Calls for Better Mental Healthcare After Inmate Found Dead

Litla-Hraun Prison in South Iceland

An inmate at Litla-Hraun Prison was found dead in his cell yesterday morning, RÚV reports. There is no suspicion of foul play. Prisoner advocacy group Afstaða criticised the Icelandic government for not ensuring adequate mental health services for inmates in the country’s prisons.

Director General of the Prison and Probation Administration Páll Winkel stated that the South Iceland Police is investigating the death.

Mental health services lacking

In a statement published on Facebook, Afstaða, an Icelandic organisation that advocates for prisoners’ rights, called on “the government to wake up from its slumber and do something about prison issues, not least with regard to the mental health of people who are deprived of their freedom.”

Lack of mental healthcare for inmates has been a persistent problem in the Icelandic prison system for years. In 2018, there were only three psychologists and no psychiatrist serving some 1,000 people in the system, 75% of whom were believed to require mental health services. Between 2017-2019, two prisoners committed suicide, and their deaths were linked to the disarray in mental health services.

In December 2019, a specialised, interdisciplinary mental health team was established to provide prisoners across the country with mental health services, but more recent reports from international supervisory bodies point to continual issues.

Aging facilities

Litla-Hraun is one of Iceland’s two closed prisons. Its first building was completed in 1929 and was meant to be a hospital but was never used as such. In the ensuing decades, more buildings were added to the prison, but never with a holistic design strategy. A November 2023 Icelandic National Audit Office report stated that the prison does not fulfil modern safety requirements.

Litla-Hraun is set to be replaced by a brand-new facility in 2028. In an interview in February 2024, Þórunn Sveinbjarnardóttir, chair of the Parliament’s Constitutional and Supervisory Committee, stated that authorities cannot simply wait for the new facilities to improve conditions in Icelandic prisons. Þórunn stated that it was necessary to improve existing facilities and improve the prisoners’ environment so that it supports their rehabilitation.

Read more about prisons in Iceland.

Reykjavík Delays School Start for Teens in Sleep Health Initiative

Reykjavík City Council has approved a three-year pilot project, starting in autumn 2024, to delay school start times for teenagers, Vísir reports. The initiative is the result of two studies led by Dr Erla Björnsdóttir on teen sleep duration.

Mental well-being on the decline

Following two studies on the sleep duration of teenagers in Reykjavík City primary schools, led by Dr Erla Björnsdóttir, the city council of Reykjavík has approved a three-year pilot project to delay the start of the school day for adolescents.

Beginning in the autumn of 2024, the school day for teenagers will start no earlier than 8:50 AM. Each school will be free to choose how best to adapt to this change, having the option of beginning the day later than 8:50 AM if it suits their school’s schedule.

Read More: Mad World, on Iceland’s Mental Health Crisis

In a statement from the City of Reykjavík, it was noted that despite increased awareness of the importance of sleep, many teenagers still do not get enough. Moreover, the number of those not sleeping sufficiently is growing annually.

“At the same time as more teenagers are sleeping too little, studies show that their mental well-being is deteriorating. It is clear that there are significant connections between sleep and mental health,” the statement notes.

As noted by Vísir, a working group was established to propose the implementation and details of this delay, leading to the decision described above.

Read More: Stop All the Clocks, on the too-fast Icelandic clock

Insecticide – With a Buzz

nicotine pouches in iceland

According to data from the Directorate of Health, 34.2% of Icelanders between the ages of 18 and 69 smoked cigarettes on a daily basis in 1989. In 2022, 23 years later, that percentage had shrunk to an impressive 6.3%. This decline is not, however, so straightforward as it may appear, for the introduction of new […]

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MENTAL NOTE

Unnsteinn’s insights from half a lifetime in the music industry. It’s the last night of the Iceland Airwaves festival. There have been some good shows and a few bad ones. I’ve stopped trying to adhere to my thoroughly-researched festival plan in favour of a more vibe-based approach. What sounds like fun?As a more-interesting-than-expected act wraps […]

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More Support for Children’s Mental Health Services

In a recent government announcement, an agreement has been reached to increase mental health services for children.

Ásmundur Einar Daðason, Minister of Education and Children’s Affairs, has signed an agreement with SÁÁ, an Icelandic organisation that offers treatment and counselling for individuals suffering from addiction.

The agreement is intended to increase support for SÁÁ’s services for children after the difficulties posed in the last years by the COVID-19 pandemic, including increasing services and reducing wait times for children who live with relatives suffering from addiction.

The agreement is one point in the measures taken by the government to increase government support for children and their families, consistent with laws on integrated services for children’s wellbeing.

Regarding the new agreement, Minister Ásmundur Einar Daðason stated: “To promote children’s success, it is not enough to focus only on them, but also the environment in which children grow up. The problems of relatives can become the problem of children in one way or another if the children and their families are not considered in a wider context with effective and early support.”

Projects to be supported in the agreement include an additional psychologist for children with parents served by SÁÁ, parents admitted to care facilities or receiving outpatient services will receive more information on children’s psychological services, and children’s psychological services are now set to begin at the same time as the parents’ alcohol and drug treatment.

Read more about mental health and Icelandic youth here.

Mad World

“Exceptionally rudimentary software” On Friday, November 11, I attended an appointment with a psychologist in Reykjavík. For weeks leading up to the appointment, my wife had encouraged me to “see someone,” for my moods were vacillating, my fuse was growing increasingly shorter, and I was prone to habitual crashes. I didn’t, she observed, seem “all that […]

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Evidence to Support Allegations of Pervasive Abuse in Long-Term Mental Health Wards

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.

Long Wait Times for Mental Health Services: Report

Landspítali national hospital

The demand and need for mental health services has been growing in Iceland each year. The wait times for services are too long and not in line with government aims, a new report from the Icelandic National Audit Office indicates. According to the report, mental health services need to be better coordinated so that fewer people fall through the cracks in the system.

“Gray areas where individuals end up between services and do not receive the appropriate services need to be eliminated,” the report states. “Many of these areas are well known, but attempts to eliminate them have not been successful.”

Staffing is a challenge

One of the challenges the report pointed out was a need to ensure a sufficient supply of qualified staff in mental health services, an issue that must be addressed by examining wages, working conditions, and housing issues. Ensuring study programs and residencies is also key in counteracting the shortage within specific mental health professions, according to the report.

Equalising access is important

When it comes to ensuring people have equal and timely access to mental health services, improvements are needed. The report’s authors suggest such issues could be addressed by concluding agreements with self-employed psychiatrists and psychologists and by ensuring services are available in languages other than Icelandic.

The National Audit Office also points out that many mental health teams currently operating within the public healthcare system only have temporary funding. Permanent funding would ensure they could continue their work, while ensuring a social services representative on such teams would help better coordinate health and social services.

Immigrants Rate Mental Health Lower than Native-Born Icelanders

Fiskur Útgerð Frystihús

Immigrants’ mental health is noticeably worse than natives’ in Iceland. Unemployment, financial insecurity, and loneliness are likely major factors, according to the authors of a labour market study that asked workers in Iceland to rate their mental health. The authors call for targeted measures to prevent immigrants’ poor mental health from becoming a long-term problem.

The study was conducted by labour market research institute Varða and Margrét Einarsdóttir was the lead author. The aim of the research was to examine the differences in self-rated mental health among workers in Iceland during COVID-19 in relation to their immigration status. “Unemployment, financial insecurity, and loneliness are all known risk factors for mental illness. It can be assumed that COVID-19 measures have hit immigrants harder than natives in relation to these factors, while at the same time affecting their mental health,” the study abstract states.

Over 22% of Locals and 34% of Immigrants Have Poor Mental Health

Respondents were asked to state their country of origin and were divided into two groups: those who were born in Iceland and those who had another country of origin. They were asked how many times in the last 14 days they had experienced nine different mental symptoms. “The results show a significant difference depending on immigration status and that mental health is noticeably worse among immigrants,” the study abstract states. More immigrants than natives stated they experienced almost all of the nine symptoms on an almost daily basis. When it came to overall mental health, 34.9% of immigrants measured as having poor mental health while 22.3% of native-born respondents did.

The abstract noted that immigrant’s financial situation was generally worse than that of native-born respondents and they face 3-4 times higher unemployment rates. The study’s authors concluded that authorities must take measures to address the issue. “Immigrants’ access to mental health services, their job security, and their earnings must be ensured.” The data was compiled from 8,461 responses.