Capacity-based legislation in Norway has so far scarcely influenced the daily life and responsibilities of patients' carers: a qualitative study.

BACKGROUND: When capacity-based mental health legislation was introduced in Norway in 2017, there was concern about the consequences of change in the law for patients'carer whose community treatment order was revoked as a result of being assessed as having capacity to consent. The concern was that the lack of a community treatment order would increase carers' responsibilities in an already challenging life situation. The aim of this study is to explore carers' experiences of how their responsibility and daily life were affected after the patient's community treatment order was revoked based on capacity to consent. METHOD: We conducted individual in-depth interviews from September 2019 to March 2020 with seven carers of patients whose community treatment order was revoked following assessment of capacity to consent, based on the change in the legislation. The transcripts were analysed with inspiration from reflexive thematic analysis. RESULTS: The participants had little knowledge about the amended legislation, and three out of seven did not know about the change at the time of the interview. Their responsibility and daily life were as before, but they felt that the patient was more content, without relating this to the change in the law. They had found that coercion was necessary in certain situations, which made them worry whether the new legislation would make it more difficult to use coercion. CONCLUSION: The participating carers had little or no knowledge of the change in the law. They were involved in the patient's everyday life as before. The concerns prior to the change about a worse situation for carers had not affected them. On the contrary, they found that their family member was more satisfied with life and the care and treatment provided. This may suggest that the intention of the legislation to reduce coercion and increase autonomy was fulfilled for these patients, without resulting in any significant change in carers' lives and responsibilities.

Health professionals' experience of treatment of patients whose community treatment order was revoked under new capacity-based mental health legislation in Norway: qualitative study.

BACKGROUND: Norway introduced capacity-based legislation in mental healthcare on 1 September 2017 with the aim of increasing patient autonomy and legal protection and reducing the use of coercion. The new legislation was expected to be particularly important for patients under community treatment orders (CTOs). AIMS: To explore health professionals' experiences of how capacity-based legislation affects healthcare services for patients whose compulsory treatment order was revoked as a result of being assessed as having capacity to consent. METHOD: Nine health professionals responsible for treatment and care of patients whose CTO was revoked owing to the new legislation were interviewed in depth from September 2019 to March 2020. We used a hermeneutic approach to the interviews and analysis of the transcripts. RESULTS: The participants found that capacity-based legislation raised their awareness of their responsibility for patient autonomy and involvement in treatment and care. They also felt a need for more frequent assessments of patients' condition and capacity to consent and more flexibility between levels of care. CONCLUSIONS: The study shows that health professionals found that capacity-based legislation raised their awareness of their responsibility for patient autonomy and involvement in treatment and care. They sought closer dialogue with patients, providing information and advice, and more frequently assessing patients' condition to adjust treatment and care to enable them to retain their capacity to consent. This could be challenging and required competence, continuity and close collaboration between personnel in different healthcare services at primary and specialist level.

Increased autonomy with capacity-based mental health legislation in Norway: a qualitative study of patient experiences of having come off a community treatment order.

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.