CAT/C/NOR/CO/8 (c) About the lack of clarity on the frequency and circumstances surrounding the use of coercive electroconvulsive treatment in different mental health care institutions and the existence of geographical differences in the use of involuntary measures as well as the absence of formal registration of involuntary forms of treatment and the notification of patients about it in writing; (d) That involuntary administration of electroconvulsive treatment is governed by guidelines and not formally adopted law; (e) About the lack of a requirement for an independent health-care professional to give a second opinion; (f) That the implementation of the national strategy to increase the prevalence of voluntary treatment in mental health services (2012–2015) has not led to a reduction in the use of coercion (arts. 2, 11, 12, 13, 14 and 16). 22. The Committee reiterates its recommendation (see CAT/C/NOR/CO/6-7, para. 14) that the State party: (a) Ensure that every competent patient, whether admitted voluntarily or involuntarily, is fully informed about the treatment to be prescribed, including shielding, and given the opportunity to refuse shielding, treatment or any other medical interventions, such as the administration of neuroleptic drugs and electroconvulsive treatment; (b) Promote psychiatric care aimed at preserving the dignity of patients, both adults and minors, and continue its efforts to end the unjustified use of coercive force, including by further amending legislation; (c) Employ coercive measures in mental health care only in compliance with human rights standards and prescribe by law any derogations to the principle of free and informed consent, which should only relate to clearly and strictly defined exceptional circumstances; (d) Ensure that non-consensual coercive measures are formally registered and patients are informed about them in writing; (e) Ensure that non-consensual psychiatric treatment, if applied at all, is only used in exceptional cases as a measure of last resort, for the shortest possible period of time and when absolutely necessary to protect the health or life of the person concerned, only if he or she is unable to give consent and under independent review; (f) Provide clear and detailed regulations on the use of restraints, including restraint beds, and other coercive methods in psychiatric institutions, with the aim of substantially reducing their use and duration of use, and prevent geographical differences in these indicators; (g) Establish clear and effective procedural safeguards for patients, including provisions in law for assisted decision-making by proxy and effective complaints mechanisms, and ensure patients’ effective access to legal advice, including free legal aid, as well as obligatory information to patients about this right, for as long as it is required, and that they are not subject to retribution by staff if they avail themselves of complaints mechanisms; (h) Strengthen the regulatory framework and stipulate in law the circumstances allowing for the limited use of coercive electroconvulsive treatment, and establish a system for the collection and publication of uniform statistical information on the use of restraints and other coercive methods, including electroconvulsive treatment, which should be officially registered and subjected to close scrutiny by the supervisory commissions; (i) Consider incorporating into law the abolition of the enforced administration of intrusive and irreversible treatments, such as electroconvulsive therapy; 6