Special Report to the Storting Document 4:3 (2018–2019) 28 Dayplan in a restrictive unit. "Avslo" = Rejected. 4.3 Harmful effects in particularly ­vulnerable individuals People who already have mental health problems or a developmental disability are particularly sensitive to the harmful effects of isolation.79 Both Norwegian and international research shows that mental health issues are more prominent in the prison population than in the general population. The majority of all inmates have mental health problems.80 A Norwegian survey from 2014 of mental health problems among inmates showed that as many as 65 per cent of the respondents suffered from a primary disorder ­classified as an ­anxiety or mood disorder.81 This includes panic ­disorders, social anxiety, depressions and post- ­traumatic stress disorders. The same survey showed that the proportion of drug-related disorders was much greater than in the general population. In a survey in 2018, the Directorate of the Norwegian Correctional Service asked all prisons to report on the number of inmates 79 80 81 82 83 84 ‘who, based on their state of mental health, can be perceived as having special needs over and above what the units can reasonably be expected to handle, and that cannot be met by use of regular measures. It was made clear that the units should not obtain medical diagnoses or assessments in connection with the survey, and that the survey sought to register the Correctional Service’s own impression of the inmates in their units’.82 The prisons reported that there were 848 inmates in this category, that is approximately a quarter of all inmates in Norwegian prisons.83 At the same time, research indicates that one in ten inmates in Norwegian prisons have learning difficulties that correspond to a light intellectual disability.84 Shalev, S (2008). A Sourcebook on Solitary Confinement. London: Mannheim Centre for Criminology, London School of Economics. See also http://solitaryconfinement.org/uploads/sourcebook_web.pdf, p 30. Fazel, S & Danesh J (2002). Serious mental disorder in 23 000 prisoners: a systematic review of 62 surveys. The Lancet, 359, 545-550. Cramer, V (2014). The Prevalence of mental disorders among convicted inmates in Norwegian prisons (Project report from the Centre for Research and Education in Forensic Psychiatry, 2014-1). Oslo: Oslo University Hospital. Directorate of the Norwegian Correctional Service, Addendum no 4 to the letter of allocation for 2018 – oppfølging av kritikk vedrørende psykisk syke og isolasjon i fengsel (’follow-up of criticism regarding mentally ill inmates and isolation in Norwegian prisons’), letter of 25 September 2018 to the Norwegian Ministry of Justice. As of 28 August 2018, there were 3,357 inmates in Norwegian prisons. Søndenaa, E (2009). Intellectual disabilities in the criminal system. Trondheim: Norwegian University of Science and Technology (NTNU). 29 Minors and young adults are also particularly vulnerable to the harmful effects of isolation.85, 86 Former UN ­Special Rapporteur Juan E Méndez has advised against solitary confinement of children. In his report on children deprived of their liberty, he points out that since children are still in a process of development, both ­physically and mentally, they have different needs from adults. They will also experience pain and ­suffering differently from adults. Ill-treatment can therefore cause even greater or more irreversible damage in children than in adults. Excessive and prolonged exposure to physiological stresses can have devastating effects on normal development. It can result in learning difficulties, behavioural problems and health problems, including in the long term.87 Juvenile offenders have a high incidence of mental health problems and learning difficulties, and come from backgrounds of neglect and trauma in the form of maltreatment and abuse.88 The brain of young adults continues to develop until they are well into their 20s.89 Normal development depends on adequate relational security, social contact, model learning and activation.90 Isolation from the rest of the world is a threat to such development. It has also been pointed out that the possibility of favourable ­development is undermined through reinforcing ­aggression and crime.91 Cultural and language barriers can prevent a person from seeking help for the problems that arise in solitary confinement.92ʼ 93 Language barriers can also reduce ­social contact and reinforce the feeling of isolation. 85 86 87 88 89 90 91 92 93 94 95 96 97 98 ­ uring our visits, we have also seen that language D barriers can give rise to misunderstandings and communication difficulties, and, in turn lead to solitary confinement. Figures from the Directorate of Norwegian Correctional Service suggest that non-Norwegian nationals are overrepresented among those held in prolonged isolation in security cells. 4.4 Delayed injurous effects and ­rehabilitation after solitary confinement The longer the period of confinement, the greater the risk of lasting disorders and complaints.94 We know that difficult life events can trigger mental health problems, and that such problems can develop and reinforce themselves so that it is difficult to get rid of them even if one’s life situation improves.95,96 For ­example, further withdrawal following a person’s ­release from solitary confinement or prison can further the development of a depression or anxiety disorder. As described above, solitary confinement can be ­experienced as highly burdensome, particularly when it entails little social contact, lack of external stimuli and ­activities, little predictability and a great loss of ­autonomy. In addition, many inmates have previously experienced traumas in their lives, and a significant ­proportion suffer from post-traumatic stress ­disorders.97 Situations involving significant loss of control and autonomy can trigger retraumatisation and exacerbate traumatic and other mental health disorders. 98 Norwegian Official Report NOU 2008: 15 (2008). Barn og straff – utviklingsstøtte og kontroll (’Children and punishment – development support and control’). Oslo: Norwegian Government Security and Service Organisation. American Psychiatric Association (8 June 2017). Solitary confinement of juvenile offenders. https://www.apa.org/advocacy/criminal-justice/solitary.pdf The UN Human Rights Council, report from the UN Special Rapporteur on Torture, 5 March 2015, A/HRC/28/68. The following is stated in Norwegian Official Report NOU 2008: 15 (2008): ‘Children who have committed criminal acts are a marginalised and vulnerable group who will be particularly sensitive to detrimental effects’. NOU (2008). Barn og straff – utviklingsstøtte og kontroll (‘Children and punishment – development support and control’). Oslo: Norwegian Government Security and Service Organisation. Lee, J (2016). Lonely Too Long – Redefining and Reforming Juvenile Solitary Confinement. Fordham Law Review, 85, 846–870 See, for example, Tetzchner, S V (2012). Utviklingspsykologi. (‘Development psychology’) Oslo: Gyldendal akademisk. Meritt, J (2018). Is there a good justification for the segregation of young people? Prison Service Journal, 236, 27-32. Leong, F T and Kalibatzeva, Z (2011). Cross-cultural barriers to mental health services in the United States. Cerebrum, 2011, 5. Erdal, K et al. (2011). Attitudes about depression and its treatment among mental health professionals, lay persons and immigrants and refugees in Norway. Journal of Affective Disorder, 133, 481-488. Smith, P S (2006). The Effects of Solitary Confinement on Prison Inmates: A Brief History and Review of the Literature. Crime and Justice, 34, 494. Dohrenwend, B P (1998). Adversity, Stress and Psychopathology. New York: Oxford Press. Berge, T & Repål, A (2015). Håndbok i kognitiv terapi (’Handbook in cognitive therapy’). Oslo: Gyldendal akademisk. Cramer, V (2014). Prevalence of mental disorders among convicted inmates in Norwegian prisons (Project report from the Centre for Research and Education in Forensic Psychiatry, 2014-1). Oslo: Oslo University Hospital Sweeney, A; Filson, B; Kennedy, A; Collinson, L; & Gillard, S (2018). A paradigm shift: relationships in trauma-informed mental health services. BJ Psych advances, 24, 319–333.