In recent years, the number of people sentenced to compulsory mental health care increased sharply, from 171 in 2015 to over 300 last year. The increase looks set to continue this year. At the same time, the number of inpatient places in psychiatry has roughly halved since the period 1990 to 2019. Pia Therese Wiig is concerned that many psychiatry places are filled by people who have been sentenced to compulsory mental health care. Photo: Olav Døvik / news Experts fear that convicted persons are increasingly occupying much-needed inpatient places, particularly in secure psychiatric wards. This can lead to ordinary patients, with a greater need for treatment, not receiving it, believes Pia Therese Wiig. She is section leader for the regional security department at Dikemark in Asker. – These are the sickest people in Norway, says Wiig outside Dikemark. 90 percent of the patients here are sentenced to compulsory mental health care. Now the hospital is full. – I am concerned that there are patients out in the community who need admission, who are terribly ill, and who may get so bad that they commit violence, says Wiig. – Declaration of bankruptcy from the health care system Around 40 per cent of the patients who are admitted to secure psychiatric wards in Norway are sentenced to stay there. Among other things, Wiig has been responsible for the treatment of Espen Andersen Bråthen, after he killed five people in Kongsberg last year. Bråthen was sentenced to compulsory mental health care. The section leader, who is speaking on a general basis, says she is, among other things, concerned about the lack of available in-patient places, where the sickest can be treated over time. Premature discharge can contribute to more people becoming dangerous, Wiig believes. – All experience indicates that they need more time. They need treatment with medication and therapy. Now it is the case that patients who do not receive it can become so ill out there that they become a danger to society. Wiig points out that the path to treatment for many of society’s sick can now come in the form of a sentence, only after a serious act of violence has been committed. The section leader says that it is then difficult to claim that you have succeeded in protecting society. – I consider that to be a declaration of bankruptcy from the healthcare system. Five people were killed by Espen Andersen Bråthen in Kongsberg last year. Bråthen was sentenced to compulsory mental health care. Photo: Cicilie Sigrid Andersen / news Concerned about decommissioning Øyvind Holst is a researcher at Oslo University Hospital. He says no one knows why there has been such a marked increase in the number of people sentenced to compulsory mental health care in recent years. – It may be due to a more forward-leaning prosecuting authority, it may be due to psychiatry being overburdened and further behind, so that the justice sector feels that they have to take more responsibility. But all this is just speculation, says Holst. Øyvind Holst is a researcher and lawyer at Oslo University Hospital. Photo: Olav Døvik / news He also points out that in recent years there has been a steady reduction in the number of inpatient beds in Norwegian psychiatry. In the period 1990 to 2019, the number of overnight places in mental health care was reduced from 7,745 to 3,649, according to a report from Oslo University Hospital. This means that the 24-hour places in security psychiatry are increasingly being used for criminal justice patients, he points out. – On the other hand, it has the consequence that those patients who could need the places, and perhaps have greater treatment potential, do not get access to these places, says Holst. Convictions in psychiatry In recent years, the number of people sentenced to compulsory mental health care has increased sharply, from 171 in 2015 to over 300 last year. The increase looks set to continue this year. The justice sector’s legal basis for deciding whether to admit people to the mental health system has been expanded in recent years. In the period 1990 to 2019, the number of overnight places in mental health care was reduced from 7,745 to 3,649, according to a report from Oslo University Hospital. This means that accused and convicted persons are increasingly occupying in-patient places in the mental healthcare system, and particularly in the security psychiatric wards. Experts fear that this will lead to patients who have a greater need for treatment being pushed out. Patients admitted on the basis of criminal law are distributed at different levels in mental health care and are treated both with and without a 24-hour stay in an institution. Source: Holst/Kilden/OUS What is compulsory mental health care In order to be punished (prison or detention), an offender must be sane at the time of the act. The offender is not sane if, at the time of the act, he is psychotic, mentally retarded to a high degree, or has a severe disturbance of consciousness. When it is considered necessary to protect the life, health or freedom of others, an offender who has been punished can be transferred to compulsory mental health care through a sentence. The condition is that the person concerned has committed or attempted to commit a violent offence, a sexual offence, a deprivation of liberty, an arson attack or another offense which violated the life, health or freedom of others. Source: Sections 20 and 62 of the Criminal Code. – Triangle drama The OUS researcher believes that it is high time that the relevant bodies sit down and assess who should be responsible for the combination of social protection and serious mental disorders. He describes the current situation as a “triangular drama” between the justice sector, the health sector and the municipal sector, where no one wants to take responsibility. – It becomes a kind of hot potato that is shuffled back and forth, without anyone ultimately taking the final responsibility, and without there having been any overarching plan for the whole thing, says Holst. Shares the concern Health and care minister Ingvild Kjerkol says she shares the concern that patients who are seriously ill can go out into society without getting the help they need, because the capacity is not good enough. Minister of Health and Care Ingvild Kjerkol (Ap). Photo: André Børke / André Børke Kjerkol also points out that in its proposal for the state budget, the government has earmarked NOK 150 million for increased 24-hour capacity in mental health care. – Why haven’t these 24-hour places been built up earlier? – It is a question that former health ministers must also answer. We have a clear priority, both in the government declaration and in the proposal for the national budget, that we should strengthen the 24-hour capacity. When asked whether it is a correct development that more and more people should be sentenced to receive treatment, Kjerkol answers, among other things, that it is the rule of law that must assess the correct response. Oslo University Hospital has a number of services for the treatment of mental health, addiction and addiction at Gaustad. Photo: Kristoffer Steffensen Lenes / news
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Fears increase in convictions means that the seriously mentally ill do not get help – news Norway – Overview of news from different parts of the country
