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Hempeler C, Potthoff S, Scholten M, Juckel G, Gather J. Strategies to promote treatment compliance: a grounded theory study with relatives of people with a serious mental health condition. BMC Psychiatry 2024; 24:490. [PMID: 38977963 PMCID: PMC11229214 DOI: 10.1186/s12888-024-05907-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/10/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Treatment pressures encompass communicative strategies that influence mental healthcare service users' decision-making to increase their compliance with recommended treatment. Persuasion, interpersonal leverage, inducements, and threats have been described as examples of treatment pressures. Research indicates that treatment pressures are exerted not only by mental healthcare professionals but also by relatives. While relatives play a crucial role in their family member's pathway to care, research on the use of treatment pressures by relatives is still scarce. Likewise, little is known about other strategies relatives may use to promote the treatment compliance of their family member with a serious mental health condition. In particular, no study to date has investigated this from the perspective of relatives of people with a serious mental health condition. AIM The aim of this study was to answer the following research questions: Which types of treatment pressures do relatives use? Which other strategies do relatives use to promote the treatment compliance of their family member with a serious mental health condition? How do treatment pressures relate to these other strategies? METHODS Eleven semi-structured interviews were conducted with relatives of people with a serious mental health condition in Germany. Participants were approached via relatives' self-help groups and flyers in a local psychiatric hospital. Inclusion criteria were having a family member with a psychiatric diagnosis and the family member having experienced formal coercion. The data were analyzed using grounded theory methodology. RESULTS Relatives use a variety of strategies to promote the treatment compliance of their family member with a serious mental health condition. These strategies can be categorized into three general approaches: influencing the decision-making of the family member; not leaving the family member with a choice; and changing the social or legal context of the decision-making process. Our results show that the strategies that relatives use to promote their family member's treatment compliance go beyond the treatment pressures thus far described in the literature. CONCLUSION This qualitative study supports and conceptually expands prior findings that treatment pressures are not only frequently used within mental healthcare services but also by relatives in the home setting. Mental healthcare professionals should acknowledge the difficulties faced and efforts undertaken by relatives in seeking treatment for their family member. At the same time, they should recognize that a service user's consent to treatment may be affected and limited by strategies to promote treatment compliance employed by relatives.
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Affiliation(s)
- Christin Hempeler
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstraße 258a, 44799, Bochum, Germany.
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, 44791, Bochum, Germany.
| | - Sarah Potthoff
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstraße 258a, 44799, Bochum, Germany
- Institute for Experimental Medicine, Department for Medical Ethics, Christian-Albrechts University Kiel, Preusserstraße 1-9, 24105, Kiel, Germany
| | - Matthé Scholten
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstraße 258a, 44799, Bochum, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, 44791, Bochum, Germany
| | - Jakov Gather
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstraße 258a, 44799, Bochum, Germany
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, 44791, Bochum, Germany
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Cameron SLA, Laletas S, Gallo Cordoba B, McLean L. Who Cares? Service Users' Opinions and Opportunities for Family Involvement in Mental Health Care. Int J Ment Health Nurs 2024. [PMID: 38973754 DOI: 10.1111/inm.13372] [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: 02/19/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 07/09/2024]
Abstract
Involving families in mental health care can provide benefits to service users, their families and clinicians. However, family involvement is neither uniform nor routine. Understanding the complexities of this involvement is critical to improving application. This study sought to increase current knowledge about service users' opinions and opportunities for family involvement in mental health care. Data were collected from a total of 10 adult participants through 10 individual semi-structured interviews of approximately 30 min each. Findings are reported in accordance with COREQ and EQUATOR guidelines. Thematic analysis identified several consistent themes: respect for service user opinions of family involvement; opportunities for family involvement; negative and positive service user opinions of family involvement. Our findings support previous appeals for routine family involvement in care but extend this charge with the assertion that as important is a customary discussion with service users to ask their opinions about this involvement. Establishing this dialogue prior to treatment commencement has the potential to alleviate or resolve service user concerns and potentially improve and/or increase how families are engaged.
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Affiliation(s)
- Sarah L A Cameron
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Clayton, Victoria, Australia
| | - Stella Laletas
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Clayton, Victoria, Australia
| | - Beatriz Gallo Cordoba
- The Centre for International Research on Education Systems, Mitchell Institute, Victoria University, Melbourne, Victoria, Australia
| | - Louise McLean
- School of Educational Psychology and Counselling, Faculty of Education, Monash University, Clayton, Victoria, Australia
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Schüttengruber G, Olsson MM, Holmberg C, Großschädl F, Hessman E, Sjöblom H, Heckemann B. Understanding ageism towards older nursing staff and service users: A systematic mapping review from the perspective of clinical leaders and healthcare managers. Geriatr Nurs 2024; 58:171-182. [PMID: 38820985 DOI: 10.1016/j.gerinurse.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 06/02/2024]
Abstract
INTRODUCTION Ageist attitudes negatively affect the quality of care for service users and the working conditions of older nursing staff. Clinical leaders' perceptions of older service users and nursing staff are unknown. AIM To map research evidence on ageist attitudes in healthcare towards service users and older nursing staff, from the leadership perspective. MATERIAL AND METHODS A systematic mapping review with database searches in March 2021 and May 2023). Nineteen articles (qualitative n = 13, quantitative n = 3, mixed methods n = 3) were analysed and mapped to the Nurse Executive Capability Framework. RESULTS Future planning, team building, and self-awareness are leadership categories requiring consideration. Guidelines and policies addressing the holistic needs of older service users and older nursing staff are lacking. CONCLUSIONS Organizational planning, team building, and self-awareness are crucial for the holistic care of older service users and for creating attractive workplaces for older nursing staff.
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Affiliation(s)
| | - Maja M Olsson
- Centre for Healthcare Transformation, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Christopher Holmberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Psychotic Disorders, Sahlgrenska University, Gothenburg, Sweden
| | | | - Eva Hessman
- Biomedical Library, Gothenburg University Library, University of Gothenburg, Gothenburg, Sweden
| | - Helen Sjöblom
- Biomedical Library, Gothenburg University Library, University of Gothenburg, Gothenburg, Sweden
| | - Birgit Heckemann
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Anaesthetics, Surgery and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
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Bartl G, Stuart R, Ahmed N, Saunders K, Loizou S, Brady G, Gray H, Grundy A, Jeynes T, Nyikavaranda P, Persaud K, Raad A, Foye U, Simpson A, Johnson S, Lloyd-Evans B. A qualitative meta-synthesis of service users' and carers' experiences of assessment and involuntary hospital admissions under mental health legislations: a five-year update. BMC Psychiatry 2024; 24:476. [PMID: 38937705 PMCID: PMC11209989 DOI: 10.1186/s12888-024-05914-w] [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] [Received: 02/29/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Compulsory admissions occur in psychiatric hospitals around the world. They result in coercive and sometimes traumatic experiences for service users and carers. Legal and service reforms in various countries are intended to reduce rates of detention and improve service user experience. We aimed to inform policy and service delivery by providing an up-to-date synthesis of qualitative evidence on service users' and carers' experiences of assessment and detention under mental health legislation, updating previous reviews in which we searched for literature published up to 2018. METHODS We searched five bibliographic databases for studies published between January 2018 and March 2023. We identified 24 additional studies reporting qualitative investigations of service users' or carers' experiences of assessment or detention under mental health legislation. A team including researchers with relevant personal experience analysed and synthesised data using a thematic synthesis approach. RESULTS Findings suggest that views on compulsory admissions and assessment varied: many reports highlighted its often negative, traumatic impacts on emotional well-being and self-worth, with fewer accounts of it as an opportunity to access help and support, accompanied by feelings of relief. Experiences of racial discrimination, inequality of access, and dissatisfaction with support before and after hospital stay were more prominent than in our previous reviews. CONCLUSIONS Increasing service user and carer involvement in treatment decisions, provision of timely information at key stages of the admission process, training of key personnel, addressing the issue of discrimination, and investing in community alternatives of inpatient care may contribute to and lead to better overall treatment experiences. PROTOCOL REGISTRATION The study protocol has been registered in the PROSPERO database on 30th May 2023 (CRD42023423439).
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Affiliation(s)
- Gergely Bartl
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Ruth Stuart
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Nafiso Ahmed
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Katherine Saunders
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Sofia Loizou
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Grainne Brady
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Hannah Gray
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Andrew Grundy
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
- Lived Experience Working Group, University College London, London, UK
| | - Tamar Jeynes
- Lived Experience Working Group, University College London, London, UK
| | - Patrick Nyikavaranda
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
- Lived Experience Working Group, University College London, London, UK
| | - Karen Persaud
- Lived Experience Working Group, University College London, London, UK
| | - Ari Raad
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Una Foye
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Alan Simpson
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Sonia Johnson
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
- Camden and Islington National Health Service Foundation Trust, London, UK
| | - Brynmor Lloyd-Evans
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK.
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Aragonés-Calleja M, Sánchez-Martínez V. Evidence synthesis on coercion in mental health: An umbrella review. Int J Ment Health Nurs 2024; 33:259-280. [PMID: 37908175 DOI: 10.1111/inm.13248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 10/10/2023] [Accepted: 10/15/2023] [Indexed: 11/02/2023]
Abstract
Coercion in mental healthcare is ubiquitous and affects the physical health, recovery and psychological and emotional well-being of those who experience it. Numerous studies have explored different issues related to coercion, and the present umbrella review aims to gather, evaluate and synthesise the evidence found across systematic reviews. The protocol, registered in the International Prospective Register of Systematic Reviews (PROSPERO registration number: CRD42020196713), included 46 systematic reviews and meta-analyses of primary studies whose main theme was coercion and which were obtained from databases (Medline/PubMed, PsycINFO, EMBASE and CINAHL) and repositories of systematic reviews following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. All the reviews were subjected to independent assessment of quality and risk of bias and were grouped in two categories: (1) evidence on specific coercive measures (including Community Treatment Orders, forced treatment, involuntary admissions, seclusion and restriction and informal coercion), taking into account their prevalence, related factors, effectiveness, harmful effects and alternatives to reduce their use; and (2) experiences, perceptions and attitudes concerning coercion of professionals, mental health service users and their caregivers or relatives. This umbrella review can be useful to professionals and users in addressing the wide variety of aspects encompassed by coercion and the implications for professionals' daily clinical practice in mental health units. This research received funding from two competitive calls.
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Affiliation(s)
- Miriam Aragonés-Calleja
- Mental Health Department, Hospital Padre Jofre, Valencia, Spain
- Department of Nursing, Faculty of Nursing and Chiropody, University of Valencia, Valencia, Spain
| | - Vanessa Sánchez-Martínez
- Department of Nursing, Faculty of Nursing and Chiropody, University of Valencia, Valencia, Spain
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Oute J, McPherson S. Conflict and antagonism within global psychiatry: A discourse analysis of organisational responses to the UN reports on rights-based approaches in mental health. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:473-494. [PMID: 37796528 DOI: 10.1111/1467-9566.13717] [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: 07/16/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
Between 2017 and 2020, the UN Special Rapporteur (SR) Dainius Puras published three reports that called for significant changes to organisation, funding and service provision in mental health care in ways that emphasise inclusive, rights-oriented, democratic and sustainable community health services. This article aims to examine formal organisational responses to the UN mental health reports and consider the underlying arguments that either support or delegitimise the SR stance on the need for a paradigmatic shift towards a human rights-based approach to mental health. By combining several different search strategies to identify organisational responses across the web, a total of 13 organisational responses were included in the analysis. Given the political nature of the responses, concepts from discourse theory were used to analyse the responses. The analysis showed how the responses articulated two binary positions and contesting articulations of good mental health care, which formed a backdrop for rejecting the SR reports in defence of psychiatry. The discussion elucidates how the responses tend to resemble previous ways in which critique has been dealt with mainly by 'biological psychiatry', but that the counter-critical nature of the medical and psychiatric organisational responses remains in contrast to the broader reception within the UN community.
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Affiliation(s)
- Jeppe Oute
- Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Drammen, Norway
| | - Susan McPherson
- School of Health and Social Care, University of Essex, Colchester, UK
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Laureano CD, Laranjeira C, Querido A, Dixe MA, Rego F. Ethical Issues in Clinical Decision-Making about Involuntary Psychiatric Treatment: A Scoping Review. Healthcare (Basel) 2024; 12:445. [PMID: 38391820 PMCID: PMC10888148 DOI: 10.3390/healthcare12040445] [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: 12/15/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
In mental health and psychiatric care, the use of involuntary psychiatric treatment for people with mental disorders is still a central and contentious issue. The main objective of this scoping review was to map and systematize the literature on ethical issues in clinical decision-making about involuntary psychiatric treatment. Five databases (Embase, PsycINFO, CINAHL, Medline, and Scopus) were searched for articles on this topic. Out of a total of 342 articles found, 35 studies from 14 countries were included based on the selection criteria. The articles were analyzed using the inductive content analysis approach. The following main categories were identified: (1) ethical foundations that guide clinical decision-making; (2) criteria for involuntary psychiatric treatment; (3) gaps, barriers, and risks associated with involuntary psychiatric treatment; (4) strategies used to reduce, replace, and improve the negative impact of involuntary treatment; and (5) evidence-based recommendations. Most of the selected articles discuss the logic underlying involuntary treatment of the mentally ill, exploring ethical principles such as autonomy, beneficence, non-maleficence, or justice, as well as how these should be properly balanced. During the process of involuntary psychiatric admission, there was a notable absence of effective communication and a significant power imbalance that disenfranchised those seeking services. This disparity was further intensified by professionals who often use coercive measures without a clear decision-making rationale and by family members who strongly depend on hospital admission. Due to the pluralistic and polarized nature of opinions regarding legal capacity and the complexity and nuance of involuntary admission, further studies should be context-specific and based on co-production and participatory research.
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Affiliation(s)
- Cláudio Domingos Laureano
- Psychiatric and Mental Health Service, Local Health Unit of the Leiria Region-Hospital of Santo André, Rua das Olhalvas, 2410-197 Leiria, Portugal
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal
| | - Carlos Laranjeira
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal
- School of Health Sciences, Polytechnic University of Leiria, Campus 2-Morro do Lena, Alto do Vieiro-Apart. 4137, 2411-901 Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-801 Évora, Portugal
| | - Ana Querido
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal
- School of Health Sciences, Polytechnic University of Leiria, Campus 2-Morro do Lena, Alto do Vieiro-Apart. 4137, 2411-901 Leiria, Portugal
- Center for Health Technology and Services Research (CINTESIS), NursID, University of Porto, 4200-450 Porto, Portugal
| | - Maria Anjos Dixe
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal
- School of Health Sciences, Polytechnic University of Leiria, Campus 2-Morro do Lena, Alto do Vieiro-Apart. 4137, 2411-901 Leiria, Portugal
| | - Francisca Rego
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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Paradis-Gagné E, Holmes D, Bernheim E, Cader M. The Judiciarization of People Living with Mental Illness: A Grounded Theory on the Perceptions of Persons Involuntary Admitted in Psychiatric Institution. Issues Ment Health Nurs 2023; 44:1200-1208. [PMID: 37913502 DOI: 10.1080/01612840.2023.2265468] [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: 11/03/2023]
Abstract
The involvement of people living with mental illness in the judicial process, whether in civil or criminal justice system, is a growing phenomenon that can be defined as judiciarization. Such over-representation of people with mental illness in the justice system is related to several issues, including stigma, experienced coercion, loss of autonomy and social isolation. To explore this understudied phenomenon in nursing research, we conducted a study to better understand how judiciarization affects people living with mental illness. The specific objectives were: 1) to understand how insertion into a judicial process affects people living with mental illness; 2) to explore the perception of these people and their lived experience within the judicial trajectory. For the methodology, grounded theory was used as a research model. The theoretical framework of the total institution, proposed by Erwin Goffman, was used conceptually. Participants were recruited from a university-affiliated hospital. Hospitalized persons who had been involved in the justice system were interviewed (n = 10). Three conceptualizing categories were identified through the analyzed data: 1) Diversity of Judicial Trajectories; 2) Involuntary Psychiatric Admission Process; 3) Judiciarization Lived as a Complex Experience. The results of this research can be used to better inform nurses, clinicians, and policy makers about the impacts of the judiciarization of mental illness, and how clinical practices can be better adapted to populations with very complex health needs.
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Affiliation(s)
| | - Dave Holmes
- School of Nursing, University of Ottawa, Ontario, Canada
| | | | - Myriam Cader
- Faculty of Nursing, Université de Montréal, Québec, Canada
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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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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: 0] [Impact Index Per Article: 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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Liberati E, Richards N, Ratnayake S, Gibson J, Martin G. Tackling the erosion of compassion in acute mental health services. BMJ 2023; 382:e073055. [PMID: 37402535 PMCID: PMC10316385 DOI: 10.1136/bmj-2022-073055] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Affiliation(s)
- Elisa Liberati
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
| | - Natalie Richards
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
| | | | | | - Graham Martin
- The Healthcare Improvement Studies (THIS) Institute, University of Cambridge, Cambridge, UK
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Pértega E, Holmberg C. A systematic mapping review identifying key features of restraint research in inpatient pediatric psychiatry: A human rights perspective. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2023; 88:101894. [PMID: 37244128 DOI: 10.1016/j.ijlp.2023.101894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Restraints, a highly regulated and contentious measure in pediatric psychiatry, have significant negative impacts on children. The application of international human rights standards, such as the Convention of the Rights of the Child (CRC) and the Convention of the Rights of Persons with Disabilities (CRPD), has spurred global efforts to reduce or eliminate the use of restraints. However, a lack of consensus on definitions and terminology, as well as quality indicators in this field, hinders the ability to compare studies and evaluate interventions consistently. AIM To systematically map existing literature on restraints imposed upon children in inpatient pediatric psychiatry against a human rights perspective. Specifically, to identify and clarify gaps in literature in terms of publication trends, research approaches, study contexts, study participants, definitions and concepts being used, and legal aspects. These aspects are central to assess whether published research is contributing to achieve the CRPD and the CRC in terms of interpersonal, contextual, operational, and legal requirements of restraints. METHODS A systematic mapping review based on PRISMA guidelines was conducted, adopting a descriptive-configurative approach to map the distribution of available research and gaps in the literature about restraints in inpatient pediatric psychiatry. Six databases were searched for literature reviews and empirical studies of all study designs published between each database's inception and March 24, 2021, manually updated on November 25, 2022. RESULTS The search yielded 114 English-language publications, with a majority (76%) comprising quantitative studies that relied primarily on institutional records. Contextual information about the research setting was provided in less than half of the studies, and there was an unequal representation of the three main stakeholder groups: patients, family, and professionals. The studies also exhibited inconsistencies in the terms, definitions, and measurements used to examine restraints, with a general lack of attention given to human rights considerations. Additionally, all studies were conducted in high-income countries and mainly focused on intrinsic factors such as age and psychiatric diagnosis of the children, while contextual factors and the impact of restraints were not adequately explored. Legal and ethical aspects were largely absent, with only one study (0.9%) explicitly referencing human rights values. CONCLUSIONS Research on restraints of children in psychiatric units is increasing; however, inconsistent reporting practices hinder the understanding of the meaning and frequency of restraints. The exclusion of crucial features, such as the physical and social environment, facility type, and family involvement, indicates inadequate incorporation of the CRPD. Additionally, the lack of references to parents suggests insufficient consideration of the CRC. The shortage of quantitative studies focusing on factors beyond patient-related aspects, and the general absence of qualitative studies exploring the perspectives of children and adolescents regarding restraints, suggest that the social model of disability proposed by the CRPD has not yet fully penetrated the scientific research on this topic.
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Affiliation(s)
- Elvira Pértega
- Faculty of Law, University of Technology Sydney, Sydney, Australia; Child and Adolescens Mental Health Department, Hospital Lucus augusti, Lugo, Spain.
| | - Christopher Holmberg
- Department of Psychotic Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Health and Care Science, University of Gothenburg, Gothenburg, Sweden
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Law S, Stergiopoulos V, Zaheer J, Nakhost A. "Everyone means well but the one person who's really going to go to bat" - experiences and perspectives of substitute decision makers in caring for their loved ones with serious mental illness. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2023; 88:101873. [PMID: 36950980 DOI: 10.1016/j.ijlp.2023.101873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/26/2023] [Accepted: 02/28/2023] [Indexed: 06/01/2023]
Abstract
In the era of on-going efforts to empower persons with mental illness to be independent decision makers as informed by the United Nations' Convention on the Rights of Persons with Disability (CRPD), family members acting as substitute decision makers (SDM) for people suffering from disabling serious mental illness (SMI) remain an integral part of the medical-legal system in psychiatric care in many parts of the world, including Canada; yet their experiences and perspectives are rarely studied. This explorative qualitative study examines the lived experiences and reflections of 14 family member SDMs in Toronto, Canada. Five key themes related to being SDM emerged: 1) Varied subjective understanding of the responsibility and authority of the SDM role; 2) Varied role demands and impact on SDMs' lives; 3) Challenges in dealing with the mental health system; 4) Leveraging decision making status to promote patient care; and 5) SDM role impact on family relationships. The need to improve SDM understanding of their role, acknowledging their value and care-taker burden, finding a balance for their involvement, and improving their support in efforts to enhance care for the patients are discussed.
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Affiliation(s)
- Samuel Law
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Department of Psychiatry, St. Michael's Hospital, Unity Health Toronto, Ontario, Canada.
| | - Vicky Stergiopoulos
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Addictions and Mental Health, Toronto, Ontario, Canada.
| | - Juveria Zaheer
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Addictions and Mental Health, Toronto, Ontario, Canada.
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Feeling coerced during voluntary and involuntary psychiatric hospitalisation: A review and meta-aggregation of qualitative studies. Heliyon 2023; 9:e13420. [PMID: 36820044 PMCID: PMC9937983 DOI: 10.1016/j.heliyon.2023.e13420] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/19/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Objective This review aimed to provide an aggregative synthesis of the qualitative evidence on patients' experienced coercion during voluntary and involuntary psychiatric hospitalisation. Design A qualitative review. Data sources The search was conducted, in five bibliographic databases: Embase.com, Ovid MEDLINE(R) ALL, APA PsycINFO Ovid, Web of Science Core Collection and the Cochrane Database of Systematic Reviews. Review methods Following the Joanna Briggs Institute approach, a systematized procedure was applied throughout the review process, from data search to synthesis of results. The reporting of this review was guided by the standards of the PRISMA 2020 statement. The quality of the included studies was critically appraised by two independent reviewers using the JBI Critical Appraisal Checklist. Included findings were synthesized using meta-aggregation. Confidence in the review findings was assessed following the Confidence in the Output of Qualitative research synthesis (ConQual) approach. Results A total of 423 studies were identified through the literature search and 26 were included in the meta-aggregation. Totally, 151 findings were extracted and aggregated into 27 categories and 7 synthesized findings. The synthesized findings focused on: the patients' experience of the hospitalisation and the associated feeling of coercion; the factors affecting this feeling, such as the involvement in the decision-making process, the relationships with the staff and the perception of the hospital treatment as effective and safe; the coping strategies adopted to deal with it and the patients' suggestions for alternatives. All synthesized findings reached an overall confidence score of "moderate". The seven findings were downgraded one level due to dependability limitations of the included studies. Conclusion Based on these findings, seven recommendations for clinical practice where developed, such as fostering care ethics, promoting patients' voice and shared decision-making, and enhancing patients' perceived closeness, respect and fairness. Five recommendations for future research were also prompted, for instance improving the methodological quality and cultural variation of future qualitative studies, and exploring the psychosocial impact of experienced coercion on patients. For these recommendations to be effectively implemented, a profound change in the structure and culture of the mental health system should be promoted. The involvement of patients in the design, development and scientific evaluation of this change is strongly recommended.
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Holmberg C. Schizophrenia in Print, Digital, and Audiovisual Media: Trends, Topics, and Results From an Anti-Stigma Intervention Targeting Media Professionals. SCHIZOPHRENIA BULLETIN OPEN 2023; 4:sgad018. [PMID: 39145329 PMCID: PMC11207655 DOI: 10.1093/schizbullopen/sgad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Background Negative portrayals of schizophrenia in media can prompt the condition's stigmatization. However, because research on language stigmatizing schizophrenia has focused on paper-based media, its results have limited generalizability to contemporary media. Also, research on interventions to guide media professionals in accurately depicting schizophrenia has been scarce. The present study had two aims: (1) to assess how print, web, and radio/TV news media in Sweden portray schizophrenia and (2) to evaluate a campaign targeting media professionals' responses to information about schizophrenia and the consequences of stigmatizing language. Study Design Using data from Retriever's database, considering media types and topics, the terms "schizophrenia" and "schizophrenic" were examined in the past 20 years, whereas analyses of stigmatizing reporting of these terms used media from the past 10 years. Media professionals' responses and actions in the anti-stigma information campaign StigmaWatch were also evaluated. Study Results Between 2002 and 2022, "schizophrenia" was mentioned 34 141 times in the dataset and "schizophrenic" 10 058 times. However, no trends were statistically significant. All media topics and most types of media contained stigmatizing reporting. Of the 230 media professionals who received informative emails from StigmaWatch, 77 (33%) responded. Most responses were supportive, and 14% of the professionals reported taking corrective measures (eg, revising erroneous descriptions of schizophrenia) following the email. Conclusions No media topic was free of language stigmatizing schizophrenia. The anti-stigma information campaign seemed to have been effective, for most media professionals who responded were supportive, and a sizable proportion reported taking corrective measures.
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Affiliation(s)
- Christopher Holmberg
- Department of Psychotic Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
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Bremmers LGM, Hakkaart-van Roijen L, Gräler ES, Uyl-de Groot CA, Fabbricotti IN. How Do Shifts in Patients with Mental Health Problems' Formal and Informal Care Utilization Affect Informal Caregivers?: A COVID-19 Case Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16425. [PMID: 36554308 PMCID: PMC9778175 DOI: 10.3390/ijerph192416425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: This study investigated how potential shifts in patients' formal and informal care utilization during the COVID-19 pandemic impacted their informal caregivers in terms of their subjective burden, psychological wellbeing, and happiness. (2) Methods: A retrospective cohort study design was employed for a panel of Dutch informal caregivers of persons with mental health problems (n = 219) in June 2020. Descriptive statistics and differences between means were determined for the patients' informal and care utilization and informal caregivers' subjective burden, happiness, and psychological wellbeing. Three mediation analyses were conducted using the PROCESS macro. (3) Results: Informal caregivers reported significantly worse happiness and subjective burden scores during the COVID-19 pandemic compared with before the lockdown. There were minimal shifts in patient's care utilization reported, with the exception of a decrease in significant emotional and practical support provided by the informal caregiver. In the mediation analyses, there was not a significant indirect effect of shifts in patients' formal care utilization on informal caregivers' subjective burden, psychological wellbeing, and happiness through shifts in patients' informal care utilization. (4) Discussion and conclusion: Whilst we found that shifts in patients' care utilization during the first wave of the pandemic did not affect the informal caregiver in the short term, it is unclear what the long-term impact of the pandemic might be on informal caregivers. More research should be conducted to understand the implications of short- and long-term impact of substitution on informal caregivers of persons with mental health problems, with special consideration of the COVID-19 context and uptake of e-health technology.
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Affiliation(s)
- Leonarda G. M. Bremmers
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Leona Hakkaart-van Roijen
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Eleonora S. Gräler
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Carin A. Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - Isabelle N. Fabbricotti
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
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Dechent F, Moeller J, Huber CG. Meaning Analysis and Alienation: A Method of Immanent Critique in Acute Psychiatry. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16194. [PMID: 36498269 PMCID: PMC9735647 DOI: 10.3390/ijerph192316194] [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: 10/25/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
In acute psychiatry, where people with severe mental disorders are frequently treated, there can be contradictions between concepts of illness among, e.g., patients and healthcare professionals, and also between medical and legal aspects. These contradictions do not manifest themselves openly but are immanent in the social practices of the treatment teams as contradictions between the social level and the individual level. They can lead to alienation, which may be reflected in poorer quality of treatment, such as the more frequent use of coercive measures or poorer adherence to therapy in patients. In the normal daily routine of a clinic, these contradictions are mostly hidden by hierarchical structures or by unbalanced concepts of psychiatric illness, or external critique is used to try to solve these contradictions. However, another way of dealing with these contradictions could be to analyze the potential and causes for alienation through systematic analysis and transformation of the whole system of a psychiatric ward to reduce the level of contradiction within it. The aim of this work is to use the concept of meaning elaborated by Luhmann to identify and recognize alienation potentials as concretely as possible and thus make them accessible to immanent critique. Meaning in Luhmann's use of the term serves to reduce complexity in a social context and always opens up consequential possibilities for action. Consequential limited possibilities at the level of action in a rigid social system (which psychiatric wards can be) can-at an individual level-lead to people subordinating themselves to the rigid system to an excessive degree and thus alienating themselves from the system. Thus, a rigid system with a narrowing of consequential possibilities excludes meaningful consequential possibilities. This leads to alienating contradictions and to possibilities of world appropriation being missed. The aim of the current analysis is not to make a general critique of psychiatry but to improve the theoretical basis to better understand the problem of alienation in acute psychiatry as a symptom of system-immanent contradictions and thus open up the possibility of transforming systems, e.g., psychiatric acute care units, by means of immanent critique.
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Affiliation(s)
- Frieder Dechent
- University Psychiatric Clinics Basel, University of Basel, 4002 Basel, Switzerland
| | - Julian Moeller
- University Psychiatric Clinics Basel, University of Basel, 4002 Basel, Switzerland
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, 4055 Basel, Switzerland
| | - Christian G. Huber
- University Psychiatric Clinics Basel, University of Basel, 4002 Basel, Switzerland
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How Do Psychiatrists in Japan Choose Involuntary Admission, and What Do They Think of Supported Decision Making? A Thematic Analysis of Peer to Peer Interviews. Community Ment Health J 2022; 59:654-663. [PMID: 36327042 DOI: 10.1007/s10597-022-01046-1] [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: 05/21/2022] [Accepted: 10/15/2022] [Indexed: 11/05/2022]
Abstract
To include people with disabilities as equal citizens, CRPD (Convention on the Rights of Persons with Disabilities) promotes direct or supported decision-making by people with disabilities. However, involuntary psychiatry admission is considered in many countries to be necessary for people with psychosocial disabilities. To overcome the tension and implement CRPD, it is essential to understand the experiences and concerns of service users, family members, and medical professionals in each country. To understand the process and the factors that make psychiatrists decide involuntary psychiatric admission in Japan, and explore their attitudes toward direct or supported decision-making by people with psychosocial disabilities. Psychiatrists who had authorized involuntary admission and who were in charge of the service users were recruited at hospitals in Japan. The interviews were individual, peer to peer, and semi-structured. The interviews were audio-recorded, transcribed verbatim, and the analysis followed reflexive thematic analysis using NVIVO 12. Six psychiatrists (five designated psychiatrists and one psychiatric resident) participated in the study at two hospitals in urban Japan. The study found that the psychiatrists assessed symptoms, behaviors, and perceptions of the service users together with supports and wishes of their families. The psychiatrists decided on involuntary admission when they saw self-harm or violence, weak insights and judgment abilities, family's wishes, or when they wanted to avoid the service users leaving the hospital with incomplete treatment. The psychiatrists felt that the service users would not understand any explanations, which made their communications minimal. The psychiatrists thought it was hard to imagine a system other than the current involuntary admission mechanism. If it was to change, they felt the essential things were to avoid abuse, clarify who is responsible, make plans medically valid and feasible, and assess and plan through everyday life, not just in crisis. During a crisis, the psychiatrists were most careful about complying with the Mental Health Act and responded to the family's wish. The psychiatrists justified involuntary admission as they believed that people in a psychiatric crisis cannot decide or understand and need protection. Related protocols, laws, and expectations from family members shapes the values and practices of psychiatrists in Japan. The paper concludes with several recommendations to regard people with psychosocial disabilities as equal citizens, and promoting the aim of reducing or ending involuntary admission.
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Moll MF, Brito ESD, Ventura CAA. The rights to legal capacity, personal freedom, and safety during psychiatric hospitalizations at a general hospital. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2022; 84:101827. [PMID: 35932502 DOI: 10.1016/j.ijlp.2022.101827] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Abstract
The aim of this study is to analyze the exercise of rights to legal capacity, personal freedom, and safety during psychiatric hospitalizations at a general hospital in an inner city from the state of São Paulo, Brazil, from the perspective of patients. This is a cross-sectional qualitative research study. Data were collected by interviewing 20 patients in the process of being discharged from the studied hospital who agreed to participate in the investigation. The guiding instrument of this interview was based on the WHO QualityRights interview tool and the obtained data were processed by means of thematic and content analyses. Results showed that the legal processes resulting from the Psychiatric Reform did not ensure the full exercise of the human rights of people with mental disorders admitted at general hospitals. Participants generally did not know about their rights to have access to their information and referred that they received information about their own health or these were given to their representatives.
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Affiliation(s)
- Marciana Fernandes Moll
- University of Uberaba, Av. Nenê Sabino, 1801 - Universitário, Uberaba, MG 38055-500, Brazil.
| | - Emanuele Seicenti de Brito
- University of São Paulo at Ribeirão Preto College of Nursing WHO Collaborating Centre for Nursing Research Development, 3900 Bandeirantes Av, Campus Universitário, 14040-902, Ribeirão Preto, Brazil.
| | - Carla Aparecida Arena Ventura
- University of São Paulo at Ribeirão Preto College of Nursing WHO Collaborating Centre for Nursing Research Development, 3900 Bandeirantes Av, Campus Universitário, 14040-902, Ribeirão Preto, Brazil.
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Potthoff S, Gather J, Hempeler C, Gieselmann A, Scholten M. "Voluntary in quotation marks": a conceptual model of psychological pressure in mental healthcare based on a grounded theory analysis of interviews with service users. BMC Psychiatry 2022; 22:186. [PMID: 35296288 PMCID: PMC8928679 DOI: 10.1186/s12888-022-03810-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychological pressure refers to communicative strategies used by professionals and informal caregivers to influence the decision-making of service users and improve their adherence to recommended treatment or social rules. This phenomenon is also commonly referred to as informal coercion or treatment pressure. Empirical studies indicated that psychological pressure is common in mental healthcare services. No generally accepted definition of psychological pressure is available to date. A first conceptual analysis of psychological pressure focused on staff communication to promote treatment adherence and distinguished between persuasion, interpersonal leverage, inducements and threats. AIM The aim of this study was to develop a conceptual model of psychological pressure based on the perspectives of service users. METHODS Data were collected by means of semi-structured interviews. The sample consisted of 14 mental health service users with a self-reported psychiatric diagnosis and prior experience with coercion in mental healthcare. We used theoretical sampling and contacted participants via mental healthcare services and self-help groups to ensure a variety of attitudes toward the mental healthcare system in the sample. The study was conducted in Germany from October 2019 to January 2020. Data were analyzed according to grounded theory methodology. RESULTS The study indicated that psychological pressure is used not only to improve service users' adherence to recommended treatment but also to improve their adherence to social rules; that it is exerted not only by mental health professionals but also by relatives and friends; and that the extent to which service users perceive communication as involving psychological pressure depends strongly on contextual factors. Relevant contextual factors were the way of communicating, the quality of the personal relationship, the institutional setting, the material surroundings and the level of convergence between the parties' understanding of mental disorder. CONCLUSIONS The results of the study highlight the importance of staff communication training and organizational changes for reducing the use of psychological pressure in mental healthcare services.
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Affiliation(s)
- Sarah Potthoff
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstraße 258a, 44799, Bochum, Germany.
| | - Jakov Gather
- grid.5570.70000 0004 0490 981XInstitute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstraße 258a, 44799 Bochum, Germany ,grid.5570.70000 0004 0490 981XDepartment of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, 44791 Bochum, Germany
| | - Christin Hempeler
- grid.5570.70000 0004 0490 981XInstitute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstraße 258a, 44799 Bochum, Germany ,grid.5570.70000 0004 0490 981XDepartment of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, 44791 Bochum, Germany
| | - Astrid Gieselmann
- grid.5570.70000 0004 0490 981XInstitute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstraße 258a, 44799 Bochum, Germany ,grid.6363.00000 0001 2218 4662Department of Psychiatry, Charité_Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Matthé Scholten
- grid.5570.70000 0004 0490 981XInstitute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstraße 258a, 44799 Bochum, Germany
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Every-Palmer S, Dunn A, Foulds J, Reuvecamp I, Dawson J. Restricted patients in New Zealand: A failed social experiment with a hybrid form of civil/forensic compulsory mental health treatment. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2022; 80:101762. [PMID: 34861488 DOI: 10.1016/j.ijlp.2021.101762] [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: 10/28/2021] [Revised: 11/12/2021] [Accepted: 11/23/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION In 1992, New Zealand's mental health legislation created the distinct concept of a 'restricted patient' - effectively creating a pathway into forensic patient status, but via the civil committal process, without the patient passing through the criminal justice system en route. This regime was aimed at civilly committed patients who present "special difficulties" because of the danger they pose to others. It remains in force but has attracted little scrutiny. OBJECTIVE This paper traverses the background to restricted patient status, and the legal regime, before describing and analysing, in anonymous form, the circumstances of all those declared to be restricted patients, and their outcomes, since the regime began. It then considers the continuing appropriateness of this legal regime in light of contemporary human rights principles. METHODS We reviewed the records of every person placed under restricted patient status since the legislation came into force over a nearly 30-year-period. RESULTS New Zealand's restricted patient status is rarely used. Only eight people have been subject to such orders (seven male, median age 45 years at the making of the order). All had a history of violent offending and had previously been forensic patients. None re-offended after becoming a restricted patient, but they spent longer as compulsory inpatients than patients unfit to stand trial or not guilty by reason of insanity. There is no evidence they were uniquely dangerous. The legal criteria, namely, that the person presented with "special difficulties", are unclear and have been interpreted differently by the judiciary. They have sometimes included the risk of inadequate care being provided by mental health services. CONCLUSION Given the rarity with which restricted patient status has been used in New Zealand, the subsequent evolution and development of forensic services providing alternative pathways through care, and its problematic human rights aspects, we would not recommend equivalent restricted patient provisions to other countries. We suggest this hybrid form of civil/forensic compulsory mental health treatment is a form of arbitrary detention and incompatible with human rights norms. It should be omitted from New Zealand's next Mental Health Act.
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Affiliation(s)
- Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago, Wellington, PO Box 7343, Newtown, Wellington 6242, New Zealand.
| | - Alice Dunn
- Mental Health, Addictions and Intellectual Disability Service, 3DHB, Wellington, Hutt and Wairarapa, c/o Wellington Regional Hospital, Private Bag 7902, Wellington 6242, New Zealand.
| | - James Foulds
- Department of Psychological Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand.
| | - Iris Reuvecamp
- Barrister and Solicitor, Vida Law, PO Box 38235, Wellington Mail Centre, Wellington 5045., New Zealand.
| | - John Dawson
- Faculty of Law, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
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Global mental health should engage with the ethics of involuntary admission. Int J Ment Health Syst 2021; 15:20. [PMID: 33653347 PMCID: PMC7923659 DOI: 10.1186/s13033-021-00448-0] [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] [Received: 01/28/2021] [Accepted: 02/23/2021] [Indexed: 11/10/2022] Open
Abstract
Global mental health, as a field, has focused on both increasing access to mental health services and promoting human rights. Amidst many successes in engaging with and addressing various human rights violations affecting individuals living with psychosocial disabilities, one human rights challenge remains under-discussed: involuntary inpatient admission for psychiatric care. Global mental health ought to engage proactively with the debate on the ethics of involuntary admission and work to develop a clear position, for three reasons. Firstly, the field promotes models of mental healthcare that are likely to include involuntary admission. Secondly, the field aligns much of its human rights framework with the UN Convention on the Rights of Persons with Disabilities, which opposes the discriminatory use of involuntary admission on the basis of psychosocial disability or impairment. Finally, global mental health, as a field, is uniquely positioned to offer novel contributions to this long-standing debate in clinical ethics by collecting data and conducting analyses across settings. Global mental health should take up involuntary admission as a priority area of engagement, applying its own orientation toward research and advocacy in order to explore the dimensions of when, if ever, involuntary admission may be permissible. Such work stands to offer meaningful contributions to the challenge of involuntary admission.
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Wormdahl I, Husum TL, Kjus SHH, Rugkåsa J, Hatling T, Rise MB. Between No Help and Coercion: Toward Referral to Involuntary Psychiatric Admission. A Qualitative Interview Study of Stakeholders' Perspectives. Front Psychiatry 2021; 12:708175. [PMID: 34484000 PMCID: PMC8415795 DOI: 10.3389/fpsyt.2021.708175] [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: 05/11/2021] [Accepted: 07/13/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: Paths toward referral to involuntary psychiatric admission mainly unfold in the contexts where people live their everyday lives. Modern health services are organized such that primary health care services are often those who provide long-term follow-up for people with severe mental illness and who serve as gatekeepers to involuntary admissions at the secondary care level. However, most efforts to reduce involuntary admissions have been directed toward the secondary health care level; interventions at the primary care level are sparse. To adapt effective measures for this care level, a better understanding is needed of the contextual characteristics surrounding individuals' paths ending in referrals for involuntary admission. This study aims to explore what characterizes such paths, based on the personal experiences of multiple stakeholders. Method: One hundred and three participants from five Norwegian municipalities participated in individual interviews or focus groups. They included professionals from the primary and secondary care levels and people with lived experience of severe mental illness and/or involuntary admission and carers. Data was subject to constant comparison in inductive analysis inspired by grounded theory. Results: Four main categories emerged from the analysis: deterioration and deprivation, difficult to get help, insufficient adaptation of services provided, and when things get acute. Combined, these illustrate typical characteristics of paths toward referral for involuntary psychiatric admission. Conclusion: The results demonstrate the complexity of individuals' paths toward referral to involuntary psychiatric admission and underline the importance of comprehensive and individualized approaches to reduce involuntary admissions. Furthermore, the findings indicate a gap in current practice between the policies to reduce involuntary admissions and the provision of, access to, and adaptation of less restrictive services for adults with severe mental illness at risk of involuntary admissions. To address this gap, further research is needed on effective measures and interventions at the primary care level.
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Affiliation(s)
- Irene Wormdahl
- NTNU Social Research, Norwegian Resource Centre for Community Mental Health, Trondheim, Norway.,Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tonje Lossius Husum
- Centre for Medical Ethics, Institute for Health and Society, University of Oslo, Oslo, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | | | - Jorun Rugkåsa
- Health Service Research Unit, Akershus University Hospital, Lørenskog, Norway.,Centre for Care Research, University of South-Eastern Norway, Porsgrunn, Norway
| | - Trond Hatling
- NTNU Social Research, Norwegian Resource Centre for Community Mental Health, Trondheim, Norway
| | - Marit B Rise
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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