Akershus University Hospital, department for emergency psychiatry

Inadequate documentation threatens due process protection

During a visit to the emergency psychiatric unit at Akershus University Hospital in May 2017, the Parliamentary Ombudsman found several examples of poor and incorrect documentation in administrative decisions relating to the use of force. This can make it difficult to understand why force was used and can affect the patients’ due process protection.

The report from the visit to the emergency psychiatric unit at Akershus University Hospital (Ahus) on 2–4 May 2017 is now available on the Parliamentary Ombudsman’s website. During the visit, particular attention was paid to the use of force at the unit.

The full report in Norwegian can be found here.

Inadequate documentation

‘After the visit, we see that there is inadequate documentation of the use of force, particularly as regards the use of forced medication,’ says Aage Thor Falkanger, Parliamentary Ombudsman.

There were also some cases of brief undocumented blocking of doors and holding of patients.

‘A weak or incorrect basis for an administrative decision makes it harder for the patient to understand why they have been subjected to force and it also makes it more difficult to file a complaint against the use of force,’ says Parliamentary Ombudsman Aage Thor Falkanger.

Less use of restraint beds

The unit has significantly reduced the use of restraint beds in the past year. A project has also been initiated to reduce the use of force. It was nevertheless found that restraints were sometimes used for a very long time, and that, in some cases, any efforts made to discontinue the use of restraints were poorly documented. Also in connection with the use of forced medication, the extent to which the patient had been allowed to make their own choices was poorly documented.

In principle, ECT treatment (electroconvulsive therapy) without consent is unlawful, and can only be administered in cases of acute risk to life or health and if no other lawful means are possible (grounds of necessity). A review of recent use of ECT on grounds of necessity showed that it had not been documented whether there was an acute risk to life or health that could not be prevented in any other way. ‘It appears that these treatments were administered on grounds that are problematic in relation to the requirements for the principle of necessity,’ says Falkanger.