Today I learned a lot more about the Swedish mental health care system and law. This was mainly positive, some negative and some just different... I will begin with the negative so as to finish of a positive note!
The first major difference is the use of physical restraint. Just as in Scotland, physical restraint is always a very last resort and not something any person or health professional would ever like to be involved in. However, what is different here, than in Scotland, is the use of belts and isolation rooms as a form of restraint. This form of restraint must be approved by a specialized doctor, and as I said, as a very last resort. However, even the thought of this kind of restraint has proved to be distressing to me. A person may be kept in an isolation room, for the safety of themselves or others, for up to 8 hours. After 8 hours, a doctor must review the situation carefully, and if he/she decides this restraint is still necessary, it may be continued for a further 8 hours. As for the use of belts - belts may be used to physically restrain a person - a belt around the torso, and one around each ankle and each wrist. A person may be kept in this restraint for up to 4 hours, and then reviewed by a doctor. As I said, I find the thought of this very distressing and very far removed from restraint procedures in Scotland, of which I have fortunately not yet witnessed.
Now on to the "just different" ... here in Sweden dementia care is not under the umbrella of "mental health" instead it is under the umbrella of "geriatric" or "somatic" care. Therefore, mental health nurses generally do not work in the care of people with dementia. Furthermore, there is no such nursing field here as Learning Disability nursing. Instead, learning disabilities come under mental health. And therefore, the care of people who have a learning disability is the responsibility of mental health nurses. These two seemingly small differences actually change a big part of the role of a mental health nurse between Scotland and Sweden.
And finally, what in my own opinion, is a very positive difference. I have been fortunate enough to work, for only short periods of time on placement, with people who are addicted to substances such as drugs and/or alcohol. What has saddened me, however, has been our society's attitude at times, towards such people. Very negative language is often thrown around with a very little insight of a person's circumstances. Furthermore, what has disappointed me is the fact that addiction does not fall under mental health law. In many ways it is still viewed as "an adult choice" of which I, personally, strongly disagree. Here in Sweden, there is a law named "the Care of Alcohol and Drug Abusers (Special Provisions) Act (LVM)" generally called "LVM" I will include a short description of the development of LVM and a link which concisely and shortly describes the act for anyone who is further interested. I feel this law proves the general reputation of Sweden as a socially inclusive country, one in which it's citizens strive to take care of one another. One in which prejudice does not belong. From speaking with Swedish people both in a professional and a social capacity I have been informed that unfortunately, this culture is changing. Social tolerance and compassion is running low. And therefore I am aware this country is not perfect. I am still in love with Scotland and it's fantastic health care system and mental health care system. However, I believe it is good to learn and take form each other what we can.
LVM:
The Swedish Act on ward for substance abusers in certain cases (LVM). In 1980 a new
Social Service Act passed the Swedish Parliament. This law did not contain any legal
foundation for real compulsory interventions. An important aspect of the act was that individual measures should be based on voluntariness and the right of self-determination (SOU 1981:7, p 7). However, the Parliament expressed a strong wish to elucidate the topic of coercion further, and in 1981 the Social Committee presented a proposal for a new bill (LVM) (SOU 1981:7). This proposal was introduced to the Parliament without any mayor changes (Prop 1981/82:8) and passed the Parliament in December 1981 (Rskr 91). According to this act compulsory placing was permitted for 2 months with an opportunity to prolong the stay for another 2 months under certain circumstances.
Social Service Act passed the Swedish Parliament. This law did not contain any legal
foundation for real compulsory interventions. An important aspect of the act was that individual measures should be based on voluntariness and the right of self-determination (SOU 1981:7, p 7). However, the Parliament expressed a strong wish to elucidate the topic of coercion further, and in 1981 the Social Committee presented a proposal for a new bill (LVM) (SOU 1981:7). This proposal was introduced to the Parliament without any mayor changes (Prop 1981/82:8) and passed the Parliament in December 1981 (Rskr 91). According to this act compulsory placing was permitted for 2 months with an opportunity to prolong the stay for another 2 months under certain circumstances.
During this time it was important to motivate the substance abuser to accept further treatment on a voluntary basis. The conditions for compulsory interventions were attached to different kinds of dangers. Firstly, the health condition of the abuser and other kinds of serious dangers to him-/herself related to certain situations (for example risks of accidents or freezing to death). Secondly, possible risks related to the security of his family. The reason for this last condition was, according to the committee, that family members were not properly protected from domestic violence by the Penal Code. Due to loyalty and fear such cases were rarely reported to the police. Since substance abuse often was an important cause of such violence, the committee at the time found it adequate to regulate these kinds of problem in social law (SOU 1981:7).
In 1987 the Social Committee presented a proposition for a revision of the act (SOU 1987:22) that also lead to an extension of the foundation of compulsory intervention. The committee emphasized that the respect for the client as a person should not result in passivity concerning a previous heavy substance abuse. It could not be accepted that the social workers just waited for a client to change his/her motivation for treatment (op.cit. p 245). The Social Service had a duty to initiate an investigation to make sure that the substance abuser was given proper support and help. The co-operation between the Social Service and the police ought to be intensified. As a result of the committee’s proposals the scope of time for compulsory placing was increased from 2 to 6 months. The reason was to give the substance abuser a realistic foundation to fulfil a long-range treatment program. In section 4 the word “can” was replaced by the word “shall”, meaning that compulsory intervention had to be decided if the criteria of the law were fulfilled. The committee also discussed if the protection of the family should comprise an unborn child (foetus), but concluded that such an interpretation was not to be recommended. One main argument was that this might scare the woman away from contacting the relevant public services and thus decrease the chances to help her by voluntary measures.
The revised act was effectuated the first of January 1989. Even though the respect for individual autonomy and integrity (as formulated in the Social Service Act) was emphasized as the founding principle in the care of substance abusers, the decisive factor of the LVM was the need of help related to substance abuse (Norström & Thunved 2001). The act does not request that voluntary treatment have to be tried (and failed) before compulsory interventions may be effectuated. Related to the health-criteria (serious risk of damaging mental or physical health) the committee had added a “social indication” which emphasized the risk of substance abusers to damage their lives more generally (related to work, education and “normal behaviour”). The reason for doing this was to enable the Social Service to intervene at an earlier stage, especially towards young adults.
More info on this link which is short & easy to read! It's a bit more concise too:
http://www.domstol.se/Funktioner/English/Matters/Compulsory-care/Substance-abusers/
http://www.domstol.se/Funktioner/English/Matters/Compulsory-care/Substance-abusers/
Hope this post was too boring for those of you who are not nurses/mental health professionals.
Julie :)
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