Visits in 2017 Mental health care institutions Stavanger University Hospital’s special unit for adults 9–12 January 2017 Stavanger University Hospital’s special unit for adults has four sections with a total of 114 beds. Five wards were visited. Main findings The wards visited consistently had pleasant and open communal areas. The patient rooms felt bare. Several wards had a strong focus on offering patients opportunities for physical activity, but many would like other forms of meaningful activity, therapy and services adapted to their level of functioning and interests. Most of the wards visited had no direct exit for patients who wanted to spend time outdoors. The patients had limited access to outdoor areas, and the situation was particularly challenging for patients in the segregation units. The hospital has succeeded in achieving a significant reduction in the use of mechanical restraints, but the use of isolation is prevalent. Important measures had been implemented to prevent the use of coercive measures. A document review showed that the hospital generally ensures that its use of mechanical restraints is well documented. The documentation showed that many coercive measures were of short duration, with frequent attempts at releasing the patient from the restraints. It nevertheless gives cause for concern that some patients had been continuously restrained in a restraint bed for more than 24 hours. The staff mostly had good practical training aimed at ensuring that patients were restrained in the gentlest way possible. At the same time, some problematic circumstances were identified in connection with the restraining of patients, such as covering of their mouth or face, active involvement by the local police and patients sleeping in restraint beds. Findings indicate that segregation was an integrated part of the treatment. The physical conditions on the wards, with more than a quarter of patient 35 rooms located in the segregation sections, seemed in itself to represent a risk of disproportionate use of segregation. The segregation sections had a sterile feel, particularly the patient rooms. Many found the segregation sections prison-like. The premises were cramped and inflexible, which made it difficult to address all the patients’ needs, particularly when all the segregation rooms were in use at the same time. Findings made during the visit showed that this was common, and that many patients were therefore told to stay in their room. The doors were not locked, but they were hard to open because of the round doorknobs. This form of segregation gave it a feel of solitary confinement. The measure was perceived as distinctly more invasive than segregation with unrestricted access to the segregation section's living room, since it entailed greater restrictions on the freedom of movement, human contact, activities and stimuli. Most of the wards had also had patients who had been subject to continuous segregation for periods of several months, sometimes for five months or more. Segregation for such prolonged periods of time entails a clear risk of inhuman or degrading treatment, particularly in light of the physical conditions in the segregation sections and the practice of segregation in the patient's own room. Several patients stated that it was traumatic to take medication against their own will, and some experienced unpleasant side effects of the medication. At the same time, findings indicate that the personnel treating the patients respected the fact that forced medication is a measure that represents a serious violation of a patient's integrity. The document review showed that the hospital mostly ensures good documentation of the assessments carried out before a decision is made. Some decisions were nonetheless inadequate, either in that the person responsible for the decision had not considered whether all the statutory requirements were met, or because the grounds given for the decision appeared inadequate. This applied in particular to the requirement that there must be a ‘great likelihood’ that the treatment will have a positive effect. In recent years, Stavanger University Hospital has performed ECT on a small number of patients on the basis of the legal principle of necessity. There is