19 Selected topics from 2017 that continuous monitoring should be considered for security cells.5 In addition to monitoring by the prison staff, health personnel are obliged to check on the inmates at least once a day. The log entries show that, in most cases, the monitoring consists of a prison officer observing the inmate through a hatch or window to check that the inmate is breathing or showing other signs of life. Even in cases where an inmate is deemed to be at acute risk of committing suicide, the logs show that monitoring entails limited human contact and that conversations of any length are rare. In most cases, the use of a security cell will mean that it is not possible for the inmate to commit suicide during the acute phase, as the cell contains no objects that can be used for this purpose. However, the NPM’s reports have pointed out that the use of security cells can traumatise the inmate. Based on what is known about the effects of isolation, it cannot be ruled out that the use of a security cell as a suicide prevention measure may have the opposite effect, in that the risk of suicide actually increases in both the short and long term. This highlights the importance of exercising particular caution as regards placement in a security cell where there is a risk of suicide or self-harm. If security cells are to be used, however, it is important that there must be more human contact than is the case under the current practice. Exclusion at own request A common reason given for exclusion is that the inmate is excluded at his or her own request. A review of administrative decisions and interviews with inmates show that there can be a number of reasons for this. Not feeling safe is often stated as a reason, however. The Cramer study shows that a total of 65 per cent of those included in the study had a primary disorder that could be classified as an anxiety or mood disorder. This includes panic disorders, social anxiety, depressions and post-traumatic stress disorder. Many of the people interviewed by the NPM say that they have chosen to isolate themselves, because of such mental disorders, in their own section or in restricted sections. It would appear that many of those who choose to isolate themselves have an unmet need for treatment, and that inadequate follow-up of this vulnerable group can add to the burden for the inmates concerned. — Based on what is known about the effects of isolation, it cannot be ruled out that the use of a security cell as a suicide prevention measure may have the opposite effect, in that the risk of suicide actually increases in both the short and long term. — 5 Guidelines to the Execution of Sentences Act, revised 27 October 2008, statutory and regulatory provisions updated 10 October 2017, section 38.4.