39 Visits in 2018 Administrative decisions were not consistently made when patients were held down on the ground, and such situations were often inadequately described in the patient records. Evaluation interviews were not always carried out after use of force, and the NPM identified a lack of systematic and more active use of evaluation interviews as part of the patients’ right to influence the work on reducing use of force. All of the emergency units at Tønsberg had separate nightshift staff. The nightshift staff appered to be more distanced from management and other staff. It was reported that the basic nightshift staffing was inadequate, at the same time as many new admissions took place during this shift. This increased the workload and the risk of use of force. It seemed that the high focus on security and a somewhat strict framework affected the nightshift staff. In addition nightshift staff rarely participated in general straff training. The number of segregation decisions in the past year had increased and some patients were segregated for long periods. Some examples of good practice during segregation also emerged, where human contact and joint activities with the staff throughout the day were emphasised. In some cases, however, coercive measures were used in the segregation units because the patients felt locked in and tried to get out, and we also observed examples of patients being handled in a way that led to unrest and the situation escalating. There had been a decrease in the number of administrative decisions on forced medication last year. The legal requirement that the patient must be incapable of giving their consent was not always ­a dequately described, and a number of patients ­stated that they had not received sufficient information about the potential side effects of the medicines they were given. Over the past two and a half years, the hospital performed Electroconvulsive treatment (ECT) on a small number of patients on grounds of necessity. (i.e. without informed consent in a life-threatening situation). Although the threshold for performing ECT on grounds of necessity was high, the findings highlighted several of the problematic aspects of using the principle of necessity provision in the General Civil Penal Code as grounds for treatment as invasive as ECT. Bergen Hospital, Sandviken psychiatric clinic 14–16 August 2018 A key finding from the visit to Sandviken psychiatric clinic was that segregation (in Norwegian law termed ‘shielding’) was conducted in premises with undignified conditions. All sections had a segregation unit where patients were kept apart from the other patients. Most of the units had a patient room for segregation, an isolation cell, and a room for ­mechanical restraints. The segregation premises had a sparse design with very few sensory impressions. The rooms often had no furniture other than a bed that was fixed to the floor. The isolation cells only contained a mattress with bedding on the floor. A high occupancy rate meant that the isolation cells were often used for segregation. The segregation was often performed in a manner similar to isolation and the patients were subject to strict rules. The staff appeared to lack a clear plan of what a segregation period should include, and there were limited possibilities to spend time outdoors. It was common practice at the clinic to use mobile restraints as a form of mechanical restraint. This created a risk of normalising the use of coercive measures, and could thereby lead to restraints being used for longer periods. Restraints were use during ambulance transport even if there was no legal authority for so doing. Spit hoods had in some cases been used to cover the patients’ faces while being restrained. The NPM advised against using spit hoods, since they can be humiliating to wear and provoke anxiety, particularly for someone who is fixated to a restraint bed.