Helse Nord must soon make a decision on the reorganization of mental health care in Northern Norway. This is also the topic of the newspaper Tromsø on 18 April, in two posts (Kristina Torbergsen, reader’s post, and Egon Holstad, comment). As I understand it, they are both arguing for the preservation of the district psychiatric centers in the northern counties. It is joyful. But will Helse-Nord listen to those and many others who have shouted warnings?
Helse Nord will continue to close down mental health services. Helse Nord carried out a retreat earlier this year when it came to closing down large local hospitals in Gravdahl and Narvik, but appears to be sticking to its centralization and closure plans for important parts of mental health care. In addition to the intention to close down the DPSs, it is also planned to close down drug-free treatment services at Åsgård. This is a department that works very well for a group of patients who often fall between two chairs in the traditional system. There is great opposition to all these closure plans, both locally and in Tromsø.
Lack of personnel or economics? The arguments for the closure plans seem to be twofold. What is now highlighted most strongly from Helse Nord’s side is the lack of personnel. But you also understand that it is about saving money. With regard to the latter, I agree with Holstad’s description of the situation that the will to prioritize mental health care has gone up and down for time immemorial, both in itself and in relation to the somatic part of the health service. There have been many promises. But in a situation where the demand for mental health services is increasing strongly, especially among young people, the choice is now to cut the offer for a large group of patients. It’s frustrating; primarily for those who are ill, but also for us who work in the service.
Why reorganization? Self I work at the Adult Psychiatric Outpatient Clinic in Åsgård. We have recently added positions to be able to accept more patients, thereby reducing waiting lists. It is good. But it is an illusion to think that we can help all the patients without having sufficient support in beds at the DPSs. Many of our patients are in a critical condition due to, among other things, a risk of suicide, and at times need round-the-clock supervision. In the new proposal, only the two 24-hour wards (DPS) at Åsgård will be retained as far as Troms is concerned. This is insufficient. Today, the capacity of these two departments is already under severe pressure, also because they must largely serve as relief posts for the hospital’s emergency departments.
The reorganization which is proposed to strengthen the services for the sickest patients at Åsgård deserves full support. But why must one choose between a strengthening of core functions at Åsgård rather than decentralized offers? Is it about finances or is the main argument that it is about a lack of personnel?
How to get healthcare professionals to stand in their jobs? The shortage of healthcare personnel is a reality, and the reasons are complex. Growth in the private healthcare market is one aspect. Education conditions and salary are other aspects. But I also think a lot is about the importance of well-being and good working conditions where the employees have the opportunity to use their knowledge, without being pressured and/or experiencing a system that does not work optimally. Nor is it the case that if the services in the district are closed, the employees will automatically move to Tromsø to work. At the DPS, there are currently no problems with access to nursing staff, although it is true that there are certain difficulties with access to specialists (psychiatrists). People thrive, and perhaps one of the reasons is that they work close to their roots.
At the polyclinic at In Åsgård, we have recently succeeded in establishing a good working environment with a high degree of trust, and have experienced that healthcare personnel want to stay in their positions. We have also previously read similar stories in the press from the somatic health service, that when staff get to work on what they do best, and are given the opportunity to develop professionally under reasonable working conditions, they choose to stay in their jobs. I believe that the public specialist healthcare service must look at such solutions to a greater extent rather than reducing the offer, which will affect both patients and staff.
How to get people to continue living in the rural areas? Nor is it a good solution to centralize services to Tromsø at the expense of the districts. The professional development has shown that there are many benefits in providing the services closest to where people live. In addition, over the years it has been a stated aim to maintain the settlement outside the large city centres. In this respect, closing down local offers will be a step backwards.
There is one old wisdom that it takes a hundred years for a tree to grow strong, while it takes an hour to cut it down. In the same way, we know that it takes a very long time to establish psychiatric services that work, while a closure means that a professional environment is scattered to all winds with the stroke of a pen. It’s not too late to turn around!
Maintain equal mental health services in the districts and drug-free treatment.
