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HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester

How can we reduce the use of compulsion of people with severe mental illness? A cross-sectoral, multi-methods study

Alternative title: Hvordan kan vi redusere bruken av tvang?

Awarded: NOK 15.3 mill.

This project addresses the policy ambition of reducing compulsion of people with severe mental illness. Compulsion remains controversial, and it is not clear how public policy match the concerns of those subjected to compulsion and those who carry it out. As referrals for compulsion often comes from GPs or municipal services, an understanding of both primary and specialist levels of health and social care is needed to identify potential for reduction. There is significant variation in the use of compulsion across services and regions of Norway, which might indicate scope for reduction where prevalence is high. However, as the extent of service variation has not been fully established, and no analysis of how current compulsion levels correlate to population profiles exist, this remains unknown. Implementation of interventions aimed to reduce compulsion in hospital and in specialists out-patient services have shown positive outcomes. No such intervention has been developed or tested for the municipal setting nor tailored for the Norwegian service context. In this study we aim to address these knowledge gaps. Five work packages seek to answer the following questions: -WP 1: How is the 'problem' of coercion represented in public policy, among service users and health professionals and how are the identified solutions aligned with current efforts to reduce it? -WP2: What is the level of service variation in compulsion and what characterises services with high and low compulsion rates? -WP 3: What are population predictors for and effects of service variation in compulsion? -WP 4: Can a tailored intervention at the municipal level reduce the rate of compulsion? -WP5: What are the implications of findings in WP1-4 for the delivery of good quality, ethical services and how can this be implemented into services and education? Progress, Autumn 2021: In work package 1 we have published one article, which analyses the debate surrounding the introduction of medicine free services as an example of how different discursive positions on coercive treatment are expressed. We are now conducting a systematic review of patients? negative experiences with coercive treatment and their perspective on how to avoid these. Work package 2 and 3 uses complete data on all use of compulsory care from the Norwegian Patiet Registry 2014-19. So far, we have published one article that shows significant variation between catchment areas in the use of compulsory care. This has received considerable media attention, which demonstrates the public interest in this topic. In work package 4 we have, together with five Norwegian municipalities, co-created an intervention at the primary care level to reduce the number of referrals and admissions to compulsory care. We are now testing this out in a cluster-randomised controlled tria, and the results should be ready in 2022. Two articles are published, using data from a comprehensive preparatory mapping exercise, and these focus on what characterises pathways towards compulsion, and how those working in primary mental health care perceive the potential to reduce the use of compulsion. All our publications are open access, and thus publically available.

This project addresses the policy ambition of reducing compulsion of people with severe mental illness. Compulsion remains controversial, and it is not clear how public policy match the concerns of those subjected to compulsion and those who carry it out. As referrals for compulsion often comes from GPs or municipal services, an understanding of both primary and specialist levels of health and social care is needed to identify potential for reduction. There is significant variation in the use of compulsion across services and regions of Norway, which might indicate scope for reduction where prevalence is high. However, as the extent of service variation has not been fully established, and no analysis exits of how current compulsion levels correlate to population profiles, this remains unknown. Implementation of interventions aimed to reduce compulsion in hospital and in specialists out-patient services have shown positive outcomes. No such intervention has been developed or tested for the municipal setting nor tailored for the Norwegian service context. In this study we aim to address these knowledge gaps. Five work packages seek to answer the following questions: - WP 1: How is the 'problem' of coercion represented in public policy, among service users and health professionals and how are the identified solutions aligned with current efforts to reduce it? - WP2: What is the level of service variation in compulsion and what characterises services with high and low compulsion rates? - WP 3: What are population predictors for and effects of service variation in compulsion? - WP 4: Can a tailored intervention at the municipal level reduce the rate of compulsion? - WP5: What are the implications of findings in WP1-4 for the delivery of good quality, ethical services and how can this be implemented into services and education?

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HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester