NORWEGIAN PARLIAMENTARY OMBUDSMAN National Preventive Mechanism 10 11 USE OF RESTRAINT BEDS IN NORWEGIAN PRISONS 4 Intrusive and Detrimental to Health Being placed in a restraint bed is a major violation on personal integrity, and creates a risk of somatic injuries, trauma and other negative consequences to mental health. Somatic risks include dehydration, circulation and skin problems, loss of muscle strength and mobility and incontinence. It also entails a risk of death as a result of blood clots.11 Two fatalities have occurred during or after the use of restraints in mental healthcare institutions in Norway in the past 25 years: one as a result of a blood clot in 1998, and one due to cardiac arrest in 2011. In Denmark, a death was reported in 2016 as a result of a blood clot shortly after the use of a restraint bed in prison.12 ‘The inmate claims that they have childhood trauma [...] and that the restraint bed reminds them of the trauma.’ From the supervision log A restraint bed in a prison is inspected by the NPM. Under Section 38 second paragraph of the Execution of Sentences Act, restraints shall only be used if the circumstances make this strictly necessary and less intrusive measures have been attempted unsuccessfully or are obviously inadequate. Restraint measures must be used with caution in order to prevent unnecessary harm or suffering. The guidelines stress that the Correctional Service will continually assess whether there is a need to uphold the measure. In addition, the Act has rules for notifying a doctor and reporting long-term use of restraint beds to the governing authority, as well as separate, stricter rules for the use of restraint beds for ­persons under 18. The health service’s assistance to a person placed in restraints is regulated in the Health Personnel Act Section 4 concerning professional ­responsibility and diligent care. We know that the use of restraints in mental healthcare institutions pose a risk of personal injury. Such injuries can occur during the initial phase of the application of the restraint, due to lack of supervision, the inmate being placed in the bed for an excessive amount of time, or other reasons, such as body parts being trapped prior to ­application of the restraint, or aggressive behaviour from staff. In an attempt to control the inmate, the staff may overreact, thus leading to heavy-handed and painful use of force.13 The person put in the restraint bed will react with fear and panic, which is normal in this situation as he or she may feel that they are fighting for their life. Aggressive reactions from staff can result in conduct that escalates the conflict and constitutes a greater risk of injuries.14 There is also a considerable risk of negative mental health consequences. Feelings of powerlessness, helplessness, loneliness, fear and re-traumatisation are reported. In addition to the immediate harmful effects, being put in a restraint bed can lead to negative long-term effects, such as traumatising memories, feelings of mistrust and symptoms of post-traumatic stress disorder.15 Studies also show that experiences of harmful coercive events are made worse when there is a sense of ­miscommunication in the situation, such as the feeling of not being taken seriously, humiliated or being punished. Such negative experiences can last for several years after the event.16, 17 11 Norwegian Official Report NOU 2019:14 (2019). Draft Law on the Reduction of Coercive Measures [Tvangsbegrensningsloven]. Oslo: Norwegian Government Security and Service Organisation, p. 267. 12 Ankerstjerne, (2018) Young man in restraint bed for 9 days in Vridsløselolle - died few days after release [Ung mand lå fastspændt i 9 døgn i Vridsløselille - døde få dage efter], TV2Lorry.no, 14. mars 2018. Available from: https://www.tv2lorry.dk/albertslund/ung-mand-la-fastspaendt-i-9-dogn-i-vridsloselille-dode-fa-dage-efter 13 Norwegian Official Report NOU 2019:14 (2019). Draft Law on the Reduction of Coercive Measures [Tvangsbegrensningsloven]. Oslo: Norwegian Government Security and Service Organisation, p. 265. 14 Norwegian Official Report NOU 2019:14 (2019). Draft Law on the Reduction of Coercive Measures [Tvangsbegrensningsloven]. Oslo: Norwegian Government Security and Service Organisation, p. 265. 15 Norwegian Official Report NOU 2019:14 (2019). Draft Law on the Reduction of Coercive Measures [Tvangsbegrensningsloven]. Oslo: Norwegian Government Security and Service Organisation, p. 267. 16 Norwegian Official Report NOU 2011:9 (2011). More self-determination and legal safeguards. Oslo: Norwegian Government Security and Service Organisation, p. 124. 17 Strout, T.D. (2010). Perspectives on the experience of being physically restrained: An integrative review of the qualitative literature. International journal of mental health nursing, 19, 416–427.