Edvard Hauff

Of all patients with functional psychosis from one catchment area treated in an acute ward in Oslo, eight patients (9%) committed suicide during the following 8 years, six men and two women, with an age range of 18–70 years. Four had affective psychoses, three schizophrenia, and one atypical psychosis. Five problematic issues in the treatment of these patients have been identified: 1) poor therapeutic alliance, 2) countertransference problems, 3) problems with drug compliance, 4) discrepancy between treatment ideology and patient needs, and 5) disputes between treatment units over treatment responsibility. The clinical problems are illustrated by three case stories. These patients need continuity of care, but the establishment of long-term aftercare is complicated by psychopathology, lack of therapist capacity, and controversies between units about treatment responsibility. Countertransference problems are common, and wards should develop clinical milieus that offer openness for personal reactions and available supervisors. The authors suggest that the political resolution to give priority to acute psychiatry and the ongoing sectorization, at least in the observation period (1980–88), may have affected the treatment of these patients negatively. A major problem was lack of an effective, suprasectorial administration that could settle disputes between the different units.