Selected topics from 2018 What is segregation? Segregation in Norwegian mental healthcare ­insti­­­­­­­­tu­tions entails that the patient is being com­­­­ pletely  or partly removed from the other patients, reducing human contact to health personell only. Segrega­­­­tion can be implemented against the patient’s will and take place in the patient’s room or in a dedicated segregation unit. A segregation unit is a room with one or more beds separated from the other parts of the department, normally with a door that can be locked. Patients in segregation units can be denied access to communal rooms in the ordinary department, and will normally not be able to have social contact with patients or others in the other parts of the department. Low threshold for using segregation Norway is one of the few countries that has a special legal provision on the use of segregation as a coercive measure, distinct from the use of isolation. Segregation can be used both as a control measure to protect the patient or others against aggressive behaviour, and as a treatment measure where the idea is that reduced sensory impressions will calm the patient. The legal threshold for being able to impose segregation as a control measure is clearly lower than for isolation, which requires that the situation is acute. In practice, however, the patients often perceive segregation as being the same as isolation. Using segregation as a compulsory treatment measure is also problematic because there is insufficient knowledge of the effect of the treatment. Extensive use of segregation Public figures and surveys indicate that the use of segregation increased significantly in the period 2001–2016. The figures also indicate that some hospitals use segregation more than others, and that some patients are segregated for long periods of time. 29 The NPM's visits have also shown that in some hospitals, segregation is an integral part of the treatment regime, for example in that a large proportion of the available beds are located in segregation units. Several of the wards the NPM has visited had a culture characterised by strict boundary setting and correction of undesirable behaviour that could trigger conflicts and segregation measures. The visits also found that inadequate options for engaging in meaningful activities and spending time outdoors can trigger segregation. Segregation often takes place in undignified conditions The segregation units in most of the hospitals the NPM has visited have a bare and sterile appearance. Many patients and staff referred to them as being prison-like. The rooms often had no furnishing apart from a bed, and sometimes a table and a chair. In almost all cases, the rooms are painted white with no decoration or pictures on the walls. Many rooms had windows with film that made it completely or partly impossible to look out of. The bare design of the segregation unit premises is often justified as a security precaution. The NPM believes that such a view of security is problematic as research does not support the notion that a lack of furnishing prevents violence and destruction. On the contrary, research indicates that humane design can contribute to reducing the use of coercion. The hospitals also contended that the patients’ sensory impressions should be limited to help them calm down. However, the patients’ experience indicates that the bare design reinforces the impression of segregation as a form of punishment. The NPM's visits found that many of the institutions have a low awareness of the potential negative effects of a lack of sensory impressions. Several segregation units also had restraint beds and isolation rooms. This further reinforces the impression of segregation as a form of punishment. Such segregation units generally do not adequately safeguard patients’ dignity.