NORWEGIAN PARLIAMENTARY OMBUDSMAN National Preventive Mechanism ANNUAL REPORT 2019 34 present play a crucial role in creating a sense of security and identifying inmates who withdraw from the company of others and from daily activities. of common guidelines and training on how to safeguard inmates to limit the detrimental effects of solitary confinement. Harmful effects of solitary confinement The report presents a wealth of documentation available about the physical and mental health effects of solitary confinement. Contact with other people is one of the most fundamental human needs, and research confirms that a high ­proportion of those in solitary confinement experience some form of physical or mental health issue as a result of the solitary confinement.1 The harmful effects of solitary confinement can be immediate, but the number of inmates who develop health problems and the severity of such problems increase with the length of confinement. People who already have mental health issues or a mental disability are particularly vulnerable to the harmful effects of solitary confinement. The most effective way of reducing the harmful effects of solitary confinement is to facilitate meaningful human contact. The most effective measure will always be to ensure that inmates have the opportunity to spend time with others for most of the day. In cases where this is not feasible, it is imperative that the prison ensures that inmates have contact with people in other ways, such as contact with staff, external parties such as prison visitors, or other inmates when possible. During the NPM's visits to prisons, inmates frequently tell us that prison officers rarely find the time to have long and meaningful conversations with them, and that the only contact they have with staff is in connection with daily tasks, such as handing out meals and medication. On the other hand, the prison officers often point out that they do not have time to focus on individual inmates in solitary confinement and that the staffing levels are too low. There is a lack 1 Inadequate follow-up from the health service International standards state that medical ­personnel must visit inmates in solitary ­confinement every day. There is no such minimum requirement in Norwegian legislation, and the Directorate of Health recommends that medical personnel visit inmates when medical reasons so indicate. This is not sufficient because it means inmates are dependent on the assistance of prison staff to get in touch with the health service. We have found examples in several prisons where the health service was not contacted or notified, despite documentation showing that inmates had repeatedly requested the assistance of medical personnel. There are multiple cases where several days passed between visits from medical ­personnel, despite the inmate in question ­displaying major and obvious mental anguish or reported physical injuries. The report also makes reference to an absence of statutes and central guidelines that ensure that medical personnel follow up inmates in solitary confinement in a responsible manner. Our visits have also uncovered a clear lack of competence among medical personnel regarding the harmful effects of solitary confinement and a lack of adequate follow-up and measures to prevent such effects. See, inter alia: Shalev, S. (2008). A Sourcebook on Solitary Confinement. London: Mannheim Centre for Criminology, London School of Economics. Smith, P. S. (2006). The Effects of Solitary Confinement on Prison Inmates: A Brief History and Review of the Literature. Crime and Justice, 34, 476-487. Howard, F. F. (2018). The effect of segregation. Prison Service Journal, 236, 4-11. Smith, P. S. (2008). Solitary confinement. An introduction to the Istanbul Statement on the Use and Effects of Solitary Confinement. Torture Journal, 18, 56-62