ICELAND by Janice Grant

In the most recent national census, Iceland had a population of 329,279, with a nearly perfect ratio of 101 men for every 100 women (World Health Organization, 2011, 1). The population is also fairly young, with 25% under age 18 and only 12% above age 60 (World Health Organization, 2011, 1). Iceland is considered the least racially diverse country in the world, with 94% of the population being a native mix of Norse and Celts, and 6% being a “population of foreign origin” (Central Intelligence Agency, 2010).

            The overall picture that I got of Iceland’s treatment of mental illness is a curious blend of progressive philosophies and stigmatized neglect. From about 1400 – 1907, the mentally ill of Iceland were managed by local authorities, which often meant they were put in poor houses and made to do hard labor in primitive working conditions (Gudmundsson, 2012, 26). There were no treatment or alternative care options for those with mental illness until Kleppur Hospital for the mentally insane was opened in 1907 – about 100-150 years behind most of Europe (Gudmundsson, 2012, 25). Kleppur Hospital is most notable for the mental health policies and practices spearheaded by staff psychiatrist and physician-in-chief Helgi Tomasson, who chose to burn all straitjackets and restraints and prohibit any use of insulin shock, drug-induced convulsions, ECT, and surgical procedures like lobotomies in the entirety of Iceland (Gudmundsson, 2012, 28).

            Like many countries, after drugs like thorazine became widely used in the 1950’s, Iceland started moving patients out of Kleppur and into community treatment centers (Gudmundsson, 2012, 28-29). Unlike many countries, today Iceland no longer has any mental hospitals in the entire country, and involuntary commitment into general hospital psychiatric wards make up only 3.6% of all admissions – and restraints are still not used (Gudmundsson, 2012, 30).

            I could find no official sources that cited hard numbers on the number of people with mental illness, but the 2011 WHO census mentions that, “neuropsychiatric disorders are estimated to contribute to 32.5% of the […] burden of disease” (World Health Organization, 2011, 1). The only statistical information provided regarding mental health treatment were given in “rates per 100,000” (World Health Organization, 2011, 4), which I used to calculate the approximate number of people treated in:

Outpatient mental health facilities: 5,489

Mental health day treatment facilities: 635

Psychiatric ward of a general hospital: 2,647

Community residential facilities: 340

(World Health Organization, 2011, 2)

            Despite these apparently forward-thinking approaches to mental illness, Iceland has no official mental health policies or dedicated legislation protecting the rights of people with mental illness (World Health Organization, 2011, 1). WHO also reports that the majority of Iceland’s primary care providers had received no official in-service mental health training in the previous five years, and most primary care clinics had no official manuals on managing and treating mental disorders to guide said providers (World Health Organization, 2011, 1). To underscore this concerning information, a recent study of attitudes toward mental illness in Iceland found that they are most often presented by the media as a tragedy – “the person who is ‘wrestling’ or ‘battling’ disability” (Bjornsdottir and Johannesson, 2009, 440), as well as highlighting their need for family and community support as a “societal burden” (Bjornsdottir and Johannesson, 2009, 440).

References

Bjornsdottir, K., & Johannesson, I.A. (2009). People with intellectual disabilities in Iceland: A Bourdieuean interpretation of self-advocacy. Intellectual and Developmental Disabilities, 47(6), 436-446.

Central Intelligence Agency. (2010). The world factbook: Iceland. Retrieved from https://www.cia.gov/library/publications/the-world-factbook/geos/ic.html

Gudmundsson, O. (2012). History of Icelandic psychiatry. Nordic Journal of Psychiatry, 66(S1), 25-30.

World Health Organization. (2011). Iceland. Retrieved from http://www.who.int/mental_health/evidence/atlas/profiles/isl_mh_profile.pdf