The legislative amendment would allow the use of three different restraint measures, Made Bambus, adviser to the health services department at the Ministry of Social Affairs, told ERR.

"Physical restraint, meaning holding a patient down by staff, for example using physical force. Mechanical restraint, or the use of mechanical devices such as magnetic straps to immobilize a limb — for instance, an arm with an IV drip or similar. Third, restraint by medication, meaning certain drugs are administered in specific doses to alleviate symptoms of agitation," Bambus explained.

Dr. Andres Lehtmets, head of the psychiatry clinic at Tartu University Hospital, said such a legal change has been long awaited.

"Not all patients necessarily need to be in psychiatry. Rather, those who are in a state of agitation or have certain other problems related to aggression or self-aggression may instead require somatic treatment because of their condition — meaning they should be in an intensive care unit, an internal medicine department or, in the case of elderly patients, possibly in a nursing care ward. Bringing them to psychiatry solely for the purpose of restraint is not particularly justified," Lehtmets said.

Under the draft, the decision on whether a patient needs to be restrained would be made by a physician. However, because a doctor may not always be present in a hospital ward or ambulance, the initial decision to use physical or mechanical restraint could also be made by a nurse, Bambus added.

"That initial decision to restrain may be made by a nurse, but continuing the restraint or determining its duration must be a medical decision. A nurse cannot independently decide to use medication for restraint; a doctor must arrive or a physician consultation must take place," Bambus explained.

Both Lehtmets and Bambus emphasized that restraint must remain a measure of last resort.

If restraint is used, it must be properly documented to ensure the process is traceable, Lehtmets said.

"Everything — who made the decision, at what time it was made, how long the restraint lasted and how the patient was monitored during the restraint — must be properly documented."

Bambus added that whether it is a hospital or an ambulance service provider, staff must be trained so that documentation includes the required data and correct entries are made at the proper intervals.

"Depending on the type of restraint and the patient's condition, continuous monitoring may indeed mean that a nurse checks on the patient at certain intervals, a caregiver checks on them at certain intervals — but in practice, the caregiver also works under the supervision of a nurse."

The draft bill has passed its first reading in the Riigikogu and could enter into force on July 1 of this year.

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