[This article was published in the Norwegian Ombudsman’s annual report 2015. Read the report here.]
The most commonly used coercive measures were security cells and restraint beds in prisons, handcuffs (during arrest and until detention) in police custody facilities; security cells, handcuffs and the restraining system known as BodyCuff at the police immigration detention centre at Trandum, and restraint beds and injections of short-acting medication in mental health care institutions.
«Coercive measures are never to be used as treatment or punishment»
According to human rights standards, encroachments on personal integrity must comply with legality, necessity and proportionality requirements. Coercive measures can be used to prevent an acute and serious situation that endangers the life and health of the person subject to coercive measures or persons nearby. In some cases, it is also possible to use coercive measures to prevent significant material damage. Coercive measures are never to be used as treatment or punishment. The strict conditions reflect that coercive measures represent a major encroachment on an individual’s personal integrity.
From a preventive perspective, the use of coercive measures entails a clear risk of violating the prohibition against torture and ill-treatment. The NPM therefore always investigates what coercive measures are available at each place of detention, what the practice is for their use, for how long and how often are they used, how their use is documented, the possibility to file complaints, and how those deprived of their liberty feel about being subjected to coercive measures.
«From a preventive perspective, the use of coercive measures entails a clear risk of violating the prohibition against torture and ill-treatment»
Security cells are used both in prisons and at the immigration detention centre at Trandum. The security cells are usually the same size as a police custody cell, but are slightly smaller at Trandum. Apart from a squat toilet in the floor and a mattress, the security cells have no furniture etc. Food and drinks are often inserted through a hatch by the floor. The Parliamentary Ombudsman expressed concern about, among other things, the length of stays in the security cells and that, in some cases, inadequate administrative decisions had been made. Some prisons have now obtained clothing that should not be possible to use for self-harm by twisting or tearing. This is an important measure to ensure that inmates do not have to be naked in the security cell. At the same time, these clothes can be perceived as stigmatising, unpleasant and an encroachment in itself, and they should therefore only be used in situations involving a concrete suicide risk. Apart from in this type of situation, inmates should have their own or other ordinary clothes from the institution.
«It is also emphasised in several of the Parliamentary Ombudsman’s reports that stays in security cells constitute a particularly invasive form of solitary confinement»
Regular supervision and regular conversations that prevent people deprived of their liberty from feeling isolated and helpless are important measures to reduce the risk of suicide and of aggravating mental illness. It is also emphasised in several of the Parliamentary Ombudsman’s reports that stays in security cells constitute a particularly invasive form of solitary confinement. Reference was made to existing knowledge that isolation can increase the risk of suicide, self-harm and the development of serious mental illness. The NPM’s experience to date indicates that the risk of serious self-harm and suicide is among the most commonly cited grounds for administrative decisions placing someone in a security cell. This gives cause for concern, given the negative effect of solitary confinement on inmates’ mental health. A review of supervision logs kept for security cells revealed instances in several prisons whereby inmates reacted to the situation by becoming apathetic, by undressing, by urinating on the floor and walls or by attempting to self-harm.
Using a restraint bed
Using a restraint bed is one of the most invasive measures that can be legally used on someone. Like other coercive measures, this measure is intended to prevent an acute situation and is never to be used in connection with treatment or as punishment. In contrast to the correctional services, where health personnel are not to be involved in decisions to use a restraint bed, in mental health care it is health personnel who decide and implement the use of a restraint bed for committed patients. The unique aspects of the role of health personnel in relation to people deprived of their liberty are discussed in a separate article (see page 23 of the Annual Report 2015). The fact that health personnel both treat and implement the use of coercive measures creates special challenges for relations with people deprived of their liberty and reinforces the need for control mechanisms. Supervisory commissions have been appointed for mental health care institutions to review the use-of- force records, which include the use of restraint beds, and to check that the use of such measures has a legal basis and is properly documented.
Hospitals are urged to ensure that administrative decisions to use restraint beds apply for the shortest possible time. In mental health care, people who are restrained using a restraint bed can also be forced to take short-acting medication. The review of use- of-force records during visits to mental health care institutions revealed that the use of restraint beds is often combined with injections of short-acting medication.
People restrained in a restraint bed must be under constant supervision. The NPM also found that some prison inmates had been so affected by solitary confinement that they had asked to be restrained in a restraint bed so that they would not be left on their own. This is a serious indication of what it feels like to be in solitary confinement in a security cell.
The police custody facilities are no longer allowed to use restraint beds, but the custody facilities and immigration detention centre at Trandum is authorised to use the BodyCuff. This is a type of transport restraint system that is fastened around the wrists (with handcuffs), ankles and stomach and where straps between the hands and feet can be tightened to pull the hands and feet towards the stomach or back, respectively. This coercive measure is primarily used in connection with people being escorted out of the country, on planes etc. The NPM found no instances of non-regulated use of the BodyCuff during its visits in 2015, but did call for systematic registration of its use and the use of other coercive measures when escorting foreign nationals out of Norway.
Some police custody facilities were found during visits to have hooks to which detainees could be handcuffed to the wall above a bench in the waiting room (’the registration room’). This is a practice that has previously been criticised by the European Committee for the Prevention of Torture (CPT), and the NPM recommends that these hooks be removed. The recommendation was, in most cases, speedily followed up by the custody facilities in question.
During visits to prisons, inmates on remand were found to have missed appointments with the specialist health service because they were wearing handcuffs and health personnel concluded that the examination could not be carried out with the inmate in handcuffs. This could constitute ill-treatment, and the NPM recommends a change in practice.
Documentation of the use of coercive measures
The use of coercive measures must be documented through written administrative decisions and by logging the sequence of events. This is important because it provides a basis for expedient internal control and ensures a real possibility to fi a com- plaint. Documentation is also crucial for ensuring that the supervisory authorities are able to control the use of coercive measures. The different supervisory councils, supervisory commissions and the County Governor carry out important preventive work and must be able to check compliance with laws and regulations and that proper conditions are ensured for the people concerned.
During the visits, some major differences were found in practice and in the quality of documentation in administrative decisions and supervision logs. These factors should be rectified through clear internal guidelines and regular training of employees. The NPM made several recommendations to that effect and also made a recommendation concerning patients’ right of access to use-of-force records and the opportunity to enclose their own comments to the records.