55 Follow-up of recommendations Solitary confinement, isolation, and segregation The NPM has been concerned about the use of solitary confinement in prisons following its visits. Isolation can have a serious impact on the inmate's mental health and may incite more aggressive behaviour and weaken impulse control. It can also increase the risk of suicide among inmates. The UN Special Rapporteur on Torture has concluded that solitary confinement in certain cases can constitute a violation of international conventions. During its visits to mental healthcare institutions, the NPM expressed similar concerns about the use of segregation. This can be considered both a treatment and control measure, where patients are physically segregated from other patients and removed from social interaction with other patients. Findings have shown that segregation often takes place in premises with few sensory impressions and little human contact, making the measure comparable to isolation. Child welfare institutions have a very restricted right to place young people in isolation. This can only be done in emergency situations and never without the presence of adults. Still, the NPM has discovered unlawfull isolation in several visits. Findings and recommendations Prisons and the immigration detention centre have been recommended to avoid placing persons with severe mental health challenges in solitary confinement, and rather seek alternative measures. ›› ››At most of its visits to mental healthcare institutions, the NPM has seen the need to underline that segregation under conditions similar to isolation must not be used. ››After the NPM’s visit to the child welfare institution Kvammen, it recommended ensuring that all use of unauthorised isolation cease with immediate effect. Follow-up Åna Prison reviewed cases where inmates were isolated at their own request in order to analyse the causes and find measures to counteract them. It also implemented measures to activate inmates in isolation and new procedures to ensure their daily supervision to prevent harm resulting from prolonged isolation. ›› ››After the NPM’s visit, Arendal Prison developed internal guidelines on how inmates isolated at their own request are to be followed up. ››Following the NPM’s criticism of the hospital's segregation practice, Akershus University Hospital specified that patients who are segregated must be under constant supervision. ››The child welfare institution Kvammen was temporarily closed to ensure, among other things, that all unauthorised use of isolation is stopped with immediate effect. Changes were implemented to prevent this happening again after the institution was reopened.