Factors influencing decision-making capacity assessments in involuntary care and treatment in Norway: A qualitative exploration of multi-stakeholder perspectives

IF 1.3 4区医学 Q1 LAW

International Journal of Law and Psychiatry Pub Date : 2025-10-09 DOI:10.1016/j.ijlp.2025.102157

Jacob Jorem , Reidun Førde , Tonje Lossius Husum , Jørgen Dahlberg , Reidar Pedersen

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引用次数: 0

Abstract

Background

Decision-making capacity (DMC) is a widely used criterion in health laws to balance respect for patient autonomy with protection from the potential consequences of treatment decisions. In 2017, lacking DMC was introduced as an additional criterion for involuntary care and treatment following comprehensive amendments to the Norwegian Mental Health Care Act. Despite the amendments aiming to reduce involuntary care and treatment rates, national health registry data indicate continued rising rates along the pre-2017 trajectory after an initial reduction in 2017. While previous studies suggesting varying DMC assessment quality, little is known about the potential factors influencing these variations.

Aims

To identify factors influencing DMC assessments after introducing a capacity-based mental health law governing involuntary care and treatment.

Methods

60 purposively sampled stakeholders, including patients, families, health professionals, and lawyers, participated in semi-structured interviews and focus groups in 2018, with 26 of these participating in follow-up interviews in 2022–23. The transcribed interviews were analysed using thematic analysis.

Results

Data analysis generated four themes: 1) available resources' influence on DMC assessments; 2) health professionals' values and practices regarding involuntary care; 3) legal interpretations by supervisory bodies regarding involuntary care; and 4) political signals from the health authorities regarding involuntary care.

Conclusion

DMC assessments appear to be influenced by several factors, including resource availability, health professionals' values and practices, legal interpretations by supervisory bodies, and political signals from health authorities. Combined with a lack of systematic training and validated tools, these factors may have raised the threshold for accessing mental healthcare beyond what systematic DMC assessments would suggest, contributing to increased illness severity among patients and rising involuntary care rates post-2017. Further research is needed to better understand the complex dynamics involved in DMC assessments and how to effectively implement capacity-based health laws.

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影响挪威非自愿护理和治疗决策能力评估的因素：多方利益相关者视角的定性探索

决策能力（DMC）是卫生法中广泛使用的一项标准，用于平衡尊重患者自主权和保护患者免受治疗决策潜在后果的影响。2017年，在对《挪威精神卫生法》进行全面修订后，将缺乏精神分裂症作为非自愿护理和治疗的额外标准。尽管这些修正案旨在降低非自愿护理和治疗率，但国家健康登记数据显示，在2017年初步下降后，非自愿护理和治疗率在2017年前的轨迹上继续上升。虽然先前的研究表明DMC评估质量存在差异，但对影响这些差异的潜在因素知之甚少。目的在引入以能力为基础的精神卫生法管理非自愿护理和治疗后，确定影响DMC评估的因素。方法2018年，有目的地抽样60名利益相关者，包括患者、家属、卫生专业人员和律师，参加了半结构化访谈和焦点小组，其中26人参加了2022-23年的随访访谈。访谈记录采用专题分析进行分析。结果数据分析产生了四个主题：1)可用资源对DMC评估的影响；2)卫生专业人员关于非自愿护理的价值观和做法；3)监督机构对非自愿护理的法律解释；4)来自卫生当局关于非自愿医疗的政治信号。结论dmc评估似乎受到多种因素的影响，包括资源可用性、卫生专业人员的价值观和做法、监管机构的法律解释以及卫生当局的政治信号。再加上缺乏系统的培训和经过验证的工具，这些因素可能提高了获得精神卫生保健的门槛，超出了系统的DMC评估所显示的水平，导致患者疾病严重程度上升，2017年后非自愿护理率上升。需要进一步研究，以更好地了解发展中国家能力管理评估所涉及的复杂动态，以及如何有效地执行基于能力的卫生法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Law and Psychiatry Multiple-

CiteScore

4.70

自引率

8.70%

发文量

审稿时长

41 days

期刊介绍： The International Journal of Law and Psychiatry is intended to provide a multi-disciplinary forum for the exchange of ideas and information among professionals concerned with the interface of law and psychiatry. There is a growing awareness of the need for exploring the fundamental goals of both the legal and psychiatric systems and the social implications of their interaction. The journal seeks to enhance understanding and cooperation in the field through the varied approaches represented, not only by law and psychiatry, but also by the social sciences and related disciplines.