NORWEGIAN PARLIAMENTARY OMBUDSMAN National Preventive Mechanism 16 17 USE OF RESTRAINT BEDS IN NORWEGIAN PRISONS Most inmates are transferred to the restraint bed from a security cell, like this one. Our visits and review of documents have uncovered many weaknesses in the supervision provided by medical personnel. These are in contrast to the rules applicable to the mental healthcare service requiring continuous supervision by nursing staff when patients are placed in restraints.27 There is increasing recognition in the mental healthcare service that self-harm and suicidal tendencies should not be met with coercive measures such as restraint beds, as this increases the risk of coercion being used rather than reducing the behaviour one wishes to prevent. A decision regarding the use of restraints in compulsory mental health care can only be made by a doctor who is an approved specialist, or a clinical psychologist with the relevant practice and further education set out in the regulations. The decision can be appealed to an oversight commission (called Control Commission) independent of the hospitals.28 The oversight commission must at its own initiative revise all decisions regarding restraints.29 ‘In the administrative decision, emphasis was placed on the fact that you banged your head into the brick wall, and that you were not responsive to our message that this was not good for you. You were therefore lifted up and placed in a restraint bed. The doctor from the accident and emergency unit came to the prison to assess you [and] did not admit you to the psychiatric department but said that you were receiving the treatment that was best for you at the moment.’ 6 Restraint Beds and the Prohibition Against Inhuman Treatment From the supervision log ‘02:08 – The blanket is starting to slide off. Says yes to having it put back on. Asks for another blanket, as they are cold. […] 05:16 – Inmate asks for help with the blanket. Asks for a regular pillow. The inmate is told that this is not possible. […] 05:33 – Complains about back pain. Says they want to move to the security cell to sleep.’ The role of doctors in connection with decisions to use restraints must be limited to advising against using such measures if there are health reasons for doing so. Our review shows that there were several instances where medical personnel r­ ecommended using a restraint bed. In some ­cases, the medical personnel also stated that supervision by medical personnel was ­unnecessary as the prison staff carried out continuous ­supervision. This attests to a lack of understanding of the role of medical personnel, and a lack of knowledge about the adverse health effects of restraint beds. The supervision logs also showed examples of both prison officers and the prison’s health ­personnel attempting to get inmates placed in restraints transferred to a mental healthcare i­nstitution, but that this was rejected by the s ­ pecialist health service. The Requirement of Strict Necessity The ECtHR requires that the use of restraint belts must be necessary and proportional to prevent immediate harm.30 According to Norwegian ­legislation, the use of restraints must only be employed when strictly necessary to prevent the inmate from hurting him or herself. The straps must be removed immediately when the risk of harm ceases. Less intrusive measures must always be attempted, unless it is obvious that they will have no effect. From the supervision log We found a significant number of decisions regarding the use of restraint beds that lacked adequate reasons. Several decisions lacked an individual description of the specific situation that made the decision necessary. In some prisons, half of the decisions lacked reasons for the use of restraint beds. In total, around half of the eighteen prisons had one or several decisions that contained inadequate reasons. No ­administrative decision has been made in eight of the 82 cases concerning the use of restraint beds. 27 The Mental Health Care Act Section 4-8 fourth paragraph. 28 The Mental Health Care Act Section 4-8 fifth paragraph. 29 The Control commission’s case processing, Circular, the Directorate of Health, 22 November 2016. 30 Bures v. the Czech Republic, application no. 37679/08, judgment of 18 October 2012.