28 NORWEGIAN PARLIAMENTARY OMBUDSMAN National Preventive Mechanism ANNUAL REPORT 2020 What is segregation? A segregation room used for children at one of the places we have visited. a spit hood, and was later placed in restraint belts. The adolescent was restrained for five hours and fifteen minutes. It was not sufficiently documented as to why it had been necessary to keep the adolescent restrained for four and a half hours after the adolescent had fallen asleep. This type of situation could potentially amount to a violation of the prohibition against inhuman treatment.14 The use of segregation is another intrusive meas­ ure used in child and adolescent psychiatry. Some adolescents are subjected to segregation for long periods, with repeated measures and a great deal of coercion. At two of the three places we visited, we criticised the use of segregation. The segre­ gation zones at one of the places was designed in such a way that it appeared threatening and frightening.15 We were particularly critical of some segregation rooms that resembled isolation cells. The Ombudsman stated that long-term placement in such rooms was unacceptable and represented a risk of inhuman treatment. The hospital has subsequently improved the segregation zones and changed segregation routines. Segregation in Norwegian mental healthca­ re means that the patient is fully or partially segregated from other patients and only has contact with health personnel. The measure can be introduced without the consent of the patient, in the patient’s room or in a segregation zone. A segregation zone is an area with one or several beds that is separated from other parts of the institution, normally with a lockable door. Patients that are admitted to a segregation zone can be refused access to common rooms in the ordinary part of the section and will normally be unable to have social contact with other patients and personnel. Norway is one of few countries that has a distinct set of enforcement regulations rela­ ted to segregation. Segregation is used both as a control measure to protect patients or others against aggressive behaviour, and as a treatment measure with the idea that reduced sensory impressions will provide calm for the patient. Our findings also showed that children are sub­ jected to intrusive treatment measures without their consent, such as force-feeding where the patient suffers from a serious eating disorder. For treatment not to violate the child’s right to personal integrity, the treatment must be necessary to prevent serious harm to health. The method of how treatment is carried out must also be propor­ tional.16 In two of our visits we found examples of situations that gave grounds for concern that force-feeding was carried out without the measure 14 See ECHR judgement Bures v. Czech Republic, application no. 37679/08, judgement of 18 October2012, section 102–104 and Aggerholm v. Denmark, application no 45439/18, 1 September 2020, section 95–115. 15 The Parliamentary Ombudsman’s report after the visit to Helse Stavanger HF, Section for children and adolescent mental health care, 8–10 and 29–30 October 2019. 16 Forcibly administered treatment can be in violation of the European Convention on Human Rights article 3, see ECHR judgement in Herczegfalvy v. Austria, application no. 10533/83, 24 September 1992, section 82. Enforce treatment may also breach European Convention on Human Rights article 8 no. 2. See ECHR judgement X v. Finland, 3 July 2012, application no. 34806/04.