42 The security sections at Østfold Hospital 9–11 October 2018 The NPM visited security sections 1 and 2 at Østfold Hospital Trust. The sections are part of the department of psychiatry and adult habilitation. The NPM also visited the geriatric psychiatric section which is described above. The security sections were both local high-risk psychiatric units. The sections were on the ground floor with a way out to a joint atrium. This ensured that the patients who were subject to restrictions in their section could spend time outdoors. The atrium was encompassed by high walls with many windows. It seemed dark and did not promote a sense of security. The communal areas in the sections had sterile white surfaces. The communal areas appeared too small in relation to the number of patients and staff. This is unfortunate since it can lead to patients isolating themselves in their rooms, and because it can make it difficult to effectively prevent conflicts, violence and uncontrolled behaviour in a security section. The patient rooms did not have curtains and the patients could not control the blinds, which were also transparent. The segregation units consisted of a large room, and a separate small caged-in outdoor area. All of the segregation rooms had beds with straps fixed to it for restraints, which hung down from the bed, fully visible. The premises did not appear suitable for providing good treatment to the patients. The activity programme was not particularly well developed seen in light of the fact that patients were admitted to the security sections for long periods. The use of restraints over the past year was much more prevalent in security section 2 than security section 1. Certain patients had many administrative decisions issued to them, but restraints had also been used on considerably more patients in total in this section. This difference in occurrence was also found for segregation and forced medication. NORWEGIAN PARLIAMENTARY OMBUDSMAN National Preventive Mechanism ANNUAL REPORT 2018 The staff at all levels had little knowledge of these systematic differences between the sections. There was also little interest in keeping track of use-of-force figures and little belief that the sections could do anything to reduce the use of force. There were several cases of prolonged use of ­restraints in both sections. Mobile restraints were used extensively. This appeared to extend and ­normalise the use of restraints. It also seemed that nursing staff and specialist registrar were reluctant to release patients from restraints. This prevented a continuous assessment of whether the conditions for using restraints were met. Findings from the visit indicated that ­administrative decisions had not been made for all situations where patients were physically restrained by staff against their will. We found several cases of prolonged use of segregation. This is problematic among other things because of the physical conditions patients are s ­ ubjected to during segregation. Staff seemed to provide continual social contact and care to patients during segregation. However, certain findings indicated that a rigid approach was used with the patients, which could lead to unnecessary frustration during segregation. In general, there were shortcomings in the administrative decisions on treatment without the consent of the patient, and the duty to provide grounds was not sufficiently addressed in several cases. The house rules, particularly in security section 1, encompassed among other things restrictions on the use of mobile phones, tablets and computers, which are not ­permitted under the Mental Health Care Act. A number of segregation instructions and documents showed that the patients’ access to the outside world was greatly limited during segregation, without this being based on an individual administrative decision.