753/2018) – VTH outpatient clinic in Pyhäselkä, 10 October 2018 (4986/2018) – VTH outpatient clinic in Helsinki, 29 November 2018 (5323/2018) Prevention of the mistreatment of patients Closed institutions always involve the risk of mistreatment of their patients. Such institutions must employ preventive structures and practices for preventing mistreatment. One such practice is a generally known procedure for reporting mistreatment. In the opinion of the Ombudsman, the unit should have clear instructions for reporting mistreatment and on how such reports will be processed and what will be done to intervene. This also requires that mistreatment is correctly identified and defined, and that a clear position is taken by the management that mistreatment is unacceptable and will always lead to consequences. All hospital employees – not just the nursing staff, but all other professions and substitutes as well – should be instructed in the use of the reporting procedure. Patients and their families should also be notified of the instructions. At the same time, it should be made clear that making a report must never lead to any negative consequences for the person making it (5338/2017, 3712/2018). The authority reported that its development and patient safety unit will consider the reporting procedure issue mentioned in the feedback at the level of the entire authority and seek to find a technological solution for its implementation. In the meantime, the psychiatric ward units have agreed that matters involving mistreatment shall be reported to the patient ombudsman. The patient ombudsman will attend the head nurse meeting at which the pro- 117