The doors are always locked. They do not ventilate the first floor. The curtains are often drawn. The children are never allowed to play outside without the supervision of an adult. Stine knows that her brother had concrete plans to kill members of the family. Therefore, they take no chances. Their situation is not unique. Professionals believe that there are many potentially dangerous patients walking around in society because they are not forcibly treated. The sister always has the doors in her house locked. She has taught her children that they must not go out into the hall if the doorbell rings. The family is afraid that the brother will come to the door to kill them. Photo: Martin Torstveit / news news has chosen to anonymize the family mentioned in this case. We know their identities and have seen documentation that corroborates the story they tell. – He said he was going to kill us. Three years ago, he was a completely ordinary man. A caring son, brother and uncle, who never hurt a fly. Someone who carried shopping bags for old ladies at the store, describes his sister Stine. But strange things had begun to happen. The family realized something was wrong. How serious it was, neither of them knew. One night something happened that made them realize how sick he had become. The man who came up the stairs in his mother’s house was unrecognizable. The mother saw that her son had a grin on his face and his eyes were pitch black. He carried a long knife, and walked toward his mother with determined steps. The mother does not know how she managed to reach her son with the message. “Now you go. Turn around. Go down.” On some level, he understood that he had to do as she said and went his way, the mother describes. The family are absolutely certain that the man on the stairs was on his way up to kill. Afterwards, the family found footage he had taken of himself in a psychotic state. Hours of videos from six months back in time. – He said he was going to kill us. He said how he was going to kill us. He said at one point in what order and who should look at who was killed, says the sister. Dissatisfied with follow-up Three years after they began to see the first signs that something was wrong, the man today sits alone in his own apartment. He has long since been discharged from emergency psychiatry. He is seen every two weeks at the district psychiatric centre. In practice, it is a 10-15 minute consultation, says the sister. He is also offered follow-up by the municipal mental health team, but the sister says that the brother sends them out the door after about 10 minutes. There have been several rounds of psychosis, paranoia, delusions and threats of violence. The police have moved out a number of times, says Stine. Now the psychiatry is planning to end the follow-up, she says. The man is left entirely to himself. No one can detect if he becomes ill again, before it happens, the family claims. The health service has assessed the man as competent to consent. This means that he is apt to make good decisions in all areas of life. The sister must remain anonymous for the sake of the family’s safety. Photo: Martin Torstveit / news The family does not understand how this is possible. They see a brother and son rotting in their own apartment. It piles up with rubbish, food scraps and dirt. If they don’t help him, he has none. At the same time, they are terrified every time they visit to wash or shop. It has been assessed that the man has little risk of becoming violent, as long as he takes medication and does not become intoxicated. But the family say they know that he gets drunk regularly. Now they are just waiting for the next psychosis. They fear a ticking bomb will go off. – If he becomes unwell and no one catches it, I am afraid that he will join the ranks of other experiences one has in society with such sick people, says the sister. – Like what? – Like the Kongsberg murders and Theresesgate. – What kind of messages have you received when you have tried to secure him better help? – We have been told that he cannot be punished for previous periods of illness. They also largely repeat that he must be allowed to make choices on his own behalf. – When is it bad enough? When he has injured or killed someone, Stine asks. – A shame Renowned psychiatrist Randi Rosenqvist is upset when she hears the family’s cries for help. – I scream when I hear such stories. It’s a shame, she says. Rosenqvist is convinced that something has gone wrong in this case. She believes public authorities must intervene. – If he is psychotic and a danger to himself or others, he must be hospitalized. Dot. Psychiatrist Randi Rosenqvist believes that politicians do not understand that coercion is in many cases good care. Photo: Martin Torstveit / news The story is an example of how political development has gone too far, says Rosenqvist. – We have been told in recent years that coercion is bad and volunteering is good. Rosenqvist believes that the politicians do not understand that coercion is in many cases good care. – Very little coercion is carried out by force. It is treatment the patient has not requested himself. If you are very ill, you are not able to ask for it. Then it is the public’s responsibility to ask for it. She believes that the politicians have not realized that some people are so ill that they must have long-term, targeted treatment. – The major legal security problem in Norway is that patients who need it do not receive treatment, not that patients who do not need it are forcibly admitted. Murder and attempted murder Almost every third murder and attempted murder between 2014–2021 was committed by people with serious mental disorders, a Kripos report shows. Perpetrators with serious mental disorders more often directed the violence at their own parents than perpetrators without such disorders. The report points to several challenges in preventing the use of violence by people with serious mental disorders. They have also found that a recurring challenge is patients with a potential for violence, who are frequently admitted and discharged again after regaining their competence to consent. – In the worst case, someone will be killed The security psychiatric ward Granli in Vestfold houses some of the country’s sickest and most dangerous patients. They treat patients who have been forcibly admitted. “Stine” and the family believe that the brother should be given a place in a place like this. The family’s history is far from unique, says senior doctor Torkel Vang. Vang sees similar situations weekly. That patients he believes should have been under duress are given free rein. They don’t get the help they need. He believes this leads to many of them becoming life-threatening to themselves, relatives or society. – There is a great deal about the system here that does not work. It takes far too long, far too often, before something is done. Torkel Vang, senior physician at Granli, which is a security psychiatric ward in Vestfold. Photo: Martin Torstveit / news There is an option in the law to use coercion, but Vang believes it is used far too rarely. He says that many patients and relatives would be much better off than today, if the danger criterion were used more often. Then many more patients would be on compulsory mental health care, and the health care system could ensure follow-up and prevent relapse, he says. – It is in connection with the relapses that the risk of violence increases. At worst, someone gets killed. – Is this a system you are proud to be a part of? – No. It’s embarrassing. That is bad. The fact that the danger criterion is not used more often, Vang believes, is about several things. – One is a lack of competence. The second is paralysis or a lack of action, he says. In 2017, the act on mental health care was changed. It was then decided that the patient must lack the competence to consent in order to be forced into treatment. This means that you as a patient must be able to understand what you are saying yes or no to. – It has probably, excuse the expression, created a lot of noise in the system. Because there has been a tremendous focus on the consent competence assessment itself, people also forget to assess the danger criterion, says Vang. Will evaluate legislative change The Ministry of Health and Care Services will not comment on this individual case. news requested an interview with the Minister of Health, but we have only received a written response from State Secretary Kristian Bekeng. Bekeng says that an expert committee is in the process of evaluating the change in the law on competence to consent from 2017. – The aim is a piece of legislation and practice that both ensures the patient a proper health service, and at the same time emphasizes the needs of relatives and social security. “Stine” and the family do not understand why no one listens to their cries for help. They feel powerless and tired of living a limited life in constant alertness. – Neither he nor we should have to live like this. This is how we have worked with the case: news has met the family on several occasions. We have gained access to documents and video material that confirm the family’s history. Normally, we always contact everyone we mention in our cases and those who are criticized. In this case, we still choose to publish the case without having obtained a response from the mentioned brother and the hospital that has treatment responsibility for him. For reasons of safety and source protection for the family, we cannot contact the mentioned brother to get his view on the matter. It also means that news cannot present the family’s criticism towards the hospital, which has treatment responsibility. The hospital cannot be exempted from confidentiality without the man becoming aware that he is mentioned in the case. It may mean that the family is put in danger because of the brother’s serious mental health condition. The case is part of a series of articles in collaboration with the newspaper Østlands-Posten. Together, news and ØP have taken a closer look at the conditions for the most dangerous and sickest patients in psychiatry, and met several of those affected.
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Fears that his brother will kill – news Vestfold and Telemark – Local news, TV and radio
