2011: Restrictions of freedom
A new law covering the use of compulsory admission, treatment and other forms of coercion was implemented in 2001 in the Mental Health Care Act of 1999.
All institutions, regional mental health care centres and outpatient clinics within mental health care are linked to a supervisory commission.
The supervisory commission is headed by a lawyer and consists in addition of one doctor and two other members. One of the two other members must have a history as a patient or as close relative of a patient, or have represented patient interests in a professional or voluntary capacity.
In addition, a new paragraph in The Patients’ Rights Act was implemented in January 2009. The new paragraph deals with the specific term of involuntary internment for the purpose of providing healthcare. The necessity of health care must be evaluated prior to any compulsory measures and the decision must be based solely on the patient’s health situation i.e. not on that of someone else such as the health care provider or the security for other patients.
The conditions for involuntary internment
Compulsory admission and treatment requires that patients have a serious mental illness and have been diagnosed by an authorised doctor. In addition, the following criteria must be met:
- There is a possibility of cure or considerable improvement which would not be possible if the patient were not interned.
- The patient represents a considerable danger to him/herself or others.
- Acceptable voluntary solutions, if there are any, have been tried.
The procedure for involuntary internment
Involuntary internment requires an examination by an authorised doctor who must evaluate the patient if the terms and conditions are fulfilled. If the patient resists, measures can be taken to oblige the person to allow the authorised doctor to carry out such an evaluation. However, compulsory measures may only be implemented in accordance with a separate special resolution under the provisions of the relevant paragraph and coercion may only be used when deemed strictly necessary.
On the basis of the information provided by the authorised doctor, the responsible mental health professional must ensure that the following conditions have been fulfilled before the person can be admitted for compulsory observation:
- Voluntary measures have been tried but to no avail.
- The person has been examined by two doctors (one of whom should be independent of the institution).
- It is probable that the person satisfies the condition for compulsory mental health care
- The institution is able to offer the kind of treatment and care needed.
- The person has been given the opportunity to express his/her views.
- Even if all conditions are fulfilled, compulsory admittance for observation should only take place if it is considered the best solution for the person concerned.
On the basis of information from the doctor who carried out the initial examination and from the information gained during compulsory observation, as well as consideration of whether the conditions are fulfilled, the responsible mental health professional decides whether the person should be admitted for compulsory mental health care. If this is the case, the person concerned, his/her next-of-kin and the authority which made the request are informed.
The duration of involuntary internment
Patients can also be admitted for compulsory observation for up to ten days. Compulsory observation is understood as treatment, admission and other forms of coercion when no consent has been given by the patient. Compulsory observation can be prolonged for a further ten days if necessary.
Compulsory mental care is decided for periods of up to one year at a time.
The right to appeal
The supervisory commission is the court of appeal for resolutions related to compulsory mental health care and coercion.
No one can be held under compulsory mental health care unless the terms of the Mental Health Care Act are fulfilled. The person responsible for a decision to impose compulsory mental health care must continuously assess whether the terms of legislation are fulfilled, and should this not be the case, must pass a resolution of termination (discharge). A patient or his/her relative has the right to request termination of compulsory mental health care at any time.
Resolutions regarding examination and treatment without consent can be appealed to the District Governor. Moreover, the supervisory commission monitors all compulsory treatment in its review of records of compulsory mental health care.
Patient ombudsmen endeavour to promote patients’ needs, interests and legal protection in connection with the Health Service, and to improve the quality of the Health Service. Patient ombudsmen are organised federally with office in every county. The Patient ombudsmen’s objects and responsibilities are embodied in ch 8. in the Patients’ Rights Act.
A patient ombudsman can provide information about a person’s rights as a patient or relative/friend. A patient ombudsman can also help provide advice and guidance when certain issues are difficult or incomprehensible. S/he provides support within municipal and regional health care. Patient ombudsmen maintain an autonomous, independent position.
A law codifying and expanding patients’ rights was implemented in 1999 in the Patients’ Rights Act of 1999. These rights include:
- the right to necessary treatment and care.
- the right to an evaluation of the need for treatment within a maximum of 30 days.
- the right to an individual plan for treatment and care.
- the right to a second opinion.
- the right to choose where to receive treatment.
The use of coercive measures is not specifically mentioned in existing legislation except for a few examples in the Mental Health Care Act. The focus in legislation, both in the Act of Mental Health Care and the Act of the Patient’s Right, is on protective measures for the patient. However, in the guidelines linked to a new paragraph in the Act of Patient’s Right there are examples of some coercive measures which can be used, after voluntary solutions and protective measures have been tried.
Section 223 of the General Civil Penal Code deals with the deprivation of liberty. It states that any person who unlawfully deprives another person of his or her liberty or who aids and abets such deprivation of liberty shall be liable to imprisonment for a term not exceeding five years.
According to section 219 of the General Civil Penal Code, any person who by threats, duress, deprivation of liberty, violence or any other wrong grossly or repeatedly mistreats any person in his or her household or in his or her care shall be liable to imprisonment for a term not exceeding three years. This also applies to anyone who aids or abets such an offence.
According to §21 of the Road Traffic Act of 1965:
“No one must drive or attempt to drive a vehicle when s/he is in such a state that s/he cannot be deemed to be capable of driving safely, irrespective of whether this is due to the fact that s/he is under the influence of alcohol or any other intoxicating or narcotic agent, or to the fact that s/he is ill, weak, worn out or tired, or to other circumstances. “
The regulation of driver license, paragraph 4 in the Road Traffic Act of 1965, states that when a person turns 70 s/he must have a medical examination. If the general practitioner (GP) considers the person incapable of driving safely, the GP informs the Norwegian Board of Health Supervision in the county of residence of the personwhich then will consider the case before forwarding it to the local police.
 to aid and abet means to help someone to do something illegal or wrong
The Norwegian Board of Health is a national supervisory authority with responsibility for general supervision of health and social services. The Institution oversees the population’s need for health and social services and those services are run in accordance with adequate professional standards. The Board also collaborates in preventing failures and mistakes within the health care system. Locally, supervision is carried out by the Governmental Regional Board. In matters of health and social affairs, the regional boards report to The Norwegian Board of Health
Last Updated: Wednesday 14 March 2012