Alternative report to the un human Rights Committee regarding Norway’s sixth Periodic report under the International Covenant on Civil and Political Rights December 2010



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Coercion in connection with mental health care


72, 72, 74

Involuntary treatment

Once the patient is hospitalized, inside the hospital, the treatment remedies can be coercive. Long-lasting use of seclusion/ segregation has been criticized by CPT (2005). Patients can experience such isolation as punishment more than protection and tranquillity. Many patients have also complained over coerced medical remedies that are used for long periods of time, and the mental health professionals don’t evaluate frequently enough the effect of psycho pharmaceuticals. This is also a problem for patients who receive coerced psychopharmacological treatment outside the hospital. Physical restraints are also methods that can be used in a brutal way, and the patients can feel re-traumatized and feel that their integrity is violated.

In the “Norwegian NGO-Forum for Human Rights regarding the Universal Periodic review of Norway,


scheduled for December 2009
”, it is written that “Electro Convulsive Treatment (ECT) can be administered without informed consent. The legislation requires such consent, but the practice is nevertheless accepted. It is purportedly justified by the "principle of necessity". We are not aware of any official statistics on the extent of forced ECT (nor on ECT administered with informed consent). We recommend that Norway minimise the use of force in psychiatric institutions and produce statistics on the use of ECT”. But in the Sixth periodic report, electro convulsive treatment is not mentioned.

Some patients do not complain on the use of coercive remedies in themselves, but rather in which way these coercive remedies are used. Thus, in cases where the use of coercion is necessary it’s important to implement the coercive remedies in a manner that is as considerate and respectful as possible.

In the current Mental Health Act and related regulations, there is no time limit for application of coercive measures, with the exception of isolation (up to two hours at a time). To prevent long-term use of mechanical restraints, there should be introduced a time limit for these.

Such an important question about the safety of the patient's and others' lives and health should be out for consultation with various professional bodies before setting an absolute limit. Ideally, any change in the Mental Health Act and related regulations should be done within the framework of a research project with randomized controlled design, as the Norwegian Knowledge Centre for Health Services proposes in response to a letter from the Norwegian Directorate of Health in 2005. The Norwegian Knowledge Centre for Health Services also concluded: "With a total absence of controlled studies we can ascertain that the efficacy and adverse effects with the use of coercive measures is unknown. The relative effects of different types of remedies, such as in isolation, holding firm and mechanical remedies are not known.”



Recommendation to Norway:

  • Secure a maximum limit for the time period in which coercive measures may be used.

  • Ensure that treatment without a documented effect will never be allowed against a patient’s consent.

  • Strengthen appeal possibilities in cases of coercion.

  • Give priority to research and necessary statistics on the use of coercive measures in psychiatry.



ICCPR Art.

Subject

State Report para.

Keyword

7

Protection of whistle-blowers in psychiatric institutions


76-78

Protection in practice

It should be noted that the Act Pertaining to Health Personnel § 17 establishes an obligation for health personnel on his or her own initiative to report to the Supervisory Authorities findings that patients may be exposed to safety hazards. Accordingly § 16 obligates the authority which runs the health activity to organize the activity to make health personnel able to comply with this legal obligations.

The closed nature of mental health institutions needs to be recognized. If patients’ rights are being violated within an institution, whistle-blowing is one of few possible alleys to remedies.

After the amendment of the Work Environment Act whistle blowers enjoy legal protection from retaliation and/or harassment after having reported e.g. censurable conditions. Stories from real life tell that whistle blowers’ frequently have been exposed to retaliation and harassment after having reported such conditions, in particular forms of concealed and/or informal harassment that is difficult to observe, and which is even more difficult to prove. Such harassment may be performed both by the employer and by colleagues.

Thus we are of the opinion that the protection against retaliation and harassment of “whistle blowers” within this particular sensitive area of the health care system needs to be improved in practice.



Recommendation to the Committee:

Ask what steps Norway intends to take to ensure that whistle-blowers in psychiatry are protected in practice.

ICCPR Art.

Subject

State Report para.

Keyword

7
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