Visits in 2016 There were no written procedures or overview of activities for patients at any of the units in the emergency psychiatric section. Nor did the clinic have an overview of how often the patients made use of the activities that were offered. The hospital's activity centre was closed down on 1 January 2016, and patients and staff said that few organised activities had been offered at the hospital since then. The units in the emergency psychiatric section stated that it was difficult to offer committed patients daily walks outdoors because of the staffing situation. Administrative decisions on the establishment of compulsory mental health care, segregation, treatment without the patient's consent and the use of coercive measures are filed in electronic patient records. Separate record entries stating the grounds for each individual decision are also filed there. The grounds are not stated in the decisions themselves. Patients did not routinely receive the written grounds for such decisions together with the decision. It was a consistent finding when reviewing use-of-force decisions and the medical grounds for the use of force that any attempts to use milder means were not documented. The supervisory commission for the hospital meets every second week to consider complaint cases, to verify administrative decisions and carry out document control. The commission had not carried out welfare checks in 2015 and 2016. Nor were the wards routinely visited, and the patients were not offered an opportunity to speak to the commission when it was present at the hospital. No written information was posted in the inpatient units about rights in connection with the use of force or information about the right to lodge a complaint. It became apparent that there was uncertainty at all management levels about what patient injuries must be registered and reported. According to the management of the department and the units, 45 there was uncertainty about whether patient injuries were actually reported, and thereby whether the procedure for identifying and registering patient injuries was complied with. One case gave special cause for concern. It concerned a patient who was seriously injured when wrestled to the floor by staff in the inpatient ward. The injuries had to be followed up by medical personnel from outside the unit, but, despite the nature of the injuries, it was not noted in the records that the examining doctor followed up the patient's injuries. There was no report on the patient injury, neither in the hospital's internal system for registering patient injuries nor to the Directorate of Health or the Board of Health Supervision. The supervisory commission stated that they had asked the management for information about patient injuries on several occasions. However, they had not received information about any injuries, although it had come to their knowledge, among other things through information in patient records, that such injuries had occurred. In one case, repeated administrative decisions were made for committal pursuant to Section 3-3 of the Mental Health Care Act based on a provisional personality disorder diagnosis. According to the patient records, the responsible health professional considered the provisional diagnosis to indicate such a great change in the patient's behavioural pattern and ability to cope that this could be seen as corresponding to the Act's requirement for a serious mental disorder. No assessment was carried out, however, to establish whether the Act's requirement was met, despite the fact that the patient had been committed on the same grounds several times over a prolonged period. One case was found where a patient had been placed in restraints for six hours before a new duty doctor was informed. It appeared to be unclear what had happened in connection with the instigation of the restraint during the previous shift, and an admin-