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Trends in use of coercion in Norway

Trends in use of coercion in Norway. Trond Hatling Head. Legal framework. 1848, 1961, 1999, 2006 In principle the same since 1961 Compulsory admissions Compulsory observation (not allowed to treat involuntary) Compulsory admission Compulsory Outpatient Treatment

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Trends in use of coercion in Norway

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  1. Trends in useofcoercion in Norway Trond Hatling Head

  2. Legal framework • 1848, 1961, 1999, 2006 • In principle the same since 1961 • Compulsory admissions • Compulsory observation (not allowed to treat involuntary) • Compulsory admission • Compulsory Outpatient Treatment • Usually at discharge – but not exclusively

  3. Legal framework • Involuntary Treatment • Primarily medical • Separate decision • Coercive measures • Open Area Seclusion • Not coercion - Legally regulated since 1999

  4. Policy initiatives to reduceuseofcoercion • Escalation plan 1999-2008 • Money –restructuring – ideals of voluntary as the «principle» not defined • Strategic plan to reduce and quality «assure» use of coercion – 2006 • A paper plan • Revised plan to reduce and quality «assure» use of coercion – 2012 • Requiring ditto Health region and health board plans • A paper plan?

  5. Policy initiatives to reduce use of coercion • Bernt-Committee (2009) • The Health Directorate • The treatment criterion • Revising the 2006-strategy • Recommended a Law revision • Paulsrud-Committee (2011) • Ministry of Health – Law revision • Suggested a number of revisions • Put in a drawer (one sentence in the 2012 state budget)

  6. What is coercion? • Formal coercion - legal • Experienced coercion • Users –relatives - staff • De facto coercion • Power ”embraces ” – house rules • Different definitions – Different parties – Different perspectives • Coercion has legitimacy in the population – in particular when considered dangerous • debated

  7. Compulsory admissions • Compulsory admissions • Additional Mandatory Criteria • Community Treatment Orders/Compulsory Community Treatment/Assisted Outpatient Treatment/Mandated Community Treatment

  8. Compulsoryadmissions 1848-1996 • 1848-1915 (Hospitals) • 44/100 000 inhabitants • 1916-1935 (Hospitals – a few psych. clinics) • 70/100 000 inhabitants • 1936-1960 (Hospitals – a few psych. clinics) • 78/100 000 inhabitants • 1961-1984 (Hospitals – a few psych. clinics/Nursing homes) • 98/100 000 inhabitants • 1996 (Hospitals – Nursing homes/DPC) • 195/100 000 inhabitants

  9. The nationalpicture – 2011

  10. AdditionalMandatoryCriteria

  11. Regional differences

  12. Compulsory Community Treatment • Since 1961 • Ease compulsory admission process • Requirement for compulsory medical treatment • But not «included» • The last decade about 2000 (1600-2600) compulsory dicscharged • Figures uncertain

  13. Involuntary treatment • About 30% of those compulsory admitted are Involuntary treated (1994-2007) • Figures uncertain

  14. Coercive measures • Mechanical restraints • Forced medication • Seclusion • Holding/restraint (since 2006) • Open area seclusion (skjerming)

  15. Holding – 2007-2009 • 2007 • 272 Persons – 999 Times • 2009 • 574 Persons – 1680 Times • Due to changes in recording practice – more than changes in clinical practice?

  16. Conclusion • Use of coercion last 10-30 years • ”constant” – despite considerable public attention • Regulatory means main strategy to reduce coercion • Limited – if any - effect • Broad set of means necessary to reduce coercion • Deep into i the clinical practice • Methods exists – not applied on a broad scale

  17. Conclusion – Cont. • National leadership (as good as?) absent • International research on reducing coercion difficult to implement

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