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Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Riittakerttu Kaltiala, Tampere University Hospital
- Second opponent: Professor Richard Whittington, NTNU - Norwegian University of Science and Technology
- Third member and chair of the evaluation committee: Professor Tron Anders Moger, University of Oslo
Chair of the Defence
Professor Emeritus Per Hjortdahl, Faculty of Medicine, University of Oslo
Principal Supervisor
Professor Tonje Lossius Husum, Faculty of Health Sciences, OsloMet
Summary
Perspectives from psychiatric epidemiology and medical ethics are combined in a comprehensive analysis of geographical variation in compulsory hospitalisation in mental health care. The thesis contains important new knowledge that can help reduce unwarranted geographical variation and compulsion.
The magnitude of variation is quantified by analysing registry data spanning the whole population who were compulsorily hospitalised in Norway during 2014 - 2018. Different patterns of variation appear when counts are based on events, individuals and duration. Variations are large and stable over time.
These variations suggest that some areas use more compulsion than necessary. They also question if some areas manage with less compulsion than expected due to efficient local services. We explore how municipal mental health services relate to compulsory hospitalisation by applying hierarchical models to panel data, specifically Random Effects Within-Between models. Fewer compulsory hospitalisations were seen when the number of general practitioners, mental health nurses and public housing was higher, compared to the area average. This indicates that situations where compulsory hospitalisation is considered necessary can hinge on supply of local services.
The thesis includes an ethical inquiry of how geographical variation in compulsory hospitalisation can challenge principles of medical ethics. Supply-driven use of compulsion, due to lack of less restrictive alternatives, infringes on the principle of justice. Geographical variation in compulsory hospitalisation can also infringe on the principles of respect for autonomy and non-maleficence, since the principles are challenged differently, depending on area. Uncertainty surrounding beneficial outcomes makes it hard to identify overuse and underuse, but the right level of compulsory hospitalisation would never be higher than minimally necessary in a service system with good practices that promotes voluntariness.
Additional information
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