NORWEGIAN PARLIAMENTARY OMBUDSMAN National Preventive Mechanism ANNUAL REPORT 2016 26 The European Committee for the Prevention of Torture (CPT) has pointed out: ‘It should be acknowledged that resort to restraint measures appears to be substantially influenced by non-clinical factors such as staff perceptions of their role and patients’ awareness of their rights. Comparative studies have shown that the frequency of use of restraint, including seclusion, is a function not only of staffing levels, diagnoses of patients or material conditions on the ward, but also of the ‘culture and attitudes’ of hospital staff.' 6 A perception that staff will be held accountable for abusive practices, on the other hand, has a strong socialising effect in the positive direction. Institutional culture and management as a protective factor An institutional culture marked by openness, reflection on own practice, accountability, participation by those deprived of their liberty and a good working environment will be important protective factors for the detainees. The management is responsible for ensuring that its institution’s social identity and culture supports compliance with fundamental rights such respect for dignity and patient safety. Staff perception of the management's acceptance or engagement will reinforce the culture. Addressing the needs of staff will also be important in this work. Secure employees who feel they are looked after, seen and respected are important for ensuring a protective institutional culture. It is also important that staff receive follow-up if serious incidents occur at work, or if anyone is injured during working hours. In order to counteract the risk of ill-treatment, it is very important that institutions where people are deprived of their liberty actively promote values, attitudes and a shared culture that are in accordance with the right to be treated humanely and with dignity.7 6 The European Committee for the Prevention of Torture (CPT), CPT standards, CPT/Inf/E (2002) 1 - Rev. 2015 English, page 68, paragraph 54. 7 The UN Convention Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (CAT), Article 10. See also the Scottish Human Rights Commission (2009): Human Rights in a Health Care Setting: Making it Work for Everyone. An evaluation of a human rights-based approach at the State Hospital.