Logo til fagbladet Fontene

Svakt av Fontene

Andelen utviklingshemmede med tvangsvedtak varierer fra snaut en prosent i Finnmark til drøyt 12 prosent i Hedmark. Tidsskriftet Fontene omtalte forholdene, uten å stille et eneste kritisk spørsmål, uten å sjekke en eneste opplysning.

"Petter blir friere under tvang" var oveskriften som prydet Fontene den 18. april. Uten et eneste refleksjon, presenterer Fontene en person som mange hevder har fått det bedre med tvangstiltak. Slike tilfeller kan en finne mange av, uten at det forteller særlig mye. Statistikk fra Helsetilsynet viser at de fleste tvangsvedtaken stadfestes av fylkesmannen og få påklages. Historien om Petter forteller ikke noe årsakene til Petters problematiske oppførsel, alternative tiltak til tvang, hvor lenge tvangstiltakene skal opprettholdes eller eventuelle negative konsekvenser av tvangstiltakene. Historien om Petter forklarer overhode ikke hvorfor andelen av utviklingshemmede med tvangstiltak i Hedmark er 20 ganger høyere enn i Finnmark og fire ganger høyere enn i Østfold, slike forklaringer bringer Fonteneartikkelen fra andre.

– Det er ingen ting som tyder på at det brukes mer tvang i Hedmark enn i andre fylker. Antall vedtak kan være tegn på at de kjenner regelverket og er opptatt av at inngripende tiltak nedfelles i vedtak. Fra tilsyn vet vi jo at det brukes makt og tvang uten godkjenning, sier seniorrådgiver i Helsetilsynet Arve Arntsen Mosand til Fontene.

Arve Arntsen Mosand tar feil. Med mindre han har Snåsamannens evner, så mangler Mosand grunnlag for sin påstand. All informasjon vi har om fylkesvis variasjon i andelen tvangsvedtak, viser at tvang er mer utbredt i Hedmark enn i andre fylker. Hedmark har desidert høyest andel av tvangsvedtak. Kun tre fylker har en høyere andel meldinger om bruk av tvang og makt i nødssituasjoner enn Hedmark.

Arve Arntsen Mosand kan likefullt ha rett i sin påstand. Det kan være at listen for å skrive vedtak og listen for å sende meldinger om tvangsbruk i nødssituasjoner er laver i Hedmark  enn i andre fylker. Det kan også være at uhjemlet tvangsbruk er langt mindre vanlig i Hedmark enn i andre fylker. Men det kan like godt være motsatt eller helt andre forhold som forklarer den store utbredelsen av registrert tvang i Hedmark. Det er skremmende når spesialrådgivere i Helsetilsynet baserer sine påstander på svake hypoteser.

– Dersom man skal få et riktig bilde av tvangsbruken, må man se hele bildet. Vi er ikke urolige for at det innvilges vedtak over en lav sko, sier Arve Arntsen Mosand til Fontene.

Når verken Helsetilsynet eller andre har informasjon om "hele bildet", så bør i det minste statens kontrollorgan være forsiktig med å benytte helheten som faktagrunnlag.

Seniorrådgiver hos Fylkesmannen i Hedmark, Jørn Kroken, viser til at antallet tvangsvedtak i Hedmark samsvarer med forskningen som viser at 10-15 prosent av utviklingshemmede har utfordrende atferd som må møtes med makt og tvang. Påstanden er absurd:

  1. Det ingen naturlov at 10 til 15 prosent av utviklingshemmede må vise utfordrende atferd. Utfordrende atferd er i stor grad en reaksjon på den enkeltes situasjon.
  2. Flere studier viser at 10 til 15 prosent av utviklingshemmede viser utfordrende atferd. Ingen studier viser at 10 til 15 prosent av utviklingshemmed må møtes med makt og tvang.
  3. Hvor stor andel som viser utfordrende atferd blant personer uten utviklingshemming, sier Jørn Kroken ikke noe om, men vi vet at tvangstiltakene ville vært straffbare å anvende overfor folk flest.
  4. Jørn Kroken forteller videre at tvangsvedtak ofte dreier seg om mindre alvorlige inngrep som f.eks. "Det handler om å passe på geitosten, så den ikke spises opp i en smell, eller ta vekk tannbørste og tannkrem for å hindre skade på tannkjøttet", sier Jørn Kroken og feier grunnlaget bort for sin egen referanse til andelen som viser utfordrende atferd.

Jeg mistenker at den store utbredelsen av registrert tvangsbruk i Hedmark dels skyldes positive holdninger til bruken av tvang og makt i habiliteringstjenesten og hos fylkesmannen. Lav vektlegging av selvbestemmelse. En lovforståelse blant tjenesteytere som en kan stille alvorlige spørsmål med.

Høsten 2015 mottok jeg et brev fra en av pådriverne for tvangstiltak i habiliteringstjenesten. Fra brevet kan en lese: "Utviklingshemmede over 18 år skal ivaretas av bostedskommune, og essensen i kommunal helse- og omsorgstjenestelov (KHOL) er at alle skal leve et verdig liv. Utviklingshemmede har i tillegg krav på beskyttelse. Det er det som er essensen i kapittel 9 (Lov om tvang og makt) i KHOL".

Det er all grunn til å stille kritiske spørsmål med tvangsbruken i Hedmark. Helsetilsynet skal ikke trekke konklusjoner før de har grunnlag for konklusjonene. Seniorrådgiver Arve Arntsen Mosand bør lære seg forskjellen på spekulasjoner og dokumentasjon. Fontene bør kanskje fortsette den litt mer gravende journalistikken som de er blitt priset for tidligere. Mikrofonstativ har vi nok av.

Jens Petter Gitlesen

8 juli 2018

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  • 2018-07-09 Viser til formuleringen – Det er ingen ting som tyder på at det brukes mer tvang i Hedmark enn i andre fylker. Antall vedtak kan være tegn på at de kjenner regelverket og er opptatt av at inngripende tiltak nedfelles i vedtak. Fra tilsyn vet vi jo at det brukes makt og tvang uten godkjenning, sier seniorrådgiver i Helsetilsynet Arve Arntsen Mosand til Fontene. Fylkesmennene har lik kjennskap og det samme gjelder også kommuner men utfordringen er at det å fatte et tvangsvedtak innebærer et betydelig kommunalt byråkrati. Man plikter å lytte til fastlege, kommunelege, pårørende, verge osv. Jeg har blitt opplyst at fra man starter med å lage et tvangsvedtak til et endelig vedtak foreligger kan det ta opp mot et år. Jeg mistenker derfor at enkelte kommuner ikke gidder å ta seg bryet med dette arbeidet mens andre kommuner trolig er mer nøye. For å trekke parallell til en annen sak som ikke har noe med denne saken å gjøre men som likevel har en overføringsverdi. Jeg er fra Østfold fylke. Før sykehuset Kalnes i Sarpsborg sto klar til drift holdt sentralsykehuset i Østfold til i Fredrikstad. Til stadighet hørte man om legetabber med svært alvorlig utfall. Så kom jeg i den situasjon at jeg skulle følge nær familie til Feiringklinikken for å skifte hjerteklaff i 2015. Her tok vi opp at det skjedde mange feil ved sykehuset i Fredrikstad. Da svarer sykepleieren på Feiringklinikken at sykehuset i Fredrikstad var blant de flinkeste i landet til å melde inn avvik og videre sa sykepleieren at feil og tabber skjer overalt og det er rimelig likt fordelt basert på antall ansatte og pasientgrunnlag. Det er nettopp det som er poenget mitt med saken om tvang. Enkelte kommuner er flinke med ta initiativ til tvangsvedtak og sørger for å få det godkjent hos fylkesmannen mens andre kommuner utøver tvang og makt uten å få dette hjemlet i noe lovverk. Steinar Wangen
  • 2018-07-09 Vi hadde en virksomhetsleder (nå pensjonist) som la stort ansvar på tjenesteyterne når behovet for tvang dukket opp. Denne glimrende lederen søkte altså først i egne rekker for å unngå tvangsvedtak. Tore E. Olsen
  • 2018-07-08 Dersom tjenestetilbudet blir bedre tilpasset den enkelte bruker så vil i svært mange tilfeller grunnlaget for tvang og makt forsvinne. Når Dag Olav flyttet ut fra det kommunale bofellesskapet forsvant all bruk av tvang og makt selv om tjenestetilbudet er det samme. https://www.youtube.com/watch?v=lpH1VS7DtRs Torunn Stensland
  • 2018-07-08 Så bra skrevet,dessverre er det slik mange steder👍 Jeg bor i Telemark fylke og der er saken du skriver om like aktuell desverre 😥 Torunn Thygesen

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