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Efkemann SA, Lickiewicz J, Doedens P, Lantta T, Bali P, Husum TL. A Scoping Review on Staff Attitudes towards the Use of Coercion in Mental Healthcare. Healthcare (Basel) 2024; 12:1552. [PMID: 39201112 PMCID: PMC11354183 DOI: 10.3390/healthcare12161552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 07/31/2024] [Accepted: 08/01/2024] [Indexed: 09/02/2024] Open
Abstract
Attitudes of mental health professionals towards the use of coercion are highly relevant concerning its use coercion in mental healthcare, as mental health professionals have to weigh ethical arguments and decide within a legal frame in which situations to use coercion or not. Therefore, assessment of those attitudes is relevant for research in this field. A vital instrument to measure those attitudes towards the use of coercion is the Staff Attitude to Coercion Scale. This scoping review aims to provide a structured overview of the advantages and limitations in the assessment of attitudes toward coercion. We conducted a scoping review in Medline, PsycINFO, CINAHL, and Web of Science, based on the PRISMA-ScR. Inclusion criteria were empirical studies on the attitudes of mental health professionals. We included 80 studies and systematically mapped data about the main results and limitations in assessing attitudes toward coercion. The main results highlighted the relevance and increased interest in staff attitudes towards coercion in mental healthcare. Still, the majority of the included studies relied on a variety of different concepts and definitions concerning attitudes. The data further indicated difficulties in developing new and adapting existing assessment instruments because of the equivocal definitions of underlying concepts. To improve the research and knowledge in this area, future studies should be based on solid theoretical foundations. We identified the need for methodological changes and standardized procedures that take into account existing evidence from attitude research in social psychology, nursing science, and other relevant research fields. This would include an update of the Staff Attitude to Coercion Scale based on the limitations identified in this review.
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Affiliation(s)
- Simone Agnes Efkemann
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, 44791 Bochum, Germany
| | - Jakub Lickiewicz
- Department of Health Psychology, Jagiellonian University Medical College, 31-501 Krakow, Poland
| | - Paul Doedens
- Department of Psychiatry, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
- Urban Vitality—Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, 1105 BD Amsterdam, The Netherlands
| | - Tella Lantta
- Department of Nursing Science, University of Turku, 20014 Turku, Finland;
- Centre for Forensic Behavioural Sciences, Swinburne University of Technology, Melbourne 3122, Australia
| | - Panagiota Bali
- Second Department of Psychiatry, Medical School, University General Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Chaidari, Greece
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Fossum SØ, Moen ØL, Gonzalez MT, Schröder A, Skundberg-Kletthagen H. Investigating the Associations between Patient-Reported Quality of Care and Perceived Coercion: A Norwegian Cross-Sectional Study. Issues Ment Health Nurs 2024; 45:784-793. [PMID: 38976249 DOI: 10.1080/01612840.2024.2361336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
Patient perspectives on the quality of care received are fundamental to mental health care. This study aimed to investigate the association between patient-reported mental health care quality, perceived coercion, and various demographic, clinical, and ward-related factors. Using a cross-sectional design, data were collected from 169 patients in Norwegian mental health wards using the quality in psychiatric care-inpatient (QPC-IP) instrument and experienced coercion scale (ECS). The analysis revealed a consistent pattern in which patients with higher perceived coercion consistently rated lower quality on all QPC-IP dimensions. The significant findings of the multiple regression models further supported this association. Beyond coercion, the factors influencing quality ratings include self-reported treatment results, participation in treatment planning, and knowledge of complaint procedures. Emphasizing the pivotal role of coercion in enhancing mental health care quality, these findings contribute to a nuanced understanding of patient experiences and underscore the importance of patient participation in mental health care improvement efforts.
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Affiliation(s)
- Siri Ødegaard Fossum
- Faculty of Medicine and Health, Institute of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Øyfrid Larsen Moen
- Faculty of Medicine and Health, Institute of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
| | - Marianne Thorsen Gonzalez
- Faculty of Medicine and Health, Institute of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
- Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Agneta Schröder
- Faculty of Medicine and Health, Institute of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
- Faculty of Health and Social Sciences, Institute of Nursing and Health Sciences, University of South-Eastern Norway (USN), Drammen, Norway
| | - Hege Skundberg-Kletthagen
- Faculty of Medicine and Health, Institute of Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway
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Golay P, Martinez D, Bachelard M, Silva B, Brodard A, Perrin J, Pedro Fernando N, Renaud LA, Bonsack C, Morandi S. Measurement of perceived pressures in psychiatry: paper-and-pencil and computerized adaptive version of the P-PSY35 scale. Ann Gen Psychiatry 2024; 23:18. [PMID: 38730459 PMCID: PMC11088176 DOI: 10.1186/s12991-024-00501-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/01/2024] [Indexed: 05/12/2024] Open
Abstract
PURPOSE Formal coercion in psychiatry is widely studied yet much less is known about pressures patients may experience, partly because of the very few measures available. The goal of this study was to validate the P-PSY35 (Pressures in Psychiatry Scale) and provide a paper-and-pencil and a computerised adaptive test (CAT) to measure pressures experienced by patients in psychiatry. METHODS The P-PSY35 items were developed with users. Patients were evaluated during psychiatric hospitalisation or through an online survey. Mokken scale analysis and Item response theory (IRT) were used to select and estimate the items parameters. A Monte-Carlo simulation was performed to evaluate the number of items needed to transform the paper-and-pencil test into a reliable psychometric CAT. RESULTS A total of 274 patients were assessed. The P-PSY35 demonstrated good internal validity, internal consistency, convergent and divergent validity. The P-PSY35 could be substantially shortened while maintaining excellent reliability using the CAT procedure. CONCLUSION The P-PSY35 was developed in collaboration with users. It is a psychometrically rigorous tool designed to measure experienced pressures in French-language. The development and successful validation of the P-PSY35 represent a welcome step towards implementing and evaluating programs aimed at reducing negative consequences of coercion.
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Affiliation(s)
- Philippe Golay
- Service of Community Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Consultations de Chauderon, Place Chauderon 18, 1003, Lausanne, Switzerland.
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Debora Martinez
- Service of Community Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Consultations de Chauderon, Place Chauderon 18, 1003, Lausanne, Switzerland
| | - Mizué Bachelard
- Service of Community Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Consultations de Chauderon, Place Chauderon 18, 1003, Lausanne, Switzerland
| | - Benedetta Silva
- Service of Community Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Consultations de Chauderon, Place Chauderon 18, 1003, Lausanne, Switzerland
- Cantonal Medical Office, Directorate General for Health of Canton of Vaud, Department of Health and Social Action (DSAS), Avenue Des Casernes 2, 1014, Lausanne, Switzerland
| | - Alexandra Brodard
- Service of Community Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Consultations de Chauderon, Place Chauderon 18, 1003, Lausanne, Switzerland
| | - Jonathan Perrin
- Service of Community Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Consultations de Chauderon, Place Chauderon 18, 1003, Lausanne, Switzerland
| | - Nolan Pedro Fernando
- Service of Community Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Consultations de Chauderon, Place Chauderon 18, 1003, Lausanne, Switzerland
| | - Lou-Ann Renaud
- Service of Community Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Consultations de Chauderon, Place Chauderon 18, 1003, Lausanne, Switzerland
| | - Charles Bonsack
- Service of Community Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Consultations de Chauderon, Place Chauderon 18, 1003, Lausanne, Switzerland
| | - Stéphane Morandi
- Service of Community Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Consultations de Chauderon, Place Chauderon 18, 1003, Lausanne, Switzerland
- Cantonal Medical Office, Directorate General for Health of Canton of Vaud, Department of Health and Social Action (DSAS), Avenue Des Casernes 2, 1014, Lausanne, Switzerland
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Slack SK, Barclay L. First-person disavowals of digital phenotyping and epistemic injustice in psychiatry. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2023; 26:605-614. [PMID: 37725254 PMCID: PMC10725846 DOI: 10.1007/s11019-023-10174-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/21/2023]
Abstract
Digital phenotyping will potentially enable earlier detection and prediction of mental illness by monitoring human interaction with and through digital devices. Notwithstanding its promises, it is certain that a person's digital phenotype will at times be at odds with their first-person testimony of their psychological states. In this paper, we argue that there are features of digital phenotyping in the context of psychiatry which have the potential to exacerbate the tendency to dismiss patients' testimony and treatment preferences, which can be instances of epistemic injustice. We first explain what epistemic injustice is, and why it is argued to be an extensive problem in health and disability settings. We then explain why epistemic injustice is more likely to apply with even greater force in psychiatric contexts, and especially where digital phenotyping may be involved. Finally, we offer some tentative suggestions of how epistemic injustice can be minimised in digital psychiatry.
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Affiliation(s)
- Stephanie K Slack
- Philosophy, School of Philosophical, Historical and International Studies, Monash University, Clayton, VIC, 3800, Australia.
| | - Linda Barclay
- Philosophy, School of Philosophical, Historical and International Studies, Monash University, Clayton, VIC, 3800, Australia
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Brekke E, Clausen H, Brodahl M, Landheim AS. Patients' experiences with coercive mental health treatment in Flexible Assertive Community Treatment: a qualitative study. BMC Psychiatry 2023; 23:764. [PMID: 37853402 PMCID: PMC10585822 DOI: 10.1186/s12888-023-05264-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/08/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Flexible Assertive Community Treatment (FACT) teams have been implemented in Norwegian health and social services over the last years, partly aiming to reduce coercive mental health treatment. We need knowledge about how service users experience coercion within the FACT context. The aim of this paper is to explore service user experiences of coercive mental health treatment in the context of FACT and other treatment contexts they have experienced. Are experiences of coercion different in FACT than in other treatment contexts? If this is the case, which elements of FACT lead to a different experience? METHOD Within a participatory approach, 24 qualitative interviews with service users in five different FACT teams were analyzed with thematic analysis. RESULTS Participants described negative experiences with formal and informal coercion. Three patterns of experiences with coercion in FACT were identified: FACT as clearly a change for the better, making the best of FACT, and finding that coercion is just as bad in FACT as it was before. Safety, improved quality of treatment, and increased participation were described as mechanisms that can prevent coercion. CONCLUSION Results from this study support the argument that coercion is at odds with human rights and therefore should be avoided as far as possible. Results suggest that elements of the FACT model may prevent the use of coercion by promoting safety, improved quality of treatment and increased participation.
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Affiliation(s)
- Eva Brekke
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Postbox 104, Brumunddal, 2381, Norway.
| | - Hanne Clausen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Postbox 104, Brumunddal, 2381, Norway
- Department of Research and Development, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Morten Brodahl
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Postbox 104, Brumunddal, 2381, Norway
| | - Anne S Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Postbox 104, Brumunddal, 2381, Norway
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Wullschleger A, Vandamme A, Mielau J, Heinz A, Bermpohl F, Mahler L, Montag C. Relationship between perceived coercion and perceived justification of coercive measures - secondary analysis of a randomized-controlled trial. BMC Psychiatry 2023; 23:712. [PMID: 37784077 PMCID: PMC10546675 DOI: 10.1186/s12888-023-05192-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Subjective perception of coercion has gained attention as an important outcome. However, little is known about its relation to patients' appraisal of the justification of coercive measures. The present study aims to analyze the relationship between patients' appraisal of the justification of coercive measures and their level of perceived coercion. METHODS This study presents a secondary analysis of the results of a multi-center RCT conducted to evaluate the effects of post-coercion review. Patients who experienced at least one coercive measure during their hospital stay were included in the trial. Participants' appraisal of the justification of coercive measures was categorized into patient-related and staff-related justifications. Subjective coercion was assessed using the Coercion Experience Scale (CES) and used as dependent variable in a multivariate regression model. RESULTS 97 participants who completed the CES were included in the analysis. CES scores were significantly associated with the perception of the coercive measure as justified by staff-related factors (B = 0,540, p < 0,001), as well as with higher level of negative symptoms (B = 0,265, p = 0,011), and with mechanical restraint compared to seclusion (B=-0,343, p = 0,017). CONCLUSIONS Patients' perceptions of coercive measures as justified by staff-related factors such as arbitrariness or incompetence of staff are related to higher levels of perceived coercion. Multiprofessional efforts must be made to restrict the use of coercive measures and to ensure a transparent and sustainable decision-making process, particularly with patients showing high levels of negative symptoms. Such key elements should be part of all coercion reduction programs.
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Affiliation(s)
- Alexandre Wullschleger
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany.
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Ch. Du Petit-Bel-Air 2, Thônex, 1226, Switzerland.
| | - Angelika Vandamme
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Juliane Mielau
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Lieselotte Mahler
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
- Department of Psychiatry, Clinics in the Theodor-Wenzel-Werk, Berlin, Germany
| | - Christiane Montag
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
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Shields MC, Hollander MAG, Busch AB, Kantawala Z, Rosenthal MB. Patient-centered inpatient psychiatry is associated with outcomes, ownership, and national quality measures. HEALTH AFFAIRS SCHOLAR 2023; 1:qxad017. [PMID: 38756837 PMCID: PMC10986256 DOI: 10.1093/haschl/qxad017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/24/2023] [Accepted: 05/16/2023] [Indexed: 05/18/2024]
Abstract
Following discharge from inpatient psychiatry, patients experience elevated suicide risk, unplanned readmission, and lack of outpatient follow-up visits. These negative outcomes might relate to patient-centered care (PCC) experiences while hospitalized. We surveyed 739 former patients of inpatient psychiatric settings to understand the relationship between PCC and changes in patients' trust, willingness to engage in care, and self-reported 30-day follow-up visits. We also linked PCC measures to facility-level quality measures in the Inpatient Psychiatric Facility Quality Reporting program. Relative to patients discharged from facilities in the top quartile of PCC, those discharged from facilities in the bottom quartile were more likely to experience reduced trust (predicted probability [PP] = 0.77 vs 0.46; P < .001), reduced willingness to go to the hospital voluntarily (PP = 0.99 vs 0.01; P < .001), and a lower likelihood of a 30-day follow-up (PP = 0.71 vs 0.92; P < .001). PCC was lower among patients discharged from for-profits, was positively associated with facility-level quality measures of 7- and 30-day follow-up and medication continuation, and was inversely associated with restraint use. Findings underscore the need to introduce systematic measurement and improvement of PCC in this setting.
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Affiliation(s)
- Morgan C Shields
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, United States
| | - Mara A G Hollander
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC 28223, United States
| | - Alisa B Busch
- Department of Health Care Policy, Harvard University, Harvard Medical School, Boston, MA 02115, United States
- McLean Hospital, Belmont, MA 02478, United States
| | - Zohra Kantawala
- Brown School, Washington University in St. Louis, St. Louis, MO 63130, United States
| | - Meredith B Rosenthal
- Department of Health Policy and Management, Harvard University, Harvard T. H. Chan School of Public Health, Boston, MA 02115, United States
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Loubière S, Loundou A, Auquier P, Tinland A. Psychiatric advance directives facilitated by peer workers among people with mental illness: economic evaluation of a randomized controlled trial (DAiP study). Epidemiol Psychiatr Sci 2023; 32:e27. [PMID: 37096868 PMCID: PMC10130836 DOI: 10.1017/s2045796023000197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023] Open
Abstract
AIMS We aimed to assess the cost-effectiveness of psychiatric advance directives (PAD) facilitated by peer workers (PW-PAD) in the management of patients with mental disorders in France. METHODS In a prospective multicentre randomized controlled trial, we randomly assigned adults with a Diagnostic and Statistical Manual of Mental Disorders, fifth edition diagnosis of schizophrenia, bipolar I disorder or schizoaffective disorders, who were compulsorily hospitalized in the past 12 months, to either fill out a PAD form and meet a peer worker for facilitation or receive usual care. We assessed differences in societal costs in euros (€) and quality-adjusted life-years (QALYs) over a year-long follow-up to estimate the incremental cost-effectiveness ratio of the PW-PAD strategy. We conducted multiple sensitivity analyses to assess the robustness of our results. RESULTS Among the 394 randomized participants, 196 were assigned to the PW-PAD group and 198 to the control group. Psychiatric inpatient costs were lower in the PW-PAD group than the control group (relative risk, -0.22; 95% confidence interval, [-0.33 to -0.11]; P < 0.001), and 1-year cumulative savings were obtained for the PW-PAD group (mean difference, -€4,286 [-4,711 to -4,020]). Twelve months after PW-PAD implementation, we observed improved health utilities (difference, 0.040 [0.003-0.077]; P = 0.032). Three deaths occurred. QALYs were higher in the PW-PAD group (difference, 0.045 [0.040-0.046]). In all sensitivity analyses, taking into account sampling uncertainty and unit variable variation, PW-PAD was likely to remain a cost-effective use of resources. CONCLUSION PW-PAD was strictly dominant, that is, less expensive and more effective compared with usual care for people living with mental illness.
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Affiliation(s)
- S Loubière
- Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique - Hôpitaux de Marseille, Marseille, France
- Health Service Research and Quality of Life Center (UR 3279), Aix-Marseille University, School of Medicine, Marseille, France
| | - A Loundou
- Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique - Hôpitaux de Marseille, Marseille, France
- Health Service Research and Quality of Life Center (UR 3279), Aix-Marseille University, School of Medicine, Marseille, France
| | - P Auquier
- Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Assistance Publique - Hôpitaux de Marseille, Marseille, France
- Health Service Research and Quality of Life Center (UR 3279), Aix-Marseille University, School of Medicine, Marseille, France
| | - A Tinland
- Health Service Research and Quality of Life Center (UR 3279), Aix-Marseille University, School of Medicine, Marseille, France
- Department of Psychiatry, Assistance Publique - Hôpitaux de Marseille, Marseille, France
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Gousset R, Alamowitch N, Mache C, Gourevitch R. [Failure to draw up medical certificates increase judiciary releases]. L'ENCEPHALE 2023; 49:165-173. [PMID: 35725514 DOI: 10.1016/j.encep.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/06/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES In France, a systematic control of compulsory psychiatric admissions has existed since the enactment of the law of July 5th 2011. The Court of Cassation clarified that the liberty and custody judges (JLD) cannot supersede the medical opinion described in the medical certificates. In 2015, the JLD ordered the release of 8.4 % of all compulsory psychiatric admissions. The goal was to compare the quality of medical certificates derived from judicial release based on medical grounds with non-released witnesses from the cohort of compulsory psychiatric admissions ordered in the Groupe Hospitalier Universitaire Paris Psychiatrie & Neurosciences (GHU-Paris) between November 1, 2017 and October 31, 2018. METHODS We included as cases all the medical certificates derived from judicial release based exclusively on medical grounds from the release cohort of the GHU-Paris from November 1, 2017 to October 31, 2018, concerning the systematic control 12 days after compulsory psychiatric admissions. A witness whose compulsory care had been maintained was matched according to the same judge, place and date of hearing, mode of compulsory care and site of hospitalization. Each certificate was analyzed according to a reading grid relating to the good decisions in matters of compulsory admission and medical certificates' redaction. An overall score, based on the description of the clinical and symptomatic evolution, the level of discernment, the capacity of consent and the mode of compulsory care was awarded to each certificate. RESULTS Seventeen release files were included in the comparative study. Globally, the clinical progression, psychiatric symptoms, level of consciousness and ability to consent did not differ in the two groups. The grade of quality of certificate was lower in case of withdrawal (2.92±1.08 VS 3.28±0.88, P=0.026). Psychiatric symptoms in "justifiable notice" (the last medical certificate prior to the judicial hearing) were less specified in case of withdrawal (58.8 % VS 94.1 %, P=0.015). Not describing any symptoms led to a 12.51 risk of withdrawal (95 % CI=[1.16; 135.19], P=0.038). Even with witness certificate, clinical progression was noticed in only 85.3 % of cases, in 89.3 % of psychiatric symptoms, in 68.0 % of level of consciousness and 80.0 % for the ability to consent. CONCLUSIONS Judiciary releases of compulsory psychiatric admissions exclusively based on medical grounds are not arbitrarily decided by the JLD but are based on a failure to draw up medical certificates. Doctors must comply with a careful drafting of all medical certificates: description of symptoms, clinical course, level of consciousness and ability to consent. It is necessary to be attentive to judiciary releases based on medical grounds to evaluate and improve medical practices concerning the drafting of medical certificates.
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Affiliation(s)
- R Gousset
- Ancien interne au CPOA, GHU-Paris, 1, rue Cabanis, 75014 Paris, France.
| | - N Alamowitch
- Direction des usagers et des affaires juridiques, GHU-Paris, 1, rue Cabanis, 75014 Paris, France
| | - C Mache
- Direction des usagers et des affaires juridiques, GHU-Paris, 1, rue Cabanis, 75014 Paris, France
| | - R Gourevitch
- Psychiatre, chef de service du CPOA, Centre psychiatrique d'orientation et d'Accueil, GHU-Paris, 1, rue Cabanis, 75014 Paris, France
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10
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Logan RG, McLemore MR, Julian Z, Stoll K, Malhotra N, Vedam S. Coercion and non-consent during birth and newborn care in the United States. Birth 2022; 49:749-762. [PMID: 35737547 DOI: 10.1111/birt.12641] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/19/2022] [Accepted: 03/31/2022] [Indexed: 12/01/2022]
Abstract
UNLABELLED In the United States, Black, Indigenous, and People of Color (BIPOC) experience more adverse health outcomes and report mistreatment during pregnancy and birth care. The rights to bodily autonomy and consent are core components of high-quality health care. To assess experiences of coercion and nonconsent for procedures during perinatal care among racialized service users in the United States, we analyzed data from the Giving Voice to Mothers (GVtM-US) study. METHODS In a subset analysis of the full sample of 2700, we examined survey responses for participants who described the experience of pressure or nonconsented procedures or intervention during perinatal care. We conducted multivariable logistic regression analyses by racial and ethnic identity for the outcomes: pressure to have perinatal procedures (eg, induction, epidurals, episiotomy, fetal monitoring), nonconsented procedures performed during perinatal care, pressure to have a cesarean birth, and nonconsented procedures during vaginal births. RESULTS Among participants (n = 2490), 34% self-identified as BIPOC, and 37% had a planned hospital birth. Overall, we found significant differences in pressure and nonconsented perinatal procedures by racial and ethnic identity. These inequities persisted even after controlling for contextual factors, such as birthplace, practitioner type, and prenatal care context. For example, more participants with Black racial identity experienced nonconsented procedures during perinatal care (AOR 1.89, 95% CI 1.35-2.64) and vaginal births (AOR 1.87, 95% CI 1.23-2.83) than those identifying as white. In addition, people who identified as other minoritized racial and ethnic identities reported experiencing more pressure to accept perinatal procedures (AOR 1.55, 95% CI 1.08-2.20) than those who were white. DISCUSSION There is a need to address human rights violations in perinatal care for all birthing people with particular attention to the needs of those identifying as BIPOC. By eliminating mistreatment in perinatal care, such as pressure to accept services and nonconsented procedures, we can help mitigate long-standing inequities.
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Affiliation(s)
| | - Monica R McLemore
- Department of Family Health Care Nursing, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, CA, USA
| | - Zoë Julian
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.,Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Kathrin Stoll
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nisha Malhotra
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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- The Birth Place Lab, Vancouver, BC, Canada
| | - Saraswathi Vedam
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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11
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Satisfaction and Perceived Coercion in Voluntary Hospitalisations: Impact of Past Coercive Experiences. Psychiatr Q 2022; 93:971-984. [PMID: 36279029 PMCID: PMC9674755 DOI: 10.1007/s11126-022-10005-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/01/2022] [Indexed: 11/27/2022]
Abstract
Coercion in psychiatry is associated with several detrimental effects, including in the long term. The effect of past experience of coercion on the perception of subsequent hospitalisations remains less studied. The present study aimed to assess the impact of past experience of coercion on the perception of coercion and satisfaction with subsequent voluntary hospitalisations. A total of 140 patients who were hospitalised on a voluntary basis were included. Fifty-three patients experienced coercion before this hospitalisation and 87 did not. Patients were assessed for treatment satisfaction and perceived coercion. Health status was also evaluated by both patients and carers. Past experience of coercion was the independent variable. Perceived coercion and satisfaction scores were used as different dependent variables in a series of regression models. Results suggested a long-term detrimental impact of past experience of coercion on some aspects of satisfaction and perceived coercion in subsequent voluntary hospitalisations even when controlling for self and carers-rated health status. Overall, this study suggests that special attention should be paid to patients who are voluntarily admitted to hospital but have a history of coercion, as they may still be impacted by their past coercive experiences. Ways to increase satisfaction and reduce perceived coercion of these patients are discussed.
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12
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Aluh DO, Ayilara O, Onu JU, Grigaitė U, Pedrosa B, Santos-Dias M, Cardoso G, Caldas-de-Almeida JM. Experiences and perceptions of coercive practices in mental health care among service users in Nigeria: a qualitative study. Int J Ment Health Syst 2022; 16:54. [PMID: 36424651 PMCID: PMC9694572 DOI: 10.1186/s13033-022-00565-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND People with mental health problems are more vulnerable to a broad range of coercive practices and human rights abuses. There is a global campaign to eliminate, or at the very least decrease, the use of coercion in mental health care. The use of coercion in psychiatric hospitals in developing countries is poorly documented. The primary aim of this study was to explore service users' perceptions and experiences of coercion in psychiatric hospitals in Nigeria. METHODS Four focus group discussions were carried out among 30 service users on admission in two major psychiatric hospitals in Nigeria. The audio recordings were transcribed verbatim and then analyzed thematically with the aid of MAXQDA software. RESULTS The Focus group participants included 19 males and 11 females with a mean age of 34.67 ± 9.54. Schizophrenia was the most common diagnosis (40%, n = 12) and had a secondary school education (60%, n = 18). The focus group participants perceived coercion to be a necessary evil in severe cases but anti-therapeutic to their own recovery, an extension of stigma and a vicious cycle of abuse. The experience of involuntary admission revolved mainly around deception, maltreatment, and disdain. Participants in both study sites narrated experiences of being flogged for refusing medication. Mechanical restraint with chains was a common experience for reasons including refusing medications, to prevent absconding and in other cases, punitively. The use of chains was viewed by participants as dehumanizing and excruciatingly painful. CONCLUSION The experiences of coercion by participants in this study confirm that human rights violations occur in large psychiatric hospitals and underscore the need for mental health services reform. The use of coercion in this context reflects agelong underinvestment in the mental health care system in the country and obsolete mental health legislation that does not protect the rights of people with mental health problems. The study findings highlight an urgent need to address issues of human rights violations in psychiatric hospitals in the country.
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Affiliation(s)
- Deborah Oyine Aluh
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Rua Do Instituto Bacteriológico nº5, 1150-082, Lisbon, Portugal.
- Lisbon Institute of Global Mental Health, Lisbon, Portugal.
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nsukka, Enugu State, Nigeria.
| | - Olaniyi Ayilara
- Department of Clinical Services, Federal Neuropsychiatric Hospital, Uselu, Edo State, Nigeria
| | - Justus Uchenna Onu
- Department of Mental Health, Faculty of Medicine, Nnamdi Azikiwe University, Nnewi Campus, Awka, Anambra State, Nigeria
| | - Ugnė Grigaitė
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Rua Do Instituto Bacteriológico nº5, 1150-082, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - Barbara Pedrosa
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Rua Do Instituto Bacteriológico nº5, 1150-082, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - Margarida Santos-Dias
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Rua Do Instituto Bacteriológico nº5, 1150-082, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - Graça Cardoso
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Rua Do Instituto Bacteriológico nº5, 1150-082, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - José Miguel Caldas-de-Almeida
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Rua Do Instituto Bacteriológico nº5, 1150-082, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
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13
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Husum TL, Pedersen R, Aasland O. Frequent Violations and Infringements against Users in Mental Health Care Confirmed by Both Users and Professionals - A Quantitative Study. Issues Ment Health Nurs 2022; 43:862-869. [PMID: 35452344 DOI: 10.1080/01612840.2022.2063461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The main task of mental health care services is to provide good quality of care. Despite this, users are sometimes treated badly by staff. The purpose of this study was to investigate violations and infringements towards users in mental health care services, from the perspectives of both staff and users. Data were gathered through an anonymous online questionnaire sent to staff and users in Norway. Staff were recruited in collaboration with professional organisations and users in collaboration with user-organisations.
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Affiliation(s)
- Tonje Lossius Husum
- Centre for Medical Ethics, University of Oslo, Norway.,Oslo Metropolitan University, Oslo, Norway
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14
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Aceh AR, Mudatsir M, Marthoenis M. The experience of families caring for relatives with mental disorder under physical restraint: A qualitative community-based study in Indonesia. ENFERMERIA CLINICA 2022. [DOI: 10.1016/j.enfcli.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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15
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Tinland A, Loubière S, Mougeot F, Jouet E, Pontier M, Baumstarck K, Loundou A, Franck N, Lançon C, Auquier P. Effect of Psychiatric Advance Directives Facilitated by Peer Workers on Compulsory Admission Among People With Mental Illness: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79:752-759. [PMID: 35662314 PMCID: PMC9171654 DOI: 10.1001/jamapsychiatry.2022.1627] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Reducing the use of coercion in mental health care is crucial from a human rights and public health perspective. Psychiatric advance directives (PADs) are promising tools that may reduce compulsory admissions. Assessments of PADs have included facilitation by health care agents but not facilitation by peer workers. OBJECTIVE To determine the efficacy of PADs facilitated by peer workers (PW-PAD) in people with mental disorders. DESIGN, SETTING, AND PARTICIPANTS A multicenter randomized clinical trial was conducted in 7 French mental health facilities. Adults with a DSM-5 diagnosis of schizophrenia, bipolar I disorder, or schizoaffective disorder who had a compulsory admission in the past 12 months and the capacity to consent were enrolled between January 2019 and June 2020 and followed up for 12 months. INTERVENTIONS The PW-PAD group was invited to fill out a PAD form and meet a peer worker who was trained to assist in completing and sharing the form with relatives and psychiatrists. MAIN OUTCOMES AND MEASURES The primary outcome was the rate of compulsory admission at 12 months after randomization. The overall psychiatric admission rate, therapeutic alliance, quality of life, mental health symptoms, empowerment, and recovery outcomes were also investigated. RESULTS Among 394 allocated participants (median age, 39 years; 39.3% female; 45% with schizophrenia, 36% bipolar I disorder, and 19% schizoaffective disorder), 196 were assigned to the PW-PAD group and 198 to the control group. In the PW-PAD group, 27.0% had compulsory admissions compared with 39.9% in the control group (risk difference, -0.13; 95% CI, -0.22 to -0.04; P = .007). No significant differences were found in the rate of overall admissions, therapeutic alliance score, and quality of life. Participants in the PW-PAD group exhibited fewer symptoms (effect size, -0.20; 95% CI, -0.40 to 0.00), greater empowerment (effect size, 0.30; 95% CI, 0.10 to 0.50), and a higher recovery score (effect size, 0.44; 95% CI, 0.24 to 0.65), compared with those in the control group. CONCLUSIONS AND RELEVANCE Peer worker-facilitated PADs are effective in decreasing compulsory hospital admissions and increasing some mental health outcomes (self-perceived symptoms, empowerment, and recovery). Involving peer workers in the completion of PADs supports the current shift of mental health care from substitute decision-making to supported decision-making. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03630822.
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Affiliation(s)
- Aurélie Tinland
- CEReSS–Health Service Research and Quality of Life Center (UR 3279), Aix-Marseille University, School of Medicine–La Timone Medical Campus, Marseille, France,Department of Psychiatry, Assistance Publique–Hôpitaux de Marseille, Marseille, France
| | - Sandrine Loubière
- CEReSS–Health Service Research and Quality of Life Center (UR 3279), Aix-Marseille University, School of Medicine–La Timone Medical Campus, Marseille, France,Support Unit for Clinical Research and Economic Evaluation, Department of Clinical Research and Innovation, Assistance Publique–Hôpitaux de Marseille, Marseille, France
| | | | - Emmanuelle Jouet
- Laboratoire de recherche en Santé Mentale et Sciences Humaines et Sociales (Labo SM-SHS), GHU Paris Psychiatry Neurosciences, Paris, France
| | - Magali Pontier
- Department of Psychiatry, Assistance Publique–Hôpitaux de Marseille, Marseille, France
| | - Karine Baumstarck
- CEReSS–Health Service Research and Quality of Life Center (UR 3279), Aix-Marseille University, School of Medicine–La Timone Medical Campus, Marseille, France,Support Unit for Clinical Research and Economic Evaluation, Department of Clinical Research and Innovation, Assistance Publique–Hôpitaux de Marseille, Marseille, France
| | - Anderson Loundou
- CEReSS–Health Service Research and Quality of Life Center (UR 3279), Aix-Marseille University, School of Medicine–La Timone Medical Campus, Marseille, France,Support Unit for Clinical Research and Economic Evaluation, Department of Clinical Research and Innovation, Assistance Publique–Hôpitaux de Marseille, Marseille, France
| | - Nicolas Franck
- Resource Center of Psychosocial Rehabilitation, Centre Hospitalier Le Vinatier, Lyon, France,UMR 5229, Université de Lyon and CNRS, Villeurbanne, France
| | - Christophe Lançon
- CEReSS–Health Service Research and Quality of Life Center (UR 3279), Aix-Marseille University, School of Medicine–La Timone Medical Campus, Marseille, France,Department of Psychiatry, Assistance Publique–Hôpitaux de Marseille, Marseille, France
| | - Pascal Auquier
- CEReSS–Health Service Research and Quality of Life Center (UR 3279), Aix-Marseille University, School of Medicine–La Timone Medical Campus, Marseille, France,Support Unit for Clinical Research and Economic Evaluation, Department of Clinical Research and Innovation, Assistance Publique–Hôpitaux de Marseille, Marseille, France
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16
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Efkemann SA, Scholten M, Bottlender R, Juckel G, Gather J. Influence of mental health professionals' attitudes and personality traits on decision-making around coercion: Results from an experimental quantitative survey using case vignettes. Acta Psychiatr Scand 2022; 146:151-164. [PMID: 35322402 DOI: 10.1111/acps.13429] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/28/2022] [Accepted: 03/20/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Research on coercion in mental healthcare has recently shifted to the investigation of subjective aspects, both on the side of the people with mental disorders affected and the staff members involved. In this context, the role of personality traits and attitudes of staff members in decision-making around coercion is increasingly being assessed. This study aimed to examine the role of staff attitudes towards coercion and staff members' personality traits in decision-making around coercion in an experimental setting. METHODS We assessed the attitudes towards coercion and (general) personality traits of mental health professionals in psychiatric hospitals with a quantitative survey. Furthermore, we developed case vignettes representing cases in a 'grey zone' and included them in the survey to assess staff members' decisions about coercion in specific situations. RESULTS A general approving attitude towards coercion significantly influenced decisions around coercion in individual cases-resulting in a more likely approval of applying coercion in the cases described in the vignettes. Personality traits did not seem to be relevant in this regard. CONCLUSION Strategies to reduce coercion in mental healthcare institutions should focus more on the role of staff attitudes and encourage staff members to reflect on them critically.
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Affiliation(s)
- Simone Agnes Efkemann
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital Bochum, Ruhr University, Bochum, Germany
| | - Matthé Scholten
- Institute for Medical Ethics and History of Medicine, Ruhr University, Bochum, Germany
| | | | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital Bochum, Ruhr University, Bochum, Germany
| | - Jakov Gather
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital Bochum, Ruhr University, Bochum, Germany.,Institute for Medical Ethics and History of Medicine, Ruhr University, Bochum, Germany
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17
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Hammervold UE, Norvoll R, Sagvaag H. Post-incident reviews after restraints-Potential and pitfalls. Patients' experiences and considerations. J Psychiatr Ment Health Nurs 2022; 29:472-483. [PMID: 34060178 DOI: 10.1111/jpm.12776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN ABOUT THE SUBJECT?: Restraint has negative psychological, physical and relational consequences for mental health patients and care providers. Several countries have implemented seclusion and restraint (S/R) reduction programmes in which post-incident reviews (PIRs) including patients and care providers are one of several strategies. Existing knowledge indicates that PIRs have the potential to contribute to S/R prevention, but knowledge of the patients' perspectives on PIRs is scarce. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper provides in-depth knowledge about patients' experiences of being participants in PIRs after restraint events. Patients experience PIRs to result in being strengthened and developing new coping strategies. The paper reveals pitfalls when planning and conducting PIRs that make patients experience PIRs as meaningless, feel objectified or long for living communication and closeness. The patients' mental state, the quality of the relationships and the services' care philosophies, influence patients' experiences of PIRs as supporting their personal recovery processes or as continuation of coercive contexts. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Patients' vulnerability during the PIRs must be acknowledged. Trusted persons or advocacy must support the patient in the PIR and thus reduce the power-dependence imbalance. The PIR must be conducted in a supportive, non-punishing atmosphere. Patients must influence planning for the PIR concerning time point and participants and themes to be discussed. The PIR forms should be extended to support the patients' empowerment and well-being. ABSTRACT: Introduction Post-incident reviews (PIRs), including patients, nurses and other care providers, following incidents of restraints are recommended in mental health services. Few studies have examined patients' experiences and considerations concerning PIRs. Aim The study aims to explore patients' perspectives on PIRs in relation to how they experience participation in PIRs and further view PIRs' potential for care improvement and restraint prevention. Method We conducted a qualitative study based on individual interviews. Eight current and previous inpatients from two Norwegian mental health services were interviewed. Results The patients experienced PIRs as variations on a continuum from being strengthened, developing new coping strategies and processing the restraint event to at the other end of the continuum; PIRs as meaningless, feeling objectified and longing for living communication and closeness. Discussion PIRs' beneficial potential is extended in the study. The findings highlight however that personal and institutional conditions influence whether patients experience PIRs as an arena for recovery promotion or PIRs as continuation of coercive contexts. Implications for practice We recommend patients' active participation in planning the PIR. PIRs should be conducted in a supportive atmosphere, including trusted persons, emphasizing and acknowledging a dialogical approach.
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Affiliation(s)
- Unn Elisabeth Hammervold
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Reidun Norvoll
- Work Research Institute, Oslo Metropolitan University, Oslo, Norway
| | - Hildegunn Sagvaag
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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18
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Duarte Madeira L, Costa Santos J. Reconsidering the ethics of compulsive treatment in light of clinical psychiatry: A selective review of literature. F1000Res 2022; 11:219. [PMID: 36329795 PMCID: PMC9617066 DOI: 10.12688/f1000research.109555.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 11/01/2023] Open
Abstract
The ethics of compulsive treatment (CT) is a medical, social and legal discussion that reemerged after the ratification by 181 countries of the 2007 United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD). The optional protocol of the UN-CRPD was ratified by 86 countries aiming to promote, protect and ensure the full and equal enjoyment of all human rights. It also determined the need to review mental health laws as under this light treatment of persons with disabilities, particularly those with mental disorders, cannot accept the use of CT. This selective review of literature aims to clarify inputs from clinical psychiatry adding evidence to the multi-disciplinary discussion. It provides contradictory evidence on how patients experience CT and its impact on their mental health and treatment programs, also which are main reasons for the use of CT and what efforts in psychiatry have been made to reduce, replace and refine it.
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Affiliation(s)
- Luis Duarte Madeira
- Instituto de Medicina Preventiva, Faculdade de Medicina - Universidade de Lisboa, Lisboa, Lisboa, 1649-035, Portugal
- Psiquiatria, CUF Descobertas, Lisboa, 1998-018, Portugal
| | - Jorge Costa Santos
- Instituto Universitário Egas Moniz, Monte de Caparica, 2829-511, Portugal
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19
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Duarte Madeira L, Costa Santos J. Reconsidering the ethics of compulsive treatment under the light of clinical psychiatry. F1000Res 2022; 11:219. [PMID: 36329795 PMCID: PMC9617066 DOI: 10.12688/f1000research.109555.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 11/01/2023] Open
Abstract
The ethics of compulsive treatment (CT) is a medical, social and legal discussion that reemerged after the ratification by 181 countries of the 2007 United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD). The optional protocol of the UN-CRPD was ratified by 86 countries aiming to promote, protect and ensure the full and equal enjoyment of all human rights. It also determined the need to review mental health laws as under this light treatment of persons with disabilities, particularly those with mental disorders, cannot accept the use of CT. This selective review of literature aims to clarify inputs from clinical psychiatry adding evidence to the multi-disciplinary discussion. It focuses on how patients experience CT and its impact on their mental health and treatment programs, the reasons for the use of CT versus voluntary treatment and what efforts have been made to reduce, replace and refine the presence of CT in psychiatry.
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Affiliation(s)
- Luis Duarte Madeira
- Instituto de Medicina Preventiva, Faculdade de Medicina - Universidade de Lisboa, Lisboa, Lisboa, 1649-035, Portugal
- Psiquiatria, CUF Descobertas, Lisboa, 1998-018, Portugal
| | - Jorge Costa Santos
- Instituto Universitário Egas Moniz, Monte de Caparica, 2829-511, Portugal
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20
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Duarte Madeira L, Costa Santos J. Reconsidering the ethics of compulsive treatment in light of clinical psychiatry: A selective review of literature. F1000Res 2022; 11:219. [PMID: 36329795 PMCID: PMC9617066 DOI: 10.12688/f1000research.109555.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/01/2023] Open
Abstract
The ethics of compulsive treatment (CT) is a medical, social and legal discussion that reemerged after the ratification by 181 countries of the 2007 United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD). The optional protocol of the UN-CRPD was ratified by 86 countries aiming to promote, protect and ensure the full and equal enjoyment of all human rights. It also determined the need to review mental health laws as under this light treatment of persons with disabilities, particularly those with mental disorders, cannot accept the use of CT. This selective review of literature aims to clarify inputs from clinical psychiatry adding evidence to the multi-disciplinary discussion. It provides contradictory evidence on how patients experience CT and its impact on their mental health and treatment programs, also which are main reasons for the use of CT and what efforts in psychiatry have been made to reduce, replace and refine it.
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Affiliation(s)
- Luis Duarte Madeira
- Instituto de Medicina Preventiva, Faculdade de Medicina - Universidade de Lisboa, Lisboa, Lisboa, 1649-035, Portugal
- Psiquiatria, CUF Descobertas, Lisboa, 1998-018, Portugal
| | - Jorge Costa Santos
- Instituto Universitário Egas Moniz, Monte de Caparica, 2829-511, Portugal
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21
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Badu E, O'Brien AP, Mitchell R, Osei A. A Qualitative Study of Consumers' Experiences of the Quality of Mental Health Services in Ghana. Issues Ment Health Nurs 2022; 43:172-183. [PMID: 34129434 DOI: 10.1080/01612840.2021.1931584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Integrating consumers' experiences into quality mental health service assessment is relevant to improve service outcomes. Despite this, limited studies have attempted to explore consumers' experiences, particularly in developing countries, such as Ghana. This paper aims to explore consumers' subjective experiences of the quality of mental health services. A qualitative method involving in-depth interviews was used to collect data from 21 consumers of mental health services. Thematic analysis was used to analyse the data, which is discussed using a realistic evaluation approach. The study identifies four themes, 33 inductive codes and 594 references. The themes used to interpret the verbatim narratives are the available mental health services, therapeutic interaction with the professionals, competency and skills of the professionals, and the changes experienced in the consumers' lives. The study indicates that the mental health services aim to provide a range of treatments and medications as well as recovery-oriented services, using mechanisms such as ensuring an effective therapeutic relationship and improving technical competency and skills. The contextual factors and the mechanisms have helped to achieve some changes in the lives of consumers (increased satisfaction, reduced symptoms, improved functionality, feeling normal, improved living skills and self-care, work and capabilities, and social inclusion). The study concludes that policymakers and clinicians should integrate evidence-based recovery services, principles and values into the existing mental health services. The mechanisms used to promote quality of mental health services should be strengthened, through periodic monitoring and evaluation, using approaches such as sensor data capturing, to ensure good coordination and continuity.
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Affiliation(s)
- Eric Badu
- School of Nursing and Midwifery, Faculty Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Anthony Paul O'Brien
- School Nursing and Midwifery, Faculty Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Rebecca Mitchell
- Health & Wellbeing Research Unit (HoWRU), Macquarie Business School, Macquarie University, Macquarie Park, NSW, Australia
| | - Akwasi Osei
- Ghana Mental Health Authority, Ghana Health Services, Accra, Ghana
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22
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Ting SY, Lan TH, Shen LJ, Lin CY, Lee SK, Ma WF. The Chinese Mandarin Version of the Crisis Triage Rating Scale for Taiwanese with Mental Illness to Compulsory Hospitalization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413392. [PMID: 34949001 PMCID: PMC8707910 DOI: 10.3390/ijerph182413392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022]
Abstract
Background: A controversial issue of the need to protect human rights and ensure public safety still remains a conflict in Taiwan. The purpose of this study was to translate the Crisis Triage Rating Scale to Chinese Mandarin (CMCTRS). Method: A cross-sectional design with convenient sampling was employed in this study. The CMCTRS was tested on 302 Taiwanese individuals with mental illness who were admitted to the emergency room (ER) of a psychiatric center. A higher score indicated a greater need for mandatory psychiatric admission. Psychiatrists rated the patients’ status according to three scale criteria and six action plans of recommendations. Results: Five specialists evaluated the content validity index to be 0.8. A total of 210 participants (69.5%) were deemed suitable for compulsory hospitalization or admission for observation in ER. The optimal cut-off score was 8, with a Youden Index of 1.46, a sensitivity of 0.748, and a specificity of 0.712 in deciding the need for hospitalization or observation. Conclusions: The CMCTRS exhibited an acceptable criterion validity with psychiatrists in a population of 302 patients at the ER of a psychiatric center. A cut-off point of 8 is recommended for determining hospitalization or a minimum 24 h stay at emergency for observation.
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Affiliation(s)
- Shuo-Yen Ting
- Department of General Psychiatry, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou 54249, Taiwan; (S.-Y.T.); (T.-H.L.); (C.-Y.L.)
- School of Nursing, Asia University, Taichung 41354, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Tsuo-Hung Lan
- Department of General Psychiatry, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou 54249, Taiwan; (S.-Y.T.); (T.-H.L.); (C.-Y.L.)
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli 35053, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Lih-Jong Shen
- Department of Mental and Oral Health, Ministry of Health and Welfare, Taipei 115204, Taiwan;
| | - Chun-Yuan Lin
- Department of General Psychiatry, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou 54249, Taiwan; (S.-Y.T.); (T.-H.L.); (C.-Y.L.)
- Department of Sport, National Changhua University of Education, Taichung 41354, Taiwan
| | - Shih-Kai Lee
- Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou 54249, Taiwan;
| | - Wei-Fen Ma
- PhD Program for Health Science and Industry, China Medical University, Taichung 406040, Taiwan
- School of Nursing, China Medical University, Taichung 406040, Taiwan
- Department of Nursing, China Medical University Hospital, Taichung 404332, Taiwan
- Correspondence: ; Tel.: +886-4-22053366-7107; Fax: +886-4-22053748
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23
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Smith P, Simpson L, Madill A. Service user experiences of a novel in-reach rehabilitation and recovery service for people with profound and enduring mental health needs. Int J Ment Health Nurs 2021; 30:1106-1116. [PMID: 33772984 DOI: 10.1111/inm.12861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2021] [Indexed: 11/28/2022]
Abstract
This article provides an organizational case study using exploratory qualitative and visual research methods. We address the research question: What are the experiences of service users who use a novel in-reach rehabilitation and recovery service for people with severe and enduring mental health needs? Fifteen purposefully sampled service users were recruited from across a Service that is novel in embedding community sectors within inpatient provision. The sample reflects approximately the demographic of the Service and comprises: 10 men, 5 women; 12 white British, 3 ethnic minority; aged 18-60 years; and across inpatient care and supported community living. Photo-elicitation was used to enrich data collection through lightly structured interviews focused on the images brought by participants. Interview transcripts were analysed using interpretative phenomenological analysis. Analysis indicates that participants oriented towards four 'meta-questions': What does mental well-being mean to you? What difficulties have you encountered? What do you appreciate about the Service? What do you need for change to occur? We also identified six themes which told the story of a journey. The journey begins with challenge and moves towards making connections with others. Here, power dynamics are often experienced and addressed in the development of a greater sense of independence. This then provides opportunities for raised awareness around possibilities of recovery and a new-found hope. Our three main conclusions are all relevant to clinical practice: service users (a) place great importance on building relationships; (b) aspire to make informed choices throughout their recovery journey; and (c) desire greater transparency regarding treatment options.
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Affiliation(s)
- Penn Smith
- School of Psychology, University of Leeds, Leeds, UK
| | - Lisa Simpson
- Community Links part of the Inspire North Group, Leeds, UK
| | - Anna Madill
- School of Psychology, University of Leeds, Leeds, UK
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24
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Kozelka EE, Jenkins JH, Carpenter-Song E. Advancing Health Equity in Digital Mental Health: Lessons From Medical Anthropology for Global Mental Health. JMIR Ment Health 2021; 8:e28555. [PMID: 34398788 PMCID: PMC8406126 DOI: 10.2196/28555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 01/26/2023] Open
Abstract
Digital health engenders the opportunity to create new effective mental health care models-from substance use recovery to suicide prevention. Anthropological methodologies offer a unique opportunity for the field of global mental health to examine and incorporate contextual mental health needs through attention to the lived experience of illness; engagement with communities; and knowledge of context, structures, and systems. Attending to these diverse mental health needs and conditions as well as the limitations of digital health will allow global mental health researchers, practitioners, and patients to collaboratively create new models for care in the service of equitable, accessible recovery.
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Affiliation(s)
| | - Janis H Jenkins
- Department of Anthropology, University of California San Diego, La Jolla, CA, United States.,Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
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25
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Dawson S, Muir-Cochrane E, Simpson A, Lawn S. Community treatment orders and care planning: How is engagement and decision-making enacted? Health Expect 2021; 24:1859-1867. [PMID: 34382300 PMCID: PMC8483198 DOI: 10.1111/hex.13329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/12/2021] [Accepted: 07/16/2021] [Indexed: 01/07/2023] Open
Abstract
Background In many jurisdictions worldwide, individuals with a mental illness may be forced to receive care and treatment in the community. In Australia, legislation states that such care should be driven by a care plan that is recovery‐focussed. Key components in the care planning process include engagement and decision‐making about a person's support needs and care options, with trust being an essential component of care planning relationships. Objective This study examines how these components were enacted during service care contacts for individuals on community treatment orders. Methods The study was located at two community mental health teams in South Australia. Ethnographic observations of care planning discussions between consumers, their carers and clinicians, and interviews with individuals from these groups, were conducted over 18 months. Carspecken's critical ethnography provided a rigorous means for examining the data to identify underlying cultural themes that were informing day‐to‐day care interactions. Results Care planning was not occurring as it was intended, with service culture and structures impeding the development of trusting relationships. Clinicians striving to work collaboratively with consumers had to navigate a service bias and culture that emphasized a hierarchy of ‘knowing’, with consumers assumed to have less knowledge than clinicians. Conclusions Services and clinicians can challenge prejudicial ethical injustice and counter this through testimonial justice and implementation of tools and approaches that support genuine shared decision‐making. Patient or Public Contribution This study included individuals with lived experience of mental illness, their carers and clinicians as participants and researchers.
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Affiliation(s)
- Suzanne Dawson
- School of Allied Health Science and Practice, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.,Mental Health Directorate, Central Adelaide Local Health Network, Adelaide, Australia
| | - Eimear Muir-Cochrane
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Alan Simpson
- Health Service and Population Research Department, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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26
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Standal K, Solbakken OA, Rugkåsa J, Martinsen AR, Halvorsen MS, Abbass A, Heiervang KS. Why Service Users Choose Medication-Free Psychiatric Treatment: A Mixed-Method Study of User Accounts. Patient Prefer Adherence 2021; 15:1647-1660. [PMID: 34326632 PMCID: PMC8315812 DOI: 10.2147/ppa.s308151] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Medication has been a central part of treatment for severe mental disorders in Western medicine since the 1950s. In 2015, Norwegian Health Authorities decided that Norwegian health regions must have treatment units devoted to medication-free mental health treatment to enhance service users' freedom of choice. The need for these units has been controversial. The aim of this study was to examine why service users choose medication-free services. This article examines what purpose these units serve in terms of the users' reasons for choosing this service, what is important for them to receive during the treatment, and what factors lay behind their concerns in terms of medication-related views and experiences. METHODS Questionnaires were answered by 46 participants and 5 participants were interviewed in a mixed-method design integrated with a concurrent triangulation strategy applying thematic analysis and descriptive statistics. RESULTS Negative effects of medications and unavailable alternatives to medication in ordinary health care were important reasons for wanting medication-free treatment. Medication use may conflict with personal values, attitudes, and beliefs. CONCLUSION This study broadens the understanding of why the demand for separate medication-free units has arisen. The findings may contribute to making medication-free treatment an option in mental health care in general. To this end, clinicians are advised to communicate all treatment alternatives to service users and to be mindful of the effect of power imbalances in their interactions with them.
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Affiliation(s)
- Kari Standal
- District Psychiatric Center Nedre Romerike, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | | | - Jorun Rugkåsa
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Centre for Care Research, University of South-Eastern Norway, Porsgrunn, Norway
| | - Astrid Ringen Martinsen
- District Psychiatric Center Nedre Romerike, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | | | - Allan Abbass
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kristin Sverdvik Heiervang
- Department of Research and Development, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Centre of Medical Ethics, Faculty of Medicine, University of Oslo, Oslo, Norway
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27
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Nyttingnes O, Rugkåsa J. The Introduction of Medication-Free Mental Health Services in Norway: An Analysis of the Framing and Impact of Arguments From Different Standpoints. Front Psychiatry 2021; 12:685024. [PMID: 34366919 PMCID: PMC8340297 DOI: 10.3389/fpsyt.2021.685024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/14/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Debates about coercive practices have challenged a traditional biomedical hegemony in mental health care. The perspectives of service user organizations have gained considerable ground, such as in the development of the Convention on the Rights of Persons with Disabilities. Such changes are often contested, and might in practice be a result of (implicit) negotiation between stakeholders with different discursive positions. To improve understanding of such processes, and how discursive positions may manifest and interact, we analyzed texts published over a 10 year period related to the introduction of medication-free inpatient services in Norway. Methods: We conducted qualitative analyses of 36 policy documents related to the introduction of medication-free services and 75 opinion pieces from a subsequent debate. We examined discursive practices in these texts as expressions of what is perceived as legitimate knowledge upon which to base mental health care from the standpoints of government, user organizations and representatives of the psychiatric profession. We paid particular attention to how standpoints were framed in different discourse surrounding mental health care, and how these interacted and changed during the study period (2008-2018). Results: The analysis shows how elements from the discourse promoted by service user organizations-most notably the legitimacy of personal experiences as a legitimate source of knowledge-entered the mainstream by being incorporated into public policy. Strong reactions to this shift, firmly based in biomedical discourse, endorsed evidence-based medicine as the authoritative source of knowledge to ensure quality care, although accepting patient involvement. Involuntary medication, and how best to help those with non-response to antipsychotic medication represented a point at which discursive positions seemed irreconcilable. Conclusion: The relative authorities of different sources of knowledge remain an area of contention, and especially in determining how best to help patients who do not benefit from antipsychotics. Future non-inferiority trials of medication-free services may go some way to break this discursive deadlock.
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Affiliation(s)
- Olav Nyttingnes
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- R&D Department Mental Health, Akershus University Hospital, Lørenskog, Norway
| | - Jorun Rugkåsa
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Centre for Care Research, University of South-Eastern Norway, Porsgrunn, Norway
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28
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Silva M, Antunes A, Azeredo-Lopes S, Loureiro A, Saraceno B, Caldas-de-Almeida JM, Cardoso G. Factors associated with involuntary psychiatric hospitalization in Portugal. Int J Ment Health Syst 2021; 15:37. [PMID: 33879207 PMCID: PMC8056508 DOI: 10.1186/s13033-021-00460-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/07/2021] [Indexed: 11/24/2022] Open
Abstract
Background Identifying which factors contribute to involuntary psychiatric hospitalization may support initiatives to reduce its frequency. This study examines the sociodemographic, clinical, and contextual factors associated with involuntary hospitalization of patients from five Portuguese psychiatric departments in 2002, 2007 and 2012. Methods Data from all admissions were extracted from clinical files. A Poisson generalized linear model estimated the association between the number of involuntary hospitalizations per patient in one year and sociodemographic, clinical, and contextual factors. Results An increment of involuntary hospitalizations was associated with male gender [exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 1.31; 95%CI 1.06–1.62, p < 0.05], having secondary and higher education [exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 1.45; 95%CI 1.05–2.01, p < 0.05, and exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 1.89; 95%CI 1.38–2.60, p < 0.001, respectively], a psychiatric diagnosis of psychosis [exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 2.02; 95%CI 1.59–2.59, p < 0.001], and being admitted in 2007 and in 2012 [exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 1.61; 95%CI 1.21–2.16, p < 0.01, and exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 1.73; 95%CI 1.31–2.32, p < 0.001, respectively]. A decrease in involuntary hospitalizations was associated with being married/cohabitating [exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 0.74; 95%CI 0.56–0.99, p < 0.05], having experienced a suicide attempt [exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 0.26; 95%CI 0.15–0.42, p < 0.001], and belonging to the catchment area of three of the psychiatric services evaluated [exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 0.65; 95%CI 0.49–0.86, p < 0.01, exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 0.67; 95%CI 0.49–0.90, p < 0.01, and exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 0.67; 95%CI 0.46–0.96, p < 0.05 for Hospital de Magalhães Lemos, Centro Hospitalar Psiquiátrico de Lisboa and Unidade Local de Saúde do Baixo Alentejo, respectively]. Conclusions The findings suggest that involuntary psychiatric hospitalizations in Portugal are associated with several sociodemographic, clinical, and contextual factors. This information may help identify high-risk patients and inform the development of better-targeted preventive interventions to reduce these hospitalizations.
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Affiliation(s)
- Manuela Silva
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal. .,Lisbon Institute of Global Mental Health, Lisbon, Portugal.
| | - Ana Antunes
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.,Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | | | - Adriana Loureiro
- Centre of Studies on Geography and Spatial Planning (CEGOT), Faculty of Arts and Humanities, Coimbra, Portugal
| | - Benedetto Saraceno
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.,Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - José Miguel Caldas-de-Almeida
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.,Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - Graça Cardoso
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.,Lisbon Institute of Global Mental Health, Lisbon, Portugal
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29
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Fyhn T, Øverland S, Reme SE. Predictors of employment in people with moderate to severe mental illness participating in a randomized controlled trial of Individual Placement and Support (IPS). Int J Soc Psychiatry 2021; 67:150-157. [PMID: 32666858 PMCID: PMC8191162 DOI: 10.1177/0020764020934841] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Many people with moderate to severe mental illness have a desire to obtain ordinary employment. To aid further development of health and social services for this group, the aim of this study was to examine candidate modifiable and prognostic markers of employment, and moderating effects of group allocation in a clinical trial. METHOD The sample consists of 327 patients in treatment for mental illness, randomized to Individual Placement and Support (IPS) or treatment as usual (TAU) as part of a clinical trial. Psychosocial and demographic baseline characteristics were included as predictors in log binary regression analyses with employment 18 months after inclusion as the outcome, and group allocation as the moderator (IPS or TAU). RESULTS Directive emotional support and non-directive instrumental support seemed to positively predict employment, but effects were small. Involuntary hospitalization seemed to be a strong negative predictor of employment. Group allocation did not moderate any main effects. CONCLUSION Interpretation of the findings suggest that attention should be given to certain aspects of health and social services provided to this target group, and in particular the effect of receiving appropriate types of social support. The findings are novel because social support and involuntary hospitalization do not seem to have been included in previous predictor studies. The results from this study identify new topics for research on employment outcomes for this population.
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Affiliation(s)
| | - Simon Øverland
- Norwegian Institute of Public Health, Bergen, Norway.,Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Silje E Reme
- Department of Psychology, University of Oslo, Oslo, Norway
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30
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Ethnicity and power in the mental health system: experiences of white British and black Caribbean people with psychosis. Epidemiol Psychiatr Sci 2021; 30:e12. [PMID: 33543688 PMCID: PMC8057456 DOI: 10.1017/s2045796020001043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
AIMS Persistent inequalities exist in how individuals from minority ethnic groups access mental health care. A failure to investigate how these inequalities are experienced and what they mean to people with psychosis has privileged professional narratives and hindered our understanding of how they are sustained and what could be done to reduce them. The aim of this study was to investigate the long-term experience of living with psychosis and navigating mental health services within different ethnic groups. METHOD Our approach was informed by work on narrative analysis and prioritised the meaning that mental health services held for participants. In-depth interviews with 17 black Caribbean, 15 white British and 3 non-British white people with psychosis as part of AESOP-10, a 10-year follow-up of an ethnically diverse cohort of individuals with first-episode psychosis in the UK. Thematic narrative analysis was used to examine experiences at the personal level within and then across the individual accounts. RESULTS Service users shared many defining experiences and narratives frequently returned to individuals' first contact with mental health services, first hospital admission, the experience of impatient wards, and the meaning of medication and diagnosis in their lives. We found that experiences of powerlessness punctuated the journey through mental health services and this appeared to dominate the accounts of black Caribbean, and to a lesser extent, white British participants. The findings reveal how negative expectations and experiences of mental health services are compounded over time, creating a vicious cycle of disempowerment and mistrust that manifests for many in resistance to - or at the best passive acceptance of - intervention by mental health services. High levels of need, coupled with alienation from services, contributed to negative patterns of service use among black Caribbean participants. White participants recounted substantial, though fewer, experiences of disempowerment and more instances of shared decision making that for some helped protect positive aspects of their lives. CONCLUSIONS Against a background of entrenched social and economic disempowerment, services were experienced as disempowering by many black Caribbean people, compounding and perpetuating a sense of alienation. Concerted efforts by services to more systematically target social needs and to share power through partnership working may reduce the mistrust that many with psychosis feel when entering services and in turn reduce persistent inequalities across ethnic groups.
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31
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Gemsa S, Noorthoorn EO, Lepping P, de Haan HA, Wierdsma AI, Hutschemaekers GJM. The Compulsory Care Act: Early Observations and Expectations of In- or Outpatient Involuntary Treatment. Front Psychiatry 2021; 12:770934. [PMID: 35222103 PMCID: PMC8864544 DOI: 10.3389/fpsyt.2021.770934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND On January 1, 2020, the Dutch Compulsory Care Act (WvGGZ) replaced the Special Admissions Act (BOPZ). While the old law only allowed compulsory treatment in hospitals, the new law allows it both inside and outside the hospital. Moreover, the new law prioritizes the patient's own opinion on coercive measures. By following patients' own choices, the Compulsory Care Act is hoped to lead to fewer admission days and less inpatient compulsory treatment in involuntarily admitted patients. METHODS We studied the seclusion and enforced-medication events before and after January 1, 2020, using coercive measures monitoring data in a Mental Health Trust. Trends in hours of seclusion and the number of enforced-medication events per month from 2012 to 2019 were compared with 2020. We used generalized linear models to perform time series analysis. Logistic regression analyses and generalized linear models were performed to investigate whether patient compilation determined some of the observed changes in seclusion use or enforced-medication events. RESULTS The mean number of hours of seclusion between 2012 and 2019 was 27,124 per year, decreasing from 48,542 in 2012 to 21,133 in 2019 to 3,844 h in 2020. The mean incidence of enforced-medication events between 2012 and 2019 was 167, increasing from 90 in 2012 to 361 in 2019 and then fell to 294 in 2020. In 2020, we observed 3,844 h of seclusion and 294 enforced-medication events. Near to no outpatient coercion was reported, even though it was warranted. The time series analysis showed a significant effect of the year 2020 on seclusion hours (β = -1.867; Exp(β) = 0.155, Wald = 27.22, p = 0.001), but not on enforced-medication events [β = 0.48; Exp(β) = 1.616, Wald = 2.33, p = 0.13]. DISCUSSION There was a reduction in the number of seclusion hours after the introduction of the Compulsory Care Act. The number of enforced-medication events also increased from a very low baseline, but from 2017 onwards. To see whether these findings are consistent over time, they need to be replicated in the near future. CONCLUSION We observed a significant increase in enforced-medication use and a decrease in seclusion hours. The year 2020 predicted seclusion hours, but not enforced-medication events.
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Affiliation(s)
- Stephan Gemsa
- Ggnet Mental Health Institute, Child Psychiatry Service, Warnsveld, Netherlands
| | - Eric O Noorthoorn
- Ggnet Mental Health Institute, Child Psychiatry Service, Warnsveld, Netherlands
| | - Peter Lepping
- Betsi Cadwaladr University Health Board, Wrexham, United Kingdom.,Wrexham Academic Unit, Centre for Mental Health and Society, Bangor University, Wrexham, United Kingdom.,Mysore Medical College and Research Institute, Mysuru, India
| | - Hein A de Haan
- Ggnet Mental Health Institute, Child Psychiatry Service, Warnsveld, Netherlands.,Tactus Verslavingszorg, Addiction Care and Treatment Service, Deventer, Netherlands
| | - Andre I Wierdsma
- Department of Psychiatry, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Giel J M Hutschemaekers
- Behavioral Science Institute, University of Nijmegen, Nijmegen, Netherlands.,Pro Persona Mental Health Care, Indigo Centre, Nijmegen, Netherlands
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32
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Morandi S, Silva B, Mendez Rubio M, Bonsack C, Golay P. Mental health professionals' feelings and attitudes towards coercion. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2021; 74:101665. [PMID: 33401095 DOI: 10.1016/j.ijlp.2020.101665] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Despite absence of clear evidence to assert that the use of coercion in psychiatry is practically and clinically helpful or effective, coercive measures are widely used. Current practices seem to be based on institutional cultures and decision-makers' attitudes towards coercion rather than led by recommendations issued from the scientific literature. Therefore, the main goal of our study was to describe mental health professionals' feelings and attitudes towards coercion and the professionals' characteristics associated with them. METHOD Mental health professionals working in the Department of Psychiatry of Lausanne University Hospital, Switzerland, were invited to participate to an online survey. A questionnaire explored participants' sociodemographic characteristics, professional background and current working context, and their feelings and attitudes towards coercion. Exploratory Structural Equation Modelling (ESEM) was used to determine the structure of mental health professionals' feelings and attitudes towards coercion and to estimate to which extent sociodemographic and professional characteristics could predict their underlying dimensions. RESULTS 130 mental health professionals completed the survey. Even if a large number considered coercion a violation of fundamental rights, an important percentage of them agreed that coercion was nevertheless indispensable in psychiatry and beneficial to the patients. ESEM revealed that professionals' feelings and attitudes towards coercion could be described by four main dimensions labelled "Internal pressure", "Emotional impact", "External pressure" and "Relational involvement". The personal as well as the professional proximity with people suffering from mental disorders influences professionals' feeling and attitudes towards coercion. CONCLUSIONS As voices recommend the end of coercion in psychiatry and despite the lack of scientific evidence, many mental health professionals remain convinced that it is a requisite tool beneficial to the patients. Clinical approaches that enhance shared decision making and give the opportunity to patients and professionals to share their experience and feelings towards coercion and thus alleviate stress among them should be fostered and developed.
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Affiliation(s)
- Stéphane Morandi
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland; Cantonal Medical Office, Public Health Service of Canton Vaud, Department of Health and Social Action (DSAS), Avenue des Casernes 2, 1014 Lausanne, Switzerland..
| | - Benedetta Silva
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland; Cantonal Medical Office, Public Health Service of Canton Vaud, Department of Health and Social Action (DSAS), Avenue des Casernes 2, 1014 Lausanne, Switzerland
| | - Monserrat Mendez Rubio
- Service Universitaire de Psychiatrie de l'Âge Avancé, Lausanne University Hospital and University of Lausanne, 1008 Prilly, Switzerland
| | - Charles Bonsack
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland
| | - Philippe Golay
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland
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Efkemann SA, Ueberberg B, Haußleiter IS, Hoffmann K, Juckel G. Socio-economic impact on involuntary admissions and coercive measures in psychiatric hospitals in Germany. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2020; 71:101597. [PMID: 32768099 DOI: 10.1016/j.ijlp.2020.101597] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The present study aimed to characterize involuntary psychiatric admissions and coercive measures within psychiatric hospitals regarding their temporal development and processual aspects. Moreover, the influence of socio-economic factors on involuntary admissions and coercive measures was investigated. METHODS Different data sets from the federal state of North-Rhine Westphalia (NRW) were used in this study. In addition to a survey in which n = 33 hospitals responded (40.7%), official data from the Federal Health Ministry were analysed over a decade regarding involuntary admissions and coercive measures. These data were available for all n = 54 districts, respectively, all n = 81 psychiatric hospitals in NRW. Datasets were mainly analysed comparing different socio-economic clusters. RESULTS The hospital admission rate increased significantly over time (from 1.12 to 1.34 per 1000 inhabitants) within ten years. However, whereas the admission rates differed significantly between socio-economic clusters, the amount of coercive measures used in the hospitals did not. Compared to general psychiatry and addiction medicine, geriatric psychiatry had the highest amount of involuntary admissions (12.2% under public law, 14.1% under civil law). Furthermore, most coercive measures lasted at least an hour. CONCLUSION It seems that, despite intense discussions and enhanced efforts to reduce coercion, there are still some neglected aspects, such as the need for coercive measures and their duration, particularly in the geriatric psychiatric setting. In addition, the results show that further approaches to prevent involuntary admissions are needed to address other stakeholders beyond the hospitals and further aspects of the socio-economic environment.
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Affiliation(s)
- S A Efkemann
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Germany.
| | - B Ueberberg
- LWL-Institute of Mental Health, LWL University Hospital, Ruhr University Bochum, Germany
| | - I S Haußleiter
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Germany; LWL-Institute of Mental Health, LWL University Hospital, Ruhr University Bochum, Germany
| | - K Hoffmann
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Germany; LWL-Institute of Mental Health, LWL University Hospital, Ruhr University Bochum, Germany
| | - G Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Germany; LWL-Institute of Mental Health, LWL University Hospital, Ruhr University Bochum, Germany
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Hammervold UE, Norvoll R, Vevatne K, Sagvaag H. Post-incident reviews-a gift to the Ward or just another procedure? Care providers' experiences and considerations regarding post-incident reviews after restraint in mental health services. A qualitative study. BMC Health Serv Res 2020; 20:499. [PMID: 32493391 PMCID: PMC7268524 DOI: 10.1186/s12913-020-05370-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 05/26/2020] [Indexed: 12/14/2022] Open
Abstract
Abstract Public guidelines in many western countries recommend post-incident reviews (PIRs) with patients after restraint use in mental health care. PIRs are one of several elements of seclusion and restraint reduction in internationally used programmes. PIRs may improve restraint prevention, patients’ recovery processes and care providers’ ethical mindfulness. The knowledge base on PIRs is, however, vague. This qualitative study explores professional care providers’ experiences and considerations regarding PIRs that included patients after restraint use in a Norwegian context. Methods Within a phenomenological hermeneutical framework, 19 multidisciplinary care providers were interviewed about their experiences and views regarding PIRs that included patients after restraint events. The interviews were performed over the period 2015–2016. Data analysis followed a data-driven stepwise approach in line with thematic content analysis. A group of two patient consultants in mental health services, and one patient’s next of kin, contributed with input regarding the interview guide and analysis process. Results Care providers experienced PIRs as having the potential to improve the quality of care through a) knowledge of other perspectives and solutions; b) increased ethical and professional awareness; and c) emotional and relational processing. However, the care providers considered that PIRs’ potential could be further exploited as they struggled to get hold on the patients’ voices in the encounter. The care providers considered that issue to be attributable to the patients’ conditions, the care providers’ safety and skills and the characteristics of institutional and cultural conditions. Conclusion Human care philosophies and a framework of care ethics seem to be preconditions for promoting patients’ active participation in PIRs after restraints. Patients’ voices strengthen PIRs’ potential to improve care and may also contribute to restraint prevention. To minimise the power imbalance in PIRs, patients’ vulnerability, dependency and perceived dignity must be recognised. Patients’ individual needs and preferences should be assessed and mapped when planning PIRs, particularly regarding location, time and preferred participants. Care providers must receive training to strengthen their confidence in conducting PIRs in the best possible way. Patients’ experiences with PIRs should be explored, especially if participation by trusted family members, peers or advocates may support the patients in PIRs.
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Affiliation(s)
- Unn Elisabeth Hammervold
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway.
| | - Reidun Norvoll
- Work Research Institute, Oslo Metropolitan University, Oslo, Norway
| | - Kari Vevatne
- Department of care and ethics, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Hildegunn Sagvaag
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
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Golay P, Morandi S, Silva B, Devas C, Bonsack C. Feeling coerced during psychiatric hospitalization: Impact of perceived status of admission and perceived usefulness of hospitalization. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 67:101512. [PMID: 31785727 DOI: 10.1016/j.ijlp.2019.101512] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Perceived coercion is not exclusively related to the patient's legal status at admission. Patients are not always aware of their correct status and voluntary patients often report having felt coerced. Moreover, involuntary patients commonly report that their hospitalization was justified. The first goal was to disentangle the contribution of the legal and of the perceived status of admission in predicting perceived coercion. The second goal of this study was to investigate to which extent perception of the usefulness of the hospitalization affected perceived coercion. MATERIAL AND METHODS 152 inpatients were interviewed about their knowledge of their legal status of admission, perceived need for hospitalization and subjective improvement. They completed the MacArthur's Admission Experience Survey and the Coercion Experience Scale. RESULTS 6.6% of voluntarily admitted patients and 30.4% of involuntarily admitted patients reported an erroneous status of admission. 88.2% of voluntarily admitted patients and 44.7% of involuntarily admitted patients felt that they needed hospitalization during their stay. Levels of perceived coercion at admission and during hospitalization were mostly predicted by their perceived legal status. While involuntary patients frequently perceived the need for hospitalization and reported subjective improvement after admission, their perception of coercion markedly differed from voluntary patients. CONCLUSIONS Perceived coercion was marginally related to the legal admission status, which leaves room for interventions that reduce the patients' feeling of being coerced and avoid its negative effects. If many patients revised their belief on the need for and benefits of hospitalization during their stay, their perception of coercion was left partially unchanged.
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Affiliation(s)
- Philippe Golay
- Service of Community Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Switzerland; Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Switzerland.
| | - Stéphane Morandi
- Service of Community Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Switzerland; Cantonal Medical Office, Directorate General for Health of Canton of Vaud, Department of Health and Social Action (DSAS), Avenue des Casernes 2, 1014 Lausanne, Switzerland
| | - Benedetta Silva
- Service of Community Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Switzerland; Cantonal Medical Office, Directorate General for Health of Canton of Vaud, Department of Health and Social Action (DSAS), Avenue des Casernes 2, 1014 Lausanne, Switzerland
| | - Célia Devas
- Service of Community Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Charles Bonsack
- Service of Community Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Switzerland
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Abstract
OBJECTIVE To explore the clinical implications associated with the United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD), and coercive practice. CONCLUSIONS Both human rights and clinical perspectives are necessary in the management of the mentally ill.
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Affiliation(s)
- John D Little
- Consultant Psychiatrist, Kapiti Community Mental Health Team, Paraparaumu, New Zealand
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37
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Corring D, O'Reilly R, Sommerdyk C, Russell E. The lived experience of community treatment orders (CTOs) from three perspectives: A constant comparative analysis of the results of three systematic reviews of published qualitative research. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 66:101453. [PMID: 31706379 DOI: 10.1016/j.ijlp.2019.101453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 04/10/2019] [Accepted: 05/22/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Deborah Corring
- Department of Psychiatry, Western University, London, Ontario, Canada.
| | - Richard O'Reilly
- Department of Psychiatry, Western University, London, Ontario, Canada; Parkwood Institute, St. Joseph's Health Care London, London, Ontario, Canada
| | | | - Elizabeth Russell
- Parkwood Institute, St. Joseph's Health Care London, London, Ontario, Canada
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Haram A, Jonsbu E, Hole T, Fosse R. Dialogue therapy in psychosis: A philosophical-ethical approach. NORDIC PSYCHOLOGY 2019. [DOI: 10.1080/19012276.2019.1586570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Annbjørg Haram
- Department of Psychiatry, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Egil Jonsbu
- Department of Psychiatry, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torstein Hole
- Clinic of Medicine and Rehabilitation, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Roar Fosse
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
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Singh SP. How to serve our ethnic minority communities better. Lancet Psychiatry 2019; 6:275-277. [PMID: 30846353 DOI: 10.1016/s2215-0366(19)30075-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 01/23/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Swaran P Singh
- Division of Health Sciences, Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
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Isobel S. 'In some ways it all helps but in some ways it doesn't': The complexities of service users' experiences of inpatient mental health care in Australia. Int J Ment Health Nurs 2019; 28:105-116. [PMID: 29897669 DOI: 10.1111/inm.12497] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/21/2018] [Indexed: 11/30/2022]
Abstract
Recovery-oriented mental health care requires active involvement of service users in the evaluation of care. While experience of care surveys is routinely given out upon discharge, capturing the depth and detail of service users' experiences in such a way to meaningfully improve services may require more in-depth and targeted approaches. This study aimed to gather voluntary and involuntary service users' experiences of care during hospitalization in two acute adult mental health inpatient units, through the collaborative completion of a purpose designed tool. The purpose of the study was to examine broad experiences of care and to identify the utility of proactive approaches to ongoing service evaluation. Overall, 67 participants were interviewed. Findings highlight the complexity of experiences of care including how an admission can seemingly facilitate clinical recovery while not being recovery-oriented. The findings also detail areas for improvement in the way that care is delivered and evaluated. The implications are particularly pertinent for mental health nurses to consider how, within the existing constraints of their roles, they can provide therapeutic care to all service users.
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Affiliation(s)
- Sophie Isobel
- Mental Health Research, Sydney Local Health District, Concord Centre for Mental Health, Concord, New South Wales, Australia
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41
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Perry BI, Ayadurai N, Hess E, Harmer D, Curry T, Broom R, White D. Use of a proforma to aid in reducing coercion into informal admission for acute adult psychiatric inpatients in the U.K. Leg Med (Tokyo) 2019; 36:103-109. [DOI: 10.1016/j.legalmed.2018.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/30/2018] [Accepted: 11/22/2018] [Indexed: 11/28/2022]
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Verbeke E, Vanheule S, Cauwe J, Truijens F, Froyen B. Coercion and power in psychiatry: A qualitative study with ex-patients. Soc Sci Med 2019; 223:89-96. [PMID: 30739039 DOI: 10.1016/j.socscimed.2019.01.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 12/28/2018] [Accepted: 01/20/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Coercion is a controversial issue in mental health care. Recent research highlights that coercion is a relational phenomenon, although, it remains unclear how this intersubjective context should be understood. The aim of this study is to propose an interactional model of the relational aspects of coercion that enhances theoretical understanding, based on the assumptions of patients. METHOD The research question was studied by means of interpretative phenomenological analysis. Twelve people who had psychiatric hospitalisations were interviewed in-depth, using broad open questions relating to the experience of coercion and power in psychiatry. Data were collected in 2016 and 2017 in Belgium. RESULTS Across participants' accounts we observed a specific structure. The relational quality of coercion seemed to be embedded within a process where individuals were one-sidedly approached as a 'sick patient', which led to profound segregation between staff and patients. This segregation caused a form of de-subjectivation: participants felt that important aspects of their subjectivity were neglected and they experienced professionals as de-subjectivated. They felt as if power resides within the (non-) interactions between patients and mental health workers. De-subjectivation arose and was enlarged within relations by broken contact, by silence in coercive acts, and by the necessity of patients to conform to the professionals' treatment regime. Helpful encounters that were not deemed coercive were those where patients and staff were individuated, which altered their relation. CONCLUSIONS To understand the relational quality of coercion, interventions like seclusion and house rules should also be understood within this structure of de-subjectivation. We need to tackle this dynamic if we want to reduce coercion in psychiatric care.
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Affiliation(s)
- Evi Verbeke
- Univeristy of Ghent, Department of Psychoanalysis and Clinical Consulting, Henri Dunantlaan 2, 9000, Gent, Belgium.
| | - Stijn Vanheule
- Univeristy of Ghent, Department of Psychoanalysis and Clinical Consulting, Henri Dunantlaan 2, 9000, Gent, Belgium.
| | - Joachim Cauwe
- Univeristy of Ghent, Department of Psychoanalysis and Clinical Consulting, Henri Dunantlaan 2, 9000, Gent, Belgium.
| | - Femke Truijens
- Univeristy of Ghent, Department of Psychoanalysis and Clinical Consulting, Henri Dunantlaan 2, 9000, Gent, Belgium.
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Golay P, Favrod J, Morandi S, Bonsack C. Psychometric properties of the French-language version of the Coercion Experience Scale (CES). Ann Gen Psychiatry 2019; 18:4. [PMID: 31131013 PMCID: PMC6524230 DOI: 10.1186/s12991-019-0230-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 04/29/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The Coercion Experience Scale (CES) was designed to measure the psychological impact of psychiatric coercive interventions. The French-language CES was adapted using a translation/back-translation procedure. It consists originally of 31 items and 6 subscores. AIM The goal of this study was aimed to assess the psychometric properties of the French-language CES. METHOD 146 inpatients were evaluated. Internal validity was assessed using confirmatory factor analysis. Reliability was estimated using internal consistency coefficients and a test-retest procedure. Convergent validity was estimated using correlations between the AES scores and the Coercion Ladder (CL), the MacArthur's Admission Experience Survey (AES) and the World Health Organization Quality of Life (WHOQOL-BREF) scale. Discriminatory power was evaluated by comparing the scores of patients undergoing voluntary or compulsory admission. RESULTS Although the six-factor original model of the CES showed adequate fit to the data of the French-language version, two factors were almost indistinguishable. A well-defined five-factor alternative was proposed. The CES scores showed good internal consistency. Test-retest reliability varied from good to weak among the five subscores. Correlations between CES and CL, AES and WHOQOL scores suggested good convergent validity for most scores. Two CES scores were significantly higher among patients subject to compulsory psychiatric hospital admission than among those admitted voluntarily. CONCLUSIONS Overall, the French-language version of the CES is a usable tool to study different aspects of perceived coercion.
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Affiliation(s)
- Philippe Golay
- 1Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,2General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,3Institute of Psychology, Faculty of Social and Political Science, University of Lausanne, Lausanne, Switzerland
| | - Jérôme Favrod
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Stéphane Morandi
- 1Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Charles Bonsack
- 1Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Saya A, Brugnoli C, Piazzi G, Liberato D, Di Ciaccia G, Niolu C, Siracusano A. Criteria, Procedures, and Future Prospects of Involuntary Treatment in Psychiatry Around the World: A Narrative Review. Front Psychiatry 2019; 10:271. [PMID: 31110481 PMCID: PMC6501697 DOI: 10.3389/fpsyt.2019.00271] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/10/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anna Saya
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Chiara Brugnoli
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Gioia Piazzi
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Daniela Liberato
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Gregorio Di Ciaccia
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Cinzia Niolu
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Alberto Siracusano
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,Psychiatry and Clinical Psychology Unit, Department of Neurosciences, Fondazione Policlinico Tor Vergata, Rome, Italy
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McMillan J, Lawn S, Delany-Crowe T. Trust and Community Treatment Orders. Front Psychiatry 2019; 10:349. [PMID: 31164842 PMCID: PMC6536151 DOI: 10.3389/fpsyt.2019.00349] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 05/02/2019] [Indexed: 11/13/2022] Open
Abstract
There are conflicting views about the benefits of community treatment orders (CTOs) for people with mental illness. While there is a significant literature on the coercive nature of CTOs, there is less on the impact that CTOs have upon trust. A recovery-oriented approach requires a trusting therapeutic relationship and the coercion inherent in the CTO process may make it difficult for trust to be built, nurtured, and sustained between workers and patients. Our aim was therefore to examine the role of trust within the CTO experience for mental health workers and patients on CTOs. Methods: We conducted a thematic discourse analysis of 8 in-depth interviews with people who were currently on a CTO and 10 interviews with multi-disciplinary mental health workers in Adelaide, Australia (total N = 18 interviews). The interviews were coded and analyzed with the assistance of a patient representative. The findings reveal the challenges and opportunities for trust within the coercive relationship of a CTO. Findings: We found that patients have diverse experiences of CTOs and that trust or mistrust played an import role in whether or not they found the CTO beneficial.
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Affiliation(s)
- John McMillan
- Bioethics Centre, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sharon Lawn
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, SA, Australia
| | - Toni Delany-Crowe
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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Husum TL, Legernes E, Pedersen R. "A plea for recognition" Users' experience of humiliation during mental health care. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 62:148-153. [PMID: 30616849 DOI: 10.1016/j.ijlp.2018.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Studies reveal that users of mental health care services sometimes experience humiliation during care. These experiences may influence the users' recovery process and treatment satisfaction. METHOD Thirteen informants with experience in mental health services were recruited for semi-structured interviews. Informants were recruited through collaboration with users' organisations. Modified text condensation was used for analysis of the qualitative data. RESULTS Users' experiences with humiliation in mental health care were sorted into three main themes. These are themes related to different perspectives between staff and users; themes related to violence of user autonomy; and experiences related to staff attitudes. DISCUSSION The service users in this study spoke about many different kinds of experiences with humiliation during care. It was a main finding that the feeling of not being recognized for one's own perception of the situation was experienced as a humiliation. This study is a contribution to a better understanding of the humiliation process between staff and users in mental health care services. The findings may be used to improve interaction between staff and users, improve quality of care and to prevent such experiences.
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Silva B, Golay P, Morandi S. Factors associated with involuntary hospitalisation for psychiatric patients in Switzerland: a retrospective study. BMC Psychiatry 2018; 18:401. [PMID: 30594163 PMCID: PMC6311042 DOI: 10.1186/s12888-018-1966-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the scarce evidence for patients' benefits of coercion and its well-documented negative effects, the use of compulsion is still very common around Europe, with important variations among different countries. These variations have been partially explained by the different legal frameworks, but also by several individual-related, system-related and area-related characteristics, identified as predictors of the use of coercive measures. This study aimed to compare the socio-demographic and clinical profile as well as the referral and hospitalisation process of people voluntarily and involuntarily hospitalized in order to identify which factors could be associated with the use of coercion. METHODS All psychiatric admissions occurred between the 1st January 2015 and the 31st December 2015 were included in this retrospective study (n = 5027). The whole sample was split into two subgroups accordingly to the hospitalisation legal status at admission (voluntary vs involuntary) and differences between the two groups were examined. In order to identify the factors associated with coercion, all the variables reaching a p < .01 level of significance when comparing the two groups were included as independent variables into a multivariate logistic regression model. RESULTS Globally, 62% of the admissions were voluntary and 38% were involuntary. Compared to the voluntary group, involuntary patients were significantly older, more frequently widowed and living in one specific district, and had a main diagnosis of schizophrenia (F20-F29) or organic mental disorders (F00-F09). People affected by organic mental disorders (F00-F09), with higher levels of psychotic symptoms, aggression and problems with medication adherence, were more likely to be involuntarily admitted. Moreover, living in District 1, being referred by a general practitioner, a general hospital or a psychiatric hospital and being involuntarily admitted during the previous 12 months, was associated with a higher risk of coercion. CONCLUSIONS This study identified several individual-related, as well as system-related factors associated with the use of coercion. These results allowed us to trace a clearer profile of high-risk patients and to provide several inputs that could help local authorities, professionals and researchers to develop better-targeted alternative interventions reducing the use of coercion.
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Affiliation(s)
- Benedetta Silva
- Social Psychiatry Section, Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland.
| | - Philippe Golay
- Social Psychiatry Section, Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland
| | - Stéphane Morandi
- Social Psychiatry Section, Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland
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Sondhi A, Luger L, Toleikyte L, Williams E. Patient perspectives of being detained under section 136 of the Mental Health Act: Findings from a qualitative study in London. MEDICINE, SCIENCE, AND THE LAW 2018; 58:159-167. [PMID: 29742992 DOI: 10.1177/0025802418774966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Introduction Detention under section 136(1) of the Mental Health Act 1983 allows for the police to arrest a person from a public place and remove them to a 'place of safety', typically an emergency department or mental-health unit if it is 'in the interests of that person or for the protection of other persons in immediate need of care or control'. Aims/objective: The aim of this study was to describe the views and perceptions of the process for people with lived experience of mental distress who have been detained under section 136 of the Mental Health Act 1983. Method Semi-structured interviews were conducted with a non-probability sample of people with lived experience of mental distress who have been detained under section 136 across Greater London. Interviews were transcribed and thematically analysed using grounded theory. Fifty-eight people with lived experience of mental distress detained under section 136, including four carers, participated in this study. Results Three interwoven themes were identified: (a) process or procedural issues; (b) the professional-patient relationship; and (c) the importance of a supportive therapeutic environment. Conclusion The length of time, multiple assessment points and processes juxtapose against the need for a humane physical environment and supportive therapeutic interactions from all professional agencies. It is unclear how changes proposed in the Policing and Crime Act 2017 will address these patient needs.
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Affiliation(s)
- Arun Sondhi
- 1 Therapeutic Solutions (Addictions) Ltd, UK
| | | | - Lina Toleikyte
- 3 Health Equity Unit, Health Improvement Directorate, Public Health England, UK
| | - Emma Williams
- 4 Canterbury Centre for Policing Research. Canterbury Christ Church University, UK
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Does Involuntary Admission With Bipolar Disorder Differ From Involuntary Admission With Schizophrenia and Related Disorders? A Report From the Dublin Involuntary Admission Study (DIAS). J Psychiatr Pract 2018; 24:209-216. [PMID: 30015792 DOI: 10.1097/pra.0000000000000300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND While involuntary psychiatric admission and treatment are common, little is known about what impact different diagnoses have on specific features of involuntary admission and on how involuntary status is terminated (eg, by psychiatrists or tribunals, which are independent, court-like bodies reviewing involuntary admissions). METHODS We studied 2940 admissions, 423 (14.4%) of which were involuntary, at 3 psychiatry units covering a population of 552,019 individuals in Dublin, Ireland. RESULTS Involuntary patients were more likely than voluntary patients to be male and unmarried. The median length of stay for involuntary patients was 27 days compared with 10 days for voluntary patients (P<0.001). Schizophrenia (and related disorders, including schizoaffective disorder) and bipolar disorder accounted for 58.6% and 17.3% of involuntary admissions, respectively, compared with 20.1% and 12.4% of voluntary admissions (P<0.001). Psychiatrists revoked the majority of involuntary orders for both patients with bipolar disorder (85.3%) and those with schizophrenia (and related disorders) (86.6%); in contrast, tribunals did not revoke any involuntary admission orders for patients with bipolar disorder and revoked orders for 3.8% of patients with schizophrenia (and related disorders) (P=0.034). On the basis of multivariable testing, increased age among patients with bipolar disorder was the only characteristic among those studied (sex, age, marital status, occupation, involuntary admission criteria, length of stay, method of involuntary order revocation, location) that independently distinguished involuntary patients with bipolar disorder from those with schizophrenia (and related disorders) (P=0.028). CONCLUSIONS Involuntary admission of patients with bipolar disorder is similar in most respects to that of patients with schizophrenia (and related disorders). Consequently, it is important that measures aimed at reducing the need for involuntary admission (eg, patient advance statements/advance directives) are implemented equally across all diagnostic groups associated with involuntary care.
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Golay P, Semlali I, Beuchat H, Pomini V, Silva B, Loutrel L, Thonney J, Fassasi Gallo S, Morandi S, Bonsack C. Perceived coercion in psychiatric hospital admission: validation of the French-language version of the MacArthur Admission Experience Survey. BMC Psychiatry 2017; 17:357. [PMID: 29110643 PMCID: PMC5674868 DOI: 10.1186/s12888-017-1519-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/26/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The MacArthur Admission Experience Survey (AES) is a widely used tool to evaluate the level of perceived coercion experienced at psychiatric hospital admission. The French-language AES was prepared using a translation/back-translation procedure. It consists of 16 items and 3 subscores (perceived coercion, negative pressures and voice). This study aimed to assess the psychometric properties of the French-language AES. METHODS 152 inpatients were evaluated. Reliability was estimated using internal consistency coefficients and a test-retest procedure. Internal validity was assessed using a two-parameter logistic item response model. Convergent validity was estimated using correlations between the AES scores and the Coercion Ladder (CL), the Coercion Experience Scale (CES) and the Global Assessment of Functioning (GAF) scale. Discriminatory power was evaluated by comparing the scores of patients undergoing voluntary or compulsory admission. RESULTS The French-language AES showed good internal consistency and test-retest reliability. Internal validity of the three-factor model was excellent. Correlations between AES and CL, CES and GAF scores suggested good convergent validity. AES scores were significantly higher among patients subject to compulsory psychiatric hospital admission than among those admitted voluntarily. CONCLUSIONS Overall, the French-language version of the AES demonstrated very good psychometric proprieties.
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Affiliation(s)
- Philippe Golay
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital (CHUV), Consultations de Chauderon, Place Chauderon 18, 1003, Lausanne, Switzerland. .,General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital (CHUV), Lausanne, Switzerland. .,Institute of Psychology, Faculty of Social and Political Science, University of Lausanne, Lausanne, Switzerland.
| | - Imane Semlali
- 0000 0001 2165 4204grid.9851.5Institute of Psychology, Faculty of Social and Political Science, University of Lausanne, Lausanne, Switzerland
| | - Hélène Beuchat
- 0000 0001 2165 4204grid.9851.5Institute of Psychology, Faculty of Social and Political Science, University of Lausanne, Lausanne, Switzerland
| | - Valentino Pomini
- 0000 0001 2165 4204grid.9851.5Institute of Psychology, Faculty of Social and Political Science, University of Lausanne, Lausanne, Switzerland
| | - Benedetta Silva
- 0000 0001 0423 4662grid.8515.9Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital (CHUV), Consultations de Chauderon, Place Chauderon 18, 1003 Lausanne, Switzerland
| | - Laurent Loutrel
- 0000 0001 0423 4662grid.8515.9North Vaud Psychiatric Centre, Department of Psychiatry, Lausanne University Hospital (CHUV), Yverdon, Switzerland
| | - Jacques Thonney
- 0000 0001 0423 4662grid.8515.9General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP–Lausanne), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Sylfa Fassasi Gallo
- 0000 0001 0423 4662grid.8515.9General Psychiatry Service, Treatment and Early Intervention in Psychosis Program (TIPP–Lausanne), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Stéphane Morandi
- 0000 0001 0423 4662grid.8515.9Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital (CHUV), Consultations de Chauderon, Place Chauderon 18, 1003 Lausanne, Switzerland
| | - Charles Bonsack
- 0000 0001 0423 4662grid.8515.9Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital (CHUV), Consultations de Chauderon, Place Chauderon 18, 1003 Lausanne, Switzerland
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