56 8.1 Inmates who chose solitary ­confinement (self-isolation) During our visits, we often meet inmates who have ­chosen to withdraw from the prison community. Many of them do not feel safe in the communal sections, either because they suffer from mental health problems, feel that the environment is unsafe or as a result of threats from other inmates. We have found that the extent of self-isolation varies greatly between different prisons. As described in section 4.3 Harmful effects in ­particularly vulnerable individuals, a very high proportion of inmates in Norwegian prisons suffer from mental health problems. Many inmates with whom the NPM has spoken have mentioned that they choose solitary confinement because of mental health problems. It appears that several of these inmates have an unmet need for treatment. Lack of follow-up of this group can place further burdens on the individual (see section 8.2 Solitary confinement of inmates with mental disorders and a low level of functioning). I felt insecure in the exercise yard. I felt threatened and didn’t want a beating. Just want to finish serving my sentence; something to do with my past and my anxiety; I feel I have to watch out all the time. Inmate interviewed by the NPM We have also found that some inmates are afraid to participate in the prison community because they find some of the other inmates aggressive and unpredictable, and some have experienced harassment and violence in the communal sections. Convicted sexual offenders are often referred to as particularly likely to suffer such episodes. In some prisons, we have also found that transgender individuals choose isolation because they feel insecure in the communal sections. Some inmates say that little human contact makes them feel insecure in the communal areas. To gain control of the situation, they choose complete isolation instead. Special Report to the Storting Document 4:3 (2018–2019) Even if an inmate has been placed in isolation by his or her own request, the choice may have been made because the alternative was perceived as impossible or very difficult. Hence, inmates who chose isolation because they feel insecure will also be prone to suffer harmful effects of isolation. See also section 6.3 Solitary confinement by choice, on the prison administration’s responsibility for creating communal sections that are perceived as safe enough for inmates to come out of self-isolation. 8.2 Solitary confinement of inmates with mental disorders and a low level of functioning After the examination by the UN Committee against Torture in 2018, the committee concluded that too many inmates with mental health disorders were being placed in solitary confinement in Norwegian prisons, and that their condition was worsening as a result of this.183 During our visits to high-security prisons, we regularly meet inmates whose level of functioning is so low that they are only able to participate in an ordinary social regime to a very limited degree. They are therefore moved to restrictive units with little or no access to association with other inmates. In many cases, the development in their state of health gives cause for concern, and, for some, there is a gradual d ­ eterioration in their level of functioning while serving in this type of unit. Some troubling information has emerged in latter years about a group of particularly vulnerable individuals with severe ­mental health ­problems who serve their sentence in isolation for months and years on end. Ila Detention and ­Security Prison has been mentioned in particular. Our findings confirm the precarious situation of these ­individuals. At the same time, we have found that the situation is similar for individuals in a number of other prisons. We have met individuals with low communication skills who are unable to attend to their personal hygiene or keep their cells clean. Some have a high level of aggression, which makes contact with officers and other inmates difficult. In some cases, their behaviour is clearly odd or bizarre, with symptoms of severe mental disorders. Several of them have been excluded from the company of other inmates for a very long time, in some cases for months and even years. In some of these cases, we have nonetheless found that they have not been diagnosed by the health services.184 183 The UN Committee against Torture’s concluding observations on Norway’s eighth periodic report on the implementation of the UN Convention against Torture (CAT/C/NOR/CO/8), paragraphs 19–20. 184 The NPM has professional health personnel on its staff and is often accompanied by external medical experts during its visits. The NPM does not make any diagnoses of inmates during its visits, but its combined expertise enables it to say something about the inmate’s current situation, state of health and development, based on both meetings with the inmate and reviews of the documentation. 57 For a number of them, questions can be asked about whether the real reason behind their extended exclusion from company is the deterioration of their mental state resulting from solitary confinement. Findings from our visits also give cause for concern that some of the inmates held in prolonged solitary confinement suffer from some degree of mental disability. This makes them particularly prone to end up in solitary confinement and particularly vulnerable to the effects of isolation (see section 4.3 Harmful effects in ­particularly vulnerable individuals). Our findings also indicate that some of the inmates with mental health problems and a low level of functioning who are held in solitary confinement for a long time come from minority backgrounds and have poor Norwegian and English language skills. This creates further challenges for attending to their well-being, challenges that must be addressed by both the prisons and the health services. The findings also give cause for serious concerns about whether the risk of being held in solitary confinement is increased by language problems and other circumstances ­associated with their minority backgrounds. In some cases, it gives cause for concern about whether there is too little knowledge about possible war, torture-related and other traumas that the inmate may have suffered in the past. We have on numerous occasions visited cells where inmates are held in solitary confinement under highly censurable conditions. ‘Both the walls and floor were filthy. The floor, radiator and window sill were covered in bits of food and cigarette butts from several weeks’ consumption. The smell also told us that the cell had not been cleaned for a long time’.185 Inmates are tasked with cleaning their own cells, but some of them are not capable of ordinary cleaning. They depend on the assistance of other inmates or prison officers. In several instances, we have visited cells of inmates in solitary confinement whom neither the prison nor the health service seem to have provided adequate care and follow-up as regards cleanliness and personal hygiene. As a result, these inmates serve their sentences under degrading and potentially harmful conditions. Ordinary prison measures appear to work poorly for these inmates. Inmates do not appear to be able to change their behaviour while the prison escalates its security approach to the staff’s contact with them. For example, the presence of a certain number of prison officers equipped with various forms of protective ­equipment may be required whenever the cell is unlocked. This means that contact with the inmate is heavily demanding on resources and sometimes ­contributes to further solitary confinement of the individual concerned. In its standards for the use of security sections, the CPT points out that there will always be inmates who may pose a special security risk, having regard to what they are convicted of, how they cope with life in prison, or their psychological profile. It is this very profile that puts them at particular risk of suffering ill-treatment. The CPT stresses that this is a group that it is particularly ­concerned about, because the need for implementing special measure entails a higher risk of inhuman treatment.186 8.3 Lack of medical assistance to inmates with severe functional impairments in prolonged solitary confinement Inmates with mental health problems and functional impairments have a particular need for follow-up by the prison health service. We have observed, however, that follow-up of inmates can be further complicated by the fact that they often withdraw and do not want to have contact with prison officers or the health service. Medical personnel find it difficult to provide medical care to these inmates despite repeated attempts. As described in section 4.1 Harmful elements of solitary confinement, it is not uncommon for inmates to be unaware of or refuse help with problems caused by isolation, and that they withdraw from any contact offered during their period of solitary confinement. Some of these situations can start with exclusion as a result of disturbing the peace and end up with self-isolation. Where an inmate is deemed to possibly suffer from a severe mental disorder and in need of mental health care, transfer to a psychiatric inpatient ward may be relevant. An inmate may also be involuntary admitted for observation and treatment by the specialist health services where the conditions for this are met.187 185 The Parliamentary Ombudsman’s report after its visit to Ullersmo Prison, 29–31 August 2017, p. 26. 186 Council of Europe: Committee for the Prevention of Torture (CPT), The CPT standards, 8 March 2011, CPT/Inf/E (2002) 1 – Rev. 2010. 187 The Mental Health Care Act Sections 3-2 and 3-3.