Mental Healthcare

Josefin, BSN, PhD, RN · Jan 16, 2010

Hi,

I´m glad to try to answer your questions; hope you can use the answers. If you have more questions, please don´t hesitate to contact me. This will be a long reply, if you use this I would very much like to see the final result (only if you find it appropriate of course).

1. What country are these questions pertaining too?

- Sweden- I´m sorry that my English is far from perfect... :)

2. Does this country have an equivalent of the Baker Act?

- I´m not that familiar with the Baker Act, but from what I understand it's an act that protects the individual from being committed under the wrong circumstances. In Sweden mental healthcare is strongly regulated by the law, there is a special law for custodial mental healthcare ("The law concerning custodial mental healthcare"). Basically three accessories have to be fulfilled for a person to be committed against his or her will: 1. the person must suffer from a SERIOUS mental disorder (i.e. psychosis, mania, suicide attempt) assessed by a registered physician. 2. The person must declare that he or her resist voluntary care 3. It must be assessed that the care can't be given under other forms than in a specialized hospital for mental healthcare 24/7. The law also enact that it should be assessed whether the person could be consider a danger for him/herself or other persons. There are also some new paragraphs regulating custodial mental healthcare in outpatient clinics under certain circumstances.

Voluntary mental healthcare is regulated by the main healthcare laws in Sweden and does not differ from other areas of healthcare.

3. How does a mentally ill person get committed to a psych facility?

- There are basically two ways of be committed to mental healthcare in Sweden. 1. Either the person seeks help voluntary, either at a psychiatric emergency unit (24/7) or at an outpatient clinic or primary healthcare centre (office hours). The care can than take place either in a hospital or in an outpatient clinic, depending on the severity of the condition. 2. The patient is brought to a psychiatric emergency unit against his or her will, mostly with help from the police or social services. This could be indicated either by for example neighbors, relatives or by serious disturbing actions in public. Please note that relatives and friends never can determine whether the person is going to be committed for care or not, this decision can only be made by a registered physician. Only if a person is committed for care under this law the person could be forced to take medications against his or her will, forced not to leave the hospital or separated (not isolated though) from other patients.

4. How long can they be confined to a psych facility?

- If committed voluntary the care could go on for as long as the patient wish to stay, or until assessed well enough to go on to an outpatient clinic by the responsible care team. Patients committed voluntary could basically leave the hospital whenever they like, and could only be converted to custodial care if the person fulfills the three accessories mentioned above PLUS that the person needs to be assessed to be a serious threat against own or others health. Generally the goal is to keep the time in the hospital as short as only possible. If the person is committed under the law about custodial mental healthcare the care is regulated strongly. First the registered physician (could be someone in a primary healthcare setting or anywhere) issues a hospital order according to the law mentioned above. This order needs to be evaluated within 24 hours by a psychiatrist and then an executive psychiatrist of the clinic (NOT the same one evaluating the order at first) decides whether the patient should be hospitalized or not. If the patient is committed for care it can take place for 4 weeks. After this the patients is entitled to a legal assistance to appeal the care in the country court. If the court rejects the appeal the care could go on for another 4 months and then again for six months after a new trial. It must be said that it is very rare that the care continues this long. The chief physician could choose to abort the care before that, and in most cases the patient accepts voluntary care within days or a few weeks.

5. What are the requirements for discharge?

- Always, that the patient is assessed well enough to assimilate care at an outpatient clinic. This is the goal for voluntary as well as custodial mental healthcare.

6. Who pays for the treatment?

- The government. Healthcare is free in Sweden, for every citizen, paid by taxes. There is a small fee (about 12 $/day) for persons seeking voluntary and treated at hospital.

7. Are health care services readily available to the mentally ill?

- Yes. However there is a frequent debate going on about cut down in mental healthcare standard in Sweden, though I do believe that it is fairly easily accessed.

8. What medications are being used?

- All kind of psychiatric medications, I have to say that there are no limitations of that, other that older medications that are considered dated are not used. The newest and properly evaluated medications in all psychiatric conditions are used; however first choice can differ slightly on the individual physician. There is a yearly limit for what every citizen pay for medications every year, about 180 $/year. After that medications are free. The Swedish Council on Technology Assessment in Health Care decides for the whole healthcare system which treatment options are most effective for each condition, based on international research. http://www.sbu.se/en/

9. Are there alternative or folk medicine being used?

- No, that is actually considered somewhat suspicious in Swedish health care, though people can choose to buy for example St John's wort themselves in alternative medical shops. Alternative medications are never used in governmental healthcare though.

10. What are the stigmas attached to mental disorders?

- There are the regular stigmas that are common in all western cultures I believe. People still think of mental healthcare as "One flew over the cuckoo's nest" and think that people with schizophrenia have multiple personalities and so on. Really annoying according to me, people generally don't seem to see "ordinary depressions" as mental disorders, only people marked by disease are "the real psychos" (sic!) so to speak. And generally I believe that many people associate violence to people with mental disorders. Sad but true.

11. How are people with mental health disorders treated?

- Within the healthcare system I believe people generally (there are of course sad exceptions) are treated professionally as with any other disease. The best available treatment should be given. In society in general I think it may differ from case to case. People with high social status to begin with could out their depressions and gain great sympathy from other. Other persons with low social status could be more stigmatized.

12. What role does a family play in an individual's care?

- It is recommended that family should be involved as much as appropriate in the care of the patient, if the patient self wishes so of course. Adult patients always choose themselves if they want their family to know that they are committed or that they even are in contact with the healthcare system.

13. How would you describe the care received by the mentally ill?

- Although many people complain about bad healthcare standard in Sweden I think that we in comparison with many other countries provide really high standard of the mental healthcare (as well as other healthcare). Above all, no one is excluded or receive less quality because of no insurance. If this system is optimal or not is not for me to decide though. Everything can of course get better, but in general the standard of care must be considered high, and the patients integrity and legal security is high.

Josefin, BSN, PhD, RN · Jan 16, 2010

Addition to above: Now after posting this it struck me that the term custodial mental healthcare might not be correct. To explain, it means involuntary mental healthcare.

Luckyphin · Jan 16, 2010

I want to thank you so much for giving me the information on your country's standards for mental health care. I'll definitely be using it and I'll let you know how it turns out. Thanks again!

Josefin, BSN, PhD, RN · Jan 16, 2010

Oh, I hope it will turn out well, happy that I could help!

/Josefin