Children of parents with mental disorders or substance abuse – a political challenge

Dear friends,
First, I will thank you for this opportunity to participate at this meeting in the "Nordic Forum" in Iceland this year. When I was invited, I quickly grasped this opportunity to present to you the engagement and interests in this important topic by the Norwegian government: Namely the (interests of) children of parents suffering from either mental disorders and/or substance abuse. We believe that these children often are not identified or seen by society or the services that have the responsibility to offer necessary help. I notice with great satisfaction that the different Nordic Non-Governmental organisations (NGOs) and other representatives participating at this Nordic Forum in Island, for many years have been strongly engaged in the interests of these children and the importance of family interventions.

I will present to you our recent efforts in Norway at a national, political level as far as these children are concerned. First, I will give a short overview of relevant efforts according to our National Health Plan (2007 - 2010). The Government has set ambitious goals for the health service in Norway. The services shall be of high quality, be available within acceptable waiting times and distances, and the provision to reach out to everyone regardless of their financial situation, social status, age, gender and ethnic background. These high ambitions have been realised largely, and Norway has a health service that has been rated by WHO as one of the best in the world. At the same time, there are deficiencies and challenges in a number of areas, which tell us there is still much that can be improved.

In the National Health Plan for Norway, the Government suggests policy measures that are intended to result in a better health service. A better health service also means facilitating the participation of patients and their relatives.

The Norwegian Government's policy platform has made strengthening the support given to children and young people with mental health problems a priority. Efforts in this respect include the National Programme for Mental Health (1999-2008) and the strategic plan for children and young people's mental health (2003). The strategic plan, which include 100 measures have largely been implemented already, is being continued by the current Government. The remaining measures will be implemented by 2008. In 2006, Norway's regional health authorities were asked to give the services for children and young people with mental health problems and young substance abusers special priority.

Children and adolescents under the age of 23 with mental disorders and young addicts are at particular priority for the Norwegian Government. Health services to these groups have traditionally been provided on an outpatient basis. Outpatient treatment is usually delivered at units attached to general hospitals. The Government will strengthen the right to health care for these groups by introducing a special waiting time guarantee. A proposal with amendments to the patients' Rights Act was presented to the Parliament this spring.

These children and adolescents will be entitled to have her or his health condition assessed within 10 days. An assessment shall be made whether health care is necessary or not. Treatment must be given according to national guidelines, but within 90 days as a maximum limit. A national guideline will ensure proper prioritization and reduction of unwanted variation in major disease groups. Children and adolescents with a serious or life threatening illness are of course entitled to immediate treatment.

So, I will return more particularly to the topic of this meeting. The Norwegian government in their political program - "The Soria Moria Declaration" - promised that these children should be ensured follow-up. We have no precise figures in Norway how many children should be of our concern. According to our estimations, approximately 130 000 families in Norway struggle with either mental problems or problems because of abuse of drugs or alcohol. No matter how precise our figures are, this indicates the need for focus and action. Furthermore, why do we have special interest in these children? Well simply because we believe that these children suffer quite a lot. These kinds of problems in a family - mental disorders and/or substance abuse - may give a strong sense of shame. Many children will thus try to hide such problems and - maybe mistakenly - stay loyal to their parents. Unfortunately our health- and social services today, do not in a systematically way, seek to identify and follow up these children.

Therefore, our aim is to see to that both public services, as well as NGOs and society prioritizes these children to a larger degree. At this point, I will like to add that in Norway we have a high level of cooperation between the private and the public sectors. I consider an organisation as Voksne for barn, which represents Norway at this meeting, as an active and important collaborating partner. Their efforts for the children we focus on, is praiseworthy.

Measures towards these children is also one of several topics focused in our Governments action plan against poverty, launched parallel to this Government’s  budget of 2007. It is also important to underline that not only my ministry, but also the Ministry of Labour and Social inclusion and the Ministry of Children and Equality engage in measures towards these children. Therefore, in Norway this is a joint venture. According to the action plan against poverty, the Government will implement several measures to ensure that these children in a more systematic way are identified and ensured follow-up when needed. It is important that our measures directly have an effect to the children concerned. In 2006, the Directorate for Health and Social Affairs presented a circular letter on better identification. Extended guidelines to the relevant public services will be presented during 2007.

As an extra effort, we will spend 15 millions Norwegian kroner (apr. 150 mill. ISK/almost, two mill. Euro) in the following way:

• 8 millions NOK primarily to NGOs (Non-governmental organisations) implementing measures directly towards these children. Organisations and other bodies are invited to apply for funds, and our Directorate will grant the contributions for Health and Social Affairs.
•   1,5 millions to strengthen information to the children, the parents and the services. In cooperation with Voksne for barn, brochures to the children, adolescents and parents concerning the effects of both mental illnesses and substance abuse - will be made available.
•  3 millions to increase the competence of employees in this field, for instance tools to identify the children and programs to strengthen the interaction between parents and children. We will also strengthen research on interventions towards pregnant substance abusers.
•   2,5 millions to a trial of long-term follow-up of children. We will base this trial on a Danish model, namely Familieambulatoriet in Copenhagen. The target group is pregnant substance abusers and their children.

Last, but not least, it is important for me to emphasize our efforts to strengthen these children's legal rights. We will prepare a draft document with proposals to amendments to the patients' Rights Act that will contribute to make sure that these children receive necessary help.

Finally, I will like to underline our strong engagement in the interests and well-being of the children, both those who actually suffer from mental disorders and/or substance abuse or those in danger of developing such problems. Exchange of experiences and knowledge between the Nordic countries is therefore, as I see it, of great value. Once again then, I will thank you for this opportunity to present the Norwegian plans and efforts in this important field.

Thank you for your attention!