46 NORWEGIAN PARLIAMENTARY OMBUDSMAN National Preventive Mechanism ANNUAL REPORT 2016 istrative decision had not been made. Instead of ending the restraint or making a decision formalising the ongoing situation, the duty doctor noted in the patient record that this was left to the doctor who instigated the restraint and who came on duty the next day. The patient was placed in restraints for 25 1/2 hours in total. with a restraint bed was part of the segregation unit. Placing the restraint bed in the segregation unit can increase the risk that the restraint bed will be used on segregated patients instead of milder means. It was observed that patients were segregated in a separate room with members of staff sitting outside, with the door closed. The review of the patient records showed repeated instances of patients being held for brief periods without an administrative decision having been made. Some patients also told the team that they had experienced such holding as a punishment for behaviour that the milieu therapists did not like. This gave the impression that the patients were alone and without direct supervision for short or longer periods. In the inpatient ward in the secure department, a large part of the ward was set aside as a segregation unit for one patient. At the time of the NPM's visit, the patient had been segregated continuously for around three and a half years. The administrative decisions were renewed every two weeks. Many of the decisions stated that the patient had not received the decision in writing, because 'too many "routine letters" are deemed to stress the patient'. The staff at the unit explained that the patient could have a mental health condition that made it difficult for him to understand, at the moment the decision was made, the decision to use force and the right to complain. Several sources in emergency ward North reported incidences of unnecessary use of force during the implementation of coercive measures. There were no procedures for training staff in placing patients in restraints at the psychiatric department. Nor were there procedures for training in or reflection on what effect the use of coercive measures can have on patients. Next of kin are rarely or never informed about patients being placed in restraints. The emergency psychiatric section did not offer voluntary follow-up interviews after the implementation of coercive measures. The supervisory commission pointed out that the hospital appeared to lack dependable procedures for registration in the use-of-force records. In addition, the supervisory commission remarked that some of the administrative decisions on the use of coercive measures were not entered in the records, only in the electronic patient records system (DIPS). In several cases, incomplete use-of-force records were signed by the supervisory commission without comment. Three of the units at the emergency psychiatric section had separate segregation units. None of them had direct access to the open air from the segregation units. In emergency ward North, a room equipped The staff in emergency ward North were perceived as having several unfortunate characteristics and attitudes. The management is responsible for ensuring that the social identity and culture that develop among staff are in compliance with human rights and with fundamental rights such as patient safety and the inherent dignity of all human beings. When the management's attitudes and values are not clear or are not respected, there is a risk that cultures that permit abuse will develop. A clear lack of trust in the management was expressed by several members of staff during the visit. Several members of staff also pointed out that staff members were not looked after or followed up to any great extent if serious incidents occurred at work.