挪威基于能力的精神卫生立法增强自主权：一项关于患者从社区治疗令中康复的定性研究。
Increased autonomy with capacity-based mental health legislation in Norway: a qualitative study of patient experiences of having come off a community treatment order.
机构信息
Division of Mental Health and Substance Abuse, University Hospital of North Norway and UiT, The Arctic University of Norway, Norway, Tromsø.
Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
出版信息
BMC Health Serv Res. 2022 Apr 7;22(1):454. doi: 10.1186/s12913-022-07892-9.
BACKGROUND
Capacity-based mental health legislation was introduced in Norway on 1 September 2017. The aim was to increase the autonomy of patients with severe mental illness and to bring mental health care in line with human rights. The aim of this study is to explore patient experiences of how far the new legislation has enabled them to be involved in decisions on their treatment after they were assessed as capable of giving consent and had their community treatment order (CTO) revoked due to the change in the legislation.
METHOD
Individual in-depth interviews were conducted from September 2019 to March 2020 with twelve people with experience as CTO patients. Interviews were transcribed and analysed using thematic analysis inspired by hermeneutics.
RESULTS
Almost all interviewees were receiving the same health care over two years after their CTO was terminated. Following the new legislation, they found it easier to be involved in treatment decisions when off a CTO than they had done in periods without a CTO before the amendment. Being assessed as having capacity to consent had enhanced their autonomy, their dialogues and their feeling of being respected in encounters with health care personnel. However, several participants felt insecure in such encounters and some still felt passive and lacking in initiative due to their previous experiences of coercion. They were worried about becoming acutely ill and again being subjected to involuntary treatment.
CONCLUSION
The introduction of capacity-based mental health legislation seems to have fulfilled the intention that treatment and care should, as far as possible, be provided in accordance with patients' wishes. Systematic assessment of capacity to consent seems to increase the focus on patients' condition, level of functioning and opinions in care and treatment. Stricter requirements for health care providers to find solutions in cooperation with patients seem to lead to new forms of collaboration between patients and health care personnel, where patients have become more active participants in their own treatment and receive help to make more informed choices.
背景
2017 年 9 月 1 日，挪威出台了基于能力的精神卫生立法。其目的是增加患有严重精神疾病的患者的自主权，并使精神卫生保健符合人权标准。本研究旨在探讨患者的经验，了解新立法在多大程度上使他们能够参与自己治疗的决策，这些患者在被评估为有能力做出同意决定后，并因立法的改变而撤销了社区治疗令（CTO）。
方法
2019 年 9 月至 2020 年 3 月，对 12 名有 CTO 患者经验的人进行了个体深入访谈。访谈记录被转录，并使用受解释学启发的主题分析进行分析。
结果
几乎所有的受访者在 CTO 终止后的两年内都接受着同样的医疗服务。在新立法下，他们发现，在没有 CTO 的情况下，他们在决定治疗方面比以前更容易参与，而在修正案之前，他们在没有 CTO 的情况下参与治疗决策时感到更困难。被评估为有能力做出同意决定，增强了他们的自主权、他们的对话能力以及他们在与医疗保健人员接触时被尊重的感觉。然而，一些参与者在这样的接触中感到不安，一些人仍然因为以前受到的强制而感到被动和缺乏主动性。他们担心自己会突然生病，再次被迫接受非自愿治疗。
结论
基于能力的精神卫生立法的出台似乎实现了这样的意图，即治疗和护理应尽可能地按照患者的意愿提供。对同意能力的系统评估似乎增加了对患者病情、功能水平和意见的关注，从而为护理和治疗提供了帮助。对医疗保健提供者提出更严格的要求，要求他们与患者合作寻找解决方案，这似乎导致了患者和医疗保健人员之间新的合作形式，使患者成为自己治疗的更积极参与者，并获得帮助，以便做出更明智的选择。
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