Norway's Initial Report

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Compulsory mental health care for children and young people

119. Compulsory mental health care for children and young people is generally implemented on their admission to an institution. Compulsory mental health care without inpatient care is rarely provided for children and young people. Only institutions that are approved for the provision of compulsory mental health care may admit children and young people for compulsory care. For adolescents aged between 16 and 18, the same provisions as for adults in the Mental Health Care Act apply. According to health care law, young people aged under 16 are not deemed legally competent. This means that mental health care for children aged between 12 and 16 is established on the basis of parental consent from the person or persons with parental responsibility. Both parents must consent to treatment as long as both of them have parental responsibility. Establishment of mental health care on the basis of parental consent is not deemed coercion under the law. Establishment of mental health care to children aged between 12 and 16 must be brought before the supervisory commission when the child does not "agree with the measure." No further specification of what is needed to reach such a situation is given in the preparatory works to the Act. According to the preparatory works to the Act, the supervisory commission must review whether the child's refusal ought to be respected in light of the child's condition and age, the reasons for refusing, and the planned duration and intensity of the planned treatment. It is also stipulated that the review should, as a matter of course, refer to the conditions for applying compulsory mental health care.

Statistics for coercion in mental health care

120. SAMDATA rapport 2013 – tvang i psykisk helsevern [SAMDATA Report 2013: Coercion in mental health care] (November 2014) shows that 5,400 patients were involuntarily admitted in 2013. This figure is the same as in 2012 but 200 less than in 2011. With reservations for errors and omissions in the source data, this statistic indicates a slight decrease in the number of compulsory admissions from around 8,100 in 2011 to 7,700 in 2013. At the same time, the average duration of compulsory admissions increased between 2011 and 2013.

121. The use of restraint and seclusion increased between 2012 and 2013, but according to the Directorate of Health, this may be due to improved reporting procedures on the part of the health authorities.

121. In 2013, a total of 3,740 decisions were made regarding compulsory mental health care, and 2,355 appeals against decisions were filed. The number of appeals increased by 11 per cent compared with 2012. Six per cent of appeals were upheld, representing a decrease on the figures for 2012 and 2011.
123. As part of the efforts to reduce the use of coercion in mental health care, the assignment document issued to the regional health authorities set a requirement for a 5 per-cent reduction in the number of compulsory admissions in both 2013 and in 2014 (making a total of 10 per cent). The requirement for 2015 is that the figures must be further reduced compared to 2014. The figures for compulsory admissions for 2014 are expected to be available in autumn 2015.

Review of legislation

124. The Health and Care Services Act regulates the use of coercion and force as part of more specific services provided to persons with disabilities. The rules contain stringent substantive and procedural conditions governing the use of coercive measures, including requirements regarding the training of personnel in connection with the implementation of planned measures. The county governors may in exceptional circumstances grant dispensation from the training requirements specified in the Act. Furthermore, the Act stipulates that there must be two service providers present when such measures are implemented if this is not to the detriment of the health care user or patient.
125. Based on the fact that a large proportion of municipalities have a need for dispensation from the training requirements stipulated in decisions that are made, the Ministry of Health and Care Services commissioned the Directorate of Health to investigate and answer questions regarding different aspects of the educational and qualification requirements in the Health and Care Services Act and the situation regarding competence in the municipalities. The Ministry of Health and Care Services follows up the report through, among other things, the Directorate of Health's revision of Circular IS/10 – 2004 concerning due process protection when coercion and power are used against individuals with mental disabilities; see Health and Care Services Act.

Use of coercion in somatic health care

126. Chapter 4A of the Patients' Rights Act allows the use of compulsory somatic treatment on the condition that the patient is not competent to give consent and refuses treatment. Moreover, withholding health care must potentially result in serious adverse health consequences. Patient groups that are particularly relevant in this connection are persons with dementia, persons with intellectual disabilities and persons with mental illness who need somatic health care such as nursing and care, and dental treatment. The provisions in this chapter also provide legal basis for compulsory admission and detention in health care institutions, typically compulsory admission of persons with dementia to residential care homes.
127. One important measure to protect residents in residential care homes against abuse and violation of integrity is to ensure that sufficient personnel resources qualified to assess the lawfulness and harmful effects of their actions are available at all times. A review of practice shows that inadequate staffing levels and lack of professional qualifications are generally highlighted as major challenges in Norwegian residential care homes. The Government therefore promotes training and increasing the competence of personnel as part of the state’s obligations to prevent violation of the personal integrity of the individual. The aim for the plan Kompetanseløftet 2015 [Competence Reform 2015] is to create a professionally strong care service.

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