Legal Safeguards for People with Mental Disabilities. Summary of Countrywide Supervision in 2006 of Legal Safeguards Related to Use of Coercion and Restraint for People with Mental Disabilities

In 2006, the Offices of the County Governors carried out countrywide supervision in 59 municipalities to investigate legal safeguards associated with use of coercion and restraint for people with mental disabilities. It was investigated whether municipalities ensure that the services offered to clients in accordance with the Social Services Act, Section 4-2, a-d are adapted in relation to changing needs, and that services are organized in such a way that coercion and restraint are used as little as possible.

For several years, the Norwegian Board of Health Supervision has been concerned that municipalities ensure that people with mental disabilities receive social services that are in accordance with sound professional standards. In 2005 the offices of the county governors carried out countrywide supervision of municipalities that had made decisions about use of coercion and restraint and/or reported measures taken to prevent injury in critical situations. As part of supervision carried out in 2005, the Offices of the County Governors also investigated implementation of individual decisions regarding use of coercion and restraint. I 2006, supervision focused on municipalities that had not made such decisions or reported measures taken to prevent injury in critical situations. In 2006, the Offices of the County Governors primarily carried out supervision in municipalities that had not sent reports about decisions or special measures.

As a result of the supervision that was carried out in 2006, deficiencies were detected in 32 of the 59 municipalities that were investigated. These deficiencies were that the municipalities did not ensure that services offered to people with mental disabilities are adapted to the clients’ changing needs. Deficiencies were particularly associated with allocation of services. For example, documentation was often lacking about individual assessments, decisions made, and the justification for decisions. Services were not evaluated and the staff did not know about the decisions that had been made. The Offices of the County Governors also detected deficiencies related to documentation of client participation in the process of allocating services, and documentation of individual assessments and evaluation as the basis for allocation of services.

The Social Services Act, Chapter 4A allows the use of coercion and restraint in special situations. The Offices of the County Governors detected deficiencies in 44 of 59 municipalities related to use of coercion and restraint for people with mental disabilities. The findings and experience gained from this countrywide supervision are generally in line with earlier findings and experience (see previous reports: Reports from the Norwegian Board of Health 6/2005 and 2/2006). The Offices of the County Governors have ascertained that coercion and restraint are used when decisions about their use have not been made, and that control is lacking, since measures taken to prevent injury in critical situations are not followed up.