1. Pilot project on reducing use of restriants and coersive methods in Estonia Eve Pilt Advisor for Health Board 14.12.2013

2. Our Pilot team on April 03,2014 in Rõngu

3. Contributors to the Pilot Eve Pilt Estonian Health Board); Rosemary Smyth (director Director of Standards and Quality Assurance Training and Development at Mental Health Commission Ireland ); Hanna Ahonen (Counsellor of Social Welfare at Valvira); Thijs Melchior (Inspector IGZ elderly care Netherlands ); Marjolein van Vliet Senior programme officer, Quality and Innovation at Care for the disabled; Jooske Vos (EPSO) Mari Murel ( translator Dutch – Estonian and English – Estonian) Juta Varjas – Estonian Health Board Inge Mäe- Estonian Medicines Agency

4. General goal -To reduce and prevent unnecessary restraints and coercive methods in the EPSO member countries, and -If restraints or coercive methods are necessary, the use should be subject to stringent conditions in terms of quality and safety.

5. Goals of the pilot project in Estonia -To test applicability of EPSO framework for monitoring and supervisory organisations and for care providers in different settings in Estonian context - To raise awareness on the broad definition of restraints and coersive methods - To present alternatives - 60 alternatives for restraints in health care, Vilans 2011) – translated into Estonian and handed over to care providers - To encourage Health Board to adopt a policy on reducing using of restraints and coersive methods

6. Goals of the pilot project -to accommodate differences between approaches of the Health Board and the Chancellor of Justice -to send a clear message: produce jointly an optional guidelines for care providers on using restraints and coercive methods - to draft a discussion paper on chemical restraints

7. Selection of sites As we agreed that EPSO framework should be applicable in all health and social care settings we targeted to have a broad overview of various services where using of restraints or coersive methods is likely to happen.

8. Valkla Home March 31, 2014 - a unit for persons with psychiatric illness placed into closed institution based on a court order. At the time of our visit the unit accomodated 93 persons.

9. Tartu University Hospital April 1 2014 - intensive care department – 28 beds, nursing care department – 75 beds April 2 2014 - psychiatric clinic – 86 beds

10. Rõngu Hooldusravikeskus April 03 2014, altogether 75 beds, 10 beds for nursing care and others for social welfare services

11. Plans for the future - to draft a report and present it in Ireland, Dublin - to pilot the EPSO Framework in couple of more countries - to take reducing restraints and coercive methods issue to a bigger audience and develop common standards for EPSO members - To translate 80 alternatives by Vilans into EPSO member state languages

12. Drafting the report is in process Outline of the report: 1 – Introduction 2 – Level of awareness and Policy 3 – restraints and Coersive methods seen in the institutions in Estonia 4 – EPSO framework useful for the Estonian Insitutions 5- EPSO framework – usefule for the Health Board 6 – EPSO Framework – useful for the Finnish Valvira 7 – Proposed Changes to the Framework 8 – Conclusions Report will be presented at EPSO 18 –the conference in Dublin.

13. Thank You for Your Attention! Eve Pilt eve.pilt@terviseamet.ee