Mental healthcare – improved legal safeguards in mental health care facilities Strengthening the legal safeguards of those subjected to coercion during treatment is an important objective in our work on the mental healthcare sector. This applies to all forms of coercion, including when coercion forms part of the treatment plan. Since 2015, the NPM has carried out 15 visits to mental healthcare institutions. NYHETER New expectations of the oversight commissions // 13 In 2016, the Norwegian Directorate of Health sent a letter to all oversight commissions in Norway (the Control Commissions) based on the findings and recommendations from our visits.1 The Hotellsjef og styreled er Norwegian Directorate of Health made it clear brukte løsb fengselsstr art og pary aff kk halvt år. Lagmpå seks og et for å skjule ge annsrette identiteten that politiet n and the next-of-kin are to receive ga meldpatient sin på vei ho ld i at sty til og fra br led re­ an- da eren var medvirke nen de stift hotellsjefe nde et ved eget a decision in writing as soon as possible with n sa tte hotellet i hotell i Se fyr på 2016. lje. Styrelede ren reasons ARNE EDVA bl e adequate explaining the decision. It was dø m også t for øk arne.edvards RDSEN en@bt.no skap. Ifølge onomisk utro­ Sunnmør ha sp r os Hø ten ye also emphasised that patients and next-of-kin steretts an Disse op plysning keutvalg bestemt ene kom frem un at der Gulat opptatt de han får gjen­ ing lag­ were mannsre n len av informed in writing about their right to tts som gjeldtodebe an ke be n ha av straff er straffeu esaken m ndling gen på seks og et tmålin­ ot brødrene som kjørte de to fen halvt gsel. appeal and other general rights, by posting notices års til og fra Selje fra Sv erige i forb med ildsp indelse Pl anla å br åsettelsen enne hote other written information available. . and making Den tidlig llet Det var i ere styreled ved Selje nove eren de Ho t ærverdige mber 2016 at saken sin tel får nå prøvd Selje Hotel it was specified that patients must be Furthermore, tota fo lskadet i ble ifølge Sunn r Høyesterett, br ann. Hotel sjefen ble mørsposten l­ dømt til . fem og et halvt års fengs Var med informed when the Control Commission is visiting el. virkende Hotellsjefe Styrelede n forklar ren ble fø retten at te i rst dømt ha i Sogn og n i ett år hospital. The ­importance of keeping a written Fjordane planthe ha dde er om tingrett. I ankesa ken for hotellet fo å brenne ned Gulating lagmanns r å få peng rett i 2018 nytt log er of when restraints and segregation is used til ho et tell, og at fikk han han reiste utlandet til for å skaff e seg alibi . was also highlighted. These clarifications have now been added to the Norwegian Directorate of Health’s annotations.2 vordan useres. vist at orsøk ofte e folk gsler. vilte 49 First five years – some results Hotellbran opp for Hø n-saken yesterett g vi utfo rd ygg e hu ret måte s på n The Norwegian Directorate of Health has continued to follow up our work and shares our findings and recommendations to the country’s Control Commissions. Every year, the Parliamentary Ombudsman is invited to present new findings after visits to mental healthcare institutions at the national conference for all the Control Commissions in Norway. PARKBLI TROLLHUS KK We have been particularly critical of ­institutions’ decisions on the use of segregation and treatment without the consent of the patient.3 In connection with the amendments to the law that entered into force in September 2017, more stringent ­requirements were adopted for reasons for decisions regarding treatment without the consent of the patient. The new Mental Health Care Regulations Section 4–4a specified ­requirements that already followed from the Public Administration Act and the Mental Healthcare Act. The detailed requirements for written reasons correspond with the requirements for the ­assessments that have to be made by those responsible for the decision before treatment without the consent of the patient can be performed.4 1 Letter from the Norwegian Directorate of Health to the supervisory committees dated 27 September 2016: ‘Clarification of legislation following the Parliamentary Ombudsman’s visit reports during the period 2015/2016.’ 2 Circular Mental Health Care Act with annotations, Section 1–1, last paragraph. I See also the Parliamentary Ombudsman's statements regarding treatment without the consent of the patient (forced medication), 3 Ved foten kjempesto case av et no. 2017/543, rt har noen tre i Nygårdsparke n veldig sm laget seg å Proposition No 147 roll et lite hu 4 småt s. Huset akkurat så er lite at du ikke ser de hvis du far t er stort at de forbi, og akkurat så t er plass til sm par : More stringent requirements to the use of coercion Invasive coercive measures such as use of restraint beds and segregation require that adequate reasons are provided in order to ensure that patients are not subjected to unnecessary or disproportionate use of coercion. We have found it necessary to emphasise this issue in several of our reports. The practice of the Supreme Court indicates that the threshold for the adequacy of reasons is higher the more invasive the coercive measure is. Particular importance is placed on clarity and transparency, and it must be possible for the person subjected to coercion to understand why the legal requirements are met. The duty to provide adequate reasons is intended to ensure thoroughness and precision on the part of the d ­ ecision-makers and is an important part of an individual’s legal safeguards. Inadequate ­administrative decisions undermine the patients’ opportunity to appeal and reduces oversight bodies’ opportunity to perform their control functions. 2017/3156 and 2018/2278. L. (2015-2016), page 39.