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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 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, December 2022: In work package 1 are conducting a systematic review of 250 international scientific articles on negative experiences with experiences of coercive treatment and the perspectives of service users on how to avoid these. In work package 2 and 3 we use complete data on all use of compulsory care from the Norwegian Patient Registry 2014-19. So far, we have published three articles that show 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. Tore Hofstad will defend his PhD thesis on this topic at the University of Oslo in December 2022. 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. The municipalities tested this out in a cluster-randomised controlled trial in 2021. Three articles are published, using data from a comprehensive preparatory mapping exercise conducted in the development of the interventjon, 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. These formed the empirical basis for Irene Wormdahl’s PhD-thesis, which she successfully defenced in June 2022. In work package 5, we have publioshed an article om ethical considerations surrounding geographic variation in the use of compulsory admissions. All our publications are publically available through Open Access.

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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?

Publications from Cristin

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