The golden rule for prioritisation of treatment for substance use and mental health care – a qualitative study

Abstract

For many years there has been broad political agreement on prioritising substance use treatment and mental health care in the specialist health service. Between 2014 and 2021, the 'golden rule' applied, meaning that there should be higher relative growth in mental health care and interdisciplinary specialised substance use treatment compared to somatic healthcare services. This study aimed to investigate the understanding among Norwegian health leaders and bureaucrats of the golden rule's role in the prioritisation of resources to the field of substance use and psychiatry in the specialist health service. The study is based on a one-year ethnographic study of priority-setting in Norwegian health trusts and bureaucracy. Documents, observations of meetings and twelve qualitative in-depth interviews were analysed using a qualitative discourse method. The golden rule contributed to an increased investment in substance use treatment and mental health care in the health trusts, according to health leaders. However, the golden rule was only one of many competing and at times conflicting guidelines they had to take into account. Many factors impeded higher growth in substance use treatment and mental health care compared to somatic health care. Several participants argued that it was impossible to follow the golden rule. The inability to achieve the goal was explained by demographic trends, funding arrangements and lack of follow-up of the rule. Healthcare priorities are set in institutions that have to consider numerous political interests and social mandates. The study's findings illustrate the complexity of practical implementation of political priorities.