In hospital treatment - Niuvanniemen sairaala. Per Harald Bentsen_Forensic... · In hospital...

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Forensic Psychiatry in Norway In hospital treatment

Transcript of In hospital treatment - Niuvanniemen sairaala. Per Harald Bentsen_Forensic... · In hospital...

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Forensic Psychiatry in Norway

In hospital treatment

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Health trusts in Norway

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Health Trusts

• The public hospitals in Norway are

organized in 4 regional and about 50

local health trusts.

• Haukeland University Hospital is one of

the five trusts owned by Western Norway

Regional Health Authority.

• Helse Vest RHF are in charge of all the

public hospitals in Rogaland, Hordaland

og Sogn og Fjordane.

•Helse Stavanger

•Helse Fonna

•Helse Bergen

•Helse Førde

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Bergen

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Regional sikkerhetsseksjon

Forensic department

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Models in Norway

• Regional Forensic Departments

• Local Forensic Departments

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Regional Forensic Departments

• 3 Regional Forensic Departments:

• A) Oslo-Dikemark

• B)Trondheim-Brøset

• C)Bergen-Sandviken

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Local forensic departments

• one in each county generally (17?)

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Organization of psychiatry in

Bergen(and Norway)

• DPS=district psychiatric centers

• Psychiatric hospitals

• Local forensic department

• Regional forensic department

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Øyane DPS

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Who do we serve?

• We serve the general psychiatry in

addition to patients who commit violent

crimes.

• In a way we are a general psychiatric ward

with a bit more resources than the others

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Criteria for admittance

• Patients with severe mental illness who

are so demanding regarding violence /

threats so that they can not be treated

safely at lower level of care.

• Patients can be admitted under the Mental

Health Act and / or the Criminal Act

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Criteria for admittance

• Exceptionally, if there is capacity and special circumstances, admission criteria can differ.

• The forensic department can then take patients for a respite stay or special treatment.

• The forensic department shall first have considered whether this can be solved horizontally within the health region.

• The delivering ward is obliged to take the patient back when we consider that the patient is ready for discharge.

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Definition of dangerousness

• The patient has inflicted / has been close to inflicting life-threatening injuries towards other persons

• The patient has committed homicide

• The dangerous episodes are associated with psychotic episodes in patients

• The last dangerous incident happened recently (within the last year for example) or that the risk of recurrence can be documented fairly well.

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Exclusion criteria

• 1.Psychopathy alone

• 2.Criminality alone.

• a.Contact with prosecutors or courts alone

• b.Comes from the prison

• c.Sentenced to prison / sentenced to custody

• 3.Patients who are only self-destructive / deliberate self-harming (for example, BPD patients)

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Exclusion criteria

• 4.Acute psychotic conditions of short duration even though this would mean that the patient is difficult

• 5.Socially awkward or disturbing people who are intimidating the general population.

• 6.Patients who from other reasons other than the combination of psychosis and violence need insulation, such as patients with contagious infectious diseases.

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Objective

• In Norway our goal is that

psychotic,dangerous patients shall go

back to the general psychiatric

institutiones when the dangerousness has

been dealt with

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Status in Norway

• Reduction in the number of beds in the

general psychiatric services has not been

compensated with more resources to the

forensic wards

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Reduction in number of beds in

psychiatric hospitals 2007 2008 2009 2010 2011 Change

Beds 4746 4557 4433 4332 4194 - 552

Employe

es in the

municip

alty

9069* 9627 9392 9492 9326 - 301**

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How many beds do we have in

forensic psychiatry

• May 2005 Spring 2008

• Total 229 208 –21

• Regional 54 40 –14

• Local 175 168 –7

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Reality of today

• The reduction of beds in the general

psychiatry results in an increasing

pressure to take patients who does not

belong to our defined patientpopulation.

• There is also an unwillingness to take

them back

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Do we need special housing for

forensic patients?

• In Stavanger we have «rehabilitation flats»

for this group.

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Bilder