The unlawful use of physical restraints in Norwegian psychiatric wards

The unlawful use of physical restraints in Norwegian psychiatric wards

Organisation: VG (Norway)

Publication Date: 03/02/2017

Size of team/newsroom:large


VG exposed extensive unlawful use of physical restraints in Norwegian psychiatric wards and a serious lack of oversight by the health authorities. The origin was a story published in March 2016 about a young woman who petitioned the court to release her from a psychiatric hospital so she could take her own life. She had spent the majority of the last two years tied down in a bed at a psychiatric hospital in Oslo. After investigating the difficult ethical issues in her case, the journalists wondered how unique her story was: How often are patients being tied down and for how long? Health care professionals are required to record every incident of coercive restraint every time a patient is tied down. In handwritten notes the employee in charge is required to explain why restraints were needed and how long the patient had to be restrained. The procedure has not changed in 170 years. Information from patient journals are normally exempt from public disclosure and many hospitals refused to hand the logbooks over, but VG fought for 7 months for the right to review those records – and after three rounds of complaints with the national health authorities VG finally won; we were given copies of several thousand pages of information. VG contacted 115 institutions that are authorized to use coercion in April 2016. VG found that the hospitals failed to report about 1 out of 4 incidents of restraint. St Olav's Hospital in Trondheim and the Møre og Romsdal Hospital Trust, among others, failed to report 80% of all incidents where belts were used to restrain patients. Several of Norway's leading legal experts and law professors in the field of coercion in psychiatric health care, reviewed the justifications and concluded that the material exposed extensive statutory violations, questionable justifications for why restraints were used and serious discrepancies in how psychiatric wards and hospitals put coercion into practice. The final material contains the full coercion logs from 2015 for 14 psychiatric institutions, documenting 2538 incidents of coercion use against 996 patients. 640 incidents were considered unlawful or problematic by legal experts.

What makes this project innovative? What was its impact?

By exposing the material, VG revealed how the State control agencies that are tasked with ensuring patient rights failed to do their job, that the government lacked statistics and control over the use of physical restraints - and that figures indicate that twice as many decisions were made to restrain people in July and August (when regular emplyees are on vacation and patients are atteVG contacted 115 institutions that are authorized to use coercion in April 2016. VG’s publications led to several national and regional investigations into how hospitals could reduce the use of coercion. All hospitals were ordered to review their previous coercion statistics and told to report accurate figures this time. There are plans to introduce a new registration system starting in 2017. The Parliamentary Ombudsman, the Minister of Health and legal experts said VG’s journalistic efforts brought great concern for the rights of the weakest patient groups in our society. The Minister of Health announced that he would like to reorganize the entire Control Commission system. There will be made modifications to their tasks in short term, and a full reorganization or shutdown in the longer term. The Chief County Medical Officer for Oslo and Akershus Counties initiated two regulatory investigations based on VG’s findings, and many families talk about bringing their cases to the courts after learning the rights of their family members may have been violated.

Technologies used for this project:

Tools we used: D3.js, Highcharts, OpenRefine, Pandas, R, node.js, React, dc.js. Our journalists digitized the logbooks. Hard-to-read copies of the handwritten logs made OCR or automated digitization out of the question. The logs (around 10,000 rows of data) were manually digitized, cleaned, tagged to make analysis and publication of the database possible. Developer Jari Bakken devised an analytics tool where the information could be divided into graphics and diagrams that show the times of year, weeks and days on which patients were tied down. Data scientist Isabelle Valette compiled this information and compared it with information from other health registers. Our investigations determined that the hospitals that used physical coercion the most had the lowest proportion of full-time doctors and a higher number of unskilled health care employees attending to patients. VG wish to be open about our journalistic methods. We wanted to allow others to scrutinize the material we collect and our reviews. We published a database that contained all 2538 coercion decisions. Due to the sensitive nature of this information, each logbook has been subject to an ethical evaluation as to what kind of information can be published.
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