SUU, Alm.del - 2015-16 - Bilag 15: Orientering vedr. svar til FN's handicapkomité, fra sundheds- og ældreministeren

Sundheds- og Ældreudvalget 2015-16
SUU Alm.del Bilag 15
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UN’s Committee on the Rights of Persons with Disabilities

Date: October 9, 2015

Section: Primær Sundhed

Case Officer: SUMBGB

Case: 1505929

Doc.: 1788768

Response of the Danish Ministry of Health to the concluding observa-

tions on the initial report of Denmark from UN’s Committee on the

Rights of Persons with Disabilities adopted on the 12th session from the

15 September to 3 October 2014. [Danish response in

italic]

The Committee has as follow-up and dissemination requested that Denmark within

12 months provide information on the measures taken to implement the Commit-

tee’s recommendation as set out in paragraph 21, which concerns the forced hospi-

talization and treatment of children in psychiatric hospitals (paragraph 68).

Paragraph 21 in the concluding observations:

21. The Committee recommends that the State party abolish forced hospitalization

and treatment of children in psychiatric hospitals, and provide adequate opportuni-

ties for information and counselling to ensure that all children with disabilities have

the support they need to express their views.

As a general rule the activities concerning psychiatric treatment are regulated by the

general health legislation. These rules cover the treatment of physical as well as men-

tal illnesses, and state the principle of free and equal access to necessary medical

care, not depending on economic, social or racial status. The only legislation that

concerns psychiatric treatment is the so-called Psychiatric Act.

In order to use detention or compulsory treatment the patient must be insane or in a

condition similar to insanity. The criterion “similar to insanity” is construed restrictive-

ly, and so it must be a condition that cannot be distinguished from insanity.

The following two conditions must be met prior to any compulsory admission of a pa-

tient to a psychiatric ward:

1. The patient must be insane (mentally ill) or in a similar condition.

2. It must be deemed unjustifiable not to admit the patient for treatment.

This is the case:



when the prospect of recovery or a significant and decisive improvement of

the patient's condition would otherwise be seriously reduced, or



when the patient exposes him or herself or others to significant harm.

In Denmark as a general rule no admission, examination, treatment or care can be ini-

tiated or continued without informed consent of the patient unless otherwise provid-

ed for by statute or statutory provisions. Therefore every time a person is subjected to

coercive measures a separate protocol has to be filled out as required by the Danish

Psychiatric Act. Besides, this information is also reported to the National Board of

Health. The Danish data for the use of coercion are of high quality, publicly available

and highly validated.

SUU, Alm.del - 2015-16 - Bilag 15: Orientering vedr. svar til FN's handicapkomité, fra sundheds- og ældreministeren

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However the Health Act in Denmark stipulates, that when a patient has lost the ca-

pacity to handle his/her own interests, the person or persons authorized under the

law shall enter into legal rights of the patient if this proves necessary to safeguard the

interest of the patient in the relevant situation.

A patient who cannot give informed consent him/herself shall be informed and in-

volved in the discussions of treatment available in so far as the patient understands

the treatment situation, unless such information may adversely affect the patient. The

patient´s comments, if considered worthwhile and relevant, shall be taken seriously.

The Ministry of Health would like to point out as mentioned above, that whenever a

patient is exposed to coercive measures it must be noted in a special protocol at the

psychiatric ward, and this information is also reported to the local authorities as well

as the central governmental institutions.

In the Regional State Administration a local Patient Board of Complaints is set up.

Complaints about the board’s decisions concerning the deprivation of liberty (involun-

tary placement and forcible detention), restraint, involuntary treatment in out-patient

care, protective restraint, and locking of doors in the ward, can be lodged to the regu-

lar court system. The Court appoints a lawyer for the patient, and the costs are paid

by the State. Furthermore the patient must be offered a patient advisor to safeguard

these rights.

Other safeguards in connection with coercive measures are the assignment of a pa-

tient advisor, the advisor must be assigned as soon as the decision has been taken

and has to visit the patient within 24 hours of being assigned. Whenever coercive

measures are used, the patient must be advised on complaints procedures.

Furthermore patients have the right to be informed why coercion is required and what

effect treatment may be expected to have on their health condition, including what

the outcome may be if the treatment is not undertaken.

On any compulsory action the consultant physician must take measures to secure that

deprivation of liberty and use of other coercive measures is used only to a necessary

extent.

In the spring of 2015 the Danish Parliament adopted changes to the Danish Psychiatic

Act – among others – to clarify the legal position of minor psychiatric patients. The

15-17 year-olds who do not consent to admission or treatment are now covered by

the Danish Psychiatric Act and the ensured procedural safeguards listed above.

The Danish Psychiatric Act does not apply to minors under the age of 15, if the parent

who has custody has given informed consent to the admission or treatment of the

mentally ill young child.

The act also contains an obligation to report interventions performed on children un-

der the age of 15 to the National Board of Health, regardless of whether the interven-

tion is done with parental consent or not.

The parent who has custody must be informed that he or she has the opportunity to

renounce the position for use of coercion against the minor. If the parent does not

wish to rule, the minors will be covered by the Danish Psychiatric Act if the other con-

SUU, Alm.del - 2015-16 - Bilag 15: Orientering vedr. svar til FN's handicapkomité, fra sundheds- og ældreministeren

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ditions for use of individual coercive measures are met. This involves appointing pa-

tient advisor and appeal, etc.

It is important to stress that the principle of the least invasive measures must always

be followed. It is also the aim to minimize the use of immobilisation with a belt on

children.

The Ministry of Health has no immediate plans to alter this arrangement. The new

appeal for the 15-17 year-olds will however be evaluated in 2018 and adjustment of

the system will be considered e.g. in relation to the age group that has appeal.

Finally the Government has declared the goal to improve conditions for people with

mental illness, including a reduction in the use of coercion. In summer 2014 a majority

og political parties in Parliament agreed to reserve 2.2 billion Danish kroner in order

to ensure better rights and better quality of care for mentally ill persons e.g. by an in-

crease of capacity in psychiatry, e.g. in outpatient psychiatry and closed wards. The

keyword is “equal effort”. Psychiatric patients must receive the same effort, have the

same rights and get the same high quality in treatment and rehabilitation as patients

with physical illness. Specific targets are set e.g. for reducing coercion in psychiatry,

including mechanical restraint. These initiatives support the new framework and di-

rection for psychiatry that has been recommended by the Commission.

Yours sincerely,

Birgitte Gram Blenstrup