Report on the Performance of Activities of the National Preventive Mechanism for 2017 comply with this obligation and this renders a perspective on the state of the play rather unclear. In the Dubrovnik General Hospital, in some cases, it was impossible to determine how long means of coercion were applied because the hospital staff did not appropriately record the data on the day and hour when the use of means of coercion had began and ended, nor the type of the measure as prescribed by the specialist doctor. Also, notes on supervision of restrained patients are not regularly kept with medical files. Assessment of the need for additional restraint, especially in cases of patients restrained during the night, is not carried out every four hours. The justification for such practice is questionable from a medical point of view. In addition to breaching the Ordinance, such treatment is unacceptable because restraint methods can be applied for up to several days (as is the case in the Dubrovnik General Hospital, for example) and may lead to unnecessary and unlawful restriction of rights. Plus, some of the healthcare staff applying the means of coercion are not at all familiar with provisions of the APPMD and Ordinance. For these reasons, in order to strengthen the rights and freedoms of persons with mental disorders, all psychiatric institutions should establish and keep records on the means of coercion applied against their patients and organize regular trainings for the staff regarding the application thereof. During our visits, we made note of treatment contrary to regulations and international standards, as indicated in our previous reports. For example, the restraint procedure, contrary to the Ordinance, does Although we keep emphasising it is unacceptable to put adult diapers on restrained persons, even if they do not suffer from incontinence, this degrading practice is still applied. not include five persons carrying out the process. As a rule, restrained persons are left in their rooms with other patients. Not only does this pose a security threat, but also causes feelings of low self esteem and may be regarded as degrading. In addition, although we keep emphasising it is unacceptable to put diapers on restrained persons, even if they do not suffer from incontinence, this degrading practice is still applied. Electroconvulsive therapy (ECT), applied only in the Psychiatric Clinic in Croatia, is used in modified form only, with anaesthesia and muscle relaxants. This practice is in line with the WHO recommendations and COT standards. The therapy is administered to patients with certain disorders who, in general, do not react to medical therapy or those with life-threatening side effects of use of neuroleptic medicines. The Clinic does not have general guidelines for ECT use. The healthcare staff are self-trained and we think that this is commendable, yet, all the team members applying this procedure should develop standard guidelines for preparation and application of ECT and follow-up procedures. A single record keeping mechanism should be set in place, covering indications and conditions for ECT application, as well as a detailed description of results for each individual treatment. This would allow for quality monitoring. Other patients not subject to ECT are not in a position to see the application thereof, but the Clinic does not dispose of a special room for the administration of therapy. Instead, six-bed rooms in high security wards are used for the purpose. Patients accommodated in this room who are not administered the therapy leave their beds and go to the living room only to be replaced in their beds by patients subject to ECT. According to the staff statements, after being administered the therapy, they stay for two additional hours in the room and their health status is being closely monitored. This method of applying ECT is completely inappropriate. Since only the Psychiatric Clinic administers this type of treatment, appropriate conditions must be ensured. Plus, the therapy must be applied in three rooms: 30