[Tysk]
Walter Keim, 8. November
2024
Støleveien 180
N-4887 Grimstad
Norway
To
Dr. Martin Zinkler
Subcommittee
on Prevention of Torture (SPT)
Dear Mr. Zinkler,
Thank you very much for your contributions “Germany without Coercive Treatment in Psychiatry—A 15 Month Real World Experience “, “End Coercion in Mental Health Services—Toward a System Based on Support Only”, “Coping with Criticism and Embracing Change—Further Reflexions on the Debate on a Mental Health Care System without Coercion” and your collaboration on “WHO Guidance on community mental health services: Promoting person-centered and rights-based approaches” and “WHO-OHCHR new guidance to improve laws addressing human rights abuses in mental health care”.
That was also an inspiration for me. In connection with the criticism of drug-free treatment, psychiatrists came up with very optimistic assessments of antipsychotics: "Medications contribute in the overwhelming majority to symptom relief, functional improvement and a higher self-reported quality of life." "Antipsychotics ... led to a revolution in treatment" (Medical Journal, 12.05.2017)" [Norwegian: "hos det store flertallet bidrar medisiner til symptomlette, funksjonsbedring og høyere selvrapportert livskvalitet." «Antipsykotiske medisiner ... førte til en revolusjon i behandlingen» (Legetidsskrift, 12.05.2017)]. I tried to point out that Leucht et al. 2009 only documented NNT 6 for symptom attenuation (Medical Journal 15.5.2017).
Further articles in medical journals and numerous letters to readers were unsuccessful and did not encourage any insight into research results.
That is why I summarized my findings in "Promotion of a Revolution of Treatment of Schizophrenia to Achieve Recovery". The peer review said that the material suggested a paradigm shift. That is why the title was: "Paradigm Shift to Promote a Revolution of Treatment of Schizophrenia to Achieve Recovery" https://esmed.org/MRA/mra/article/view/4866. I also referred to your articles.
The Norwegian "Mental Health Care Act" is full of good intentions about human rights and human dignity. Coercion should only be used when it is "strictly necessary" (Section 4-2). 20 years ago, the reduction of coercion was supported by all politicians. However, the strategy of achieving this through dialogue with psychiatrists was a total fiasco.
Compulsory admissions rose from 5,719 in 2001 to 9,400 in 2022, 10 times as many as in Italy and Portugal. When I mention this to the Health Directorate, I get the answer: That is not certain, perhaps we have just become better at counting.
Compulsory medical treatment rose from 41 per 100,000 per year to 83 per 100,000 in 2022, 10 times as many as in Baden-Württemberg. Psychiatrists are hushing up on this and the state is also silent.
Particularly worrying is the increase in the number of people convicted of being transferred to compulsory psychiatric care from 15 in 2002 to 315 in 2021. More and more beds are being occupied for convicts from 15 in 2002 to 315 in 2021, out of a total of 3,600 beds.
Norwegian fact-finding investigators write "Several are sentenced to compulsory psychiatric treatment" (Norwegian: "Flere dømmes til tvungent psykisk helsevern") and suggest that patients have become more dangerous. But it is being ignored that the legal basis has been changed: "so that criminals who have repeatedly committed socially harmful or particularly stressful crimes can also be sentenced to compulsory psychiatric treatment" (Norwegian: "slik at også lovbrytere som har begått gjentatte lovbrudd av samfunnsskadelig eller særlig plagsom art vil kunne idømmes transfer til tvunget psychisk helsevern", jf. Strafeloven § 62 første ledd siste punktum.).
Here the so-called Law of Jante triumphs, a etiquette on how to behave in Scandinavia, human rights. Personally, I think it is very problematic when this dominates everywhere.
Parallel to increasing coercion, the possibility of medical treatment has been severely curtailed. Science journalist Robert Whitaker has written about it: “The Dying of the Light: Norway’s “Medication-Free” Services for Psychotic Patients Are Fading Away”.
The Ombudsman has indeed determined that forced drugging is against the law: Peter Gøtzsche “Forced Drugging with Antipsychotics is Against the Law: Decision in Norway”. But leading psychiatrists have subsequently claimed, with reference to Zhu et al 2017, that there is “high probability, it can lead to recovery or significant improvement in the patient’s condition” because 80% of patients achieve minimal symptom reduction. However, there is no placebo group and minimal symptom reduction cannot achieve a high probability of significant improvement.
How is this development of ever-increasing coercion possible? In Norway, on average, 5 murders per year are committed by psychiatric patients. That corresponds to a risk of 1 in a million, as Norway has 5 million inhabitants. Nevertheless, the press exaggerates every murder to create a mood against forced reduction.
This is also used as an argument against drug-free treatment and for coercion (BBC: How Norway is offering drug-free treatment to people with psychosis):
But Dr Tor Larsen, a specialist in acute psychosis, worries about this idea. He points out that most patients with untreated psychosis do not realise they are ill so will not agree to be treated with or without drugs - and drug-free units operate on a voluntary basis...
"So in cases where people have devastating psychosis, it might be important to give them treatment even on an involuntary basis."
He cites as an example the random murder of 67-year-old Bjorg Marie Skeisvoll Hereid in a graveyard in 2019 by a psychotic man with an axe. The murder shook the quiet town of Haugesund in the south-west of Norway and made national headlines.
The press picks up on such cases, creates hysteria and politicians call for action and possibly decide on more coercion.
That is why it is important that Inger-Mari Eidsvik, with the support of ICJ (International Commission of Jurists), is suing against forced treatment.
Kind regards from Grimstad, the sunniest city in Norway.
Walter Keim
Netizen: http://walter.keim.googlepages.com
KEIM, Walter. Paradigm Shift to Promote
a Revolution of Treatment of Schizophrenia to Achieve Recovery.
Medical Research Archives https://esmed.org/MRA/mra/article/view/4866
Case Keim Against Germany: No Right to Information Law in
Bavaria:https://t.co/krZaa1Jyok
http://wkeim.bplaced.net/files/enforce_access_to_information.html
Number of compulsory
admissions (Antall vedtak om tvangsinnleggelse)
Number of
involuntarily hospitalized patients (Antall tvangsinnlagte pasienter)
Judgments on transfer to compulsory psychiatric care (Dom på overføring til tvungen psykisk helsevern)
Number of beds and number of people with sentence (Antall døgnplasser...und Antall personer ... med dom)
Murders of people with mental illnesses 2012-2021:
Murders of people with mental illnesses 2011-2021:
