NORWEGIAN PARLIAMENTARY OMBUDSMAN National Preventive Mechanism ANNUAL REPORT 2018 30 Isolation-like segregation One important finding is that segregation in many cases clearly resembles isolation. Many patients spend a lot of time alone, often with little contact with the staff. Examples were also found of segregation measures being used for a prolonged period of time. Some patients are segregated for several months or, in exceptional cases, years. Need to focus on alternatives to segregation The thematic report points out that alternatives are needed to the current segregation practices. In the report, the NPM issues the following recommenda­tions to help prevent the risk of inhuman and degrading treatment caused by segregation: The implementation of segregation is often characterised by strict rules, unclear treatment content, and a lack of opportunity to spend time outdoors every day or participate in adapted activities. The NPM has also found that physically restraining patients by manual control is incorrectly considered as being covered by a segregation decision, and that patients can be held, wrestled to the ground and, in some cases, physically carried into a segregation unit, without an administrative decision being made to that effect. Statistics prepare a national overview of the duration of segregation measures. Such an overview should also include information about ­geographical ­variations and, in particular, prolonged ­measures. Furthermore, administrative decisions on the use of segregation were often inadequately documented, without a precise description of why segregation was considered necessary in each individual case. The thematic report shows that human rights standards set clear limitations on the right to use isolation-like measures in the health care services. The use of segregation, particularly if upheld over long periods of time, in an invasive manner with a low degree of freedom of movement, meaningful human contact and self-determination, can constitute a risk of violation of the prohibition against inhuman and degrading treatment. To the national health authorities ›› Assessment of the legislation carry out an assessment of whether the legislation that applies to the use of segregation is in accordance with human rights requirements and standards, both as regards the right to use segregation as a treatment measure and as a control measure. The need for special due process guarantees should also be considered to avoid prolonged segregation. ›› Knowledge building consider national professional development projects on segregation, such as projects on humane and safe design of segregation units in mental healthcare institutions, less invasive methods for implementing segregation, and alternatives to segregation. ››