A report was released saying that the health service in Norway fails young people who are mentally struggling – NRK Troms and Finnmark – Local news, TV and radio

12/01/2020 Health, Norway

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– We lack clear national requirements on what a municipality should offer, says child ombud Inga Bejer Engh.

In the recent report “Young people with unexplained illnesses”, Ukom has investigated how municipalities and specialized health services in Norway collaborate with young people with mental problems.

– The municipal health services and BUP depend on each other so that children receive good help. City services must identify problems and provide low-threshold assistance. If children have needs beyond that, they must be referred to BUP. But even when they are done at BUP, they must get an offer locally, the child ombudsman says.

– Right there there is a great variation, continue.

You have used the actual notification as the basis

The report is based on the life of “Jonas”. A 17-year-old boy, Ukom, was notified after he took his own life last spring.

They have chosen to use their story because, according to Ukom, it illustrates many of the challenges facing the health service.

“Jonas” struggled with school work from a young age. As a result, he was very absent from school. This led him to lag behind, both in knowledge and in the social sphere. Many in the municipal service participated to change course. Jonas was reported to the PPT (pedagogical-psychological service) and a total of five social workers from the PPT participated in his case.

In second grade in high school, Jonas was diagnosed with dyslexia. However, absenteeism continued to increase. He began to physically fight. The GP was connected and Jonas was referred to the specialized health service of BUP (child and adolescent psychiatric outpatient clinic). There he was rejected twice.

– After the second refusal, he did not receive much follow-up from the municipality. Everything stopped on set and looked. And soon after, Jonas took his own life.

This is what Pål Iden, director of the Norwegian Commission of Investigation of the Service of Health and Care (Ukom) says.

– Our findings show that the safety net that must care for these young people is not intertwined. This applies both to municipal health services, as well as to collaboration between municipal services and specialized health services.

Conclude immediately

In October, the Ombudsman for Children published a separate report on mental health services for children and young people. His conclusion is very similar to the one Ukom presented on Monday.

– I’m very worried. Our report also shows that children often need help if they don’t get it, and it almost seems like we’ve sat down with Ukom and worked, says Engh.

Perhaps the biggest challenge, emerging both in the report to Ukom and the Ombudsman for Children, is that cooperation between agencies is not good enough when a child is mentally struggling and needs help.

It can be anything from school and GP to PPT and BUP.

Big differences

The report also indicates that there is a large variation in the proportion of cases that are rejected by BUP in the different health trusts.

In some health trusts, such as Helse Førde and the University Hospital of North Norway (UNN), approximately nine out of ten cases are processed by BUP. In other health trusts, more than half of the cases are rejected.

The Ombudsman for Children, Inga Bejer Engh, believes that one of the reasons for this is poor communication between the municipal health service and BUP, and that BUP in some cases does not carry out its own investigations.

– The consequence is that many children are rejected for inappropriate and incorrect reasons. It also means that children are not guaranteed the same help, he says.

Psychologist Maria Østhassel specializes in helping children and young people through Facebook, Instagram and TikTok. She herself has worked at BUP and is recognized in the description.

– BUP should have had a better collaboration with GPs. If patients are rejected, the rejection is usually sent to the parents with the GP on a copy. My experience is that the GP often sits and waits for the family to get in touch again, he says.

– In addition, BUP often loses access to the file when the case is transferred to the municipality, so they are not allowed to follow-up either.

– Being rejected feels like a slap in the face.

Kamilla Mari Sørensen from Tromsø has been a patient at BUP. She herself has good experiences.

– But I also have friends and acquaintances who have not lived the same.

He is a member of the youth council of the University Hospital of North Norway and has heard many stories from young people who need help.

– I know people who have been very reluctant to seek help. Among other things, due to the stigma and questions about what they are fighting for is serious enough. When they are later rejected at BUP, it is experienced as a slap in the face for someone who is depressed, he says.

Comes with recommendations

Both Ukom, the Ombudsman for Children, Maria Østhassel and Kamilla Mari Sørensen believe that something should be done with the collaboration between the municipal health services and BUP.

In the report, Ukom makes concrete recommendations to politicians.

Ukom recommendations to politicians

The interaction between BUP and the municipalities must be binding

– BUP cannot reject anyone and hope that the municipalities will solve it. All parties should sit down to help each other. Professionals must cross borders into each other’s territories and collaborate, says Pål Iden, director of Ukom.

2. The Norwegian Health Directorate should start work to reduce variations in BUP

– There are a lot of different models, solutions and reports on how the service should be performed. That complexity has become a challenge in itself, says Iden.

3. The county governor must examine the

– When the county governor conducts inspections of these cases, it is not enough to examine the different services separately. For example, they do not benefit simply from examining whether the outpatient clinic has done what it is supposed to do. It’s important for young people that the whole is connected and provides good, solid health care, says Iden.

Sørensen also believes that we should listen more to young people. She mentions a separate project that they have presented in Tromsø, called CAPA (The Choice and Partnership Approach), where the youth themselves and the family get involved in deciding what help is best.

– So, the offer is based on the pressure they are under, that is, what the young person is struggling with, and is adapted based on the patient’s strengths and weaknesses, says Sørensen.

Furthermore, he believes that mental health care must be harmless.

– We must meet the young people where they are. I have great respect for the work Maria Østhassel does on social media. In addition, BUP must appear among young people, in schools for example. It is important to find out what such help entails. And that fighting mentally is as normal as breaking a foot.

Here’s how the Minister of Health and Care Services, Bent Høie, reacts to the report:

– This is an important report with good suggestions. The commitment to interaction between BUP and the municipalities is what we will achieve through the health communities that are now being established throughout the country. I am not satisfied with the large variation in the number of children and youth who are turned away for referral to BUP. Therefore, the report is right that someone else should not be expected to fix things, but rather to find common solutions for children. I will use the report to emphasize the importance of our success in this work.

As you can see, what can be improved in treating young people with mental problems?

– There is much that can be improved, that is why we establish health communities where children and young people with mental health problems are prioritized. We are also introducing package processes to reduce treatment variations.

How do you work to improve this offer?

– Among other things, we have proposed to legislate the right to a child coordinator in the Health and Care Services Act for children who will need complex and long-term health and care services and other welfare services. We also propose that social welfare services have a duty to cooperate with each other to provide the individual child and youth with a comprehensive and coordinated service offering. In addition, we propose that the municipality clarify which service should coordinate the offer of services to children and young people. Today, parents often have to coordinate and coordinate municipal and state services for the children and youth themselves. We believe that this will help children and young people receive a more comprehensive service offering and receive better follow-up.

How do you work to improve collaboration between the municipal health service and the specialized health service (BUP)?

We establish health communities and package processes as measures to improve collaboration. They should be given time to work, but will contribute to closer collaboration around referral and follow-up. The Norwegian Health Directorate has studied and evaluated collaborative solutions for a closer dialogue between municipal services and the specialized referral health service. Regional health authorities have been tasked with following up on the report’s proposals.

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