After two years, Martine Mjelde (32) is back at Fekjær. – I had given up everything. It shouldn’t have been that long before one of the suicide attempts actually happened. And that I hadn’t survived. Mjelde thinks back to the time before admission. Everyday life was characterized by bad feelings. She harmed herself and tried to end her life several times. She felt that she had been given up by the system. – I have been in treatment both at DPS and municipally. Before I came to Fekjær, there was a lot of in and out of acute psychiatric care. FARM IN OPERATION: Nature and animals are an important part of the treatment offer at Fekjær. – For many, animals are harmless. They don’t fail, they don’t lie and you can say anything to them, says Perlestenbakken. Photo: Arne Sørenes / news Martine Mjelde came to Fekjær just when she needed it. Free choice of treatment made it possible. Free choice of treatment gives patients the right to choose the place of treatment for all planned examinations and treatments. Today there are three possibilities. You can either choose health care in public institutions or in private institutions that have an agreement with a regional health company. In addition, you can choose a private treatment center that is approved by the public authorities. It is this last option that the government will now discontinue. The change can come as early as 1 January 2023. Little-used scheme State Secretary Karl Kristian Bekeng (Ap) believes that the current scheme has contributed to poor prioritization of resources in the health service. NOT CONCERNED: State Secretary Karl Kristian Bekeng (Ap) does not think waiting times will increase when the approval scheme is discontinued. – We have to look at whether there is a need to enter into further agreements to maintain capacity, or whether something should be built in-house, he says. Photo: Esten Borgos / BORGOS FOTO AS Bekeng says that the health services should be developed independently of free choice of treatment. He points out that substance abuse services and mental health care must be prioritized. – In the spring, there will be an escalation plan for mental health, he says. Free choice of treatment has been evaluated on behalf of the Research Council of Norway. The evaluation states that free choice of treatment is little used. As a result, no particular reduction in waiting times has been seen. At the same time, the figures show that free choice of treatment has become more used with each passing year. The report also shows that patients who have chosen private services have had a shorter waiting time than patients who have received similar treatment in public hospitals. Large demand Fekjær offers treatment to people aged 18–35. The patients have serious mental health problems. Some also struggle with addiction. Today, Fekjær psychiatric center has 30 places. A third of these come through the scheme on free choice of treatment. It is these places that can now be lost. 45 patients are on the waiting list. In its response to the consultation, the Norwegian Directorate of Health believes that the government’s proposal could lead to longer waiting times. They also believe that more patients may have to wait longer than the deadline they have been given. The clinic manager at Fekjær fears that this is exactly what will happen. – The demand for the treatment offer will not change, even if the scheme changes. We will not have the opportunity to treat as many patients, says Tor Anders Perlestenbakken. REDUCED CAPACITY: Patients from all over the country come to Fekjær psychiatric centre, says Tor Anders Perlestenbakken. All private businesses with approval will be affected if the government’s proposal is adopted. Photo: Arne Sørenes / news news wrote at the weekend that the addiction field is worried about losing good offers to patients. The same applies in both mental health care and rehabilitation. See the national overview of approved treatment centers within Free treatment choice here. What is the approval scheme in free choice of treatment? The approval scheme for free choice of treatment was introduced by the Solberg government in 2015. At the time, it was an extension of the “right to free choice of hospital”. Free choice of treatment was introduced at a time when many patients waited a long time for treatment in hospital. The aim was to reduce waiting times, increase freedom of choice for patients and stimulate public hospitals to become more efficient. The approval scheme includes 24-hour treatment within interdisciplinary specialized drug treatment, mental health care and habilitation of children with brain damage. In addition, some somatic services and rehabilitation services are included in the scheme. It is the regional health organizations that finance patient treatment carried out by private actors who are approved for free choice of treatment. The patients who make use of the scheme have the right to the necessary health care in the specialist health service, and they would alternatively have received health care in a public establishment or in a private establishment with which the regional health organizations have an agreement. Source: Hearing note. Amendments to the Patient and User Rights Act and the Specialist Health Services Act (Discontinuation of the approval scheme in free choice of treatment). Ministry of Health and Care, 2022. Life changed Martine Mjelde is glad she heard about the offer at Fekjær. She has not harmed herself since returning home. Although there have been tough times, she is now managing without follow-up from the healthcare system. – What worked was that I got plenty of time, safe surroundings and that I got to know the people who were going to help me well, she explains. ARE YOU FINE TODAY: Martine Mjelde has taken her driving licence. She has moved from municipal housing with staff present around the clock, and into her own apartment. Our thoughts go out to others who are waiting for treatment. Photo: Arne Sørenes / news Disagreement as to whether the scheme has had an effect Patients and relatives want to retain the option of choosing private services. This is shown by the consultation comments on the proposal. For many, it feels like a long time to wait for the public sector. Some also want treatment other than the public offer. Specialized offers must be able to be chosen by patients from all over the country, they believe. The government’s proposal also worries health policy spokesperson Tone Wilhelmsen Trøen (H). VERY CONCERNED: Health policy spokesperson Tone Wilhelmsen Trøen (H) believes that ending the scheme will result in less diversity and less freedom of choice for those who need it most. She also worries about the waiting times. – I am very concerned that we will see the waiting time increase for those patients who are completely dependent on getting treatment quickly when they are motivated to do so, she says. Photo: Hans Kristian Thorbjoernsen / Hans Kristian Thorbjoernsen – It is a major weakening of patients’ rights. It can be very serious, especially for patients who need treatment in addiction and mental health, she says. Trøen points out that the scheme has been of great importance to those who have taken advantage of the opportunities. She believes the evaluation could have been used to develop and improve the current solution. Transitional arrangement If the government gets its way, there will be changes from 1 January 2023. A transitional arrangement has been proposed that will apply in the first half of the year for patients who have already started their treatment. The consultation deadline for the proposal to discontinue the approval scheme in free choice of treatment was 1 July. No date has been set for when the matter will come up in Parliament. “Psych..?” At the end of September, Mjelde will return to Fekjær. With the photo exhibition “Psych..?” she focuses on taboos in mental health. – It’s a bit special to come back two years after I was discharged, not as a patient, but because I’m going to have an exhibition. LIFE CHANGED: The stay at Fekjær was a turning point for Mjelde. Today, she has no follow-up from the health services. Here together with clinic manager Tor Anders Perlestenbakken. Photo: Arne Sørenes / news Hello! Thank you for reading the matter! 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The government proposes changes to free choice of treatment – patients react – news Innlandet – Local news, TV and radio
