There is strong evidence to support long-standing allegations of pervasive violence, drug coercion, and abusive conditions endured by patients with developmental disabilities and mental health issues in long-term care facilities, RÚV reports. This according to a report compiled by a working group that the Prime Minister appointed two years ago, following RÚV’s reportage on inhumane treatment in the Arnarholt long-term care facility, as well as additional testimony compiled by the mental health advocacy group Geðhjálp and current and former staff of Landspítali’s secure and forensic mental health wards.
Employees of secure and forensic mental health wards came forward in 2020
In November 2020, staff at the Arnarholt long-term care facility came forward with detailed descriptions of inhumane treatment of patients at the facility, dating back to the 1970s. Following these reports, Geðhjálp, an organization which advocates on behalf of people with mental health issues, received an increase in complaints about the services and facilities provided by Landspítali in its secure and forensic mental health wards, both of which are located in the Kleppur psychiatric hospital. Many of these complaints were made by current or former employees. (Secure wards are intended to serve patients with severe mental health issues who need long-term care and have found success with other treatment resources. Forensic mental health wards are specialized psychiatric wards which aim to rehabilitate patients with serious mental health issues who have committed crimes and help them reintegrate into society.)
Among the complaints were reports of patients being forced to take medication against their will, denied information about their treatment, restrained with shackles, kept in the wards for months at a time if they refused treatment options, or locked in a room for days if they broke the rules of the ward. Forced injections were said to be a regular occurrence on these wards, often causing injuries to both patient and staff in the process—injuries that often went unreported.
As a result of these complaints, Geðhjálp worked with at least eight former and current employees of these wards to compile a report on conditions and patient treatment. The report and staff testimonies were then forwarded to the Directorate of Health, which said it made site visits in response to the allegations. Landspítali said it interviewed a number of employees. But both institutions refused to comment further on their investigations or conditions at the facilities when contacted by RÚV in May 2021.
More granular investigation necessary
Fast-forwarding to the present, the working group’s report, which was submitted to Alþingi on Wednesday, says that a more granular investigation is necessary. Moving forward, it suggests that there be two separate inquiries: one which focuses on the years 1970 to 2011, when treatment of the patients in question was transferred to local municipalities, and one which focuses on 2011 to the present day.
The study focusing on the years 1970 – 2011 should answer three primary questions, says the report. Firstly, what was the experience of adults with developmental disabilities and mental health issues in long-term care facilities during the stated period? Secondly, what abusive or adverse treatment did this group undergo? And thirdly, how did the parties responsible handle supervision and monitoring of these facilities during the time frame in question? The questions of the second study, focusing on 2011 to present day, would largely be the same, with a focus on systemic factors that increase the likeliness of adverse treatment and conditions within long-term care facilities.
The report also notes that while transferring the care of patients with severe mental health issues and adults with disabilities to local municipalities was intended to ensure better monitoring of patient treatment and ward conditions, this has not been the reality in many cases. It also makes particular note of the fact that it was very difficult for the working group to get information from local municipalities and that the answers they did receive were often imprecise.
Nearly half of municipalities, Directorate of Health did not reply to requests for information
In fact, nearly half of the municipalities in Iceland, or 31 of 69, didn’t bother to respond to the working group’s request for information, despite repeated reminders. Very little information was available from West Iceland; there Snæfellsbær, Grundarfjarðarbær, Helgafellssveit, Eyja- og Miklaholtshreppur, Stykkishólmsbær, Borgarbyggð, and Hvalfjarðarsveit all failed to reply. Two municipalities in the Westfjords, Bolungarvíkurkaupstaður and Súðavíkurhreppur, didn’t reply. Nine municipalities in Northeast Iceland—Hörgársveit, Svalbarðsstrandarhreppur, Grýtubakkahreppur, Þingeyjarsveit, Skútustaðahreppur, Tjörneshreppur, Svalbarðshreppur, Langanesbyggð, and Aykureyrarbær, the fifth-largest municipality in Iceland, named for the town of Akureyri—did not answer. Even worse was Northwest Iceland and Suðurnes (the Reykjanes peninsula), where no municipalities replied. The fourth-most populous municipality in Iceland, Reykjanesbær, is located on Suðurnes.
Seltjarnarnesbær and Kjósahreppur did not reply, but all other municipalities in the capital region did. All municipalities in East and South Iceland replied.
The Directorate of Health did not reply.
Upon receipt of the report, Prime Minister Katrín Jakobsdóttir said it was clear that there are serious and widespread problems in the system, but that it is not yet possible to talk about the report findings in detail. She also expressed surprise at how difficult it was for the working group to information-gather. Looking ahead, Katrín said the report would be reviewed and discussed by parliament, which would then determine the best course of action.
Wants society to learn from history
Following the working group’s delivery of the report to Alþingi, 61-year-old Ólafur Hafsteinn Einarsson spoke to RÚV about his own experience in long-term care facilities. Ólafur lived in facilities for people with mental health issues and developmental disabilities throughout his life, and said that as a child, he was beaten and subjected to verbal abuse at Sólheimar. As an adult, he lived in several different facilities from 1975 – 1990, including Arnarholt and Bitra, which was not even a proper residential facility, but actually a women’s prison. He said Bitra was the worst of the places he lived. In 1990, Ólafur moved to a group home in Kópavogur, where he lived for 22 years before moving into his own apartment in 2011, around the age of 50, which he said felt like his greatest personal triumph.
The results of the report were not entirely surprising to Ólafur, although he said that overall, it was “somewhat rougher than I thought it would be.” He continued by saying he wanted to know why living at these facilities had to be so difficult for the residents. He also said he was glad that investigations into the conditions in these facilities would go as far back as 1970.
“So people, in society in general, can see and hear it, so that they can learn from these things.”
Patients should have a seat at the table
The working group concluded its report by stating the belief that further investigations into ward conditions and patient treatment should be inclusive of the people these inquiries are intended to benefit. As such, they advocate for people with disabilities and mental health issues to be part of future inquiries and for these individuals to be provided with the necessary assistance to present their cases and experiences to the investigating committees.