Management of patients with outpatient commitment in the mental health services

Abstract

In Norway, the Mental Health Act provides the opportunity to use coercion in the treatment of people with mental disorder. Patients with an outpatient commitment (OC) decisions live in their own homes in the municipality, at the same time as they have a compulsory decision adopted by the specialist health service. The main issue for this PhD project has been to explore how the OC scheme works from a mental health service perspective based on Norwegian conditions. The PhD project has mapped the patient group receiving OC decisions. In addition, it has investigated how health personnel in mental health services experience follow-up and interaction with patients and across service levels. The study provided a complementary picture of the follow-up of patients with the OC scheme in one geographical area. The study describe patients with the OC scheme and how the mental health services collaborate. All the three sub-studies revealed a lack of interaction between the service levels. The responsibility for the follow-up of a patient with an OC decision appears to be somewhat unclear across service levels. The contact person's role and the Individual plan have not functioned as a collaboration tool in accordance with the intention of the Mental Health Act and the Patient Rights Act. When an IP is lacking, there is a lack of an absence of clear user participation and of a rehabilitation perspective for the patients with OC decisions. The new legislation in the Mental Health Act in 2017, with a requirement for consent assessment before an OC decision, has changed the practice and the basis for making an OC decision. Together, the results in this PhD project show common challenges related to follow-up of patients with OC decisions and the framework for the OC scheme. This is worrying and questionable ethically.