The relationship between area levels of involuntary psychiatric care and patient outcomes: a longitudinal national register study from Norway

Abstract

Background Mental health legislation permits involuntary care of patients with severe mental disorders who meet set legal criteria. The Norwegian Mental Health Act assumes this will improve health and reduce risk of deterioration and death. Professionals have warned against potentially adverse effects of recent initiatives to heighten involuntary care thresholds, but no studies have investigated whether high thresholds have adverse effects. Aim To test the hypothesis that areas with lower levels of involuntary care show higher levels of morbidity and mortality in their severe mental disorder populations over time compared to areas with higher levels. Data availability precluded analyses of the effect on health and safety of others. Methods Using national data, we calculated standardized (by age, sex, and urbanicity) involuntary care ratios across Community Mental Health Center areas in Norway. For patients diagnosed with severe mental disorders (ICD10 F20-31), we tested whether lower area ratios in 2015 was associated with 1) case fatality over four years, 2) an increase in inpatient days, and 3) time to first episode of involuntary care over the following two years. We also assessed 4) whether area ratios in 2015 predicted an increase in the number of patients diagnosed with F20-31 in the subsequent two years and whether 5) standardized involuntary care area ratios in 2014–2017 predicted an increase in the standardized suicide ratios in 2014–2018. Analyses were prespecified (ClinicalTrials.gov NCT04655287). Results We found no adverse effects on patients’ health in areas with lower standardized involuntary care ratios. The standardization variables age, sex, and urbanicity explained 70.5% of the variance in raw rates of involuntary care. Conclusions Lower standardized involuntary care ratios are not associated with adverse effects for patients with severe mental disorders in Norway. This finding merits further research of the way involuntary care works.

Long term outcomes and causal modelling of compulsory inpatient and outpatient mental health care using Norwegian registry data: Protocol for a controversies in psychiatry research project

“…There is, however, limited evidence to support this assumption in relation to many outcomes, including the prevention of suicide (Zalsman et al, 2016). A recent study from Norway found no worse outcomes for people with SMI residing in areas with little use of compulsory mental health care, compared to areas with frequent use (Nyttingnes et al, 2023). A Cochrane review (Kisely et al, 2017) identified three RCTs on OC, one in England (Burns et al, 2013) and two in the United States (Steadman et al, 2001;Swartz et al, 2001).…”

Psychiatrie ohne Zwang

“…Der Verzicht auf Zwangsmaßnahmen führe zu der Befürchtung, dass es zu einem Anstieg von Gewalttaten oder zu einem Verlust der „Kontrolle über psychisch Kranke“ führen könnte. Weitere Befürchtungen betreffen eine vermeintlich schlechtere Gesundheitsversorgung bis hin zu erhöhter Mortalität, die mit Verzicht auf Zwang einhergehen würde 15 , 16 . Kritischen Stimmen bzgl.…”