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Howe E. Psychotherapeutic approaches: hopefully, globally effective. Front Psychiatry 2024; 15:1322184. [PMID: 38606404 PMCID: PMC11007125 DOI: 10.3389/fpsyt.2024.1322184] [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: 10/16/2023] [Accepted: 01/23/2024] [Indexed: 04/13/2024] Open
Abstract
Many patients have lasting disorders due, for example, to excessive and chronic childhood stress. For these patients, certain psychotherapeutic approaches may be maximally effective, and this may be universally the case. This piece is intended to give providers optimal tools for reaching and helping these patients who, otherwise, may remain among those worst off. These interventions should enhance patients' trust, the quintessential precondition for enabling these patients to change. Specific interventions discussed include anticipating ambiguity and clarifying this before ambiguity occurs, therapists indicating that they will support patients' and families' wants over their own views, feeling and disclosing their emotions, validating patients' anger, laughing, going beyond usual limits, explaining why, asking before doing, discussing religion and ethics, and informing whenever this could be beneficial.
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Affiliation(s)
- Edmund Howe
- Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
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2
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Jäger M, Hotzy F, Traber R, Morandi S, Schneeberger AR, Spiess M, Ruflin R, Theodoridou A. [Cantonal Differences in The Implementation of Involuntary Admission in Switzerland]. PSYCHIATRISCHE PRAXIS 2024; 51:24-30. [PMID: 37683673 PMCID: PMC10789520 DOI: 10.1055/a-2133-4084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/30/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE To examine sociodemographic and clinical characteristics of persons hospitalized in five psychiatric hospitals from regions with different structural characteristics compared with persons hospitalized voluntarily. METHODS Descriptive analyses of routine data on approximately 57000 cases of 33000 patients treated for a primary ICD-10 psychiatric diagnosis at one of the participating hospitals from 2016 to 2019. RESULTS Admission rates, length of stay, rates of further coercive measures, sociodemographic and clinical characteristics of the affected persons differ between the different regions. CONCLUSION There are considerable regional differences between regulations and implementation of the admission procedures and the sample. Causal relationships between regional specifics and the results cannot be inferred.
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Affiliation(s)
- Matthias Jäger
- Erwachsenenpsychiatrie, Psychiatrie Baselland, Liestal,
Schweiz
| | - Florian Hotzy
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik,
Psychiatrische Universitätsklinik Zürich, Zurich,
Schweiz
| | - Rafael Traber
- Privatklinik für Psychiatrie und Psychotherapie, Clienia
Littenheid AG, Littenheid, Schweiz
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Hotzy F, Spiess M, Ruflin R, Schneeberger A, Traber R, Morandi S, Jaeger M, Theodoridou A. Association between perceived coercion and perceived level of information in involuntarily admitted patients: Results from a multicenter observational study in Switzerland. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2023; 91:101934. [PMID: 37738688 DOI: 10.1016/j.ijlp.2023.101934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/02/2023] [Accepted: 09/03/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Involuntary admissions (IA) to psychiatric hospitals are controversial because they interfere with people's autonomy. In some situations, however, they appear to be unavoidable. Interestingly, not all patients perceive the same degree of coercion during IA. The aim of this study was to assess whether the level of knowledge about one's own IA is associated with perceived coercion. METHODS This multicenter observational study was conducted on n = 224 involuntarily admitted patients. Interviews were conducted at five study centers from April 2021 to November 2021. The Macarthur Admission Experience Survey was administered to assess perceived coercion. Knowledge of involuntary admission, perceptions of information received, and attitudes towards legal aspects of involuntary admission were also assessed. RESULTS We found that higher levels of knowledge about IA were negatively associated with perceived coercion at admission. Perceived coercion did not differ between study sites. Only half of the patients felt well informed about their IA, and about a quarter found the information they received difficult to understand. DISCUSSION Legislation in Switzerland requires that patients with IA be informed about the procedure. Strategies to improve patients' understanding of the information given to them about IA might be helpful to reduce perceived coercion, which is known to be associated with negative attitudes towards psychiatry, a disturbed therapeutic relationship, avoidance of psychiatry, and the risk of further coercion.
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Affiliation(s)
- Florian Hotzy
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland.
| | | | | | | | | | - Stéphane Morandi
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Switzerland; Cantonal Medical Office, General Directorate for Health of Canton of Vaud, Department of Health and Social Action (DSAS), Lausanne, Switzerland
| | - Matthias Jaeger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland; Psychiatrie Baselland, Switzerland
| | - Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland; Psychiatrie Baselland, Switzerland
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Aluh DO, Aigbogun O, Ukoha-Kalu BO, Silva M, Grigaitė U, Pedrosa B, Santos-Dias M, Cardoso G, Caldas-de-Almeida JM. Beyond Patient Characteristics: A Narrative Review of Contextual Factors Influencing Involuntary Admissions in Mental Health Care. Healthcare (Basel) 2023; 11:1986. [PMID: 37510426 PMCID: PMC10379438 DOI: 10.3390/healthcare11141986] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/29/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Variations in the rates of involuntary admission (IA) reflect the influence of unexplained contextual variables that are typically too heterogeneous to be included in systematic reviews. This paper attempts to gather and analyze factors unrelated to the patients that have been linked to IA. The articles included in this review were selected by iteratively searching four electronic databases (PubMed, PsychINFO, EMBASE, and Web of Science). A total of 54 studies from 19 different countries and regions, including 14 European countries, the United States, Canada, China, Vietnam, and Taiwan, were selected. The factors were categorized as service-related factors, impactful events, seasonal and temporal factors, mental health legislation, staff factors, and public attitudes. The factors rarely act in isolation but rather interact and reinforce each other, causing a greater influence on IA. This paper explains how these factors present opportunities for robust and sustainable interventions to reduce IAs. The paper also identifies future directions for research, such as examining the effects of economic recessions. Enhancing global reporting standards is essential to validate future research and support further in-depth studies. The complexity of the factors influencing IA and the implicit role of society suggest that resolving it will require social change.
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Affiliation(s)
- Deborah Oyine Aluh
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nsukka 410105, Nigeria
| | - Osaro Aigbogun
- Department of Management, Marketing and Digital Business, Curtin University, Miri 98009, Malaysia
| | | | - Manuela Silva
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - Ugnė Grigaitė
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - Barbara Pedrosa
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - Margarida Santos-Dias
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
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Husum TL, Siqveland J, Ruud T, Lickiewicz J. Systematic literature review of the use of Staff Attitudes to Coercion Scale (SACS). Front Psychiatry 2023; 14:1063276. [PMID: 36824675 PMCID: PMC9941667 DOI: 10.3389/fpsyt.2023.1063276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/17/2023] [Indexed: 02/10/2023] Open
Abstract
Objective Staff's attitudes to the use of coercion may influence the number of coercive interventions employed and staff willingness to engage in professional development projects aimed at reducing the use of coercion itself. The Staff Attitude to Coercion Scale (SACS) was developed to assess the attitudes of mental healthcare staff to the use of coercion in 2008 and has been employed subsequently. This global study systematically reviews and summarizes the use of the scale in research. Methods Seven databases were searched for studies using SACS in articles published in peer reviewed journals and gray literature. In addition, researchers who have asked for permission to use the scale since its development in 2008 were contacted and asked for their possible results. Extracting of data from the papers were performed in pairs of the authors. Results Of the 82 identified publications, 26 papers with 5,838 respondents were selected for review. A review of the research questions used in the studies showed that the SACS questionnaire was mostly used in studies of interventions aimed at reducing coercion and further explain variation in the use of coercion. Conclusion SACS is, to our best of knowledge, the only questionnaire measuring staff's attitudes to the use of coercive interventions in mental health services. Its widespread use indicates that the questionnaire is perceived as feasible and useful as well as demonstrating the need for such a tool. However, further research is needed as the relationship between staff attitudes to coercion and the actual use of coercion remains unclear and needs to be further investigated. Staff attitudes to coercion may be a prerequisite for leaders and staff in mental healthcare to engage in service development and quality improvement projects.
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Affiliation(s)
- Tonje Lossius Husum
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Centre for Medical Ethics, University of Oslo, Oslo, Norway
| | - Johan Siqveland
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torleif Ruud
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jakub Lickiewicz
- Department of Health Psychology, Jagiellonian University Medical College, Kraków, Poland
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Howe EG. When, If Ever, Should Care Providers Neither Contact Families of Suicidal Patients to Gain More Information Nor Hospitalize Patients? THE JOURNAL OF CLINICAL ETHICS 2023; 34:117-122. [PMID: 37229745 DOI: 10.1086/724281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AbstractIn this piece I discuss when care providers should not contact suicidal patients' families to get collateral information from them or hospitalize patients over their objections. I suggest that when these patients are chronically suicidal, overriding these wants may be best in the short run but increase their net risk in the longer run. I also discuss in this regard how contacted families may become overprotective and how hospitalization can be traumatic. I present an alternative approach that can increase these patients' safety over the longer run and relate three practical approaches care providers may find useful: explaining their decisions to patients, monitoring their own fear, and instilling hope.
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Hustoft K, Larsen TK, Brønnick K, Joa I, Johannessen JO, Ruud T. Psychiatric patients' attitudes towards being hospitalized: a national multicentre study in Norway. BMC Psychiatry 2022; 22:726. [PMID: 36414961 PMCID: PMC9682722 DOI: 10.1186/s12888-022-04362-8] [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: 05/31/2022] [Accepted: 11/01/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The aim of the study was to explore patients' attitudes towards voluntary and involuntary hospitalization in Norway, and predictors for involuntary patients who wanted admission. METHODS A multi-centre study of consecutively admitted patients to emergency psychiatric wards over a 3 months period in 2005-06. Data included demographics, admission status (voluntary / involuntary), symptom levels, and whether the patients expressed a wish to be admitted regardless of judicial status. To analyse predictors of wanting admission (binary variable), a generalized linear mixed modelling was conducted, using random intercepts for the site, and fixed effects for all variables, with logit link-function. RESULTS The sample comprised of 3.051 patients of witch 1.232 (40.4%) were being involuntary hospitalised. As expected 96.5% of the voluntary admitted patients wanted admission, while as many as 29.7% of the involuntary patients stated that they wanted the same. The involuntary patients wanting admission were less likely to be transported by police, had less aggression, hallucinations and delusions, more depressed mood, less use of drugs, less suicidality before admission, better social functioning and were less often referred by general practitioners compared with involuntary patients who did not want admission. In a multivariate analysis, predictors for involuntary hospitalization and wanting admission were, not being transported by police, less aggression and less use of drugs. CONCLUSIONS Almost a third of the involuntary admitted patients stated that they actually wanted to be hospitalized. It thus seems to be important to thoroughly address patients' preferences, both before and after admission, regarding whether they wish to be hospitalized or not.
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Affiliation(s)
- Kjetil Hustoft
- Center of Clinical Research in Psychosis, Department of Adult Psychiatry, Stavanger University Hospital, 8100, Jan Johnsen gate 12, N-4068, Stavanger, Norway.
| | - Tor Ketil Larsen
- grid.412835.90000 0004 0627 2891Center of Clinical Research in Psychosis, Department of Adult Psychiatry, Stavanger University Hospital, 8100, Jan Johnsen gate 12, N-4068 Stavanger, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kolbjørn Brønnick
- grid.18883.3a0000 0001 2299 9255Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway ,grid.412835.90000 0004 0627 2891Centre of Age-related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Inge Joa
- grid.412835.90000 0004 0627 2891Center of Clinical Research in Psychosis, Department of Adult Psychiatry, Stavanger University Hospital, 8100, Jan Johnsen gate 12, N-4068 Stavanger, Norway ,grid.18883.3a0000 0001 2299 9255Network for Medical Sciences, Faculty of Health, University of Stavanger, 4036 Stavanger, Norway
| | - Jan Olav Johannessen
- grid.412835.90000 0004 0627 2891Center of Clinical Research in Psychosis, Department of Adult Psychiatry, Stavanger University Hospital, 8100, Jan Johnsen gate 12, N-4068 Stavanger, Norway ,grid.18883.3a0000 0001 2299 9255Network for Medical Sciences, Faculty of Health, University of Stavanger, 4036 Stavanger, Norway
| | - Torleif Ruud
- grid.411279.80000 0000 9637 455XDivision of Mental Health Services, Akershus University Hospital, Lørenskog, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Chumakov E, Petrova N, Vadivel R, Pinto da Costa M, Bhugra D, Ventriglio A. Use of Compulsory Treatment by Early-Career Psychiatrists: An International Survey. Psychiatr Serv 2021; 72:1276-1281. [PMID: 34030455 DOI: 10.1176/appi.ps.202000303] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The United Nations Convention on the Rights of Persons with Disabilities (UN CRPD) has been broadly incorporated into national frameworks for compulsory psychiatric treatment. Recently, instructions issued by the UN CRPD Committee discouraged any involuntary treatment and detention of people with mental disabilities, which has sparked clinical, legal, and ethical debates. Early-career psychiatrists (ECPs) are often at the front line of decisions to involuntarily detain psychiatric patients; here, the authors surveyed ECPs to gain insight into their experiences with compulsory psychiatric treatment in clinical practice. METHODS An anonymous, voluntary, online survey among ECPs from 43 countries was conducted between July and August 2019. RESULTS In total, 142 ECPs completed and were eligible to participate in the survey. Most of the survey respondents reported being involved in the practice of compulsory psychiatric care. More than half reported difficulties in providing compulsory psychiatric care, mostly because of the bureaucracy of legal procedures (e.g., legal correspondence with the court) and ethical issues around detention. Most respondents (96%) generally agreed with their country's legal mechanism for compulsory treatment; 43% indicated that it should remain unchanged, and 53% indicated that it should be revised. CONCLUSIONS These findings call for a broader discussion in society and among psychiatrists regarding the practice of compulsory treatment while giving due consideration to the legal, therapeutic, and ethical issues involved. The views of ECPs will be helpful in future revisions of the ethical and operational frameworks of compulsory psychiatric care.
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Affiliation(s)
- Egor Chumakov
- Department of Psychiatry and Addictions, Saint Petersburg State University (Chumakov, Petrova) and Saint Petersburg Psychiatric Hospital No. 1, Saint Petersburg, Russia (Chumakov); Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand (Vadivel); Institute of Biomedical Sciences Abel Salazar, University of Porto, and Hospital de Magalhaes Lemos, Porto, Portugal (Pinto da Costa); Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London (Pinto da Costa); Institute of Psychiatry, King's College London, London (Bhugra); Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy (Ventriglio)
| | - Nataliia Petrova
- Department of Psychiatry and Addictions, Saint Petersburg State University (Chumakov, Petrova) and Saint Petersburg Psychiatric Hospital No. 1, Saint Petersburg, Russia (Chumakov); Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand (Vadivel); Institute of Biomedical Sciences Abel Salazar, University of Porto, and Hospital de Magalhaes Lemos, Porto, Portugal (Pinto da Costa); Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London (Pinto da Costa); Institute of Psychiatry, King's College London, London (Bhugra); Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy (Ventriglio)
| | - Ramya Vadivel
- Department of Psychiatry and Addictions, Saint Petersburg State University (Chumakov, Petrova) and Saint Petersburg Psychiatric Hospital No. 1, Saint Petersburg, Russia (Chumakov); Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand (Vadivel); Institute of Biomedical Sciences Abel Salazar, University of Porto, and Hospital de Magalhaes Lemos, Porto, Portugal (Pinto da Costa); Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London (Pinto da Costa); Institute of Psychiatry, King's College London, London (Bhugra); Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy (Ventriglio)
| | - Mariana Pinto da Costa
- Department of Psychiatry and Addictions, Saint Petersburg State University (Chumakov, Petrova) and Saint Petersburg Psychiatric Hospital No. 1, Saint Petersburg, Russia (Chumakov); Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand (Vadivel); Institute of Biomedical Sciences Abel Salazar, University of Porto, and Hospital de Magalhaes Lemos, Porto, Portugal (Pinto da Costa); Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London (Pinto da Costa); Institute of Psychiatry, King's College London, London (Bhugra); Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy (Ventriglio)
| | - Dinesh Bhugra
- Department of Psychiatry and Addictions, Saint Petersburg State University (Chumakov, Petrova) and Saint Petersburg Psychiatric Hospital No. 1, Saint Petersburg, Russia (Chumakov); Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand (Vadivel); Institute of Biomedical Sciences Abel Salazar, University of Porto, and Hospital de Magalhaes Lemos, Porto, Portugal (Pinto da Costa); Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London (Pinto da Costa); Institute of Psychiatry, King's College London, London (Bhugra); Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy (Ventriglio)
| | - Antonio Ventriglio
- Department of Psychiatry and Addictions, Saint Petersburg State University (Chumakov, Petrova) and Saint Petersburg Psychiatric Hospital No. 1, Saint Petersburg, Russia (Chumakov); Waikato Hospital, Waikato District Health Board, Hamilton, New Zealand (Vadivel); Institute of Biomedical Sciences Abel Salazar, University of Porto, and Hospital de Magalhaes Lemos, Porto, Portugal (Pinto da Costa); Unit for Social and Community Psychiatry, World Health Organization Collaborating Centre for Mental Health Services Development, Queen Mary University of London, London (Pinto da Costa); Institute of Psychiatry, King's College London, London (Bhugra); Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy (Ventriglio)
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Harter TD, Sterenson EL, Borgert A, Rasmussen C. Perceptions of Medical Providers on Morality and Decision-Making Capacity in Withholding and Withdrawing Life-Sustaining Treatment and Suicide. AJOB Empir Bioeth 2021; 12:227-238. [PMID: 33719891 DOI: 10.1080/23294515.2021.1887961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study attempts to understand if medical providers beliefs about the moral permissibility of honoring patient-directed refusals of life-sustaining treatment (LST) are tied to their beliefs about the patient's decision-making capacity. The study aims to answer: 1) does concern about a patient's treatment decision-making capacity relate to beliefs about whether it is morally acceptable to honor a refusal of LST, 2) are there differences between provider types in assessments of decision-making capacity and the moral permissibility to refuse LST, and 3) do provider demographics impact beliefs about decision-making capacity and the moral permissibility to refuse LST. Methods: A mixed-methods survey using Likert assessment and vignette-based questions was administered to medical providers within a single health system in the upper Midwest (N = 714) to assess their perspectives on the moral acceptance and decision-making capacity in cases of withholding and withdrawing treatment and suicide. Results: Behavioral health providers report accepting of the moral permissibility of suicide (91.2%) more than either medical providers (77.2%) or surgeons (74.4%) (n = 283). Decision-making capacity was questioned more in the vignettes of the patients refusing life-saving surgery (36%) and voluntarily starvation (40.8%) than in the vignette of the patient requesting to deactivate a pacemaker (13%) (n = 283). Behavioral health providers were more concerned about the capacity to refuse life-saving surgery (55.9%) than medical providers (33.8%) or surgeons (23.1%) (n = 283). Conclusions: Respondents endorse the moral permissibility of persons to withhold or withdraw from treatment regardless of motive. Clinical concerns about a patient's treatment decision-making capacity do not strongly correlate to views about the moral permissibility of honoring refusals of LST. Different provider types appear to have different thresholds for when to question treatment decision-making capacity. Behavioral health providers tend to question treatment decision-making capacity to refuse LST more than non-behavioral health providers.
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Affiliation(s)
- Thomas D Harter
- Department of Bioethics and Humanities, Gundersen Health System, La Crosse, Wisconsin, USA
| | - Erin L Sterenson
- Department of Psychiatry, Allina Health System, Minneapolis, Minnesota, USA
| | - Andrew Borgert
- Department of Medical Research, Gundersen Health System, La Crosse, Wisconsin, USA
| | - Cary Rasmussen
- Department of Medical Research, Gundersen Health System, La Crosse, Wisconsin, USA
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Hotzy F, Marty S, Moetteli S, Theodoridou A, Hoff P, Jaeger M. Involuntary admission of psychiatric patients: Referring physicians' perceptions of competence. Int J Soc Psychiatry 2019; 65:580-588. [PMID: 31379244 DOI: 10.1177/0020764019866226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Involuntary admissions can be detrimental for patients. Due to legal, ethical and clinical considerations, they are also challenging for referring physicians. Nevertheless, not much is known about the subjective perceptions of those who have to decide whether to conduct an involuntary admission or not. AIMS This study aimed at answering the question whether psychiatrists' perceptions of confidence during psychiatric emergency situations and consecutive involuntary admissions differ from those of physicians without a psychiatric training. METHOD We assessed the professional background and subjective perceptions during psychiatric emergency situations in physicians who executed involuntary admissions to the University Hospital of Psychiatry Zurich. We used one-way analysis of variance (ANOVA) with Bonferroni-adjusted post hoc tests and chi-square tests to compare the responses of 43 psychiatrists with those of 64 other physicians. RESULTS Psychiatrists felt less time constraints compared with non-psychiatric residents. The latter also had more doubts on the necessity of the involuntary admission issued. Psychiatrists considered themselves significantly more experienced in handling psychiatric emergency situations and in handling the criteria for involuntary admissions than other physicians. Psychiatrists and other physicians did not differ in their satisfaction concerning course and results of psychiatric emergency situations which was overall high. About half of all participants felt pressure from third parties. CONCLUSION Psychiatric emergency situations are challenging situations not only for patients but also for the involved physicians. Physicians with a specialized training might be more confident in the handling of psychiatric emergency situations and exertion of involuntary admissions. Non-psychiatric physicians might benefit from specialized training programs.
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Affiliation(s)
- Florian Hotzy
- 1 Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Silvan Marty
- 2 University of Zurich, Zurich, Switzerland.,3 Psychiatrie Baselland, Liestal, Switzerland
| | - Sonja Moetteli
- 1 Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Anastasia Theodoridou
- 1 Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Paul Hoff
- 1 Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Matthias Jaeger
- 1 Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland.,3 Psychiatrie Baselland, Liestal, Switzerland
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