1. 17-18.9.2013Hanna Ahonen1 Restraints and coercive methods in social care 16th EPSO Conference Copenhagen 17.-18-9-2013 Hanna Ahonen

2. 17-18.9.2013Hanna Ahonen2 Realisation of the right of self-determination in 24-hour services within social welfare in child welfare, services for people with disabilities, mental health care services and substance abuse care Valvira reports 1:2013

3. 17-18.9.2013Hanna Ahonen3 Background A joint implementation programme for three supervision programmes completed in January 2012: 24-hour care and upbringing within child welfare, 24-hour residential services for people with disabilities, 24-hour residential services for persons undergoing mental health and substance abuse rehabilitation and institutional substance abuse care.

4. Legal basis Explicit legal provisions on restricting the right of self- determination are laid down in Finnish legislation only in the Child Welfare Act, which entered into force after the reform of the Constitution and which caters for the human and basic rights of children lack of a legislative framework a problem: a working group working to consider the right to self- determination of clients in social welfare and healthcare - to compile all provisions restricting the right of self- determination of patients and social welfare clients into a single Act 17-18.9.2013Hanna Ahonen4

5. Aim of the report: to determine the procedures and practices associated with the realisation of clients' right of self-determination in use at the operating units Method: Survey, supplemented with other materials as necessary 17-18.9.2013Hanna Ahonen5

6. 24-hour care and upbringing within child welfare 17-18.9.2013Hanna Ahonen6

7. 24-hour care and upbringing within child welfare 17-18.9.2013Hanna Ahonen7 Guidelines on use of restrictive measures Used during the past yearYesNo Physical guidance325 Physical restraint339 Weighted blanket00 Treatment shirt (restrictive clothing)00 Safety helmet00 Safety mat00 Regular mat11 Restraints41 Sedatives104 Locking doors00 Diaper suit (restrictive clothing)00 Restriction of freedom of movement349 Restriction of contact198 Confiscation of substances or objects3010 Bodily search256 Withholding of property and deliveries81 Inspection of client’s room3210 Special care95 Drug testing277 Breathalyser258 Blood test20 Isolation103 Other40 Total4837 Table 5. Guidelines on use of restrictive measures and measures used in care situations during the past year according to whether the unit had prepared guidelines on their use (24-hour care and upbringing within child welfare) NB. The data for three late-responding units are missing from the table.

8. units providing 24-hour services for people with intellectual and developmental disabilities 17-18.9.2013Hanna Ahonen8 “The sanction is e.g. an ‘in-house day’ during which the residents attends to personal laundry, room cleaning.”

9. intellectual and developmental disabilities 17-18.9.2013Hanna Ahonen9

10. 24-hour services for people with physical disabilities 17-18.9.2013Hanna Ahonen10

11. 17-18.9.2013Hanna Ahonen11 physical disabilities

12. 17-18.9.2013Hanna Ahonen12 Conclusions ambiguity associated with the restrictive measures imposed on social welfare clients and the grounds for such measures - in part likely due to the lack of unequivocal legal provisions on the restriction of the right of self-determination except in child welfare - The concepts and terminology related to restrictive measures is also given different meaning in the different sectors, which has resulted in units using practices which do not satisfy the requirements imposed for restricting a basic right. There was uncertainty i.a. in determining what constituted restriction and what fell into the category of ordinary care - that restrictive measures were also used as a form of punishment for unwanted behaviour - The importance of operating culture and leadership in the unit => Supervisory actions and guidelines by supervision authorities