Norway orders drug- free treatment in psychiatry. Yet it is in this remote outpost, on a hospital floor that had been closed but was recently refurbished, that one can find a startling sign on the door to the ward: medikamentfritt behandlingstilbud.
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The translation to English: medication free treatment. And this is an initiative that the Norwegian Ministry of Health ordered its four regional health authorities to create. Magnus Hald, at the entry to the medicine- free ward in Troms. This is a ward for psychiatric patients who do not want to take psychiatric medications, or who want help tapering from such drugs.
The governing principle on this ward, which has six beds, is that patients should have the right to choose their treatment, and that care should be organized around that choice.“It is a new way of thinking,” said Merete Astrup, director of the medication- free unit. We were used to saying to patients, . If patients say this is what they want, that is good enough for me. It’s about helping people move forward in their lives in the best possible way, and we should help people move forward with the use of drugs if that is what they want, and if they want to sing a drug- free song, we should be backing them. We should be making that happen.”As might be expected, this initiative, which has been long in the making, is roiling Norwegian psychiatry.
It is a story of many dimensions: successful political organizing by user groups; pushback from academic psychiatrists; debates about the merits of psychiatric drugs; and an effort—most notably in Troms. What is particularly remarkable about this mandate is that it required the health ministry to override the objections of a medical profession and listen instead to a group of people that usually have little political standing in society. When I asked the leaders of the user groups about this, they spoke—with some pride—of a political culture in Norway that strives to be inclusive of all groups. This practice has been evolving for decades, and several referred to a change in abortion law as a bellwether moment in this transformation of their society.
Prior to 1. 97. 8, a woman seeking an abortion had to apply to a commission of two physicians for permission to end her pregnancy, with the application made by her physician. If married, the woman’s husband had to consent. However, with a strong feminist movement pushing for change, that year Norway passed an Abortion on Demand law, which gave the woman the right to make this choice. That same year, Norway passed a Gender Equality Act, which stated that women and men should be given equal opportunities in education, employment, and cultural and professional advancement. Today, gender equality laws require that each gender represent at least 4. In a similar vein, labor unions remained strong in Norway, and today businesses are expected to hold yearly meetings with their employees to discuss their operations and how they might be improved.
All of this tells of a country that was intent on creating a society where the voices of all its citizens could be heard, and this ethic spilled over into health care. It became customary for hospitals and other health care providers to set up “user councils,” with the understanding that “users should have a voice and should be listened to,” said H. Users and the relatives of users in all areas of medicine should be listened to.”While this provided fertile soil for the rise of user groups in psychiatry that would have access to politicians and the health ministry, their potential political power was mitigated by the fact that the various groups had different philosophies about psychiatry and the merits of its treatments. On the one hand, there was We Shall Overcome. Founded in 1. 96. On the other hand, there are more moderate groups like Mental Helse, which, with its 7,5.
Norway. For the longest time, these differences made it difficult for the user groups to successfully lobby the government for change.“We don’t agree on anything,” said Anne Grethe Terjesen, leader of LPP, a national association for families and “carers” in mental health. At least one study found that Norway has the highest rate of forced treatment of any country in Europe, and such compulsory orders regularly follow discharged patients into the community, which user groups see as both shameful and horribly oppressive.
Today, outpatient teams come to a person’s home to ensure compliance with an order to take medication, which can be for “life,” the leaders of the user groups said.“That’s the problem,” Terjesen said. If you say you don’t want it, you can complain to a commission, but most lose there.”Added Per Overrein, a leader with a user group called Aurora: “I have never heard of a patient winning” at a hearing. In 2. 00. 9, Grete Johnsen, a long- time mental health activist, joined with other activists to write a manifesto for change titled Cooperation for Freedom, Safety and Hope.
Our goal was to create a place, or a center, with freedom and without forced treatment, and without medication being the center of care.”In fairly short order, five diverse organizations joined together to lobby for such change. Much like Mental Helse, LPP is a more moderate organization. Aurora, We Shall Overcome, and White Eagle all come more from the psychiatric- survivor end of the spectrum.“The groups are very different, and so it took quite a bit of discussion about how to say things, and how to come across to different levels of government, and how to pick the best person to come across with a united, unified message,” Ueland said. Although the groups were focused on ending forced drug treatment, they didn’t think that they could achieve that goal, and so they focused on getting the government to support “medication free” treatment for those who didn’t want to take the drugs. This was not such a radical request, as it fit with the principle that hospitals and other health care providers should listen to “user” groups and develop care responsive to their wishes.
Starting in 2. 01. Yet, year after year, the minister’s letters were regularly ignored by the four authorities, Terjesen said.“They wouldn’t listen. The hospitals weren’t doing anything.
Nothing happened. We were very frustrated. No one in Norway cared.”And then, she said, “something happened.”The “something” was a cascade of negative news about the state of psychiatry in Norway. There were stories about “illegal things happening in psychiatric wards,” and how “belts were being used so much more often,” Ueland said. A study reported that forced treatment was 2. Norway than in Germany. And outcomes for psychiatric patients weren’t particularly good, either.
The leaders of the Fellesaksjonen for Medisinfrie Behandlingsforlop“We were lucky,” Terjesen said. If treatment had been very good, it would have been more difficult.
But everything coming from the government now was that we do not have good results, people are dying early, we are using much money, the users are not satisfied, the whole package is not good. The minister says we cannot have this.”On November 2. Norwegian Health Minister, Bent H.
No one will be forced to take medication as long as there are other ways to provide the necessary care and treatment. I think the creation of drug- free treatment is too slow, and have therefore asked all the regional health authorities to have established this offer (of drug- free treatment) by 1 June 2. In addition, he said, the authorities should offer “a planned reduction of drug therapy for those patients who want it.”The health ministry had put its stake in the ground. This initiative fit in with a larger goal that H. Patients’ rights are to be strengthened.”The Resistance from Psychiatry. The leaders of Fellesaksjonen speak today about how this was a “brave” thing for H.
No regional authority met the June 1, 2. Norwegian psychiatry, psychiatrists spoke out in fierce opposition to it. Tor Larsen, a professor of psychiatry at Stavanger University, publicly derided it as a “giant mistake.”“Drug free treatment is not only a bad idea, but simply may end up being an introduction of systematic malpractice in Norwegian psychiatry. At worse, lives lost,” he wrote.
The freedom of choice the health minister now wants to impose will thus lead to a lot of very seriously ill people being deprived of the right to the best possible treatment.”This was the core argument repeatedly made by psychiatrists against the initiative: the drugs were effective; there were no non- drug treatments that had been shown to be effective for psychosis; and patients who didn’t want the medications didn’t understand that they were ill and needed the medications. This initiative will “create an attitude that largely supports a pronounced skepticism about drug therapy,” wrote Jan Ivar R. I cannot be responsible for the teaching of psychiatry at the University of Oslo that would support this development” of medication- free treatment. The debate has continued since then, and even after Troms.
The Norwegian Psychiatric Association, for its part, officially decided to “keep an open mind,” and address the topic at its annual meeting. Forced treatment meant forced use of antipsychotics, and with the controversy ongoing, a non- profit organization, Stiftelsen Humania, joined with Fellesaksjonen to organize a public debate on this initiative, which was held on February 8 in Oslo.
They titled it: “What is the knowledge base for treatment with or without the use of psychotropic drugs?”“I would like to see this argued,” Ueland said, in the afternoon before the debate. I have read a lot of articles and a lot of books, and I still have not seen proof that your drugs work. I have seen proof that they make people feel ill, that they take away their emotions, that they treat symptoms, but give me proof that they work on psychosis, that they work on what they call schizophrenia.’ I want to see that before they sit there and tell us that we can’t have drug- free treatment.”Einar Plyhn. The Longest Journey Torrent Mac Os.