Selected topics from 2015 Health personnel’s relationship to inmates Health personnel in the prison health service are generally aware of the risk of dual loyalty, and are aware of the need to put the patients’ needs and interests first. Nonetheless, the health personnel – whether they are organised as municipal health services or specialist health services – have to act efficiently within the prison walls. They must cooperate with the correctional services with respect to making appointments, arranging admission interviews, patient transport, the health department’s physical location, HSE measures, suicide prevention and health-promotion work, among other things. One particularly challenging aspect of the work of health personnel is the medical supervision of inmates who have been placed in security cells or restraint beds by the correctional services. These inmates are entitled, by law, to be seen by health personnel at least once a day. On the one hand, this supervision is important because the inmates are in a vulnerable situation in which they have very limited opportunity to control their own access to health services. On the other hand, inmates in a security cell or restraint bed can perceive regular visits from health personnel as implicit approval of the use of coercive measures, which can harm the doctor-patient relationship. Health personnel are therefore urged in such circumstances to state their role and specify their duty. Health personnel’s relationship to detainees at the police immigration detention centre The Parliamentary Ombudsman has also expressed concern relating to dual loyalty issues at the police immigration detention centre at Trandum. The doctors and nurses at Trandum work for the National Police Immigration Service (NPIS), which means that they are not employed by the health authorities as is the case in other places of detention in Norway. Since the health service at Trandum is not independent of the detaining authority, prioritising the detainees’ medical needs and interests can be challenging. The doctors at Trandum provide medical help to the detainees, but they also 25 prepare fit-to-fly declarations for enforced deportation of detainees out of Norway. The nurses at Trandum are the same nurses that accompany the detainees when they are deported from Norway by plane. The health service at Trandum’s lack of independence creates a grave risk of harming the doctor-patient relationship and compromising patient care. The NPM therefore recommends that the NPIS organises independent health services for the detainees. Health personnel’s relationship to patients in mental health care In contrast to other places of detention the NPM has visited, where there is – or should be – a clear distinction between the detaining authority and the health authorities, the health authorities are the detaining authority for patients in mental health care. The doctor has the power and authority to admit patients to involuntary mental health care institutions, shield them from other patients and practitioners, use means of restraint and other coercive measures and administer medication without the patient’s consent. The NPM is closely following national and international developments with respect to health care for people with psychosocial disabilities. Crucial to focus on the role of health personnel In its endeavours to fulfil its mandate, the NPM continues to focus on health during deprivation of liberty. On each visit to a place of detention, the health care services provided are thoroughly assessed, including a review of the role of health personnel. Health services for people who have been deprived of their liberty are an important part of any society’s overall public health services, as most of them will eventually return to their local community, bringing with them their health issues and their experience of the health service from their period of detention. It is therefore crucial that everyone involved recognises and addresses the challenges health personnel can experience while fulfilling their different roles at places of detention. This will have a health-promoting effect, not only for the people deprived of their liberty, but also for society as a whole.