1. Final report on pilot project on reducing use of restraints and coersive methods in Estonia Eve Pilt Advisor for Health Board Dublin, September 26,2014

2. Time to harvest - Seeds planted in Paris, watered in Utrecht, Brussels and Porto. - Dublin presentation of a Report of a Visit to Estonia (Estonian pilot) to test the EPSO Framework on Restraints and Coercive Methods in Health Institutions in Valkla, Tartu and Rõngu, Estonia, from March 30th to April 4th 2014

3. Contributors to the Pilot Jooske Vos (EPSO); 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; Eve Pilt Estonian Health Board); Mari Murel ( translator Dutch – Estonian and English – Estonian) Juta Varjas – Estonian Health Board Inge Mäe- Estonian Medicines Agency

4. Underlying principles Cooperation of supervisory bodies to disseminate principles of good governance and good practice in health and social care by: comparing their own working methods with the relevant experiences in other countries and regions; sharing best practices; integrating and setting relevant norms and working together towards accepted standards; respect for human rights; Respect for self – determination and dignity.

5. The EPSO Framework and standards for good practice minimum standards for supervisory or monitoring organisations minimum standards for (health) care providers; minimum standards for all (health) care providers derived from health care relevant CPT standards. Are aimed at: improving the quality of supervisory activities; reducing the use of restraints and coercive methods; setting a (common) European standard.

6. Legal context In many countries (incl Estonia) national legislation does not prescribe in detail how to behave or provides regulation only for psychiatric settings, there may be doubt on how to act. The EPSO Framework and standards for good practice can be useful to fill in the gap by providing transparent standards, written policies and procedures. The EPSO Framework, if tested in the broader European context, can serve as a mirror for good and workable practices.

7. Working group methods introductory information session with the staff on arrival; The group was shown around the institutions in small groups by the staff; examined relevant documents and residents’ files; assessed care plans and medication prescriptions in order to adhere to privacy and confidentiality legislation ; examined what kinds of medications were used; oral feedback to every institution; complete a self-assessment and return within 3 weeks of the pilot.

8. The four key research questions Are the standards of the EPSO Framework useful and adequate to reduce and prevent unnecessary restraints and coercive methods? What approaches and methods should be used to get care- providers interested in trying out new practices in their institutions? Could a hand-out of alternatives to restrictive interventions be a helpful instrument to increase awareness? Are the standards of the EPSO Framework useful to evaluate the quality of care with a view to reducing and preventing unnecessary restraints and coercive methods in health and social care organisations?

9. Overview of the report Chapter 1 provides details of the EPSO working group as well as the background to the pilot study that took place in Estonia. It includes the working methods used in the pilot, and the underlying principles that guided it. Chapter 2 discusses the importance of raising awareness of restrictive measures and having a policy in place on their use. It also addresses awareness and policy observed in the institutions visited. Chapter 3 forms the core of the report. It addresses the types of restraints and coercive methods witnessed in use in the institutions visited in Estonia. Chapter 4 discusses the usefulness of the EPSO Framework and standards for good practice for the Estonian institutions visited. The findings are based on feedback from the institutions.

10. Overview of the report Chapter 5 discusses the use of restraints and coercive methods in Finland. It highlights the potential usefulness of the EPSO Framework for the Finnish Health Board. Chapter 6 proposes changes to the EPSO Framework and standards for good practice as a result of the pilot. Chapter 7 discussed the Estonian Health Board’s response to the involvement of EPSO. Chapter 8 contains the common conclusions of the Working Group. Chapter 9 contains proposed next steps as a follow up to the Estonian pilot (to support the EPSO members (national supervisory organisations an regulators and to make next steps in health and care institutions in Europe)

11. Next steps with the report Be published on EPSO website Makes possible for EPSO member countries including countries not involved in this project, to learn from the pilot and work with the EPSO Framework and standards for good practices in their national practices. The Working Group looks forward to the proposed follow up steps on this topic in Europe and in the interested EPSO member countries

12. Thank You for Your Attention! Eve Pilt Eve.Pilt@terviseamet.ee