More and more people in Norway are being sentenced to compulsory mental health care. The people sentenced to this are too ill to serve time in ordinary prisons, but must still be shielded from the rest of society. Therefore, it is the hospitals that must take care of these. In 2002, 16 such judgments were handed down. In 2021, this number will have risen to 64. This is shown by figures from the National Coordination Unit for compulsory mental health care. This is done in separate security psychiatric units in the hospitals. In these units, the focus is on safety for the patient and the environment. There, extra measures are often put in place to reduce the chance of injuries and escapes. But these places are also intended for seriously mentally ill people who do not necessarily have a conviction on them. There may be patients who have been assessed by health personnel as needing treatment, and who at the same time pose a danger to themselves or those around them. Two routes to compulsory mental health care There are two routes to compulsory mental health care: The criminal track. The person has committed a serious criminal act, been arrested by the police and brought before the court. The court can sentence a person to compulsory mental health care if they believe that the person concerned is too ill to serve time in a prison, but that society must nevertheless be shielded from the person concerned. The health track. If a person needs urgent mental health care, a doctor can decide that the person must be treated through coercion. Two independent doctors must assess that the person meets the criteria for compulsory mental health care. After a change in the law in 2017, patients gained greater discretion over their own treatment. 90 per cent are filled by convicts The increase in the number of those sentenced to compulsory mental health care occurs at the same time as the number of inpatient places has been reduced from 5,751 to 3,604 since 2001. This is written by Dagens Medisin. At Nordlandssykehuset in Bodø, they are now struggling with the capacity of the security department. This led to them raising their preparedness from normal operation to green level in March. – We have chosen to go to green preparedness in mental healthcare and the drug addiction clinic, because we have a very large influx of patients. Then we have had to put in some extra measures to deal with it. This is what CEO Siri Tau Ursin says to news. Hospital director Siri Tau Ursin at Nordlandssykehuset says they need more security places in psychiatry. Photo: Ingrid Gulbrandsen Årdal / news There are currently 21 patients in the security unit, which is designed for 15 people. 90 per cent of these patients have a sentence from the judiciary. Nordlandssykehuset is now looking at converting premises that are not suitable for patient treatment to meet the need. The hospital director now believes that measures must be taken nationally to increase the number of places in security units in Norwegian hospitals. – We have to look at this from a national perspective. We are not the only ones in this situation, she says and adds: – We think more safety places are needed. The regional health organizations and the authorities must be involved. The change in the law in 2017 Although the tendency has been for more people to be sentenced to compulsory mental health care, there was an increase in 2017. Then a change was made in the legislation. – There, the individual patient gained greater rights to refuse consent to treatment. In other words, forced treatment became more difficult to carry out, which led to many saying no thanks to treatment and thus becoming more ill. This is what the first public prosecutor in Troms and Finnmark, Hugo Henstein, tells news. First State Attorney in Troms and Finnmark, Hugo Henstein. Photo: Ida Louise Rostad Hospital director Ursin also believes that the change in the law has led to more people being sentenced to compulsory mental health care. – We assume that it may have something to do with the case. These are patients who are too ill to serve time in prison and then they will be given a place with us. Ursin says that they would like to have more places in total, but that the development in psychiatry has been to ensure that the services are available where people live. – We have a district psychiatric center and day care. But patients who come with a judgment cannot be offered this. – Why can’t Nordlandssykehuset move more resources here? – We would like to do that if we could. But it is important to remember that psychiatry is a specialized field. It is not just going in to provide the specialized treatment needed. What we have to ensure is to educate enough people going forward. First State Attorney Henstien says that the situation is now paradoxical: – If you want to get good treatment as a mentally ill person, you have to commit a serious crime first. Put a bit on the edge; if you are sick and in danger of killing someone, you will not receive treatment. But if you have killed someone, then you get treatment, he says. – It is terribly undignified, both for the individual concerned, but also for society. Henstein summarizes the situation as follows: – It has become more difficult to treat people forcibly, and there is no room to treat people forcibly because beds have been reduced and filled up with patients through the criminal justice system. – The judge does not ask the hospital if they have room – It is a paradox. If you are to have security treatment, you must, in addition to being psychotic, commit one or more offenses so that a judge can say; you are sick, you are dangerous to society and you must get treatment. That’s what psychiatrist Steinar Nilsen says. He works in the security unit at Nordlandssykehuset with schizophrenic patients. He himself has experienced the pressure psychiatry now faces. Recently, a person in Nordland was sentenced to mental health care: – If I am going to take him in, I almost have to forcibly discharge another patient, he says. Steinar Nilsen is a psychiatrist at Nordlandssykehuset in Bodø. Photo: Lars-Bjørn Martinsen / news He says that more convicts means that patients with acute transient disorders and psychotic patients in emergency units receive less time for treatment. – What does it take for a patient to receive treatment at the security unit if he does not have a conviction? – I don’t have a good answer. As of today, that is not possible. We must have more beds in psychiatry and we must strengthen emergency psychiatry. He says it is a national problem that has lasted for many years: – I think it is tragic and shameful for Norwegian society. – The judge does not ask the hospital if they have room. The judge only looks at the law and then the patient ends up in the hospital. – These are patients who need good expertise – It is a challenge that there has been such a large increase. The hospitals have already made a number of changes to increase capacity and ensure that they have sufficient buildings, says State Secretary Karl Kristian Bekeng (Ap). Photo: Esten Borgos Last year, the Minister of Health asked the hospitals to make a plan for how to increase capacity and look at the organization of these places. It is coming now, says the state secretary. – In addition, funds are set aside annually to give the hospitals extra financial support to handle this patient group. There are plans in all regions for how to manage to create capacity to remove the increasing number of people who are in compulsory care, according to Bekeng. – It is stated in the Hurdal platform that we want to stop the construction. These are patients who need good expertise, good buildings and organization – both for the sake of the patient themselves, but also for the sake of social welfare.
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Pressured capacity in compulsory mental health care – Convicts fill up important security positions – news Nordland
