Jorem Jacob, Førde Reidun, Husum Tonje Lossius, Dahlberg Jørgen, Pedersen Reidar
Institute of Health and Society, University of Oslo, Oslo, Norway; Department of Health Care Policy, Harvard Medical School, Boston, USA; and Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, USA.
Institute of Health and Society, University of Oslo, Oslo, Norway.
BJPsych Open. 2025 Feb 25;11(2):e35. doi: 10.1192/bjo.2024.810.
Decision-making capacity (DMC) is key to capacity-based mental health laws. In 2017, Norway introduced a lack of DMC as an additional criterion for involuntary care and treatment to strengthen patient autonomy and reduce involuntary care. Health registry data reveal an initial reduction followed by rising involuntary care and treatment rates post-2017. Despite jurisdictions moving towards capacity-based mental health laws, little is known about their impact.
To explore the impact of introducing a capacity-based mental health law governing involuntary care and treatment.
Semi-structured interviews and focus groups were conducted in 2018 with 60 purposively sampled stakeholders, including patients, families, health professionals and lawyers. Of these, 26 participated in individual follow-up interviews in 2022-23. The transcribed interviews were thematically analysed following Braun and Clarke.
Four themes emerged: (a) increased awareness of patient autonomy and improved patient involvement; (b) altered thresholds for involuntary admission and discharge and more challenging to help certain patient groups; (c) more responsibility for primary health services; and (d) increased family responsibility but unchanged involvement by health services.
Introducing a capacity-based mental health law appears to raise awareness of patient autonomy, but its impact depends on an interplay of complex health, social and legal systems. Post-2017 changes, including rising involuntary care and treatment rates, higher thresholds for admissions and increased pressure on primary health services and families, may be influenced by several factors. These include implementation of decision-making capacity, legal interpretations, formal measures for care of non-resistant incompetent individuals, reduced in-patient bed availability, inadequate voluntary treatment options and societal developments. Further research is needed to better understand these changes and their causes.
决策能力（DMC）是基于能力的精神卫生法律的关键。2017年，挪威引入缺乏决策能力作为非自愿护理和治疗的附加标准，以加强患者自主权并减少非自愿护理。卫生登记数据显示，2017年后非自愿护理和治疗率最初有所下降，随后又有所上升。尽管各司法管辖区都在朝着基于能力的精神卫生法律迈进，但对其影响知之甚少。
探讨引入一项关于非自愿护理和治疗的基于能力的精神卫生法律的影响。
2018年对60名有目的抽样的利益相关者进行了半结构化访谈和焦点小组讨论，这些利益相关者包括患者、家属、卫生专业人员和律师。其中，26人在2022 - 2023年参加了个人随访访谈。按照布劳恩和克拉克的方法对转录后的访谈进行了主题分析。
出现了四个主题：（a）提高了对患者自主权的认识并改善了患者的参与度；（b）改变了非自愿入院和出院的阈值，帮助某些患者群体变得更具挑战性；（c）初级卫生服务承担了更多责任；（d）家庭责任增加，但卫生服务的参与度未变。
引入基于能力的精神卫生法律似乎提高了对患者自主权的认识，但其影响取决于复杂的卫生、社会和法律系统之间的相互作用。2017年后的变化，包括非自愿护理和治疗率上升、入院阈值提高以及初级卫生服务和家庭面临的压力增加，可能受到多种因素的影响。这些因素包括决策能力的实施、法律解释、对无反抗能力的无行为能力个体的护理正式措施、住院床位可用性减少、自愿治疗选择不足以及社会发展。需要进一步研究以更好地理解这些变化及其原因。
