In 23 years, 42 per cent of the psychiatric inpatient beds in Norway have been removed. This corresponds to a cut of over 2,500 beds from 1998 to last year. In the last four decades, 60 per cent of the 24-hour places in Finland, Sweden and Denmark have disappeared. At the same time, new services have been built up in the municipalities, and the specialist health service has switched to outpatient treatment and outpatient services, explains psychiatrist and professor of psychiatry at NTNU, Solveig Klæbo Reitan. – This is part of a professionally and politically conscious strategy that applies to the whole of Europe, which is also supported by the World Health Organization (WHO). – Long-term admission to psychiatric institutions should be the exception, says Klæbo. Instead, patients with mental disorders must live at home as long as possible, and receive help and treatment from outpatient and local services. Some Finnish researchers at Oulu University Hospital have now investigated how this transition has worked in Finland. One of the researchers, PhD student Efran Jahangiri, believes the findings are representative of the whole of the Nordic region. Erfan Jahangiri, researcher at Oulu University. Photo: Hanna Puolakka Unable to help those in need In the Finnish study, it appears that there has been a dramatic increase in patients being placed in psychiatric care homes with a low level of support. At the same time, fewer people are getting help from psychiatric outpatient clinics, where the number of beds has not increased while the number of in-patient beds has fallen, says Jahangiri. – It indicates that people with mental disorders do not get the service they need from the outpatient clinics, and that is the reason why they are moved to care homes without adequate treatment, says Jahangiri. He says that at the same time as the 24-hour places have been cut, the money has not returned to the service. Thus, neither the care homes nor the polyclinics have the resources to give the patients the treatment they should receive, says Jahangiri. – The people who work there actually do a very good job with the few resources they have, but in the big picture this trend does not work. The Norwegian Directorate of Health tells news that they cannot answer whether the Finnish study is comparable to Norway, because they are not aware that they have any Norwegian research on this particular issue. LPP: Relatives must take responsibility for treatment The head of the National Association for Relatives in Mental Health (LPP), Christine Lingjærde, believes this is a general trend that also applies to Norway. Lingjærde believes that the health services no longer have the capacity to help everyone who is ill. Therefore, patients are sent home prematurely without proper follow-up, she says. – It primarily affects the sickest, who cannot be followed up at home or by the municipality. She believes this development could create a deep crisis for the patients it affects. In addition, it affects their relatives, she says. – When there is no help to be had, it is my relatives who have to stand up. We are referred to as volunteers, but we do not do it voluntarily, because it is something we have to do. She says that relatives will of course want to help people they are happy with, but that they do not have the knowledge nor the financial support to manage it in a good way. – There are many relatives who become completely exhausted and ill, and have to leave their jobs to take care of a person who lives at home or partially at home and is very, very ill. HOD: One of the most important investment areas State Secretary in the Ministry of Health and Care (HOD), Per Aubrey, says that they share the LPP’s concern that the offer must be strengthened. – Mental health is therefore one of this government’s most important investment areas, and we are, among other things, working on our own escalation plan for mental health, says Aubrey. He says that in the state budget there is a clear priority to strengthen the offer within mental health and increase the 24-hour capacity. – At the same time, we have to strengthen the outpatient capacity, that is where we have seen an increase in waiting times. We also have a historic commitment to the GP scheme. Aubrey says that they know that many relatives are in very demanding situations over time. – Relatives are an enormous resource for their loved ones and for society, and they must receive good support. Not least, our joint health service must be good at listening to and working with relatives, who know the patient best. HOD has therefore tasked the Norwegian Directorate of Health with developing a tool for relatives’ agreements, and has seen of its own resources in next year’s state budget for measures that can strengthen the role of relatives, says Aubrey. Concludes on the wrong basis Klæbo Reitan at NTNU has read the study, and thinks the researchers are concluding on the wrong basis. – They refer to a report from 2004 which says that it may happen that the services in the municipalities are not good enough. This is a 20-year-old assumption. This cannot be used as a premise for a conclusion now, she says. The finding that the number of 24-hour places is decreasing, at the same time as the pressure is increasing in other services, she thinks is perfectly fine. The researcher Jahangiri replies that in the conclusion they have written that they are concerned about the treatment of the mentally ill in Finland, and that more research is needed to be able to say something about the effectiveness of the treatment. Demanding to investigate Professor at Oslo Met and researcher at the University of Oslo, Tonje Lossius Husum, says that it is demanding to investigate the connection between the reduction of beds and the development of other health services, such as care homes. – There may be several reasons for closing beds, and more resistance to building new services. It is often difficult to say anything certain about causal relationships in research, she says. At the same time, we know that the development described by the researchers from Finland is part of a desired and planned development. In Norway, the escalation plan called for a reduction in beds in hospitals and a build-up of services in the municipality, says Husum. – I think both parts have taken longer than planned, and have happened at different paces. She has also experienced that many of the patients in mental health care want to have their own place to live outside the hospital. She thinks it is both good and useful that the patients get their own home. – But there can be a big difference in the extent to which these services have been developed in the municipality and the quality of the services, she says.
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Cuts in psychiatric beds lead to worse treatment – news Norway – Overview of news from different parts of the country
