22 Intrusive and detrimental to health Being placed in a restraint bed is a major violation on personal integrity, and creates a risk of somatic injuries, trauma and other negative consequences to mental health. Somatic risks include dehydration, circulation and skin problems, loss of muscle strength and mobility and incontinence. It also entails a risk of death as a result of blood clots.11 Two fatalities have occurred during or after the use of restraints in mental healthcare institutions in Norway in the past 25 years: one as a result of a blood clot in 1998, and one due to cardiac arrest in 2011. In Denmark, a death was reported in 2016 as a result of a blood clot shortly after the use of a restraint bed in prison.12 We know that the use of restraints in mental healthcare institutions pose a risk of personal injury. Such injuries can occur during the initial phase of the application of the restraint, due to lack of supervision, the inmate being placed in the bed for an excessive amount of time, or other reasons, such as body parts being trapped prior to ­application of the restraint, or aggressive behaviour from staff. In an attempt to control the inmate, the staff may overreact, thus leading to heavy-handed and painful use of force.13 NORWEGIAN PARLIAMENTARY OMBUDSMAN National Preventive Mechanism ANNUAL REPORT 2019 The person put in the restraint bed will react with fear and panic, which is normal in this situation as he or she may feel that they are fighting for their life. Aggressive reactions from staff can result in conduct that escalates the conflict and constitutes a greater risk of injuries.14 There is also a considerable risk of negative mental health consequences. Feelings of powerlessness, helplessness, loneliness, fear and re-traumatisation are reported. In addition to the immediate harmful effects, being put in a restraint bed can lead to negative long-term effects, such as traumatising memories, feelings of mistrust and symptoms of post-traumatic stress disorder.15 Studies also show that experiences of harmful coercive events are made worse when there is a sense of ­miscommunication in the situation, such as the feeling of not being taken seriously, humiliated or being punished. Such negative experiences can last for several years after the event.16, 17 Because inmates are placed in restraints when they harm themselves or attempt suicide, there is reason to believe that there is an increased risk of such long-term effects. It can thus be concluded that inmates who are placed in restraint beds are subjected to an intervention that entails a clear risk of developing trauma in an acute life crisis. 11 Norwegian Official Report NOU 2019:14 (2019). Draft Law on the Reduction of Coercive Measures [Tvangsbegrensningsloven]. Oslo: Norwegian Government Security and Service Organisation, p. 267. 12 Ankerstjerne, (2018) Young man in restraint bed for 9 days in Vridsløselolle - died few days after release [Ung mand lå fastspændt i 9 døgn i Vridsløselille - døde få dage efter], TV2Lorry.no, 14. mars 2018. Available from: https://www.tv2lorry.dk/albertslund/ung-mand-la-fastspaendt-i-9-dogn-i-vridsloselille-dode-fa-dage-efter 13 Norwegian Official Report NOU 2019:14 (2019). Draft Law on the Reduction of Coercive Measures [Tvangsbegrensningsloven]. Oslo: Norwegian Government Security and Service Organisation, p. 265. 14 Norwegian Official Report NOU 2019:14 (2019). Draft Law on the Reduction of Coercive Measures [Tvangsbegrensningsloven]. Oslo: Norwegian Government Security and Service Organisation, p. 265. 15 Norwegian Official Report NOU 2019:14 (2019). Draft Law on the Reduction of Coercive Measures [Tvangsbegrensningsloven]. Oslo: Norwegian Government Security and Service Organisation, p. 267. 16 Norwegian Official Report NOU 2011:9 (2011). More self-determination and legal safeguards. Oslo: Norwegian Government Security and Service Organisation, p. 124. 17 Strout, T.D. (2010). Perspectives on the experience of being physically restrained: An integrative review of the qualitative literature. International journal of mental health nursing, 19, 416–427.