49 Follow-up of the NPM’s ­recommendations After each visit, the NPM publishes a report describing its findings and making recommendations for preventing torture, inhuman and degrading treatment.1 Much of the preventive work begins after the reports have been published. We ask all places we visit to provide written feedback on how the recommendations have been followed up within three months of the visit report being available.2 The feedback we received throughout the year indicates that the institutions generally followed up the recommendations in a thorough manner. The majority of places have implemented numerous measures that play an important role in reducing the risk of inhuman and degrading treatment. At times, institutions can be surprised by our findings, but they generally recognise the issues we raise. This forms the basis for constructive dialogue about the risks relating to the recommendations and the need for change. It also underlines the importance of the NPM’s visit in that an external force can be necessary to get to grips with challenges that are already known. Certain recommendations require limited effort to follow up, while others are more challenging. This means that the NPM’s follow-up can sometimes continue over a long period, and at other times be concluded relatively quickly. In some cases, institutions we visit do not follow up our recommendations. These institutions often refer to their resource situation as the prime reason for their inability to implement the recommendations. This has for example been the case in certain prisons, where the NPM has criticised the placement of people with mental health problems in sections without access to social interaction or in security cells, and in mental healthcare institutions where the NPM has recommended improvements to the physical conditions. The fact that some institutions have not followed up the recommendations may also be related to ambiguity in regulations. Furthermore, discussions may arise with the institutions about what constitutes a reasonable weighing of security considerations against the safeguarding of the integrity of people deprived of their liberty. One example of this is the NPM recommending that prisons change their body search procedures. Such topics are regularly raised at meetings with central government authorities. Throughout 2018, we have followed up 12 institutions visited in 2017 and 2018. Three of these are still being followed up at the turn of the year. In the following, we will highlight some examples of how the NPM’s recommendations were followed up over the past year based on the nine concluded follow-up cases.3 1 For an overview of visit reports, see: https://www.sivilombudsmannen.no/besoksrapporter/ 2 The follow-up letters and correspondence with the NPM are published on the Ombudsman’s website. See: https://www.sivilombudsmannen.no/besoksrapporter/ 3 The following institutions’ follow-up was concluded in 2018: Kvammen emergency institution, the emergency psychiatry and psychosis treatment department at Reinsvoll psychiatric hospital, Åna Prison, the section for psychosis treatment at Gaustad Hospital (Oslo University Hospital), the security section at the police immigration detention centre at Trandum, the emergency psychiatric unit at Akershus University Hospital, Arendal Prison, the child welfare institution Klokkergårdenkollektivet, and Ålesund Hospital’s psychiatry department.