Table 1 Norwegian CTO scheme

Norwegian CTO Scheme:

The CTO scheme was introduced in Norway with the Mental Health Care Act in 1961, and was continued based on an amendment to the Act in 2001. The scheme is based on clinical practice and each CTO is decided by the responsible psychiatrist or specialist psychologist. The conditions for implementing a CTO are the same as for involuntary inpatient treatment: patients must have a severe mental illness and either have an evident need for treatment or represent an imminent danger to their own life, or the life or health of others. A study of Norwegian CTOs has shown that they are solely based on patients` clear need for treatment (treatment criterion), with the addition in a few cases (18%) of the risk of posing a danger to themselves or others (harm criterion) [18]. In the case of involuntary medication treatment, a separate treatment decision is required. The legislation requires that coercion is considered necessary and a CTO presupposes that voluntary treatment has been unsuccessfully attempted, or it would be clearly futile to attempt this. Patients must also be offered adequate treatment and care that meet their needs. The CTO decision must be made on the basis of available information and a medical examination of the patient. An overall assessment must also be made as to whether a CTO is the best solution for the patient. In this assessment, patients must be allowed to express their opinion and particular emphasis must be placed on patients’ wishes, and how they feel about involuntary treatment. A CTO decision is valid for 12 months, but it must be re-assessed by the responsible professional at least every three months to determine whether the conditions are still met. If the CTO continues for more than 12 months, it must be approved by an independent review board (the Control Commission). In practice, this means that a patient may be under a CTO indefinitely. The CTO population in Norway has been shown to have the same patient characteristics as seen in studies from other jurisdictions [15, 18, 19]. There is no complete information on the numbers of CTOs in Norway, but in a study from 2012 that included a third of the population, the incidence rate was 23.8 and the prevalence rate was 47.4 per 100 000 inhabitants over the age of 18 [20].