Medication-free Ward in Tromsø, Norway May Soon Close

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This past spring, the Hurdalsjøen Recovery Center in Norway, a private hospital that offered medication-free care to Norwegian psychiatric patients, had to close due to a governmental decision to stop public funding for private enterprises. Now, the medication free-ward in Åsgård Hospital in Tromsø is threatened with closure.

This 6-bed ward had been the most visible example—perhaps anywhere in the Western World today—of inpatient treatment for psychotic and bipolar patients that promoted tapering from psychiatric drugs, or, if the patients wanted, to be treated in the hospital without use of such medications. The University Hospital of Northern Norway (UNN) has proposed replacing the in-patient treatment with “consultants” that will support drug-free treatment at outpatient clinics throughout the region.

If the closure proceeds, it will be a second significant blow to a “medication-free” initiative that dates back more than a decade, when five user groups in Norway jointly began lobbying for such treatment in hospital settings. In 2016, the Norwegian Health Ministry ordered all four health districts in the country to set aside beds for such care.

The Tromsø ward opened in 2017, and over the six years, it has shown that offering patients the option to forgo psychiatric medication, or to taper from the drugs, can be a successful model of care.

The user groups, led by We Shall Overcome (WSO), have protested this proposed closure, with their latest letter dated October 29. They wrote:

“The current drug-free treatment program at UNN is a flagship for drug-free treatment in Norway. It has attracted national and international attention, and there is great interest in visiting the ward to learn. Several users report good results, and are now expressing their support for the department to continue.

Many patients in the mental health service find that medication does not help their health condition, or experience significant side effects. It is therefore important to maintain services that can help this group, and to provide information about and offer drug-free treatment. Drug-free treatment is not currently offered in acute psychiatry, and many patients are put on medication during their first encounter with psychiatric services, under voluntary or coercive measures, and are often given large amounts of medication. It can then be difficult to stop the medication or taper, without a long-term and responsible tapering plan. By offering drug-free services, including in acute psychiatry, it is possible to prevent unnecessary use of drugs, unnecessary tapering processes and unfortunate long-term consequences of drug use.”

And:

“The drug-free program at UNN has been in operation for almost seven years. During this period, the service has built up a large competence base in drug-free services and special expertise in the responsible tapering of psychotropic drugs. The inpatient unit is a unique research arena and maintaining such an inpatient unit is important for further knowledge development in the area. Any establishment of a drug-free consultation team requires that the team is supported by a skilled competent environment, and should be anchored in such a drug-free inpatient unit.

The proposal to convert the drug-free inpatient services into a consultation team is not justified by deficiencies in the service or lack of demand, but because the aim is to free up resources for other drug-controlled services. The proposal appears to be poorly thought out in relation to the national guidelines for drug-free treatment services. WSO believes that the proposal will in practice lead to the closure of drug-free services at UNN, which will have major negative consequences for users. At the same time, it is likely that the professional community at the drug-free inpatient unit will cease and the knowledge gained will be lost if it is converted to a consultation team.”

From the outset of this initiative, the Norwegian Psychiatric Association has mostly opposed it, with prominent psychiatrists arguing that antipsychotics were an essential treatment for psychotic patients. However, as WSO wrote in their letter, the initiative in Tromsø has attracted international interest as an example of a recovery-oriented initiative that gives patients the right to choose whether they want to take antipsychotics and other psychiatric drugs, and it has shown that this approach can be helpful to patients.

Rather than close the inpatient ward and switch to providing “medication-free” treatment in the community, WSO is urging the University Hospital to do both. It writes:

“In summary, WSO requests the following: In the future structure for PHRK at UNN, the drug-free inpatient service will be retained as a separate unit as it is today. At the same time, the drug-free service will be strengthened with a consultation team that encompasses the entire region and all units.”

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33 COMMENTS

  1. This is again something that in my view does not go towards patient health recovery support and wellbeing but control again and again and again. This is inadmissible, it’s going too far, the dismissal of patient is clear, the absence of positive regard toward patient shows, this has gone too far.

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    • Easy to say that. Please provide us with the definitive proof of shared biological pathology for all forms of “schizophrenia.” Not correlations, not candidate genes – let’s hear the exact “pathology”(to use your own words) that distinguishes these conditions. I will assume failure to answer means you have no answer.

      Here’s your chance to prove us all wrong!

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      • My friend just called me about the death of her father. They had taken him to the ER several times because her was not able walk. His stage 4 cancer was misdiagnosed as arthritis until it was too late.

        If medical professionals can’t tell the difference between cancer and arthritis, what makes them think that they can tell the difference between schizophrenia and celiac disease or niacin deficiency or lead or mercury poisoning or tinnitus???

        And most infuriating, why do they refuse to even test for any other pathology?!
        Not curious enough? Don’t really like the Patient? Not a big enough kickback from pharma?

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    • Dr. Ahmed there is hope for you (and your patients, if any) because you found your way to the MIA website. I suggest you read some of the articles here. You might start with the serialization of Peter Gøtzsche’s book “Critical Psychiatry Textbook”. Even if you don’t agree with everything he says, it may help you understand how your education has been deficient.

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    • There are 2, two, paragraphs on the DSM quoted in:

      https://www.madinamerica.com/2023/10/maid-and-mental-illness-an-interview-with-dr-jeffrey-kirby/

      I have made some comments, and I did made some more comments that didn’t get in there, the missing conclusions and premises up to 6. I am not trying to repost those…

      But, I tried to squeeze my arguments of why what you are saying can’t be necessarily true, and if it is not necessarily true then it is false. Simple logic.

      If you are interested, and like informal logic, be my guest.

      On top of that, empiricism based on faulty logic can present results sometimes positive, sometimes negative, not on the size of the effect of the intervention and experimental error. But because starting from false premises can give true and false conclusion under different arguments.

      I hope it helps you…

      I am a former practitioner but not of psychiatry, but this can clarify:

      https://madinmexico.org/la-linea-divisoria-experiencia-de-violencia-endo-psiquiatrica-correctiva/

      Google translate can be used…

      Just ENARM, was the national exam for those who want and wanted to become medical specialists in Mexico.

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    • Even if you believe these drugs are effective treatments, why would you believe they can be the only effective treatment? Even if you believe these drugs are effective treatment, why would you ignore their devastating other effects? Why would you want to deny people the opportunity to try other approaches that are safer and have already proven helpful to some people, even if they haven’t been helpful to all who have tried them, who are always free to try the drugs you have so much faith in.

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    • The problem, from my previous professional experience, is it requires a lot of money to have beds in a hospital.

      Particularly if it can admit patients or cares for patiens 24/7.

      Four, 4, 8hr schedules, including 48hrs continued weekends. Or 5, five, schedules if 12hrs sunday/saturday, day AND night on weekends, say 7 to 19hrs, and 19hrs to 7 on weekends.

      And that goes for physicians, nurses, cleaning and other support personnel. So at least four or five doctors, 8 or 10 nurses, etc., for “just” five beds.

      And they do not charge in magical beans, but in Euros…

      Every day, of every year they are open. Even on vacation, or when resting at home. So, when personnel is sick, on leave, on rest or on holiday someone has to be paid on top of that. So, we need to add one more to the 4 or 5 times of each. Maternity leave, paternity leave, kids play, etc…

      Then there is lab personel, ambulance staff, radiology staff, etc…Oxygen supply and administration: tubes, tanks, tubbing. Plumbing, electricity, has to be fixed immediatly. Energy/lights backups, security personnel….just to be at the door for anything. A nurse should not do that, it might be forbidden by law!.

      And lab personnel can’t be hired for just 5 beds. Just the regulatory stuff requires at least 20-30 beds for one clinical laboratory. Taking a sample and sending it to an outside lab requires more personnel to save lab personnel, that for “efficiency” can’t usualy just leave the hospital, otherwise why hire such personnel if it has free time?.

      Even transporting a tube with blood in a road, let alone a highway is regulated. It is considered a dangerous biological material. The red bags in hospitals with the biological danger symbol say so.

      And that requires the lab available for emergencies at 1am that can’t wait.

      Radiology suits require a lot more than a “simple” lab. X-rays are dangerous and require more safety and more specialized personnel with more stringent qualifications than clinical lab personnel. Not everyone can take an X-ray at 3 am, it requires special training, even if in some hospitals nurses think they can “do” that, even non radiologists medical specialists should not do that. Depends on the regulations. Useless radiographies are not worth doing, and are dangerous, and forbidden in some laws…

      And radiology is required since patients are in the hospital, difficult to know when “one” has no hospital experience: chest pain, difficulty breathing, etc., has to be handled inside the hospital the patient is.

      Otherwise why put him or her there?. How does a physician decide a patient can be transported to ANOTHER hospital without knowing if it is SAFE to do so?.

      Even a psychiatric one, taking the “patient” to some other hospital is just plain negligent. The hospital should and must handle the patients the hospital JUDGES itself capable of handling, except for out of the ordinary patients. Or are “psychiatric” patients “healthy” as in a playground?. Why are then they in a hospital if not in danger?.

      Even first responders, the “ambulance guys”, have to be “sophisticated” enough to know to what kind of hospital take a given patient precisely because all I narrated. Like you do not grab a patient, put him/her in an ambulance to take him or her to a hospital because of a stroke or a heart attack that DOES NOT have the material, personnel, etc., to care for such patient.

      Fractures, trauma, gunshots, same thing. Pregant women, minors. All of that requires from ambulance personnel to know where to land a patient. So that, if not done correctly, the patient then gets to be now transported to the hospital that can actually treat the patient.

      That’s why proper hospital care is SO expensive: just the personnel has to be 24/7, and they charge a lot given they trained for over 10yrs in most cases, after highschool. And someone should cover their vacations, holidays, etc. And such personnel is not, NOT, like substitute primary education teachers, not denigrating…

      Aware the hospitals refered here use “economies of scale”, but that’s another matter, and does not change moneywise a lot, I think. Administrative overhead is a thing in medical industries. As is private or public insurance, oddly enough.

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  2. dr. Ahmed, it is well known that there is neither a single proof for a biological origin of any disorder, ex. serotonin and depression, for more than 30 years. Where have you been all these years, dr. Ahmed?
    I wrote a book about UNNECESSARY (!!!) medicine (Too much Medicine and Preventing Overdiagnosis are two initiatives from BMJ) in Slovenian language in 2019 and there I described in detail the story of Tromso medication-free ward. What a pitty, but, sorry, in these days a discovery of plasmid DNA in a such amounts in Pf… preparations is far far more important than the closure of a ward or any events on the field of psychiatry.
    Mako

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    • To my knowledge I dont think they have outcome data in Tromsø, but they have some ongoing qualitative research, but nothing published yet. In another medicationfree ward they have one ongoing study on outcome that also have a comparison group with traditional treatment, but there is no data out yet.
      Research on outcome naturally takes time, and require a good study-design, and its unfortunate that this has not yet been started in Tromsø.

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  3. My daughter is on antipsychotic medication and now finally off forced medication. We went to Tromsö in august and met the staff at UNN and they showed us the medicationfree section and told us how they work. It was amazing to meet so dedicated staff and very clearly, they have a lot of care about their patients and knowledge of how to do safe tapering off the medications which can be very difficult to come off. My daughter have now started a slow tapering with her psychiatrist here in Jessheim, but she plan to turn her over to her fastelege at 1 Jan 2024 and let him do the tapering. This does not seem totally safe to me, instead I would like her to come under the medicationfree section at UNN and get their professional expertice on this. We really need a safe tapering done now. I really hope that UNN can continue to exist, it doesn’t make sense to take away such a valuable institution which helps patients to come off medication if they want to.

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    • Wow, Katrin, I really hope you are able to get your daughter off the antipsychotic drugs. I do not know what a “fastelege” is. But I do hope and pray you do the best to protect your child. I was also imperfect in that realm, however maybe more successful, than not? Since I was able to protect my children from psychiatric drugging. It’s all so shameful what’s going on.

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  4. Dear Robert Whitaker,

    These are pitiful times for many.

    I am still prophesying that The Hoover Dam will be broken. Exploded. I heard that a pandemic was coming over a decade before covid arrived. A Totalitarian Regime is coming, with a Hitler style World Leader. He will cause enormous fear far and wide. He will make a new calender. Economic chaos will make people amenable. Forced conversions and executions will be done. At stake is freedom. Specifically ‘freedom of choice’ to live as each individual wants to. The hardest hit will be women, and consequently children. A massive global flood is coming. Five meteors. I cannot say when. Practice what to do when it comes.
    All I do know is that eventually humanity will grow from this time of chaos. People will recognize the extent to which humanity has allowed itself to become poisoned, in every sense of that word. After the awfullnes comes a New Epoch of peace and joy. So no matter how dour things get it is worth surviving. Very much so.

    Love and lemons,

    from Diaphanous Weeping.

    https://youtu.be/aKJvbTEnp0I?si=O1NszR55CVxDBND4

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    • I am skeptic on the bases of said predictions, but can you tell me how, without knowing me, am I going to die?, even if you don’t know, somehow, when?.

      🙂

      I mean, I need guidance…

      Or else, if specifics is much of an issue, can you tell me how any Supreme Court decisions to be delivered on Freedom of Speech is going to come out?. Since you seem to see or know the future so specifically.

      🙂

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      • I do not get prophetic insight on an individual personal level. I have no idea of how your unique life is going to go. Everything may be going to be wonderful. I simply do not know. My visions, that is how to regard them, are more like over arching global or epic changes in weather. If I feel a storm is coming all I can say is buy an umbrella. I cannot know if a wide sweeping storm will specifically land a raindrop on your lapel. I am like a cosmic weathergirl. I just say it looks like we need to prepare our waterproof outerwear, metaphorically. I do believe the Hoover Dam will be bombed and I do feel a vast flood is going to happen. But I am honest in not knowing when. You and I might be in an old folks home by then. But it is good to learn to swim whatever goes on in the future. Its good keepfit no? An Ice Age is coming to the Northern hemisphere.

        Years and years ago I saw that there would be a rise in the global sexual exploitation of children. I tried to raise the alarm but at that time everyone thought it was my imagination. Of future sense, I now tell it like I perceive it and if people hear it or do not hear it I try not to push it. Bad weather, bad changes, are inevitable, on our planet. But so are good changes. Many beautiful good changes are coming. It is just that there is alot of reshuffling of the priorities of our collective humanity that will be coming up. It is kind of necessary. An unsettling era is a crash course in helping all focus on what really matters.

        I must away now.

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  5. I find that the thoughts and opinions of the WSO in this article are well-advised and safety for the patient is at the center. I agree with them that there is another option for a separate group with its own consultants be developed then to (as I see it) keep the integrity intact of non-force prescribing, if needed, and the choice to refuse as a real, not a delusional right, and to place this significant and rare mental health measure in equal importance in the outpatient setting of the Norwegian hospital. (As it had in the inpatient unit) I think too that a separate entity would protect the focus and goals of this proposed group. It would be an immense positive bonus if a psychiatrist from anywhere in the world found philanthropic funding to measure the results of this group in terms of patient recovery, satisfaction, co-operation, chronic disease or lack of, and others I might have missed. It could save this venture from becoming extinct due largely to a monopolization of mental health by pharmaceutical companies not requiring healthy competition. I really want to see the vital content not change despite the outward change. (Of inpatient care to outpatient)

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    • I think what RW narrates in the refered articles speak more of “monopolization” from psychiatrists, than from pharma.

      They, the physicians, are the ones that did not implement the orders, guidelines, requests, whatver, made by the, I think health minister, to actually DO non-pharma psychiatric treatment, in public hospitals I think.

      And that resistance, that “blob” of bureacrats, of the medical kind, made the emergence of private non-pharma psychiatric treatment possible. As narrated of the two private hospitals that did it.

      Public ones was kind of “mandated” by the health minister, if I understood correctly.

      And psychiatrists resisted or refused to implement what the health minister wanted/ordered to do, at the request of activists groups. And the ol’ RW, let’s not deny that, somehow.

      So, in this case, as I understand, is not on pharma, but on psychiatrits: they are the ones that did not implement the request, order, mandate, whatever of the health minister.

      I did not get from RW’s, 3, three, refered pieces, legaly how that refusal/omission is to be interpreted though. In the army, the judiciary or the police that lands one in jail on disobedience.

      In my country even “administrative” disobedience can land oneself 36hrs in jail, no more, like some traffic infractions, the ol’ speeding ticket on a stubborn fellow.

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