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| | Patients rights, human rights and ethical dilemmas in psychiatry | | 2005-8-29 13:45:29 Head of Department, Psychiatric clinic Birgit Lie, PhD | Instituting legal reform, accountability procedures and effective mechanisms to provide human rights oversight becomes a cornerstone of human rights-based approach to mental health policy. The groundwork for the modern recognition of economic and social rights stemmed from Franklin Roosevelts "Four freedom speech" in 1941. This set out four freedoms among which was "freedom to want" a concept that had clear socio-economic connotations. Second generation rights have been recognized and are protected in modern constitutions and international law. This recognize the fact that it takes more that simple freedom from interference for people to survive and flourish.
The organisation of the mental health care system in Norway is based on available services for all citizens independent of socioeconomic situation. All parts of the country should have equal availability to mental health care and patient autonomy and/or involvement of family skuld be taken care of. A Governmental plan of action was launched in 1999 extending to 2008. A general need for better psychiatric health care services with special focus on and allocation of resources to psychiatric health care and prevention of mental illness among children and adolescents was obvious.
The organisation of available psychiatric services in Norway is divided into the municipality level, Psychiatric hospitals and Community mental health centres. All patients are treated by GPs. Admission to hospital must be done by the doctor. The home care is provided by home visits by nurses, paramedics and physiotherapists. Specialist health care is taken care of by psychiatric hospitals located in all counties. Admissions are either acute admissions or involuntary admissions. The additional wards available are Security wards, specialised wards such as psycho-geriatric, schizophrenic/psychotic patients. Availability varies according to geographical locations. Community mental health centre are organised into the decentralised specialist health with an 82 % coverage in the country care with outpatients and inpatients. One of the major intentions is closer contact between network and therapists
The basic education of medical doctors is the medical school. The knowledge about and understanding of the influence of biological, psychological included existential and social/cultural factors on mental health is the basic framework. The students should understand psychiatry in relation to children and adolescents, adults and old age in addition to forensic psychiatry. The aim of the program in psychiatry is to increase the respect and understanding of patients with psychiatric illnesses. After completing medical school and finishing the internship one may start specialist training. The specialisation in psychiatry requires 5 years clinical practice with supervision training courses to assure a uniform platform of knowledge.
Todays challenges in mental health care are still long waiting lists at community mental health centres. The number of available beds for inpatients have been heavily reduced, resulting in shorter time in the wards and frequent re-admissions. Regional differences are still a problem.
To assure a recognition of economical, social and cultural rights in mental health we depend upon the understanding of ethical issues / human rights issues, ongoing education of the staff to assure the right performance of the mental care and sufficient economical frames.
Birgit Lie, MD, PhD, Head of deptartment , Psychosocial team for refugees in Southern Norway, SSHF Kristiansand
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Ministry of Health, (2003) No.013
ICP:No.040657