The decentralization and integration of Norwegian psychiatric services and possible implications for coercive practices

Introduction : During the last 20 years, there has been a shift in Norway, with an increase in services provided at local district psychiatric units and in municipalities and a reduction in centralized hospital services [1]. Simultaneously, attention has been directed to the negative effects of use of coercion within the services [2]. While it has been pointed out that rates of coercion in Norway are relatively high, few have examined the implications of this organizational change for the use of coercion [3]. Methods : Drawing on data obtained from the Norwegian Patient Register, we analyzed all episodes of specialized psychiatric care given in the area of Vesteralen and Lofoten, North Norway, for the periods 2003-2006 and 2008-2012 (data from 2007 were unavailable). Patients subjected to involuntary admission and involuntary outpatient treatments were identified. Results : The number of patients being treated in the study area increased from 886 in 2003 to 1347 in 2012. The number of involuntarily admitted patients and patients in involuntary outpatient treatment fell from 110 in 2003 to 30 in 2012. Discussion, limitations and lessons learnt : Our data suggest that while the number of patients in treatment increased with more than 50% during the study period, the number of patients being coerced was reduced with more than 70%. Several factors (on which we lack data here) may be of importance to rates of involuntary admission and treatment, including patients’ diagnoses [4, 5] and staffs’ attitudes [5, 6]. However, the increased provision of decentralized psychiatric services is likely to be one important factor in the reduction of coercion [3]. Local and low-threshold psychiatric services increase access and give patients the opportunity to get help at an earlier stage, which may reduce the need for coercion [3, 5]. Further studies are needed to examine the importance of psychiatric services organization on rates of coercion. References : 1. Myklebust LH, Olstad R, Bjorbekkmo S, Eisemann M, Wynn R, Sorgaard K. Impact on continuity of care of decentralized versus partly centralized mental health care in Northern Norway. Int J Integr Care. 2011;11:e142. 2. Wynn R. Coercion in psychiatric care: clinical, legal, and ethical controversies. Int J Psychiatry Clin Pract. 2006;10(4):247-51. 3. Myklebust LH, Sorgaard K, Wynn R. Local psychiatric beds appear to decrease the use of involuntary admission: a case-registry study. BMC Health Serv Res. 2014;14:64. 4. Myklebust LH, Sorgaard K, Rotvold K, Wynn R. Factors of importance to involuntary admission. Nord J Psychiatry. 2012 Jun;66(3):178-82. 5. Rotvold K, Wynn R. Involuntary psychiatric admission: The referring general practitioners' assessment of patients' dangerousness and need for psychiatric hospital treatment. Nord J Psychiatry. 2015;69(8):637-42. d 6. Wynn R, Kvalvik AM, Hynnekleiv T. Attitudes to coercion at two Norwegian psychiatric units. Nord J Psychiatry. 2011;65:133-7.