This article describes the management of an extensive case of sexual abuse in a small Norwegian community. The victims were adult men who had been exploited in childhood and adolescence by the same abuser. A demand for support was addressed to the health services when these men realised as adults that they shared this experience. The community health service and the psychiatric department decided to arrange psycho-educative meetings in the community centre. Victims, their families and local professional helpers were invited. The meetings gave general information about sexual abuse, early and late symptoms and the treatment facilities available locally. In one facility a psychiatrist and a general practitioner led a treatment group together. Five of the victims took part in this group. Fortunately, this case never reached the public press. Cooperation between specialist and community health services in managing such cases is regarded as essential.
Some studies in first-episode schizophrenia correlate shorter duration of untreated psychosis (DUP) with better prognosis, suggesting that timing of treatment may be important. A three-site prospective clinical trial in Norway and Denmark is underway to investigate the effect of the timing of treatment in first-episode psychosis. One health care sector (Rogaland, Norway) is experimental and has developed an early detection (ED) system to reduce DUP. Two other sectors (Ullevål, Norway, and Roskilde, Denmark) are comparison sectors and rely on existing detection and referral systems for first-episode cases. The study ultimately will compare early detected with usual detected patients. This paper describes the study's major independent intervention variable, i.e. a comprehensive education and detection system to change DUP in first onset psychosis.System variables and first results from the four-year inclusion period (1997-2000) are described. It includes targeted information towards the general public, health professionals and schools, and ED teams to recruit appropriate patients into treatment as soon as possible. This plus easy access to psychiatric services via ED teams systematically changed referral patterns of first-episode schizophrenia. DUP was reduced by 1.5 years (mean) from before the time the ED system was instituted (to 0.5 years). The ED strategies appear to be effective and to influence directly the community's help-seeking behaviour.
In order to study to what degree physicians responsible for primary care are satisfied with the service provided by psychiatric outpatient clinics, we selected a catchment area of 240,000 inhabitants in Rogaland county, Norway. This area is served by 154 primary care physicians and two psychiatric outpatient clinics staffed with a total of 19 psychiatrists, psychologists, social workers and nurses. 90% of the primary care doctors answered a questionnaire on their degree of satisfaction with the psychiatric outpatient unit. 63% reported needing more and better service. 60% had patients who should have been referred, but were not, and 44% indicated that, in their experience, the patients were treated by professions other than the desired ones. 60% reported that the greatest need was for evaluation of patients, and 38% wanted more long-term treatment. The physicians found refusal of referrals unacceptable without having an opportunity to discuss the case first. Waiting lists could be accepted, but preferably after advice had been given on treatment.