Treatment teams see mental health successes in Norway

Karen Bouffard
The Detroit News

Bergen, Norway — Life seemed to crumble for Vibeke Hellesund in 2010.

Diagnosed with bipolar disorder, Hellesund was depressed after getting divorced and then breaking up with a subsequent boyfriend. The Norwegian needed several hospitalizations of decreasing length and a year of intense outpatient treatment from an Assertive Community Treatment (ACT) team to get the depression to lift. 

Vibecka Hellesund, standing in the roof-top garden at Kronstad outpatient psychiatric clinic in Bergen, Norway, received at-home visits from a psychiatric nurse once or twice a week while recovering from bipolar disorder. She's now a peer support expert who helps others with severe mental illness.

Six years since her last hospitalization, Hellesund now works as a peer support specialist on an ACT team that provides at-home mental health and social support to about 150 severely mentally ill people living in her city of Bergen. The team provides 24-hour access for clients in crisis.  

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Though ACT is available in every U.S. state including Michigan, it's more widely available in Norway. The Bergen community of about 280,000 people has two ACT teams that treat 300 people, or about 110 patients per 100,000 residents. 

The Detroit/Wayne County Mental Health Authority, serving a population of 1.75 million county residents, has 726 patients enrolled in ACT, or 41 patients per 100,000 residents. Statewide, about 60 per 100,000 Michigan residents are enrolled in ACT, according to the state Department of Health and Human Services. 

The mission of ACT is to treat patients at home and move them toward independence while avoiding hospitalization. 

The multidisciplinary teams typically include mental health professionals, social workers and peer mentors who stay in close face-to-face contact with patients, making sure they stay on their medications and that their needs for food, shelter, work and social interaction are met. 

Like all other health services in Norway, the cost is covered by taxpayers through the country's socialized health service. Severely mentally ill people in Norway also receive housing and financial support from the government. 

"I had a community psychiatric nurse that came to visit once or twice a week," Hellesund said about her recovery that was aided by an ACT team. The nurse visits lasted for about a year, she said, but ACT treatment can continue as long as it is needed. 

"We’d just go to the local shop, if that’s what I needed to do, or we’d go for a walk, or just have a chat," Hellesund said.

Hellesund now works on an ACT team that includes two psychiatrists, two psychotherapists, six psychiatric nurses, a social worker and a vocational specialist. 

"We do work together to cover all aspects that really a person needs to function in the society. There’s not much that we don’t do," Hellesund said, adding that she and other team members search the streets for patients if they disappear from their residences. 

Wayne County has 12 ACT teams, each staffed by a psychiatrist, a licensed nurse or social worker, a case manager and a peer support specialist, said Dana Lasenby, chief clinical officer for the Detroit/Wayne Mental Health Authority.

Though ACT is costly, it's covered by the Medicaid health program for patients who meet criteria that include a history of frequent hospitalizations, Lasenby said. 

The availability of ACT in Wayne County isn't limited by funding so much as by the difficulty of finding agencies willing and able to work with the challenging population in need of such services, she noted.

"It’s very intense," Lasenby said of ACT treatment. "They review each of those individuals every day.  On some level they're having some kind of contact 24/7.

"Often the challenge is finding individuals who are trained and able to take care of that very complex person," she said.

“Healing justice” is a Detroit News project made possible through a fellowship with the Association of Health Care Journalists funded by the Commonwealth Fund, a nonprofit foundation focused on health.

Twitter: @kbouffardDN

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