18 mental disorders, inmates who have been placed in isolation because of acute suicide risk and people with mental disorders who have asked to be excluded from company. Inmates with serious mental disorders There are inmates in Norwegian prisons today who have such serious mental disorders that they are unable to function together with other inmates. Some of them are excluded from company for short periods of time, while the NPM has also found during its visits that some inmates have, in practice, been in isolation for months and, in some cases, even years. A common factor for many of them is that the security risk means that a lot of staff resources are required to provide activities for them. They therefore rarely leave their cells and have limited contact with other people. For a number of them, questions can be asked about whether the real reason behind their extended exclusion from company is the deterioration of their mental state resulting from the isolation. A number of these inmates refuse to have contact with the prison health service and health personnel report finding it difficult to offer health care, despite repeated attempts. A review of administrative decisions, logs and reports shows that many of the inmates in this category are transferred back and forth between prison and the specialist health service. After a short stay in a mental health care institution, these people often return to isolation in prison without treatment. NORWEGIAN PARLIAMENTARY OMBUDSMAN National Preventive Mechanism ANNUAL REPORT 2017 Prisons themselves often report that this group of inmates live under what can be described as inhuman conditions, and the Parliamentary Ombudsman has stated that the responsible authorities must implement measures for these inmates to ensure that they receive treatment and are not confined to isolation. The use of restricted sections or security cells in the event of acute suicide risk Recent research shows that Norway is high up in the statistics on the number of suicides in prison relative to the population.3 It also shows that the most effective means of preventing suicide is good assessment procedures and human contact through talking to staff and the health service.4 Despite this, findings from the NPM’s visits indicate that placing people in restricted sections or security cells is common practice when a suicide risk is identified. The reason given by the prisons for this is that they do not have enough staff to be able to monitor the inmates over time in the ordinary prison sections. The staffing level is further reduced at night time and at weekends. In some prisons, this means that health personnel are not available to talk to suicidal inmates. If the risk of suicide is acute, security cells are therefore often the answer. The NPM has had a particular focus on analysing logs from security cells in instances where inmates have been placed there due to suicide risk. Among other things, the log contains information about monitoring and conversations to break up the isolation. The Directorate of Norwegian Correctional Service’s guidelines show that inmates are to be checked every hour, and 3 Suicide in prisons: an international study of prevalence and contributory factors Fazel S., Ramesh T., Hawton K. (2017) The Lancet Psychiatry, 4 (12), pp. 946–952. In the article, Norway tops the list for the number of suicides among the countries studied. The source data include the year 2013, when there was an unusually high number of suicides in Norwegian prisons. Norway would still feature high up the list, even if this was adjusted for. 4 Marzano L, Hawton K, Rivlin A, et al. Prevention of suicidal behavior in prisons. Crisis 2016; 37: pp. 323–34.