38 for longer periods of time, in some cases for more than a day. In some of these cases, it was poorly documented what assessments had been made and what attempts had been made to use less invasive means or release the patient. Several staff members and patients felt that the use of restraints sometimes continued after the situation that necessitated their use had ended. Findings indicated that patients had sometimes been confined to their room without an administrative decision on isolation being made. It was also found that the threshold for writing administrative decisions on holding of patients was too high, because it was believed that it was unnecessary to write down and record short-term holding of patients even if they objected to the holding. The segregation units were relatively spacious, and the patients could move around between different rooms within the segregation unit. Segregated patients had limited opportunity to spend time outdoors, including engaging in outdoor physical activities. Furthermore, the practice of regulating the time patients spent in their own rooms and in the segregation unit’s living room through daily plans seemed to take little account of the conditions similar to isolation that can arise if the patient is obliged to remain in their own room too much while staying in a segregation unit. The forced medication figures showed that considerably more administrative decisions had been made in the past year. What arrangements the medical personnel had made to facilitate patient involvement, and what information the patient had received about expected effects and possible side effects, were poorly documented. In the period from January 2015 to the end of February 2017, the department had performed ECT on eight patients on grounds of necessity. Based on the information provided about the use of ECT on such grounds, several of these treatments seem problematic in relation to the requirements for grounds of necessity. One ward in particular stood out as having had a poor working environment for a long time, with too few nurses or other staff with relevant professional backgrounds, and a high staff turnover. Several patients in this ward stated that they felt insecure. NORWEGIAN PARLIAMENTARY OMBUDSMAN National Preventive Mechanism ANNUAL REPORT 2017 Ålesund Hospital, psychiatry department 19–21 September 2017 The psychiatry department at Ålesund Hospital consists of five sections and the Ombudsman visited three of them. Main findings The wards visited had pleasant and open communal areas. The activities offered at the hospital psychiatry department were unsatisfactory. Some of the patients in the emergency section were not given the opportunity to spend time outdoors every day. It was difficult to access outdoor areas, which was particularly challenging for patients in one of the emergency section’s segregation units. Several weaknesses were found in the hospital’s practice in relation to administrative decisions to use force. Outdated templates were used that increased the risk of the person responsible for the decision not making assessments in line with applicable legislation. Several of the administrative decisions contained poor explanations of why the statutory conditions were found to be met. This particularly concerned segregation decisions and decisions regarding treatment without the consent of the patient. Patients did not receive the grounds for the decision in writing. Two restraint beds were placed in the waiting room right beside the patient entrance to the emergency section and could make patients already in a vulnerable acute phase feel even more unsafe. Information was provided that gave cause for concern about whether the threshold for using mechanical restraints was too low and indicated that prolonged use of restraints was a challenge in the emergency section. A review showed that patients still often slept in restraint beds, and examples were found of patients not being released from the restraint beds during the night shift due to inadequate staffing. Information was provided during the visit that indicated that patients were sometimes locked up in their rooms without the person responsible for decisions being informed. Information also emerged that indicated that some cases of short-term holding were not registered as administrative decisions.