Open Access Open Access  Restricted Access Subscription Access

Drug therapy in patients subject to outpatient compulsory mental health care

Karin Drivenes, Stein Bergan, Oddvar Saether


Rationale, aims and objectives: The use of coercion in mental health services is controversial. Little is known about drug therapy in patients subject to ambulant compulsory mental healthcare. The purpose of this study was to describe the drug therapy and follow-up in patients subject to ambulant compulsory mental healthcare at Sorlandet Hospital, Norway and, if possible, to improve drug therapy through specific advice from a consultant pharmacist.

Method: Relevant information was obtained from the medical records of the included patients. Drug reviews were processed. Identified drug-related problems (DRPs) were presented to the interdisciplinary treatment teams and initiatives were documented.

Results: Of the 101 patients subject to ambulant compulsory mental healthcare, 77 patients met the inclusion criteria. On average each patient used 3.6 drugs overall. All patients were using at least one antipsychotic agent, 83 % used depot injections. We identified 68 DRPs in 51 patients. Of these, 54 DRPs were concurred by the psychiatrist treating the patient. The most common type of concurred DRP was "lack of monitoring". The most common initiative was "discussion in the multidisciplinary team or with the patient".

Conclusion: Even though the indication was clear, drugs were not always prescribed. Or they were prescribed in too low doses, according to the request of the patient. Among the presented DRPs a high proportion was concurred on, but few alterations were made immediately. A pharmacist can contribute to improving drug therapy, but pharmacists are not currently regular members of the interdisciplinary treatment team.


Antipsychotics, community treatment order (CTO), compulsory treatment, consultant pharmacist, drug-related problems, monitoring of drug use, outpatient, outpatient commitment OC), person-centered healthcare, person-centered psychiatry

Full Text:



Act No. 62 of 2 July 1999 relating to the provision and implementation of mental health care (the Mental Health Care Act), with later amendments. [cited 2015 May 15]. Available from:

Kisely, S.R., Campbell, L.A. & Preston, N.J. (2011). Compulsory community and involuntary outpatient treatment for people with severe mental disorders. Cochrane Database of Systematic Reviews CD004408.

Maughan, D., Molodynski, A., Rugkasa, J. & Burns, T.A. (2014). Systematic review of the effect of community treatment orders on service use. Social Psychiatry and Psychiatric Epidemiology 49 (4) 651-663.

Diseth, R.R. & Hoglend, P.A. (2013). Compulsory mental health care in Norway: The treatment criterion. International Journal of Law and Psychiatry 37 (2) 168-173.

Ingram, G., Muirhead, D. & Harvey, C. (2009). Effectiveness of community treatment orders for treatment of schizophrenia with oral or depot antipsychotic medication: changes in problem behaviours and social functioning. Australian and New Zealand Journal of Psychiatry 43 (11) 1077-1083.

Christensen TB, Onstad S. (2003). Compulsory medical treatment in an emergency psychiatric department. Tidsskrift for Den Norske Laegeforening 123 (7) 921-924.

Husum, T.L., Bjorngaard, J.H., Finset, A. & Ruud, T. (2010). A cross-sectional prospective study of seclusion, restraint and involuntary medication in acute psychiatric wards: patient, staff and ward characteristics. BMC Health Services Research 10, 89.

Norwegian national guideline for medical reviews; 2012 (in Norwegian); [cited 2015 May 15]. Available from:

Ruths, S., Viktil, K.K. & Blix, H.S. (2007). Classification of drug-related problems. Tidsskrift for Den Norske Laegeforening 127 (23) 3073-3076.

WHO ATC/DDD Index 2014; [cited 2015 May 15]. Available from:

WHO International Classification of Diseases (ICD); [cited 2015 May 15]. Available from:

Norwegian drug and therapeutic formulary for health personnel (in Norwegian); [cited 2015 May 15]. Available from:

Bjerknes, N., Blix, H.S. & Nicolaysen, B. (2013). [Legemiddelsamstemming ved innleggelse i en psykiatrisk sengepost]. Masters thesis, University of Oslo, Oslo (in Norwegian). Available from:



  • There are currently no refbacks.