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To: 49thMIMOMander who wrote (59537)	1/1/2010 3:21:19 AM
From: average joe	Read Replies (3) \| Respond to of 218083

The main law regulating the compulsory admission of psychiatric patients to hospital in Finland is the Mental Health Act 1990/1116, which was passed in 1991 and amended in 2002. The following account refers to adults only. Provisions for children under 18 years of age differ slightly and will not be considered here. The current Finnish Mental Health Act stipulates the following criteria for compulsory admission: a person should be found to have a psychotic illness, and because of this psychosis, they are in need of psychiatric care as their condition would otherwise worsen, or a danger to their own health or welfare, or a danger to the health or welfare of others no other mental health services are suitable or adequate. ‘Psychotic illness’ in the context of this legislation is understood to include the diagnoses of delirium, severe forms of dementia, all types of schizophrenia and other psychoses, organic and other delusional disorders, major depressive disorder with psychotic features and bipolar disorder. These diagnostic criteria are comparatively restrictive and can cause practical difficulties in some situations, for example if suicidal patients clearly pose a risk to themselves but do not clearly fulfil criteria for admission because of the absence of psychotic symptoms. The dangerousness criteria on the other hand are interpreted in a rather broad way and can include risk to one’s own health as a result of poor standards of personal care, as well as endangering the development of one’s children. The process of detention is initiated by a referral for observation (known as MI), which can be written by any physician if they consider it likely that the criteria for involuntary admission are fulfilled. In hospital, the patient is then examined by a second doctor who must be a psychiatrist. At this stage the patient can be admitted on a voluntary basis, or indeed not at all, if the psychiatrist does not consider the criteria for detention to be fulfilled. If compulsory admission is recommended by the psychiatrist, a written statement (MII) describing the patient’s condition, detention criteria, as well as the patient’s own views, has to be produced on the fourth day after initial admission at the latest. A third recommendation, MIII, the final decision, is then required by the psychiatrist in charge at the hospital to which the patient is admitted. This completes the procedure; the detention is then valid for 3 months. In Finland, involuntary admission of a psychiatric patient is therefore dependent on the opinion of three independent doctors but does not involve other professionals. Compared with other European countries this is a minority position only shared by Denmark, Sweden, Ireland and Luxemburg (Salize et al, 2002). The majority of EU member states require non-medical authorities (most commonly judges) to be part of the decision-making process or to make the final decision on compulsory detention. If at the end of the 3-month period it is considered likely that detention criteria are still fulfilled, new recommendations MII and MIII are filed and the renewed detention is then valid for 6 months. However, this second period of detention has to be immediately confirmed by a local administrative court. After this 9-month period, if the patient needs further compulsory treatment the process has to start anew with a MI referral which can be initiated by any doctor outside the hospital at which the patient is currently treated. There is no legislative distinction made between involuntary placement and treatment in Finnish mental health law. Medication and other treatments can be given against the patient’s will if the advantages clearly outweigh the disadvantages, and the treatment of the patient’s illness or their safety, or that of others, necessitates it. This includes electroconvulsive therapy which can be administered in an emergency (e.g. in a catatonic state, as a life-saving measure) but would not otherwise be given compulsorily to a non-consenting patient. There are, however, no specific safeguards such as the requirement of a court order or a second opinion in relation to any compulsory treatments. However, every restriction has to be clearly documented and filed, and the patient can file a complaint to the chief executive officer of the hospital, to the courts, or even to the parliamentary ombudsman. However, restrictions of other liberties are regulated in much detail, and the law makes specific reference to restricting patient’s possessions, limiting contacts, seclusion and restraint. Every case of seclusion and mechanical restraint has to be documented and reported to the responsible authorities (the state provincial office). Compulsory out-patient treatment is not presently permitted in Finland. Patients can appeal against their detention at a local administrative court within 14 days of notification of their compulsory admission (MIII). Decisions by the local administrative court can be appealed against at the Supreme Administrative Court. In appeals cases independent psychiatric reports are commissioned. Appeals can also be lodged with the medical director of the detaining hospital. pb.rcpsych.org