The Seimas Ombudsmen have evaluated restrictions applied to patients of a psychiatric hospital

The Seimas Ombudsmen of the Republic of Lithuania have assessed application of restraints and restrictions to the rights of hospitalized patients of Forensic Psychiatric Hospital in Rokiškis.

The hospital provides health care services, among others, to persons, who having committed an act dangerous to the public have been recognized as being of diminished responsibility by the court as well as individuals, who after performing a criminal act or after hearing a sentence became mentally ill and for this reason are not able to understand the meaning of their actions or control them. Such patients are assigned coercive medical measures – inpatient treatment in a specialized mental health facility. Patients treated in this hospital are applied two types of constraints: lock belts and medical treatment in an intensive care room (hereinafter referred to as ICR). In addition, patients are subject to restrictions on freedom of movement and in some cases to restrictions on individual rights such as the right to communicate and meet with relatives.

First of all, during the inspection a particular lack of psychiatrists responsible for the application of restrictive measures on patients was observed: there were only 19 psychiatrists for 391 patients (as of 24-07-2013). Nevertheless, work of the staff of hospital divisions is well organized; patients treated at this hospital are looked after by qualified personnel with the knowledge how to deal with a patient in cases of deterioration of his/her mental state. Moreover, hospital staff tries to help the patients to overcome their mental disorders and patients do not have complaints concerning the staff behaviour.

 

However, the inspection initiated and carried out on the initiative of the Seimas Ombudsmen also revealed some drawbacks. The legal background for application of restrictive measures, which is established in internal documents of the hospital, contradicts provisions of the national law. Application of restrictive measures (transfer to the ICR) was observed:

1 ) the decision on application of these measures is possibly taken not only by a psychiatrist, but also by a middle-level medical staff and filling of medical documentation is possibly performed improperly;

2) not all cases of application of restrictive measure are registered or their descriptions are incomplete (for example, an applied restrictive measure is recorded only in the nursing history and there is no mention of the start and (or) end of its application);

3) patients are not always informed about the reason for being transferred to the ICR and the transfer is not entered in their medical records;

4) effect of the restrictive measure and the necessity of its further application are neither specified, nor monitored;

5) in some cases, a restrictive measure was applied for an unreasonably long period of time ( e.g. month), which raises a doubt as to whether a restrictive measure applied for such a period of time may be adequate, taking into account the patient's mental condition and his/her treatment methods;

6 ) transfer to the ICR usually implies application of restrictions to all of the persons rights (to interact with other people and patients, to use telephone and other means of communication, to meet visitors, to send and receive messages, to buy and to get necessary objects, to study, to read, to take sports and be involved in other leisure activities, etc ). Moreover, quite a few patients complained that there were no guided walks while staying in the ICR;

7) a big number of beds, in some ICR there were five, which possibly does not guarantee adequate monitoring conditions as well as effective treatment and protection of patients transferred to the ICR;

8) patients transferred to the ICR had unequal conditions to use a WC;

9) patients of a different legal status are held in the same room - new patients with the court assigned coercive medical measures and whose state of mental illness has not deteriorated are held together with patients of deteriorated mental condition and who are being treated in the hospital for some time already.

Inspection at the hospital has also revealed some other drawbacks: the right of movement of patients treated at strict and enhanced monitoring conditions is severely restricted, e.g. patients are all day held in locked-up rooms and such stay is unfavourable for their treatment and welfare; the right of hospital patients to engage in sports is limited because those patients who wish to go to the gym must obtain a permission from the Commission; a right of the patients treated at strict and enhanced monitoring conditions to engage in sports on dynamic simulators accessible in the corridors is limited to 20 (twenty) min.; a proper order to appeal to the administration of the hospital as well as the order of investigation of received complaints is not guaranteed, the patients are not adequately informed to whom and how they can submit complaints regarding possible violations of their rights.

After taking into consideration the established drawbacks, the following recommendations were submitted to the Head of the Hospital:

· To amend internal regulations of the hospital in order to eliminate the grounds for applying restrictions inconsistent with the provisions of the law and for the patients with a deteriorated mental state who may pose a significant danger to themselves or others to apply only those legal restrictions and only for such a period of time that is necessary for improvement of their condition;

· To secure that a decision regarding application of restrictions to a patient is taken only by a psychiatrist and the patients are informed about the reasons for application of restrictions and their expected duration;

· To guarantee that all the cases of application of restrictions are recorded in writing and an effect of an assigned treatment as well as a necessity of its further application is recorded at least once a day;

· To create conditions for proper registration and investigation of received applications;

· To take into account recommendations of the international legal acts, irrespective of a person’s mental health state, not to limit his/her right to lodge a complaint, to contact the relevant authority and (or) an attorney, to send letters; moreover, to provide an opportunity not only to seek necessary medical and psychological knowledge, but also to become better acquainted with human rights.