Sammendrag
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 stand-
ardized 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.
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