Mental Health Services in Norway and statistics on use of coercion

1. Tonje Lossius Husum, Phd, ClinicalPsychologistPost docresearcher- Centre for medicalethics in UiO Mental Health Services in Norway and statisticsonuseofcoercion

2. Norwegian network for researchoncoercion in mental health services Tonje Lossius Husum

3. Plan for presentation: • The Norwegian Mental health services • The Norwegian Mental health law • Coerciveinterventions used in Norway • Statisticsoncoercion • Geographicalvariation • Message from theUN • Mention The Norwegian Action-plan for reduced and quality-insured used ofcoercion in MH Tonje Lossius Husum

4. Hospitalservices (Specialisthealth services) Community services Forensic departements Eatingdisorders Etc… Involuntary observation and treatment, involuntary treatment and coercive means Outpatient and Wardswith beds and Different kindofoutpatient teams (ACT etc) Out-patient services, also different kindof teams and somecrisis-bed services Involuntarytreatmentoutsideinstitution (TUD)

5. Regionale helseregioner (RHF) Helsefortak (HF) Health regions in Norway (RHF)

6. UseofCoercion…. Pictures from Google

7. Lov om etablering og gjennomføring av psykisk helsevern (psykisk helsevernloven) – 1999 (Norwegian Mental Health Law)Most importantsectionsaboutwhichregulateuseofcoercion: § 2.1. The general rule of consent (voluntary)§ 3.1. Medical Examination§ 3.2. Decision on compulsory observation§ 3-3. Decision on compulsory mental health care (in institution and outside institution) § 3-4. Prohibition against transfer from voluntary to compulsory mental health care§ 3.4. Shielding§ 4-4. Treatment without consent§ 4-5. Connection with the outside world§ 4-6. Examination of the rooms and property and personal search§ 4-7. Seizures of assets (belagaveiendeler) § 4.7 Urine sample§ 4-8. The use of coercive means

8. Coercivemeans (Tvangsmidler) a. mekaniske tvangsmidler som hindrer pasientens bevegelsesfrihet, herunder belter og remmer samt skadeforebyggende spesialklær(mechanicalrestraints) b. kortvarig anbringelse bak låst eller stengt dør uten personale til stede(isolation) c. enkeltstående bruk av korttidsvirkende legemidler i beroligende eller bedøvende hensikt(acuteuseof sedative medication) d. kortvarig fastholding(physicalrestraint) Tonje Lossius Husum

9. Coercivemeans in Norway (Tvangsmidler) • Mechanical • (Isolation) • Acute sedative medication • Physicalrestraint + skjerming/shielding

10. Official statistics on coercion Unfortunately, data on the extent of compulsory treatment are incompleteand partly poor quality. This are the best approximations possible to provide on the basis of existing data…. …fra www.tvangsforskning.no Tonje Lossius Husum

11. Total admissions in mental health hospital in 2012- official health statistics Tonje Lossius Husum

12. Involuntary admissions: Calculations based on patient data from the NPR show that about 5,400 people were involountaryhospitalized a total of 7,800 times in 2012. This means that 16 percent of admissions to mental health services for adults occurred under coercion and that one in five inpatients had been involountaryhospitalized at least once during the year. Tonje Lossius Husum

13. Short admissions ? Tonje Lossius Husum

14. Short admissions: For involuntary admissions where compulsory mental health care was established, half of patients were discharged or transferred to voluntary treatment within three weeks after the forced admission took place. Tonje Lossius Husum

15. Reduction: Number of compulsory admissions were reduced by approximately four percent from 2011 to 2012, and adjusted for population growth, the decline was six percent. ….it’s mowing in the right direction  Tonje Lossius Husum

16. Stabile geographical variations !! The analyzes show consistent and significant differences in the extent of forced hospitalizations both between and within health regions, but the difference appears to be somewhat reduced last year. ….it’s mowing in the right direction  Tonje Lossius Husum

17. 0 4 5 5 0 8 14 14 3 16 6 17 2 17 6 19 11 22 8 22 8 22 0 23 1 25 13 25 6 28 0 33 8 33 22 33 9 36 14 41 6 42 16 42 17 43 13 44 3 47 7 48 18 53 14 60 9 64 22 83 3 31 88 0 0 0 Variation in coerciveinterventionsbetweenacutepsychiatricwards – percentofpatients(31 wards) Akuttavdelinger

18. Tvangsinnleggelser per 100 000 innbyggere 18 år og eldre. Fordelt etter pasientens bosted og beregnet som avvik i prosent fra gjennomsnittsrate for landet.

19. Omfang og varighet av tvangsinnleggelser i 2012, fordelt etter pasientens bosted

20. Coercivemeans 2001 – 2007 (n) Ragnild Bremnes, Trond Hatling og Johan Håkon Bjørngaard (2008): Bruk av tvangsmidler i psykisk helsevern 2001, 2003, 2005 og 2007, SINTEF Helse rapport A8231.

21. Useofcoercivemeans 2001 – 2007 Samlet tvangsmiddelbruk samt skjerming. Antall ganger, timer (mekaniske tvangsmidler, isolering og holding) og pasienter totalt. Alle institusjoner. 2001, 2003, 2005 og 2007.

22. Coercivemeans in numbers in 2009 • From : Innsamling og analyse av data om bruk av tvangsmidler og vedtak om skjerming i det psykiske helsevernet 2009 – Bjøkly, Knutzen, Furre & Sandvik (SIFER) (analyzingthecoercivemeansprotocols) • 10 939 vedtak («juridical”decisions) (total) aboutcoercivemeans and shielding towards 2432 persons • Involuntary pharmacologicaltreatment: 1875 times towards 712 persons (mean=2.63 times pr. patient) • Mechanical restraints: 4426 times towards 1065 persons (mean duration time: 3.25 hours) • Isolation:269 decisions towards 114 persons (mean duration time: 0.53 hours) • Psychical restraints: 1680 times towards 574 patients (mean=0.17 hours) • Shielding:2689 times towards 1406 patients (mean= 139.5 hours) Tonje Lossius Husum

23. Sammenligning av funn i 2009 med funn fra 2001–2007 (Bjørkly et al. 2011) Tonje Lossius Husum

24. Numberofdecisions2001-2009 Tonje Lossius Husum

25. Norway beeingobservated from the UN: Tonje Lossius Husum

26. UN’sconclusiveremarktowards Norway: • The Committee is concerned about the high frequency of compulsory treatment and confinement in the mental health system of persons with psycho-social disabilities, as well as the inadequate legal framework regulating the application of coercive treatment. (art. 12). • The Committee calls upon the State party to ensure full respect for human rights of persons with psycho-social disabilities in cases of treatment in a psychiatric institution, including through ensuring that treatment is based on the free and informed consent of the individual concerned or his or her legal representative. It recommends that the State party amend the Mental Health Act to introduce stricter procedural requirements to ensure that persons with psycho-social disabilities have adequate legal protection against the use of coercion. It also recommends that the State party incorporate into the law the abolition of the use of restraint and the enforced administration of intrusive and irreversible treatments such as neuroleptic drugs and electroconvulsive therapy (ECT). It further recommends that the State party increase the number of community-based services, including peer support and other alternatives to the medical model, for persons with psycho-social disabilities and allocate the necessary financial and human resources for the effective functioning of these services. Tonje Lossius Husum

27. Tiltaksplan for redusert og kvalitetsikret bruk av tvang i psykisk helsevern (Action plan for reduced and quality insured use of coercion) 2006 Tonje Lossius Husum

28. Takk for oppmerksomheten Tonje Lossius Husum