Background
Capacity-based legislation in Norway Capacity-based legislation was introduced on 1 September 2017 as an amendment to the Norwegian Mental Health Act [1] in order to strengthen patient autonomy in accordance with the United Nations Universal Declaration of Human Rights and the Convention on the Rights of Persons with Disabilities [2, 3]. Several European countries and Australia have also introduced various forms of capacity-based legislation [3‐5]. The change in the law represents a shift from decisions to use coercion based on diagnosis to a focus on the patient’s autonomy, i.e. a capacity-based criterion [3, 5, 6]. A new condition in Section 3–3 of the Mental Health Act §3–3 [1] is: The patient lacks capacity to consent, cf. the Patient Rights Act §4–3 [7], which states that capacity to consent may be partly or wholly invalidated if the patient, due to a physical or mental disorder, dementia or an intellectual disability, is clearly unable to understand what the consent implies. The new condition shall not apply in cases of imminent and serious danger to the patient’s own life or the life or health of others [1]. A decision to use coercion is based on a clinical assessment; the patient’s capacity to consent is assessed by the patient’s therapist, who must be a psychiatrist or specialist clinical psychologist [1]. Decisions on the use of coercion can be reviewed by a control commission, and the commission’s decision may be submitted for judicial review [1]. |
Method
Design
Carer’s involvement
Recruitment
Participants
Interviews
Analysis
Ethics
Results
“It’s a really really big role being Simon’s mother. I haven’t had a holiday for many, many years, I’m so afraid of being away from him if something happens to him.”
“Well, it hasn’t exactly been a walk in the park, I can tell you. But I’ve kept going. I’ve coped, but it’s been pretty tough at times. To be a mother in this situation.”
Little or no knowledge of the change in the law
“I love watching TV and it was on the news about the new law that had come.”
“No, this is the first time I’ve heard about it (in the interview).”
“I haven’t thought about it. But it might be because of that (the change in the law)… that she trusts the therapists much more now. Perhaps it’s the change in the law, she’s felt like she has more influence, she’s got the right to decide her own treatment and her own life in all this. It could be. I hadn’t thought much about that until you… But it may well be true. Because she’s much happier and well, all in all…”.
Responsibility, cooperation and daily life are unchanged
“He’s supposed to get the help he needs to tidy up his room in housing with 24-hour staffing, but I can see he’s not getting it. He’s been given over 30 hours a week by the social services, they should help him to tidy up and... but there’s quite a big conflict between me and this housing. I’ve told them, ‘You’re not doing your job’, and they say, ‘But he doesn’t want to’… So I say, ‘Well, how do you ask him then?’, and then I say, ‘If you get to know Per properly, you can ask him in a way that makes him say yes’. And it’s also about building relationships... if he gets a good relationship with someone there, it’s often with people who disappear again.”
“Now I feel that the system around him is working. So that... I can sort of just be his mother and I don’t have to be a kind of helper as well.”
Coercion is felt to be necessary
“I think in relation to... well, you know, there are all these admissions and there’s much less of that since he was put on a CTO and getting involuntary medication... When he’s on a CTO and he’s medicated, things are more stable for all of us.”
“I’d say he’s doing fine now…. as soon as his world is unstable, either he gets less medication, or things change... well, then he gets worse and more unstable again. But as long as he knows what’s going to happen every day, he functions very well. As long as he has a secure framework, and he gets to keep Anna (as his primary contact), I think that’s really important for him to feel ok, she knows him very well and handles him incredibly well, it’s good to see.”