Visits in 2017 39 Ålesund Hospital, psychiatry department Many of the patients in the segregation units had little freedom of movement in practice and had to spend a lot of time in their rooms. This was due to a combination of the physical surroundings, capacity challenges and the way in which segregation was carried out. The segregation units that the NPM visited were sterile and unattractive. Except for a bed, chair and table, the rooms were unfurnished and painted white. The two rooms that were originally common rooms for the patients in the emergency section’s segregation units were used by other patients when necessary due to a high occupancy level. One of the segregation units had a separate isolation room. The room appeared to be unsuitable for patients, regardless of the situation. The implementation of segregation measures seemed unplanned, and many of the patients felt lonely in the segregation unit. Voluntarily admitted patients had been segregated in the emergency section without it being documented that they had been informed about their right to discharge themselves from the institution. A decision on segregation in the emergency section was normally not extended beyond the maximum period prescribed by law of two weeks. However, in the reinforced rehabilitation section, there were instances of some very long-term decisions being made. For example, one patient had been segregated for more than 3.5 months in the course of a five-month period. The hospital’s practice of using electroconvulsive therapy (ECT) was also reviewed. It was found that the hospital did not have a system for maintaining an overview of the number of ECT treatments administered on grounds of necessity. A review of four cases where ECT had been administered on grounds of necessity showed that the patients' conditions were deemed to be serious. There seemed to be an awareness of the ethical dilemmas that arise when ECT is administered without informed consent. The review also uncovered weaknesses in the documented assessments of whether the requirements for treatment on grounds of necessity had been met. In several of the cases, treatment with drugs was not relevant because this was seen as having contributed to or even led to the serious condition. It was not clear why other treatment measures were not sufficient to prevent an acute risk to the patient's life or health. In several of the reviewed cases, ECT was administered on grounds of necessity several times. There was little documentation of the assessments made explaining why the requirements for treatment on grounds of necessity were still met.