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