Visits in 2018 41 Østfold Hospital, Kalnes Geriatric psychiatric section at Østfold Hospital 9–11 October 2018 The NPM visited the geriatric psychiatric section at Østfold Hospital, which is part of the department of psychiatry and adult habilitation. The NPM also visited the security sections, described in the summary below. The section was on the hospital’s second floor. Patients subject to restrictions or who could find it challenging to locate the roof terrace or main entrance could only get fresh air by going out onto a caged-in balcony. Both the patient rooms and communal areas had sterile white surfaces with no colour or contrasts. In the patient rooms, the patients were not able to control the blinds, which were also transparent. The segregation unit consisted of a large room and a bathroom, and a separate small caged-in balcony. The room had a bed with straps fixed to it for restraints, which hung down from the bed in full view. Findings from the visit indicated that there was uncertainty in relation to determining whether patients admitted against their will were competent to consent. In one case, a member of staff had waited a week to change the provision under which a patient had been admitted, even though the patient was considered competent to consent. Such practice is not permitted. If a patient becomes competent to consent during treatment, the person has a right to discontinue treatment. In general, the section had a low occurrence of the use of force. However, administrative decisions had not been made for all situations where patients were physically restrained by staff against their will. Among other things, there was uncertainty among the staff as to whether they could physically restrain a patient for a period before a decision had been made and, in such case, how long this period could be. The person responsible for administrative decisions was also unsure about whether a separate decision should be made if a patient in segregation was restrained. These circumstances meant that the section did not have confirmed figures on the use of force and that the patients’ right to complain, among other things, was not sufficiently safeguarded. There appeared to be little interest in and know­ledge of the occurrence and development of use-of-force figures among the section staff and the department's management. The management was under the impression that figures for how often coercive measures were used, generally were a result of the patients who were admitted and not circumstances that the section could influence through its practices. The milieu therapists were not aware of any increase or decrease in the use of coercive measures.