Norway, Mental Health and WHO

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The relationship between Norway and WHO with respect to mental health is embedded in a long tradition of Norwegian support of the organization. Generally, the indication is that Norway is giving WHO high priority, reflected in offering it extensive financial support and expertise. However, in mental health this relationship seems far more complex and ambiguous than would be expected on the basis of this tradition, for cultural and knowledge-related as well as structural issues. One might conclude that the relationship between Norway and WHO in this field appears to be: Focussed upon community-based mental health services, particularly in the public health tradition, and to a limited extent upon specialised services. A shared view that mental health services should be based upon provision of community-based service.

In Helsinki, Norway’s contribution particularly dealt with presenting user empowerment, while keeping a low profile on other issues. This approach reflects the ambiguous situation of mental health services at that time. In the initial phases of the Action Plan 1098 – 2008 mental health services provision was defined as in a critical situation, both regarding the number of hospital beds and regarding community-based/municipal services.

All in all, WHO recommendations did not influence developments in Norwegian mental health policies, but subsequent to the World Health Report the Helsinki Declaration and the WHO Action Plan were some times being cited to support policies already approved.

The image of Norway as an active partner in WHO seems to be related to the history of the relationship between the two (particularly to the role of some highprofile participants), to the extensive funding from Norwegian governments, and to health issues not related to mental health. There are few indications that Norway played an important role in the work on the Helsinki Declaration and the WHO Action Plan – apart from the issue of user perspectives/participation and services for children and adolescents.

Anglo-American countries, the UK in particular, seems to have attained a prominent role in WHO, and according to our informants, at the time of the Helsinki meeting WHO was particularly concerned with mental health developments in Eastern and Central Europe, and was looking for examples of strategies for closing down the asylums and strengthening community-based services. At the time of the Helsinki Meeting, it seems as though Norway did not represent an example to follow, given the structure of their services. At that time, mental health in Norway was a policy field where the strategies were based upon the definition of a “crises” mentioned above. Also, characteristics of the specialist services were regarded as contradictory to the WHO recommendations, and consequently a low-profile strategy seems to have been adopted. In addition, notwithstanding the sociological profile of the Action Plan, with an increase in community- based services, there was still ambiguity and resistance to the reduction of hospital beds.

At the Helsinki meeting Norway could not merely present good intentions for future developments. The Norwegian Action Plan at that time had been at work for some years, and Norwegian representatives had to be prepared to answer questions about what they had achieved from it. In the beginning of the Action Plan period the researchers studying the implementation of the plan reported little progress, which might be one reason that Norwegian representatives kept a relatively low profile, except for the issue of user perspectives.

Another explanation could be that the Helsinki Declaration was an initiative from the regional branch, WHO Europe. For some reason it seems that Norway has a weaker connection to WHO Europe than to the global WHO. Many European countries have their own WHO office – Norway does not.

In spite of shared ideology in the Norwegian Action Plan and the Helsinki Declaration about ways to develop mental health services, there are no indications of reciprocal influence between the two documents and the processes around them. The important finding is that there is a continuous exchange of ideas and practices, based upon a public health perspective as a shared knowledge base. Thus, it seems that WHO has contributed not so much to formulating national regulatory instruments for implementing mental health policies as to represent an agency to form a “public health alliance”, strengthening the arguments for community-based services in the country.

RAMSDAL Helge, VOLD HANSEN Gunnar, HELGESEN Marit & FEIRING Marte (2009), Norway, Mental Health and WHO, KNOWandPOL Report.

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