22 NPM nonetheless found that the range of activities offered at several of the hospitals was so limited as to give cause for concern. Many patients wanted the opportunity to spend more time outside in the fresh air and in physical activity, and to have more active staff who could organise indoor activities. " The European Court of Human Rights (ECtHR) and the UN Special Rapporteur on Torture have also expressed grave concern about the harmful effects of solitary confinement " Under the Mental Health Care Act, patients who are committed can be subjected to many invasive treatment and control measures, including segregation. Segregation entails that the patient is kept in a room that is almost devoid of furnishings. Like solitary confinement in prison, this limits the patient’s sensory impressions and largely cuts off his/her contact with other people. Segregation can also be used as a treatment measure or out of consideration for other patients, but never as punishment or out of consideration for the staff. Because we have relatively limited knowledge about the effects of segregation and because segregation infringes on the patient’s liberty, the NPM is investigating various segregation measures. One visit revealed that patients subject to segregation spent most of the day alone and without direct supervision in the segregation unit. The practice was therefore similar to solitary confinement. The NPM pointed out to the same hospital that it was unfortunate to place a restraint bed in the segregation units because it did not help to calm down the patients and increased the risk of restraints being used before less invasive measures were tried. It was also a concern that patients who had been committed, who already had limited contact with other people before segregation commenced and were therefore particularly vulnerable, had their contact with the outside world reduced in other ways. NORWEGIAN PARLIAMENTARY OMBUDSMAN National Preventive Mechanism against Torture and Ill-Treatment ANNUAL REPORT 2015 Unauthorised solitary confinement in police custody facilities, and remedial measures A stay in a police custody facility is meant to be short; the detainee must either be released or transferred to a prison within 48 hours. For many years, the Parliamentary Ombudsman has expressed concern about the high number of breaches of the holding period. In July 2014, Oslo District Court found that the State had violated ECHR Article 8 concerning the right to respect for private and family life and the prohibition on discrimination in Article 14 in a case concerning solitary confinement in a police custody facility. The judgment confirms that the police and prosecuting authority is obliged to do what is possible within the confines of the existing premises to prevent isolation, by facilitating extended contact with a lawyer, time outdoors with others and external visits. Solitary confinement is not legal unless there is a risk of evidence being tampered with. During visits to police custody facilities in 2015, the NPM investigated what the police do to ensure that the need for solitary confinement is assessed in each individual case and that remedial measures against solitary confinement are implemented. Stays in police custody cells often cause great mental distress to people in crisis situations and remedial measures are essential. The NPM has found that several custody facilities have not documented that an assessment has been made of whether solitary confinement is needed. Findings so far indicate that the police, in some cases, implement some remedial measures, such as more frequent stays in the exercise yard with other detainees. The Parliamentary Ombudsman has recommended, among other things, that the police facilitate external visits. A major challenge is that the custody facilities consist of custody cells without communal areas. It has yet to be clarified whether further measures, such as adaptions to buildings, are being planned to bring the Norwegian practice more in line with Norway’s human rights commitments.