Wednesday, May 18

Norway should make a long-term plan to strengthen mental health care

  • Svein Haugsgjerd

    Former chief physician, Gaustad Hospital

  • Susanne Engell

    Former hospital chaplain, Oslo Hospital and Lovisenberg Hospital

Veum Psychiatric Hospital was closed and the service moved to other premises in 2015.

Existing psychiatric hospitals will be closed with plans for co-location. For the patients, it is a great loss.

This is a debate post. Opinions in the text are at the writer’s expense.

Both the former and the current Minister of Health have promised that more will be invested in mental health care.

But how did they think it would go?

Denmark has recently presented a 10-year plan for stronger professional efforts for children, young people and adults with mental illness.

The background is that there, as in Norway, treatment capacity has been reduced, especially for adults with serious disorders. At the same time, there has been a decline in the recruitment of professionals to psychiatry.

The priority focus areas are:

  • Increased efforts towards children and young people in risk zones.
  • Strong increase in the treatment offer for people with severe disorders.
  • Strengthened development of interdisciplinary and evidence-based professional environments.
  • Stronger focus on research and other knowledge development.

Consequences of stress

Today, there is agreement that mental disorders are not brain diseases, but follow from stressful stresses throughout the life course where it is important to find one’s place in relationships – intimate, social and work-related. This applies from infancy, through childhood and puberty until the transition to adulthood.

Severe trauma in adulthood can also trigger mental illness, something we constantly see in a world marked by war and flight.

In this way, mental disorders differ from most physical ailments.

The diagnoses in psychiatry are not based on blood tests or brain images (CT and MRI), but on the basis of observed and interpreted behavior.

Good treatment

There is also no clear connection between a psychiatric diagnosis and what treatment should be offered to the individual patient.

Good treatment is based on the establishment of a relationship of trust between patient and therapist (s). Such a relationship building requires personal contact over time. Drug treatment can be indicated in many cases, but then as an aid in addition to the relationship contact.

Acquiring treatment competence in all the relevant occupational groups that are useful in mental health care requires learning from experience over a long period of time. Such learning takes place under abundant guidance, individually and in groups.

In order to build strong interdisciplinary, evidence-based and research-oriented professional environments, a rich network of competent supervisors and a well-developed culture of knowledge dissemination between the various treatment levels is required. These include child and adolescent psychiatry, early intervention teams for psychoses, residential institutions and municipal teams.

This does not just require a big financial boost. A completely different degree of professional autonomy is also required than what is possible within the current organization with the health trust model.

Land sales are a big loss

Today, companies seem to be investing in closure of the existing psychiatric hospitals and sell these valuable plots, community property, to private property developers.

This has already happened to the hospitals Veum and Lier. Blakstad and Åsgård and others are next.

The reason is that the land sales will bring in equity to the health trust’s slender coffers. For patients, on the other hand, it means a great loss.

The location of the hospitals in quiet, scenic surroundings has been chosen precisely to be able to offer these people the experience of being able to shield themselves from the city noise and stress. They can use the outdoor area for security-creating experiences and health-promoting activity.

Inpatient treatment of psychiatry will henceforth be pushed into a floor in large, newly built somatic central hospitals. At the same time, a further reduction of the places for inpatient treatment is planned, in Oslo by 25 per cent.

Already today, this means that many patients with severe symptoms are discharged far too early. This leads to congestion both for the municipal health service and for the relatives.

We have also seen that this practice of premature discharge can sometimes lead to violent behavior resulting in death.

Postpone closures

Norway should prepare a long-term plan for strengthening mental health care as a whole, as the Danish government has done.

In order to bring about a real strengthening, for the benefit and not just in the name, the distinctive character of psychiatry must be recognized. The need for professional autonomy must be respected.

The closure of existing treatment institutions and plans for co-location must therefore be postponed until a thorough impact assessment has been carried out. It must be done on a professional and not a business economic basis.

Both authors are members of the National Action for the Preservation and Development of Psychiatric Hospitals.

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