District psychiatric centres: Countrywide services, but variable quality?
Summary of Report of the Norwegian Board of Health Supervision 4/2009
In 2008, supervision of 28 of the 75 district psychiatric centres (DPS) in the country was carried out. Supervision will continue over two years until 2009. We investigated health services provided by the DPSs to patients with serious mental disorders. Supervision was carried out by regional supervision teams, augmented with specialist psychologists and psychiatrists as professional auditors. This “half-way” report presents results about the DPSs’ assessment and prioritization of referred patients and about whether they ensure that patients are adequately examined, treated and followed up. The report that will be published in 2010 will deal with client participation, cooperation, availability and prevention/use of coercion and restraint.
Supervision has shown that in over half of the DPSs, the way in which referrals were dealt with was not always in accordance with legislative requirement. This can mean that prioritization of referred patients with serious psychiatric disorders can be unpredictable and left to chance. About half of the DPSs did not ensure that patients were adequately assessed and treated. For example, they lacked procedures and/or standard practice for how these procedures should be carried out, what they should involve, and how they should be documented. Several DPSs did not systematically ensure that diagnosis and treatment were quality controlled by specialists (psychologists and psychiatrists).
According to the assessment of the Norwegian Board of Health Supervision, the first year with supervision has shown that in many DPSs there are serious deficiencies in the services that are offered to patients with serious mental disorders. Critical phases lack management and follow-up from leadership to ensure that patients are adequately assessed and treated. In many DPSs there was no well-functioning internal control system, to reduce the risk of deficiencies, and to ensure that services are provided in accordance with legislative requirements.