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Inadequate provisions for helping children and adolescents with mental health problems - Document no. 3:7 (2006-2007)

The needs of children and young people with mental health problems are not being satisfactorily met, which leads to long waiting periods. The place of residence and local competence are important factors in determining both when patients are offered help and the quality of the service provided. The coordination between local authority services and the specialist health service is poor, and this has a negative impact on the situation of the patients.
Published 5/25/2007 12:28 PM

These are some of the conclusions reached in The Office of the Auditor General’s investigation of the provisions for children and adolescents with mental health problems, Document no. 3:7 (2006–2007), which was submitted to the Storting on 10 May 2007.

The objectives of the investigation have been to shed light on the extent to which children and young people under the age of 18 with mental health problems receive satisfactory service from the local authorities and outpatient departments, to find out whether the cooperation between the service providers functions well, and whether the quality of the performance reporting is satisfactory.

The investigation shows that the goals set within the psychiatric service for children and adolescents have been partly achieved with regard to capacity, but that the waiting periods for treatment are long and are increasing. There are several reasons for this: even though capacity has increased, this has not levelled out geographical differences, and the growth in productivity has not been as large as intended. In addition there is an unequal distribution of man-years among the professionals involved, and the cooperation between the municipal services and the specialist health service does not work adequately.

A well-functioning cooperation is a prerequisite for the quality of such services. Individual plans are drawn up for very few patients, and the staff at the various levels of service have an unclear perception as to who is actually responsible for compiling such plans. There are also deficiencies and weaknesses in other tools such as referral forms and epicrises (the patients’ case summaries). For instance, these summaries may not be made at all, or are sent out too late. The Office of the Auditor General (OAG) views this as unfortunate since it results in a poorer and less coordinated service.

The investigation shows that productivity indicators for registering treatment activities can be affected without this being due to changes in service production – for instance by changing consultation patterns. In the OAG’s opinion, without valid and reliable indicators it is inappropriate to tie the funding of the outpatient departments directly to the registration of treatment activities as is the case in the current reimbursement system. This may lead to unintentional consequences for the organisation of the provisions – for instance the system may restrict the use of mobile teams, an initiative that central government authorities wish to promote.

The OAG is of the view that goal achievement appears to be better than it actually is. The investigation shows that although an increase in patient figures has been reported, there has been only a small rise in the number of newly-referred patients from 2004 to 2005 and the waiting periods have become longer. In the opinion of the OAG this can only be explained by an increase in the period of time between each patient consultation.

Overall there is a lack of management data in local services for children and adolescents with mental health problems, and there are considerable weaknesses in key management data for outpatient activities. This means that the Ministry of Health and Care Services does not have an adequate overview of how the service has developed from the start-up of the government’s action plan to improve psychiatric care up to the present.

The Ministry is of the view that the report contains a number of findings that are of importance for changing and further developing the services. In its comments to the investigation the Ministry describes several development projects that have been initiated, or are in the process of being initiated, that are expected to have a positive effect on provisions for children and adolescents with mental health problems.

The Auditor General, Jørgen Kosmo, has made the following comment:
“It is unacceptable that individual plans have been drawn up for so few children and young people with mental health problems, and that it is unclear to many of those involved where the responsibility for this actually lies. It is also very surprising that the cooperation between the various levels in the action chain is so poor that it has direct consequences for the patients.”

The document can be downloaded in Norwegian from the this website  ordered from Akademika booksellers, tel. +47 22 18 81 23.

The provision concerning delayed public access to documents that are compiled by or sent to the Office of the Auditor General in connection with Document no. 3:7 (2006-2007), cf. Section 18, paragraph 2 of the Auditor General Act, has been repealed.

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