Sammendrag
Background
In 2017, a capacity-based criterion was added to the Norwegian
Mental Health Act, stating that those with capacity to consent to
treatment cannot be subjected to involuntary care unless there
is risk to themselves or others. This was expected to reduce
incidence and prevalence rates, and the duration of episodes of
involuntary care, in particular regarding community treatment
orders (CTOs).
Aims
The aim was to investigate whether the capacity-based criterion
had the expected impact on the use of CTOs.
Method
This retrospective case register study included two catchment
areas serving 16% of the Norwegian population (aged ≥18). In
total, 760 patients subject to 921 CTOs between 1 January 2015
and 31 December 2019 were included to compare the use of
CTOs 2 years before and 2 years after the legal reform.
Results
CTO incidence rates and duration did not change after the
reform, whereas prevalence rates were significantly reduced.
This was explained by a sharp increase in termination of CTOs in
the year of the reform, after which it reduced and settled on a
slightly higher leven than before the reform. We found an
unexpected significant increase in the use of involuntary treat-
ment orders for patients on CTOs after the reform.
Conclusions
The expected impact on CTO use of introducing a capacity-based
criterion in the Norwegian Mental Health Act was not confirmed
by our study. Given the existing challenges related to defining
and assessing decision-making capacity, studies examining the
validity of capacity assessments and their impact on the use of
coercion in clinical practice are urgently needed.
Keywords
Capacity-based mental health law; community treatment orders;
compulsion; mental health legislation
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