Format

Send to

Choose Destination
Int J Law Psychiatry. 2019 Jan - Feb;62:7-15. doi: 10.1016/j.ijlp.2018.11.001. Epub 2018 Nov 10.

The use of outpatient commitment in Norway: Who are the patients and what does it involve?

Author information

1
Health Services Research Unit, Akershus University Hospital, 1478 Lørenskog, Norway; Centre for Care Research, University of South-Eastern Norway, 3900 Porsgrunn, Norway. Electronic address: jorun.rugkasa@ahus.no.
2
Health Services Research Unit, Akershus University Hospital, 1478 Lørenskog, Norway; R&D Department Mental Health, Akershus University Hospital, 1478 Lørenskog, Norway. Electronic address: olav.nyttingnes@ahus.no.
3
Health Services Research Unit, Akershus University Hospital, 1478 Lørenskog, Norway. Electronic address: tone.b.simonsen@ahus.no.
4
Institute of Clinical Medicine, Campus Ahus, University of Oslo, 0318 Blindern, Norway; Health Services Research Unit, Akershus University Hospital, 1478 Lørenskog, Norway.
5
Lovisenberg Diaconal Hospital, Norway.
6
Division of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway.
7
Division of Mental Health Care, Innlandet Hospital Trust, Postboks 104, NO-2381 Brumunddal, Norway.
8
Department of Mental Health, Sorlandet Hospital, Arendal, Norway.
9
Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
10
Institute of Community Medicine, UiT-Norway's Arctic University, 9037 Tromsø, Norway.

Abstract

PURPOSE:

Despite one of the longest histories of using Outpatient Commitment (OC), little is known about the use in the Norwegian context. Reporting from the Norwegian Outpatient Commitment Study, this article aims to: establish the profile of the OC population in Norway; ascertain the legal justification for the use of OC and what OC involves for patients; investigate possible associations between selected patient and service characteristics and duration of OC, and; explore potential differences based on gender or rurality.

METHODS:

A retrospective multi-site study, extracting data from the medical records of all patients on OC in six large regional hospitals in 2008-12, with detailed investigation over 36 months of the subsample of patients on first ever OC-order in 2008-09. We use descriptive statistics to establish the profile of the OC population and the legal justification for and the content of OC, and logistic regression to examine factors associated with duration of OC over 36 months.

RESULTS:

1414 patients were on OC over the 5 years, and 274 had their first OC in 2008-09. The sample included more men than woman, and three-quarters were diagnosed with schizophrenia. They had long service histories, including involuntary admissions. The legal justification for all OC-orders was the need for treatment, and 18% were additionally justified by dangerousness. The option to initiate OC directly from the community was not used in any of the 274 first ever OC-orders. While 98% of patients were prescribed psychotropic medication, under half had an Involuntary Treatment Order, which under the Norwegian OC regime is required in addition to the OC-order to oblige patients to accept treatment (usually medication). 60% of patients had ≥2 clinical contacts monthly. There were some gender differences in descriptive analyses with men generally being worse off, but no clear pattern in terms of rurality. Patients in the sample had been on OC between one week and 20 years. The median duration of OC over 36 months was 365 days. Three factors contributed to longer duration: the use of the dangerousness criterion; a diagnosis of schizophrenia disorder, and; considerable problems with substance abuse.

CONCLUSION:

The characteristics of the OC population in Norway are very similar to that reported in other jurisdictions. Medication seems to be the central focus of OC, yet additional Involuntary Treatment Orders are imposed for less than half of patients. While all OC-orders were justified by the need to ensure treatment, risk seems to be a concern for a subgroup of patients who are kept on for longer. How the 2017 amendment to the mental health act, which precludes compulsion for competent patients unless danger is present, will affect OC use, remains to be seen. Further studies should specifically focus on variation in the use of OC, including at the level of individual clinicians.

KEYWORDS:

Coercion; Community Treatment Order; Community psychiatry; Outpatient commitment

PMID:
30616856
DOI:
10.1016/j.ijlp.2018.11.001

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center