At least 1,000 psychiatric patients are placed in belts in Norway every year. For some it happens again and again. It is permissible to put patients in belts, fix them in beds or dress them in special clothes so that they lose the ability to move their arms and legs. The aim is that the patient does not harm himself, others or things around him. But the means of coercion must never be used unless absolutely necessary. Other alternatives must have been considered first. – Based on the investigations we have carried out, there is a high probability that there are human rights violations in several of the decisions on wearing seat belts, says civil ombudsman Hanne Harlem. Violation of human rights In 2020, Denmark was sued by the European Court of Human Rights, partly because it was not considered whether a patient who had been restrained could be released earlier. – You must be released from the belts as soon as it is safe to do so. There are examples of not unfastening the seat belts when the patient has fallen asleep, calmed down, gone out to eat and then been put back in the seat belts. Then there is every reason to ask questions about whether it is strictly necessary for them to be put back in belts, says Harlem. Civil ombudsman Hanne Harlem. Photo: Civil ombudet Unfortunately, she does not think things are much better in Norway than in Denmark. The civil ombudsman has reviewed all 59 complaints about wearing seat belts in Norwegian psychiatry that have been processed by the control commissions in 2021. We have over 50 such commissions. They must ensure that the legal security of mentally ill patients is taken care of. In the Civil Ombudsman’s report on control over the use of mechanical means of restraint, it appears that in half of the cases the commissions have not considered whether the patient could have been released from the belts earlier. – At this point, we have seen worrying weaknesses, says Harlem. – The civil ombudsman has done an extensive job with the report. We have no reason to doubt the findings. Therefore, we believe it is likely that there has been a violation of human rights when it comes to wearing seat belts, says lawyer Marianne Silsand. Lawyer Marianne Silsand. Photo: Marianne Silsand Coercion can be harmful. She works in Sifer nord and is part of the national coercion research network. In order to put a patient in a seat belt, it is not enough that the person may be dangerous, explains Silsand: – Threats or verbal outbursts alone will not be enough to use coercive means in the form of wearing a seat belt. Potential risk is not sufficient – there must be a real danger. Coercive drugs in psychiatry Short-term restraint: One or more people hold the patient’s body until the patient has calmed down. Isolation: The patient is put behind a locked door without staff present. Short-acting medication: The patient is given medication to be calm or sedated. Mechanical restraints: The patient is restrained with, for example, belts or dressed in special clothing. Source: Juslexikon According to the Civil Ombudsman, wearing a seat belt can harm the patient: Report from the Civil Ombudsman Lying in belts can cause physical harm such as dehydration, circulation and skin problems, loss of muscle strength and mobility, incontinence and blood clots in the legs. Report from the Civil Ombudsman Possible psychological harm is traumatisation, re- traumatisation, experiences of powerlessness, helplessness, loneliness, fear and anger. Report from the Civil Ombudsman Some studies show long-term negative effects in the form of traumatizing memories, mistrust and skepticism towards psychiatric treatment and institutions. Negative experiences of coercion can last for several years after the incident. Lawyer Silsand in Tvangsforsk says we know little about the extent or what injuries patients suffer after wearing seat belts. – There has been relatively little research into the use of coercion in Norway, including the consequences of wearing seat belts. We know that there have been physical injuries caused by wearing seat belts. Such as broken bones and injuries due to underlying heart problems. From 6 minutes to 76 days in seat belts One of the most important things psychiatric departments can do to ensure that they make the right assessments both before and during the wearing of seat belts is to have a clear checklist of risk factors, says Silsand. Is the patient over 60? Dehydrated or malnourished? Pregnant? Heart disease? – Follow-up interviews are also important. These should make it possible to learn, both for the patient and healthcare personnel. What was done, and what should have been done better? says Silsand. There is a big difference between the complaints that came in from patients and relatives in 2021. Some patients were put in belts for six minutes. By far the longest lasted 76 days. The civil ombudsman had no comments on the Control Commission’s assessment of this decision. Altogether, there were 25 of the cases where the seatbelts lasted for over eight hours. 16 of them lasted over a day. Illegal seat belting not detected? Civil ombudsman Harlem sometimes believes that staff at the institution fail to assess whether it is absolutely necessary to keep the patient in belts for a longer period of time. An example is a doctor who on a Friday approved that a patient could wear a seat belt throughout the weekend. Harlem believes that there are many indications that the commissions have not discovered such illegal wearing of seat belts. In another of the cases, a man had been threatening and destroyed things. The control commission considered that it was permissible to put him in seat belts in the first place. But in the decision approving the use of force, it said nothing about the patient calming down during the four days he was restrained. The commission had also not considered whether he could be released earlier. The Civil Ombudsman considers this to be “particularly serious”. The civil ombudsman’s recommendations Recommendations to the commissions: The commissions must justify why seat belt use could not have been solved with milder measures, for example short-term restraining etc. They must concretely assess and justify whether the coercion was absolutely necessary both when the patients were placed in belts and during the journey. They must always assess whether any errors in the enforcement decisions mean that the patients will be successful in their appeal, or whether the decision should be made wholly or partially invalid. The patients’ views on forced use must be assessed and included in the decision. Recommendations to the Ministry of Health and Care: They should consider changing the rules that clarify the duty to assess whether the coercion is absolutely necessary for the entire period. Recommendations to the Norwegian Directorate of Health: Should, among other things, update the template for the control commissions so that it is clear that coercion is absolutely necessary both when the seat belt is worn and during the entire period that coercion is used. Source: Civil ombudsman They have now presented the report to all the control commissions in the country, and given advice to both the Directorate of Health and the government. – We take the findings in the Civil Ombudsman’s report very seriously, writes Dag Erlend Reite in an email. He is a department director in the Directorate of Health. He emphasizes that coercion must only be used in line with human rights. The directorate is now working to follow up on the recommendations from the ombudsman. The Ministry of Health and Care Services will now assess whether they will propose changes to the regulations based on the Civil Ombudsman’s recommendations. – We take this seriously, and we expect the control commissions to take a closer look at their own practice in light of the recommendations, writes State Secretary Karl Kristian Bekeng (Ap) in an e-mail to news. State Secretary Karl Kristian Bekeng Photo: Esten Borgos / BORGOS FOTO AS
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The mentally ill are put in seat belts, the Civil Ombudsman worried about poor control – news Trøndelag
