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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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Lundahl A. Suicide-preventive compulsory admission is not a proportionate measure - time for clinicians to recognise the associated risks. Monash Bioeth Rev 2024:10.1007/s40592-024-00190-6. [PMID: 38615159 DOI: 10.1007/s40592-024-00190-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 04/15/2024]
Abstract
Suicide is considered a global public health issue and compulsory admission is a commonly used measure to prevent suicide. However, the practice has been criticised since several studies indicate that the measure lacks empirical support and may even increase suicide risk. This paper investigates whether the practice has enough empirical support to be considered proportionate. To that end, arguments supporting compulsory admission as a suicide-preventive measure for most suicidal patients are scrutinized. The ethical point of departure is that the expected benefits of compulsory admission should outweigh the potential harms of the measure to be proportionate and defensible. It is concluded that, for most suicidal patients, suicide-preventive compulsory admission cannot be presumed to be a proportionate measure. To be so, the expected medical benefits of the measure should be greater than the potential increase in suicide risk and other harms that compulsory admission could entail. Instead of using compulsory admission as a suicide-preventive measure, extra safety measures may be needed during and after compulsory admission to prevent the risk of hospitalisation-induced suicide.
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Affiliation(s)
- Antoinette Lundahl
- Stockholm Centre for Healthcare Ethics, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
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Johnson S, Birken M, Nyikavaranda P, Kular A, Gafoor R, Parkinson J, Hutchings-Hay C, Gant T, Molai J, Rivera J, Fenwick J, Bendall C, Blakley L, Bacarese-Hamilton T, White VC, Holden MK, Seale J, Hardy J, Fraser KL, Mitchell L, Lay B, Mbeah-Bankas H, McCrone P, Freemantle N, Wood L, Lobban F, Lloyd-Evans B. A crisis planning and monitoring intervention to reduce compulsory hospital readmissions (FINCH study): protocol for a randomised controlled feasibility study. Pilot Feasibility Stud 2024; 10:35. [PMID: 38378694 PMCID: PMC10877855 DOI: 10.1186/s40814-024-01453-z] [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: 01/28/2023] [Accepted: 01/22/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Rates of compulsory (also known as involuntary) detention under mental health legislation have been rising over several decades in countries including England. Avoiding such detentions should be a high priority given their potentially traumatic nature and departure from usual ethical principles of consent and collaboration. Those who have been detained previously are at high risk of being detained again, and thus a priority group for preventive interventions. In a very sparse literature, interventions based on crisis planning emerge as having more supporting evidence than other approaches to preventing compulsory detention. METHOD We have adapted and manualised an intervention previously trialled in Zürich Switzerland, aimed at reducing future compulsory detentions among people being discharged following a psychiatric admission that has included a period of compulsory detention. A co-production group including people with relevant lived and clinical experience has co-designed the adaptations to the intervention, drawing on evidence on crisis planning and self-management and on qualitative interviews with service users and clinicians. We will conduct a randomised controlled feasibility trial of the intervention, randomising 80 participants to either the intervention in addition to usual care, or usual care only. Feasibility and acceptability of the intervention and trial procedures will be assessed through process evaluation (including rates of randomisation, recruitment, and retention) and qualitative interviews. We will also assess and report on planned trial outcomes. The planned primary outcome for a full trial is repeat compulsory detention within one year of randomisation, and secondary outcomes include compulsory detention within 2 years, and symptoms, service satisfaction, self-rated recovery, self-management confidence, and service engagement. A health economic evaluation is also included. DISCUSSION This feasibility study, and any subsequent full trial, will add to a currently limited literature on interventions to prevent involuntary detention, a goal valued highly by service users, carers, clinicians, and policymakers. There are significant potential impediments to recruiting and retaining this group, whose experiences of mental health care have often been negative and traumatising, and who are at high risk of disengagement. TRIAL REGISTRATION ISRCTN, ISRCTN11627644. Registered 25th May 2022, https://www.isrctn.com/ISRCTN11627644 .
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Affiliation(s)
- Sonia Johnson
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK.
- Camden and Islington NHS Foundation Trust, London, UK.
| | - Mary Birken
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Patrick Nyikavaranda
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Ariana Kular
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Rafael Gafoor
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | | | - Chloe Hutchings-Hay
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Thomas Gant
- North East London NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom
| | - Jazmin Molai
- Camden and Islington NHS Foundation Trust, London, UK
| | | | - James Fenwick
- Camden and Islington NHS Foundation Trust, London, UK
| | | | | | - Theresa Bacarese-Hamilton
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Valerie Christina White
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Mark Keith Holden
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Janet Seale
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Jackie Hardy
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Kathleen Lindsay Fraser
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Lizzie Mitchell
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
| | | | | | - Paul McCrone
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Nick Freemantle
- Comprehensive Clinical Trials Unit, University College London, London, UK
| | - Lisa Wood
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
- North East London NHS Foundation Trust, London, UK
| | - Fiona Lobban
- Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
- Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Brynmor Lloyd-Evans
- Division of Psychiatry, Faculty of Brain Sciences, University College London, 6Th Floor, 149 Tottenham Court Road, London, W1T 7NF, UK
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Harrison H, Alarakhia T, Archard PJ. Introducing a group-based psychoeducation intervention for older people in an inpatient mental healthcare setting. Nurs Older People 2023; 35:28-34. [PMID: 37403441 DOI: 10.7748/nop.2023.e1438] [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] [Accepted: 03/22/2023] [Indexed: 07/06/2023]
Abstract
This article reports on a service evaluation of a group-based psychoeducation programme for older people in an inpatient mental healthcare setting. It sought to explore how the programme was experienced by patients and staff, as well as its acceptability and the feasibility for implementation in the longer term. Via questionnaires, views were gathered from patients and staff. A focus group interview with staff facilitating the group sessions was also undertaken, and patient attendance records for sessions were collected and compared with demographic data relating to the two wards housed in the unit where the programme took place. The programme was generally viewed as a positive addition to care delivery by staff and patient respondents in offering an adjunct to pharmacological treatment, increasing familiarity with psychology staff, encouraging patients to develop a greater degree of mastery regarding their health and fostering mutual support among the patient community. The role of the ward environment in supporting access to group-based intervention is also considered.
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Affiliation(s)
| | - Talha Alarakhia
- Children and Adolescents Placement Provisions, Bedford, England
| | - Philip John Archard
- Child and Adolescent Mental Health Service, Leicestershire Partnership NHS Trust, honorary associate professor, University of Leicester, Leicester, England, associate lecturer, Tavistock and Portman NHS Foundation Trust, London, England
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Draghetti S, Alberti S, Borgiani G, Panariello F, De Ronchi D, Atti AR. Compulsory and voluntary admissions in comparison: A 9-year long observational study. Int J Soc Psychiatry 2022; 68:1716-1726. [PMID: 34927496 DOI: 10.1177/00207640211057731] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Few studies, so far, have been specifically designed to highlight the features related to Compulsory Admissions (CA) and Voluntary Admissions (VA) in Italian psychiatric emergency wards. AIMS The main purpose of this observational study was to compare the sociodemographic and clinical characteristics of VA and CA and to explore possible predictors of re-admissions. METHODS During a 6-month Index Period (February, the 1st-July, the 31st 2008) all psychiatric admissions were documented and then followed-up through all available informatic systems for the next 9 years. RESULTS Out of 390 hospitalizations, 101 (25.9%) were compulsory (CA rate was 2.79 per 10,000 inhabitants per year, mean duration of hospitalizations of 7.33 ± 7.84 days). Diagnoses were recorded for the 325 patients who had been hospitalized during index period: schizophrenic psychoses ([p = .042], in particular schizophrenia [p = .027]), manic episode (p = .044), and delusional disorders (p = .009) were associated with CA; conversely, the diagnosis of unipolar major depression (p = .005) and personality disorders (p = .048) were significantly more frequent in VA. The 325 admitted patients were followed up for 1,801 person-years. No significant differences were found in terms of drop-outs, transferring, and discharge rates, and mortality rates due to both natural causes and suicides. Factors associated with at least one compulsory readmission were younger age and having had a previous CA (p = .011); conversely having been engaged with psychiatric services for over 1 year prior to index hospitalization was protective for a subsequent CA (p = .013). CONCLUSIONS After a 40-year old political reform, the current study shows that, in a context of integrated outpatient and inpatient services, engagement with outpatient care may be protective for compulsory rehospitalization.
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Affiliation(s)
- Stefano Draghetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Siegfried Alberti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Gianluca Borgiani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Fabio Panariello
- Servizio Psichiatrico di Diagnosi e Cura "P. Ottonello" - Azienda Sanitaria Locale di Bologna, Italy
| | - Diana De Ronchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Anna Rita Atti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
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Tinland A, Loubière S, Mougeot F, Jouet E, Pontier M, Baumstarck K, Loundou A, Franck N, Lançon C, Auquier P. Effect of Psychiatric Advance Directives Facilitated by Peer Workers on Compulsory Admission Among People With Mental Illness: A Randomized Clinical Trial. JAMA Psychiatry 2022; 79:752-759. [PMID: 35662314 PMCID: PMC9171654 DOI: 10.1001/jamapsychiatry.2022.1627] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Reducing the use of coercion in mental health care is crucial from a human rights and public health perspective. Psychiatric advance directives (PADs) are promising tools that may reduce compulsory admissions. Assessments of PADs have included facilitation by health care agents but not facilitation by peer workers. OBJECTIVE To determine the efficacy of PADs facilitated by peer workers (PW-PAD) in people with mental disorders. DESIGN, SETTING, AND PARTICIPANTS A multicenter randomized clinical trial was conducted in 7 French mental health facilities. Adults with a DSM-5 diagnosis of schizophrenia, bipolar I disorder, or schizoaffective disorder who had a compulsory admission in the past 12 months and the capacity to consent were enrolled between January 2019 and June 2020 and followed up for 12 months. INTERVENTIONS The PW-PAD group was invited to fill out a PAD form and meet a peer worker who was trained to assist in completing and sharing the form with relatives and psychiatrists. MAIN OUTCOMES AND MEASURES The primary outcome was the rate of compulsory admission at 12 months after randomization. The overall psychiatric admission rate, therapeutic alliance, quality of life, mental health symptoms, empowerment, and recovery outcomes were also investigated. RESULTS Among 394 allocated participants (median age, 39 years; 39.3% female; 45% with schizophrenia, 36% bipolar I disorder, and 19% schizoaffective disorder), 196 were assigned to the PW-PAD group and 198 to the control group. In the PW-PAD group, 27.0% had compulsory admissions compared with 39.9% in the control group (risk difference, -0.13; 95% CI, -0.22 to -0.04; P = .007). No significant differences were found in the rate of overall admissions, therapeutic alliance score, and quality of life. Participants in the PW-PAD group exhibited fewer symptoms (effect size, -0.20; 95% CI, -0.40 to 0.00), greater empowerment (effect size, 0.30; 95% CI, 0.10 to 0.50), and a higher recovery score (effect size, 0.44; 95% CI, 0.24 to 0.65), compared with those in the control group. CONCLUSIONS AND RELEVANCE Peer worker-facilitated PADs are effective in decreasing compulsory hospital admissions and increasing some mental health outcomes (self-perceived symptoms, empowerment, and recovery). Involving peer workers in the completion of PADs supports the current shift of mental health care from substitute decision-making to supported decision-making. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03630822.
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Affiliation(s)
- Aurélie Tinland
- CEReSS–Health Service Research and Quality of Life Center (UR 3279), Aix-Marseille University, School of Medicine–La Timone Medical Campus, Marseille, France,Department of Psychiatry, Assistance Publique–Hôpitaux de Marseille, Marseille, France
| | - Sandrine Loubière
- CEReSS–Health Service Research and Quality of Life Center (UR 3279), Aix-Marseille University, School of Medicine–La Timone Medical Campus, Marseille, France,Support Unit for Clinical Research and Economic Evaluation, Department of Clinical Research and Innovation, Assistance Publique–Hôpitaux de Marseille, Marseille, France
| | | | - Emmanuelle Jouet
- Laboratoire de recherche en Santé Mentale et Sciences Humaines et Sociales (Labo SM-SHS), GHU Paris Psychiatry Neurosciences, Paris, France
| | - Magali Pontier
- Department of Psychiatry, Assistance Publique–Hôpitaux de Marseille, Marseille, France
| | - Karine Baumstarck
- CEReSS–Health Service Research and Quality of Life Center (UR 3279), Aix-Marseille University, School of Medicine–La Timone Medical Campus, Marseille, France,Support Unit for Clinical Research and Economic Evaluation, Department of Clinical Research and Innovation, Assistance Publique–Hôpitaux de Marseille, Marseille, France
| | - Anderson Loundou
- CEReSS–Health Service Research and Quality of Life Center (UR 3279), Aix-Marseille University, School of Medicine–La Timone Medical Campus, Marseille, France,Support Unit for Clinical Research and Economic Evaluation, Department of Clinical Research and Innovation, Assistance Publique–Hôpitaux de Marseille, Marseille, France
| | - Nicolas Franck
- Resource Center of Psychosocial Rehabilitation, Centre Hospitalier Le Vinatier, Lyon, France,UMR 5229, Université de Lyon and CNRS, Villeurbanne, France
| | - Christophe Lançon
- CEReSS–Health Service Research and Quality of Life Center (UR 3279), Aix-Marseille University, School of Medicine–La Timone Medical Campus, Marseille, France,Department of Psychiatry, Assistance Publique–Hôpitaux de Marseille, Marseille, France
| | - Pascal Auquier
- CEReSS–Health Service Research and Quality of Life Center (UR 3279), Aix-Marseille University, School of Medicine–La Timone Medical Campus, Marseille, France,Support Unit for Clinical Research and Economic Evaluation, Department of Clinical Research and Innovation, Assistance Publique–Hôpitaux de Marseille, Marseille, France
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Duarte Madeira L, Costa Santos J. Reconsidering the ethics of compulsive treatment in light of clinical psychiatry: A selective review of literature. F1000Res 2022; 11:219. [PMID: 36329795 PMCID: PMC9617066 DOI: 10.12688/f1000research.109555.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 11/01/2023] Open
Abstract
The ethics of compulsive treatment (CT) is a medical, social and legal discussion that reemerged after the ratification by 181 countries of the 2007 United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD). The optional protocol of the UN-CRPD was ratified by 86 countries aiming to promote, protect and ensure the full and equal enjoyment of all human rights. It also determined the need to review mental health laws as under this light treatment of persons with disabilities, particularly those with mental disorders, cannot accept the use of CT. This selective review of literature aims to clarify inputs from clinical psychiatry adding evidence to the multi-disciplinary discussion. It provides contradictory evidence on how patients experience CT and its impact on their mental health and treatment programs, also which are main reasons for the use of CT and what efforts in psychiatry have been made to reduce, replace and refine it.
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Affiliation(s)
- Luis Duarte Madeira
- Instituto de Medicina Preventiva, Faculdade de Medicina - Universidade de Lisboa, Lisboa, Lisboa, 1649-035, Portugal
- Psiquiatria, CUF Descobertas, Lisboa, 1998-018, Portugal
| | - Jorge Costa Santos
- Instituto Universitário Egas Moniz, Monte de Caparica, 2829-511, Portugal
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Duarte Madeira L, Costa Santos J. Reconsidering the ethics of compulsive treatment under the light of clinical psychiatry. F1000Res 2022; 11:219. [PMID: 36329795 PMCID: PMC9617066 DOI: 10.12688/f1000research.109555.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 11/01/2023] Open
Abstract
The ethics of compulsive treatment (CT) is a medical, social and legal discussion that reemerged after the ratification by 181 countries of the 2007 United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD). The optional protocol of the UN-CRPD was ratified by 86 countries aiming to promote, protect and ensure the full and equal enjoyment of all human rights. It also determined the need to review mental health laws as under this light treatment of persons with disabilities, particularly those with mental disorders, cannot accept the use of CT. This selective review of literature aims to clarify inputs from clinical psychiatry adding evidence to the multi-disciplinary discussion. It focuses on how patients experience CT and its impact on their mental health and treatment programs, the reasons for the use of CT versus voluntary treatment and what efforts have been made to reduce, replace and refine the presence of CT in psychiatry.
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Affiliation(s)
- Luis Duarte Madeira
- Instituto de Medicina Preventiva, Faculdade de Medicina - Universidade de Lisboa, Lisboa, Lisboa, 1649-035, Portugal
- Psiquiatria, CUF Descobertas, Lisboa, 1998-018, Portugal
| | - Jorge Costa Santos
- Instituto Universitário Egas Moniz, Monte de Caparica, 2829-511, Portugal
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Duarte Madeira L, Costa Santos J. Reconsidering the ethics of compulsive treatment in light of clinical psychiatry: A selective review of literature. F1000Res 2022; 11:219. [PMID: 36329795 PMCID: PMC9617066 DOI: 10.12688/f1000research.109555.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 11/01/2023] Open
Abstract
The ethics of compulsive treatment (CT) is a medical, social and legal discussion that reemerged after the ratification by 181 countries of the 2007 United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD). The optional protocol of the UN-CRPD was ratified by 86 countries aiming to promote, protect and ensure the full and equal enjoyment of all human rights. It also determined the need to review mental health laws as under this light treatment of persons with disabilities, particularly those with mental disorders, cannot accept the use of CT. This selective review of literature aims to clarify inputs from clinical psychiatry adding evidence to the multi-disciplinary discussion. It provides contradictory evidence on how patients experience CT and its impact on their mental health and treatment programs, also which are main reasons for the use of CT and what efforts in psychiatry have been made to reduce, replace and refine it.
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Affiliation(s)
- Luis Duarte Madeira
- Instituto de Medicina Preventiva, Faculdade de Medicina - Universidade de Lisboa, Lisboa, Lisboa, 1649-035, Portugal
- Psiquiatria, CUF Descobertas, Lisboa, 1998-018, Portugal
| | - Jorge Costa Santos
- Instituto Universitário Egas Moniz, Monte de Caparica, 2829-511, Portugal
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10
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Ting SY, Lan TH, Shen LJ, Lin CY, Lee SK, Ma WF. The Chinese Mandarin Version of the Crisis Triage Rating Scale for Taiwanese with Mental Illness to Compulsory Hospitalization. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413392. [PMID: 34949001 PMCID: PMC8707910 DOI: 10.3390/ijerph182413392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/29/2022]
Abstract
Background: A controversial issue of the need to protect human rights and ensure public safety still remains a conflict in Taiwan. The purpose of this study was to translate the Crisis Triage Rating Scale to Chinese Mandarin (CMCTRS). Method: A cross-sectional design with convenient sampling was employed in this study. The CMCTRS was tested on 302 Taiwanese individuals with mental illness who were admitted to the emergency room (ER) of a psychiatric center. A higher score indicated a greater need for mandatory psychiatric admission. Psychiatrists rated the patients’ status according to three scale criteria and six action plans of recommendations. Results: Five specialists evaluated the content validity index to be 0.8. A total of 210 participants (69.5%) were deemed suitable for compulsory hospitalization or admission for observation in ER. The optimal cut-off score was 8, with a Youden Index of 1.46, a sensitivity of 0.748, and a specificity of 0.712 in deciding the need for hospitalization or observation. Conclusions: The CMCTRS exhibited an acceptable criterion validity with psychiatrists in a population of 302 patients at the ER of a psychiatric center. A cut-off point of 8 is recommended for determining hospitalization or a minimum 24 h stay at emergency for observation.
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Affiliation(s)
- Shuo-Yen Ting
- Department of General Psychiatry, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou 54249, Taiwan; (S.-Y.T.); (T.-H.L.); (C.-Y.L.)
- School of Nursing, Asia University, Taichung 41354, Taiwan
- Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Tsuo-Hung Lan
- Department of General Psychiatry, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou 54249, Taiwan; (S.-Y.T.); (T.-H.L.); (C.-Y.L.)
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli 35053, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Lih-Jong Shen
- Department of Mental and Oral Health, Ministry of Health and Welfare, Taipei 115204, Taiwan;
| | - Chun-Yuan Lin
- Department of General Psychiatry, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou 54249, Taiwan; (S.-Y.T.); (T.-H.L.); (C.-Y.L.)
- Department of Sport, National Changhua University of Education, Taichung 41354, Taiwan
| | - Shih-Kai Lee
- Department of Nursing, Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou 54249, Taiwan;
| | - Wei-Fen Ma
- PhD Program for Health Science and Industry, China Medical University, Taichung 406040, Taiwan
- School of Nursing, China Medical University, Taichung 406040, Taiwan
- Department of Nursing, China Medical University Hospital, Taichung 404332, Taiwan
- Correspondence: ; Tel.: +886-4-22053366-7107; Fax: +886-4-22053748
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11
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Williams CA, Haffizulla F. Factors Associated With Avoidable Emergency Department Visits in Broward County, Florida. Cureus 2021; 13:e15593. [PMID: 34277214 PMCID: PMC8272918 DOI: 10.7759/cureus.15593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 11/25/2022] Open
Abstract
Background Improper utilization of emergency departments (EDs) in the United States is an issue that places a large burden on the healthcare system. Previous studies have shown that differences in race, gender, and income level have been associated with avoidable ED visits. Broward County, Florida, is diverse with people from many different socioeconomic backgrounds. The objective of this study is to determine the impact that race/ethnicity, gender, and payment methods have on the rates of avoidable ED visits at hospitals in Broward County, Florida. Methods This study utilized a dataset from the Broward Regional Health Planning Council that included ED visits in Broward County in 2019. Secondary data analysis was conducted utilizing a one-way analysis of variance (ANOVA) with post-hoc analysis to compare the proportions of non-emergent, emergent primary care-treatable, and emergent preventable ED visits amongst different race/ethnicities, genders, and payment/insurance methods. Results Compared to non-Hispanic white patients, non-Hispanic black and Hispanic patients had higher mean rates of non-emergent ED visits. Women had greater mean rates compared to men for non-emergent ED visits; males had higher mean rates than females for emergent primary care-treatable and emergent preventable. Patients covered by Medicaid had greater mean rates of non-emergent and emergent primary care-treatable visits compared to patients using other payment or insurance methods. Conclusions This study identified demographics within Broward County associated with avoidable ED visits. To reduce the burden of ED overutilization on the healthcare system, healthcare providers must better educate the at-risk populations about proper ED use. In addition, a comprehensive assessment of social determinants of health in patients overutilizing the ED will allow for better alignment of resources and policy changes to improve healthcare access and community health.
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Affiliation(s)
- Caitlin A Williams
- Emergency Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Farzanna Haffizulla
- Internal Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
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12
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Silva M, Antunes A, Azeredo-Lopes S, Loureiro A, Saraceno B, Caldas-de-Almeida JM, Cardoso G. Factors associated with involuntary psychiatric hospitalization in Portugal. Int J Ment Health Syst 2021; 15:37. [PMID: 33879207 PMCID: PMC8056508 DOI: 10.1186/s13033-021-00460-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/07/2021] [Indexed: 11/24/2022] Open
Abstract
Background Identifying which factors contribute to involuntary psychiatric hospitalization may support initiatives to reduce its frequency. This study examines the sociodemographic, clinical, and contextual factors associated with involuntary hospitalization of patients from five Portuguese psychiatric departments in 2002, 2007 and 2012. Methods Data from all admissions were extracted from clinical files. A Poisson generalized linear model estimated the association between the number of involuntary hospitalizations per patient in one year and sociodemographic, clinical, and contextual factors. Results An increment of involuntary hospitalizations was associated with male gender [exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 1.31; 95%CI 1.06–1.62, p < 0.05], having secondary and higher education [exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 1.45; 95%CI 1.05–2.01, p < 0.05, and exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 1.89; 95%CI 1.38–2.60, p < 0.001, respectively], a psychiatric diagnosis of psychosis [exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 2.02; 95%CI 1.59–2.59, p < 0.001], and being admitted in 2007 and in 2012 [exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 1.61; 95%CI 1.21–2.16, p < 0.01, and exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 1.73; 95%CI 1.31–2.32, p < 0.001, respectively]. A decrease in involuntary hospitalizations was associated with being married/cohabitating [exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 0.74; 95%CI 0.56–0.99, p < 0.05], having experienced a suicide attempt [exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 0.26; 95%CI 0.15–0.42, p < 0.001], and belonging to the catchment area of three of the psychiatric services evaluated [exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 0.65; 95%CI 0.49–0.86, p < 0.01, exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 0.67; 95%CI 0.49–0.90, p < 0.01, and exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 0.67; 95%CI 0.46–0.96, p < 0.05 for Hospital de Magalhães Lemos, Centro Hospitalar Psiquiátrico de Lisboa and Unidade Local de Saúde do Baixo Alentejo, respectively]. Conclusions The findings suggest that involuntary psychiatric hospitalizations in Portugal are associated with several sociodemographic, clinical, and contextual factors. This information may help identify high-risk patients and inform the development of better-targeted preventive interventions to reduce these hospitalizations.
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Affiliation(s)
- Manuela Silva
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal. .,Lisbon Institute of Global Mental Health, Lisbon, Portugal.
| | - Ana Antunes
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.,Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | | | - Adriana Loureiro
- Centre of Studies on Geography and Spatial Planning (CEGOT), Faculty of Arts and Humanities, Coimbra, Portugal
| | - Benedetto Saraceno
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.,Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - José Miguel Caldas-de-Almeida
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.,Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - Graça Cardoso
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.,Lisbon Institute of Global Mental Health, Lisbon, Portugal
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13
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Barbui C, Purgato M, Abdulmalik J, Caldas-de-Almeida JM, Eaton J, Gureje O, Hanlon C, Nosè M, Ostuzzi G, Saraceno B, Saxena S, Tedeschi F, Thornicroft G. Efficacy of interventions to reduce coercive treatment in mental health services: umbrella review of randomised evidence. Br J Psychiatry 2021; 218:185-195. [PMID: 32847633 DOI: 10.1192/bjp.2020.144] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Coercive treatment comprises a broad range of practices, ranging from implicit or explicit pressure to accept certain treatment to the use of forced practices such as involuntary admission, seclusion and restraint. Coercion is common in mental health services. AIMS To evaluate the strength and credibility of evidence on the efficacy of interventions to reduce coercive treatment in mental health services. Protocol registration: https://doi.org/10.17605/OSF.IO/S76T3. METHOD Systematic literature searches were conducted in MEDLINE, Cochrane Central, PsycINFO, CINAHL, Campbell Collaboration, and Epistemonikos from January 2010 to January 2020 for meta-analyses of randomised studies. Summary effects were recalculated using a common metric and random-effects models. We assessed between-study heterogeneity, predictive intervals, publication bias, small-study effects and whether the results of the observed positive studies were more than expected by chance. On the basis of these calculations, strength of associations was classified using quantitative umbrella review criteria, and credibility of evidence was assessed using the GRADE approach. RESULTS A total of 23 primary studies (19 conducted in European countries and 4 in the USA) enrolling 8554 participants were included. The evidence on the efficacy of staff training to reduce use of restraint was supported by the most robust evidence (relative risk RR = 0.74, 95% CI 0.62-0.87; suggestive association, GRADE: moderate), followed by evidence on the efficacy of shared decision-making interventions to reduce involuntary admissions of adults with severe mental illness (RR = 0.75, 95% CI 0.60-0.92; weak association, GRADE: moderate) and by the evidence on integrated care interventions (RR = 0.66, 95% CI 0.46-0.95; weak association, GRADE: low). By contrast, community treatment orders and adherence therapy had no effect on involuntary admission rates. CONCLUSIONS Different levels of evidence indicate the benefit of staff training, shared decision-making interventions and integrated care interventions to reduce coercive treatment in mental health services. These different levels of evidence should be considered in the development of policy, clinical and implementation initiatives to reduce coercive practices in mental healthcare, and should lead to further studies in both high- and low-income countries to improve the strength and credibility of the evidence base.
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Affiliation(s)
- Corrado Barbui
- Professor of Psychiatry, World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Marianna Purgato
- World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Jibril Abdulmalik
- World Health Organization Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - José Miguel Caldas-de-Almeida
- Professor of Psychiatry, Lisbon Institute of Global Mental Health, Comprehensive Health Research Centre, Nova Medical School, Nova University of Lisbon, Portugal
| | - Julian Eaton
- Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, UK; and CBM Global, Laudenbach, Germany
| | - Oye Gureje
- Professor of Psychiatry, World Health Organization Collaborating Centre for Research and Training in Mental Health, Neurosciences and Substance Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Charlotte Hanlon
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, UK; and WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University; and Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Ethiopia
| | - Michela Nosè
- World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Giovanni Ostuzzi
- World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Benedetto Saraceno
- Lisbon Institute of Global Mental Health, Comprehensive Health Research Centre, Nova Medical School, Nova University of Lisbon, Portugal
| | - Shekhar Saxena
- Professor of the Practice of Global Mental Health, Global Health and Population, Harvard TH Chan School of Public Health, Boston, USA
| | - Federico Tedeschi
- World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy
| | - Graham Thornicroft
- Professor of Psychiatry, Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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14
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Morandi S, Silva B, Mendez Rubio M, Bonsack C, Golay P. Mental health professionals' feelings and attitudes towards coercion. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2021; 74:101665. [PMID: 33401095 DOI: 10.1016/j.ijlp.2020.101665] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Despite absence of clear evidence to assert that the use of coercion in psychiatry is practically and clinically helpful or effective, coercive measures are widely used. Current practices seem to be based on institutional cultures and decision-makers' attitudes towards coercion rather than led by recommendations issued from the scientific literature. Therefore, the main goal of our study was to describe mental health professionals' feelings and attitudes towards coercion and the professionals' characteristics associated with them. METHOD Mental health professionals working in the Department of Psychiatry of Lausanne University Hospital, Switzerland, were invited to participate to an online survey. A questionnaire explored participants' sociodemographic characteristics, professional background and current working context, and their feelings and attitudes towards coercion. Exploratory Structural Equation Modelling (ESEM) was used to determine the structure of mental health professionals' feelings and attitudes towards coercion and to estimate to which extent sociodemographic and professional characteristics could predict their underlying dimensions. RESULTS 130 mental health professionals completed the survey. Even if a large number considered coercion a violation of fundamental rights, an important percentage of them agreed that coercion was nevertheless indispensable in psychiatry and beneficial to the patients. ESEM revealed that professionals' feelings and attitudes towards coercion could be described by four main dimensions labelled "Internal pressure", "Emotional impact", "External pressure" and "Relational involvement". The personal as well as the professional proximity with people suffering from mental disorders influences professionals' feeling and attitudes towards coercion. CONCLUSIONS As voices recommend the end of coercion in psychiatry and despite the lack of scientific evidence, many mental health professionals remain convinced that it is a requisite tool beneficial to the patients. Clinical approaches that enhance shared decision making and give the opportunity to patients and professionals to share their experience and feelings towards coercion and thus alleviate stress among them should be fostered and developed.
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Affiliation(s)
- Stéphane Morandi
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland; Cantonal Medical Office, Public Health Service of Canton Vaud, Department of Health and Social Action (DSAS), Avenue des Casernes 2, 1014 Lausanne, Switzerland..
| | - Benedetta Silva
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland; Cantonal Medical Office, Public Health Service of Canton Vaud, Department of Health and Social Action (DSAS), Avenue des Casernes 2, 1014 Lausanne, Switzerland
| | - Monserrat Mendez Rubio
- Service Universitaire de Psychiatrie de l'Âge Avancé, Lausanne University Hospital and University of Lausanne, 1008 Prilly, Switzerland
| | - Charles Bonsack
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland
| | - Philippe Golay
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Place Chauderon 18, 1003 Lausanne, Switzerland
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15
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Cresswell-Smith J, Donisi V, Rabbi L, Sfetcu R, Šprah L, Straßmayr C, Wahlbeck K, Ådnanes M. 'If we would change things outside we wouldn't even need to go in…' supporting recovery via community-based actions: A focus group study on psychiatric rehospitalization. Health Expect 2020; 24 Suppl 1:174-184. [PMID: 32909367 PMCID: PMC8137487 DOI: 10.1111/hex.13125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 06/29/2020] [Accepted: 07/28/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Psychiatric rehospitalization is a complex phenomenon in need of more person-centred approaches. The current paper aimed to explore how community-based actions and daily life influence mental health and rehospitalization. DESIGN, SETTING AND PARTICIPANTS The qualitative study included focus group data from six European countries including 59 participants. Data were thematically analysed following an inductive approach deriving themes and subthemes in relation to facilitators and barriers to mental health. RESULTS Barriers consisted of subthemes (financial difficulty, challenging family circumstances and stigma), and facilitators consisted of three subthemes (complementing services, signposting and recovery). The recovery subtheme consisted of a further five categories (family and friends, work and recreation, hope, using mental health experience and meaning). DISCUSSION Barriers to mental health largely related to social determinants of mental health, which may also have implications for psychiatric rehospitalization. Facilitators included community-based actions and aspects of daily life with ties to personal recovery. By articulating the value of these facilitators, we highlight benefits of a person-centred and recovery-focused approach also within the context of psychiatric rehospitalization. CONCLUSIONS This paper portrays how person-centred approaches and day-to-day community actions may impact psychiatric rehospitalization via barriers and facilitators, acknowledging the social determinants of mental health and personal recovery. PATIENT OR PUBLIC CONTRIBUTION The current study included participants with experience of psychiatric rehospitalization from six different European countries. Furthermore, transcripts were read by several of the focus group participants, and a service user representative participated in the entire research process in the original study.
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Affiliation(s)
| | - Valeria Donisi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Laura Rabbi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Raluca Sfetcu
- National School of Public Health, Management and Professional Development, Bucharest, Romania.,Faculty of Psychology and Educational Sciences, SHU Bucharest, Bucharest, Romania
| | - Lilijana Šprah
- Research Centre of the Slovenian Academy of Sciences and Arts, Sociomedical Institute, Ljubljana, Slovenia
| | - Christa Straßmayr
- IMEHPS.research - Forschungsinstitut für Sozialpsychiatrie, Vienna, Austria
| | - Kristian Wahlbeck
- Finnish Institute for Health and Welfare (THL), Mental Health Unit, Helsinki, Finland
| | - Marian Ådnanes
- Department of Health Research, SINTEF Digital, Trondheim, Norway
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16
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Gibbon S, Khalifa NR, Cheung NHY, Völlm BA, McCarthy L. Psychological interventions for antisocial personality disorder. Cochrane Database Syst Rev 2020; 9:CD007668. [PMID: 32880104 PMCID: PMC8094166 DOI: 10.1002/14651858.cd007668.pub3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Antisocial personality disorder (AsPD) is associated with poor mental health, criminality, substance use and relationship difficulties. This review updates Gibbon 2010 (previous version of the review). OBJECTIVES To evaluate the potential benefits and adverse effects of psychological interventions for adults with AsPD. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, 13 other databases and two trials registers up to 5 September 2019. We also searched reference lists and contacted study authors to identify studies. SELECTION CRITERIA Randomised controlled trials of adults, where participants with an AsPD or dissocial personality disorder diagnosis comprised at least 75% of the sample randomly allocated to receive a psychological intervention, treatment-as-usual (TAU), waiting list or no treatment. The primary outcomes were aggression, reconviction, global state/functioning, social functioning and adverse events. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS This review includes 19 studies (eight new to this update), comparing a psychological intervention against TAU (also called 'standard Maintenance'(SM) in some studies). Eight of the 18 psychological interventions reported data on our primary outcomes. Four studies focussed exclusively on participants with AsPD, and 15 on subgroups of participants with AsPD. Data were available from only 10 studies involving 605 participants. Eight studies were conducted in the UK and North America, and one each in Iran, Denmark and the Netherlands. Study duration ranged from 4 to 156 weeks (median = 26 weeks). Most participants (75%) were male; the mean age was 35.5 years. Eleven studies (58%) were funded by research councils. Risk of bias was high for 13% of criteria, unclear for 54% and low for 33%. Cognitive behaviour therapy (CBT) + TAU versus TAU One study (52 participants) found no evidence of a difference between CBT + TAU and TAU for physical aggression (odds ratio (OR) 0.92, 95% CI 0.28 to 3.07; low-certainty evidence) for outpatients at 12 months post-intervention. One study (39 participants) found no evidence of a difference between CBT + TAU and TAU for social functioning (mean difference (MD) -1.60 points, 95% CI -5.21 to 2.01; very low-certainty evidence), measured by the Social Functioning Questionnaire (SFQ; range = 0-24), for outpatients at 12 months post-intervention. Impulsive lifestyle counselling (ILC) + TAU versus TAU One study (118 participants) found no evidence of a difference between ILC + TAU and TAU for trait aggression (assessed with Buss-Perry Aggression Questionnaire-Short Form) for outpatients at nine months (MD 0.07, CI -0.35 to 0.49; very low-certainty evidence). One study (142 participants) found no evidence of a difference between ILC + TAU and TAU alone for the adverse event of death (OR 0.40, 95% CI 0.04 to 4.54; very low-certainty evidence) or incarceration (OR 0.70, 95% CI 0.27 to 1.86; very low-certainty evidence) for outpatients between three and nine months follow-up. Contingency management (CM) + SM versus SM One study (83 participants) found evidence that, compared to SM alone, CM + SM may improve social functioning measured by family/social scores on the Addiction Severity Index (ASI; range = 0 (no problems) to 1 (severe problems); MD -0.08, 95% CI -0.14 to -0.02; low-certainty evidence) for outpatients at six months. 'Driving whilst intoxicated' programme (DWI) + incarceration versus incarceration One study (52 participants) found no evidence of a difference between DWI + incarceration and incarceration alone on reconviction rates (hazard ratio 0.56, CI -0.19 to 1.31; very low-certainty evidence) for prisoner participants at 24 months. Schema therapy (ST) versus TAU One study (30 participants in a secure psychiatric hospital, 87% had AsPD diagnosis) found no evidence of a difference between ST and TAU for the number of participants who were reconvicted (OR 2.81, 95% CI 0.11 to 74.56, P = 0.54) at three years. The same study found that ST may be more likely to improve social functioning (assessed by the mean number of days until patients gain unsupervised leave (MD -137.33, 95% CI -271.31 to -3.35) compared to TAU, and no evidence of a difference between the groups for overall adverse events, classified as the number of people experiencing a global negative outcome over a three-year period (OR 0.42, 95% CI 0.08 to 2.19). The certainty of the evidence for all outcomes was very low. Social problem-solving (SPS) + psychoeducation (PE) versus TAU One study (17 participants) found no evidence of a difference between SPS + PE and TAU for participants' level of social functioning (MD -1.60 points, 95% CI -5.43 to 2.23; very low-certainty evidence) assessed with the SFQ at six months post-intervention. Dialectical behaviour therapy versus TAU One study (skewed data, 14 participants) provided very low-certainty, narrative evidence that DBT may reduce the number of self-harm days for outpatients at two months post-intervention compared to TAU. Psychosocial risk management (PSRM; 'Resettle') versus TAU One study (skewed data, 35 participants) found no evidence of a difference between PSRM and TAU for a number of officially recorded offences at one year after release from prison. It also found no evidence of difference between the PSRM and TAU for the adverse event of death during the study period (OR 0.89, 95% CI 0.05 to 14.83, P = 0.94, 72 participants (90% had AsPD), 1 study, very low-certainty evidence). AUTHORS' CONCLUSIONS There is very limited evidence available on psychological interventions for adults with AsPD. Few interventions addressed the primary outcomes of this review and, of the eight that did, only three (CM + SM, ST and DBT) showed evidence that the intervention may be more effective than the control condition. No intervention reported compelling evidence of change in antisocial behaviour. Overall, the certainty of the evidence was low or very low, meaning that we have little confidence in the effect estimates reported. The conclusions of this update have not changed from those of the original review, despite the addition of eight new studies. This highlights the ongoing need for further methodologically rigorous studies to yield further data to guide the development and application of psychological interventions for AsPD and may suggest that a new approach is required.
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Affiliation(s)
- Simon Gibbon
- Arnold Lodge, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK
| | - Najat R Khalifa
- Department of Psychiatry, Queen's University, Kingston, Canada
| | - Natalie H-Y Cheung
- Forensic Research, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK
| | - Birgit A Völlm
- Department of Forensic Psychiatry, Center for Neurology, University Rostock, Rostock, Germany
| | - Lucy McCarthy
- Arnold Lodge, Nottinghamshire Healthcare NHS Foundation Trust, Leicester, UK
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17
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Tinland A, Leclerc L, Loubière S, Mougeot F, Greacen T, Pontier M, Franck N, Lançon C, Boucekine M, Auquier P. Psychiatric advance directives for people living with schizophrenia, bipolar I disorders, or schizoaffective disorders: Study protocol for a randomized controlled trial - DAiP study. BMC Psychiatry 2019; 19:422. [PMID: 31881954 PMCID: PMC6935101 DOI: 10.1186/s12888-019-2416-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/17/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Compulsory admission to psychiatric hospital is rising despite serious ethical concerns. Among measures to reduce compulsory admissions, Psychiatric Advance Directives (PAD) are the most promising, with intensive PAD (i.e. facilitated and shared) being the most effective. The aim of the study is to experiment Psychiatric Advance Directives in France. METHODS A multicentre randomized controlled trial and qualitative approach conducted from January 2019 to January 2021 with intent-to-treat analysis. SETTING Seven hospitals in three French cities: Lyon, Marseille, and Paris. Research assistants meet each participant at baseline, 6 months and 12 months after inclusion for face-to-face interviews. PARTICIPANTS 400 persons with a DSM-5 diagnosis of bipolar I disorder (BP1), schizophrenia (SCZ), or schizoaffective disorders (SCZaff), compulsorily admitted to hospital within the last 12 months, with capacity to consent (MacCAT-CR), over 18 years old, and able to understand French. INTERVENTIONS The experimental group (PAD) (expected n = 200) is invited to fill in a document describing their crisis plan and their wishes in case of loss of mental capacity. Participants meet a facilitator, who is a peer support worker specially trained to help them. They are invited to nominate a healthcare agent, and to share the document with them, as well as with their psychiatrist. The Usual Care (UC) group (expected n = 200) receives routine care. MAIN OUTCOMES AND MEASURES The primary outcome is the rate of compulsory admissions to hospital during the 12-month follow-up. Secondary outcomes include quality of life (S-QoL18), satisfaction (CSQ8), therapeutic alliance (4-PAS), mental health symptoms (MCSI), awareness of disorders (SUMD), severity of disease (ICG), empowerment (ES), recovery (RAS), and overall costs. DISCUSSION Implication of peer support workers in PAD, potential barriers of supported-decision making, methodological issues of evaluating complex interventions, evidence-based policy making, and the importance of qualitative evaluation in the context of constraint are discussed. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03630822. Registered 14th August 2018.
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Affiliation(s)
- Aurélie Tinland
- School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Aix-Marseille University, 27 Boulevard Jean Moulin, F-13005, Marseille Cedex 5, France.
- Department of Psychiatry, Sainte-Marguerite University Hospital, F-13009, Marseille, France.
| | - Léa Leclerc
- School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Aix-Marseille University, 27 Boulevard Jean Moulin, F-13005, Marseille Cedex 5, France
- Department of Psychiatry, Sainte-Marguerite University Hospital, F-13009, Marseille, France
| | - Sandrine Loubière
- School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Aix-Marseille University, 27 Boulevard Jean Moulin, F-13005, Marseille Cedex 5, France
- Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Assistance Publique - Hôpitaux de Marseille, F-13385, Marseille, France
| | - Frederic Mougeot
- Centre Max Weber, UMR 5283 - Centre hospitalier Le Vinatier, Lyon, France
| | - Tim Greacen
- Mental Health and Social Sciences Research Unit, Paris Psychiatry and Neurosciences University Hospital Group, Paris, France
| | - Magali Pontier
- Department of Psychiatry, Sainte-Marguerite University Hospital, F-13009, Marseille, France
| | - Nicolas Franck
- Resource center of psychosocial rehabilitation, Centre hospitalier Le Vinatier, UMR 5229, CNRS & Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Christophe Lançon
- School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Aix-Marseille University, 27 Boulevard Jean Moulin, F-13005, Marseille Cedex 5, France
- Department of Psychiatry, Sainte-Marguerite University Hospital, F-13009, Marseille, France
| | - Mohamed Boucekine
- School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Aix-Marseille University, 27 Boulevard Jean Moulin, F-13005, Marseille Cedex 5, France
- Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Assistance Publique - Hôpitaux de Marseille, F-13385, Marseille, France
| | - Pascal Auquier
- School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Aix-Marseille University, 27 Boulevard Jean Moulin, F-13005, Marseille Cedex 5, France
- Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Assistance Publique - Hôpitaux de Marseille, F-13385, Marseille, France
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Affiliation(s)
- Wulf Rössler
- Department of Psychiatry and PsychotherapyCharité‐Universitätsmedizin BerlinBerlinGermany,Psychiatric University HospitalUniversity of ZurichZurichSwitzerland,Institute of PsychiatryUniversity of São PauloSão PauloBrazil
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What can clinicians do to improve outcomes across psychiatric treatments: a conceptual review of non-specific components. Epidemiol Psychiatr Sci 2019; 29:e48. [PMID: 31412975 PMCID: PMC8061300 DOI: 10.1017/s2045796019000428] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS Psychiatric treatments have specific and non-specific components. The latter has been addressed in an extensive literature on the placebo-effect in pharmacology and on common factors in psychotherapy. In the practice of mental health care, pharmacological, psychotherapeutic and social treatments are combined in complex interventions. This paper aims to review non-specific components across diverse psychiatric treatments and consider implications for practice and research. METHODS We conducted a non-systematic review of non-specific components across psychiatric treatments, their impact on treatment processes and outcomes, and interventions to improve them. RESULTS The identified research is heterogeneous, both in design and quality. All non-specific components capture aspects of how clinicians communicate with patients. They are grouped into general verbal communication - focusing on initial contacts, empathy, clarity of communication, and detecting cues about unspoken concerns - non-verbal communication, the framing of treatments and decision-making. The evidence is stronger for the impact of these components on process measures - i.e. therapeutic relationship, treatment satisfaction and adherence than on clinical outcomes - i.e. symptoms and relapse. A small number of trials suggest that brief training courses and simple methods for structuring parts of clinical consultations can improve communication and subsequently clinical outcomes. CONCLUSIONS Methodologically, rigorous research advancing current understandings of non-specific components may increase effectiveness across different treatments, potentially benefitting large numbers of patients. Brief training for clinicians and structuring clinical communication should be used more widely in practice.
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Burn E, Conneely M, Leverton M, Giacco D. Giving Patients Choices During Involuntary Admission: A New Intervention. Front Psychiatry 2019; 10:433. [PMID: 31333510 PMCID: PMC6620234 DOI: 10.3389/fpsyt.2019.00433] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/03/2019] [Indexed: 12/15/2022] Open
Abstract
Background: People who receive involuntary treatment are some of the most vulnerable in psychiatric services. They are more likely to have poorer social and clinical outcomes and to be disillusioned with and disengaged from care. Research indicates that patients' experience in the first week of involuntary treatment is a critical period: a better experience of care in the first week predicts better quality of life and reduced readmission 1 year later. Patients have identified involvement in clinical decisions as key to improving their experience of care. The aim of this study was to test the feasibility and acceptability of an intervention to facilitate involvement in decision making for involuntary inpatients called OPeNS (Options, Preferences, Negotiate, and Summarise). Methods: This was a mixed method study. The OPeNS intervention was developed based on previous research carried out by a multidisciplinary team. Clinicians were trained to deliver it to involuntary inpatients. Feasibility indices (rates of participation in the intervention and time required to deliver it) were collected. Patients (N = 14) and clinicians (N = 5) provided qualitative data on their experience of the intervention in semi-structured interviews which were analysed using thematic analysis. Results: The OPeNS intervention was found to be acceptable by both patients and clinicians and feasible to conduct within the first week of involuntary treatment. Patients' and clinicians' experiences of the intervention fall into two themes: 'Enabling a different dynamic' and 'Clashing with usual practices and priorities'. Conclusion: The OPeNS intervention provides a structure that can be used by clinicians across disciplines to facilitate involving involuntary patients in decision making. Although challenges related to changing usual practices were identified, the intervention was received positively and was feasible to conduct in the first week of involuntary treatment.
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Affiliation(s)
- Erin Burn
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom
| | - Maev Conneely
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom
| | - Monica Leverton
- Division of Psychiatry, University College London, London, United Kingdom
| | - Domenico Giacco
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom
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21
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Molyneaux E, Turner A, Candy B, Landau S, Johnson S, Lloyd-Evans B. Crisis-planning interventions for people with psychotic illness or bipolar disorder: systematic review and meta-analyses. BJPsych Open 2019; 5:e53. [PMID: 31530302 PMCID: PMC6582216 DOI: 10.1192/bjo.2019.28] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Mental health services lack a strong evidence base on the most effective interventions to reduce compulsory admissions. However, some research suggests a positive impact of crisis-planning interventions in which patients are involved in planning for their future care during a mental health crisis. AIMS This review aimed to synthesise randomised controlled trial (RCT) evidence on the effectiveness of crisis-planning interventions (for example advance statements and joint crisis plans) in reducing rates of compulsory hospital admissions for people with psychotic illness or bipolar disorder, compared with usual care (PROSPERO registration number: CRD42018084808). METHOD Six online databases were searched in October 2018. The primary outcome was compulsory psychiatric admissions and secondary outcomes included other psychiatric admissions, therapeutic alliance, perceived coercion and cost-effectiveness. Bias was assessed using the Cochrane collaboration tool. RESULTS The search identified 1428 studies and 5 RCTs were eligible. One study had high risk of bias because of incomplete primary outcome data. Random-effects meta-analysis showed a 25% reduction in compulsory admissions for those receiving crisis-planning interventions compared with usual care (risk ratio 0.75, 95% CI 0.61-0.93, P = 0.008; from five studies). There was no statistical evidence that the intervention reduced the risk of voluntary or combined voluntary and compulsory psychiatric admissions. Few studies assessed other secondary outcomes. CONCLUSIONS Our meta-analysis suggests that crisis-planning interventions substantially reduce the risk of compulsory admissions among individuals with psychotic illness or bipolar disorder. Despite common components, interventions varied in their content and intensity across the trials. The optimal models and implementation of these interventions require further investigation. DECLARATION OF INTEREST E.M., S.L., S.J. and B.L.-E. received funding from the National Institute for Health Research during the conduct of the study.
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Affiliation(s)
- Emma Molyneaux
- Research Associate, NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Amelia Turner
- Trainee Clinical Psychologist, Camden and Islington NHS Foundation Trust & Royal Holloway, University of London, UK
| | - Bridget Candy
- Principal Research Associate, Division of Psychiatry, University College London, UK
| | - Sabine Landau
- Professor of Biostatistics, Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Sonia Johnson
- Professor of Social and Community Psychiatry, NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
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22
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Bone JK, McCloud T, Scott HR, Machin K, Markham S, Persaud K, Johnson S, Lloyd-Evans B. Psychosocial Interventions to Reduce Compulsory Psychiatric Admissions: A Rapid Evidence Synthesis. EClinicalMedicine 2019; 10:58-67. [PMID: 31193820 PMCID: PMC6543173 DOI: 10.1016/j.eclinm.2019.03.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/18/2019] [Accepted: 03/28/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Compulsory mental health hospital admissions are increasing in several European countries but are coercive and potentially distressing. It is important to identify which mental health service models and interventions are effective in reducing compulsory admissions. METHODS We conducted a rapid evidence synthesis to explore whether there is any evidence for an effect on compulsory admissions for 15 types of psychosocial intervention, identified by an expert group as potentially relevant to reducing compulsory admission. A search for randomised controlled trials (RCTs) reporting compulsory admission as a primary or secondary outcome or adverse event was carried out using clinical guidelines, recent systematic reviews, and database searches postdating these reviews. FINDINGS We found 949 RCTs reporting on the interventions of interest, of which 19 reported on compulsory admission. Our narrative synthesis found some evidence for the effectiveness of crisis planning and self-management, while evidence for early intervention services was mixed. We did not find evidence to support adherence therapy, care from crisis resolution teams and assertive community treatment, but numbers of relevant studies were very small. We found no trials which tested effects on compulsory admission of the nine other intervention types. INTERPRETATION Crisis planning and self-management interventions with a relapse prevention element are most promising for preventing compulsory admissions. Given our broad search strategy, the lack of evidence demonstrates that there is an urgent need for more research on interventions which may reduce compulsory admissions. FUNDING Independent research commissioned and funded by the National Institute for Health Research Policy Research Programme.
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Affiliation(s)
- Jessica K. Bone
- Division of Psychiatry, University College London, London, UK
- NIHR Mental Health Policy Research Unit, University College London, London, UK
| | - Tayla McCloud
- Division of Psychiatry, University College London, London, UK
- NIHR Mental Health Policy Research Unit, University College London, London, UK
| | - Hannah R. Scott
- Division of Psychiatry, University College London, London, UK
- NIHR Mental Health Policy Research Unit, University College London, London, UK
| | - Karen Machin
- NIHR Mental Health Policy Research Unit, University College London, London, UK
| | - Sarah Markham
- NIHR Mental Health Policy Research Unit, University College London, London, UK
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Karen Persaud
- NIHR Mental Health Policy Research Unit, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK
- NIHR Mental Health Policy Research Unit, University College London, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Brynmor Lloyd-Evans
- Division of Psychiatry, University College London, London, UK
- NIHR Mental Health Policy Research Unit, University College London, London, UK
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23
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Lay B, Kawohl W, Rössler W. Predictors of Compulsory Re-admission to Psychiatric Inpatient Care. Front Psychiatry 2019; 10:120. [PMID: 30949072 PMCID: PMC6437043 DOI: 10.3389/fpsyt.2019.00120] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 02/18/2019] [Indexed: 11/20/2022] Open
Abstract
Objective: This prospective study addresses risk factors of compulsory re-admission focusing on the role of the patient's subjective symptom distress and perceived social support, based on comprehensive patient and external (clinicians, study staff) assessments. Methods: Of the baseline sample, 168 (71%) patients with serious mental disorders, who had been compulsorily admitted to psychiatric inpatient care, were followed over 24 months after discharge within the framework of a RCT. Results: During this time 36% had compulsory re-admissions; risk was highest immediately after discharge. Regression models identified a history of previous compulsory hospitalisations and compulsory admission due to endangerment of others as the predictors most strongly associated with the outcome. Patients diagnosed with a psychotic disorder or an emotionally instable or combined personality disorder were most likely to experience compulsory re-hospitalisation, with poor response to treatment further significantly increasing the risk. The patient ratings of subjective symptom distress or perceived social support had no predictive value for compulsory re-admission, and this study did not provide evidence for a significant prognostic relevance of sociodemographic background factors. Conclusions: The present findings suggest that within individual-level variables disease-related factors are essentially the strongest predictors, but including the patients' subjective perspective does not enhance the prediction of compulsory re-hospitalisation. The psychiatric treatment of patients with recurrent and often challenging behavioural problems, at the more severe end of the spectrum of mental disorders, deserves closer attention if the use of compulsory hospitalisation is to be reduced.
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Affiliation(s)
- Barbara Lay
- Klinik für Psychiatrie und Psychotherapie, Psychiatrische Dienste Aargau AG, Windisch, Switzerland
| | - Wolfram Kawohl
- Klinik für Psychiatrie und Psychotherapie, Psychiatrische Dienste Aargau AG, Windisch, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Wulf Rössler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland.,Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
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24
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Hegedüs A, Kozel B, Richter D, Behrens J. Effectiveness of Transitional Interventions in Improving Patient Outcomes and Service Use After Discharge From Psychiatric Inpatient Care: A Systematic Review and Meta-Analysis. Front Psychiatry 2019; 10:969. [PMID: 32038320 PMCID: PMC6985781 DOI: 10.3389/fpsyt.2019.00969] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/09/2019] [Indexed: 12/28/2022] Open
Abstract
Background: The transition from psychiatric hospital to community is often hindered by challenges that influence community adjustment and continuity of care. Transitional interventions with bridging components are provided prior to discharge and continue beyond inpatient care. They provide continuity of care and may be effective in preventing readmission. We aimed to assess the effectiveness of transitional interventions with predischarge and postdischarge components in reducing readmissions and improving health-related or social outcomes of patients discharged from psychiatric hospitals. Methods: We conducted a systematic review by searching electronic databases (MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, and Psyndex) and included randomized, nonrandomized, and one-group study designs. A random effects meta-analysis was conducted with randomized controlled trials (RCTs) reporting data on readmission rates. Other study designs were synthesized qualitatively. Results: After screening 2,673 publications, 16 studies (10 RCTs, three quasi-experimental, and three cohort studies) were included and nine RCTs were included in the meta-analysis. The tested interventions included components from case management, psychoeducation, cognitive behavioral therapy, and peer support. All studies with significant improvements in at least one outcome provided elements of case management, most frequently in combination with cognitive behavioral therapy and psychoeducation. Readmission rates during follow-up ranged between 13% and 63% in intervention groups and 19% and 69% in control groups. Overall, we found an odds ratio of 0.76 (95% confidence interval = 0.55-1.05) for readmission due to transitional interventions. Heterogeneity was low at only 31% (p = 0.17) and the funnel plot indicated no obvious publication biases. Conclusions: We observed that transitional interventions with bridging components were no more effective in reducing readmission than treatment as usual; however, these results are based on limited evidence. Therefore, additional high-quality research is required to conclude the effectiveness of transitional interventions. Nevertheless, transitional interventions with bridging components are preferred by service users and could be an alternative to strategies regularly employed.
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Affiliation(s)
- Anna Hegedüs
- Research Institute, Careum School of Health Ltd., Zurich, Switzerland.,International Graduate Academy (InGrA), "Participation as Goal of Nursing and Therapy", Faculty of Medicine, Institute of Health and Nursing Sciences, Martin-Luther-University Halle-Wittenberg, Halle-Wittenberg, Germany
| | - Bernd Kozel
- International Graduate Academy (InGrA), "Participation as Goal of Nursing and Therapy", Faculty of Medicine, Institute of Health and Nursing Sciences, Martin-Luther-University Halle-Wittenberg, Halle-Wittenberg, Germany.,Department of Clinical Nursing Science, University Psychiatric Hospital of Bern, Bern, Switzerland
| | - Dirk Richter
- Centre for Psychiatric Rehabilitation, University Psychiatric Hospital of Bern, Bern, Switzerland.,Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Johann Behrens
- Faculty of Medicine, Institute of Health and Nursing Sciences, Martin-Luther-University Halle-Wittenberg, Halle-Wittenberg, Germany.,Frankfurt Institute of Supervision, Institutional Analysis and Social Research (ISIS non profit e.V.), Frankfurt, Germany
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25
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Silva B, Golay P, Morandi S. Factors associated with involuntary hospitalisation for psychiatric patients in Switzerland: a retrospective study. BMC Psychiatry 2018; 18:401. [PMID: 30594163 PMCID: PMC6311042 DOI: 10.1186/s12888-018-1966-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the scarce evidence for patients' benefits of coercion and its well-documented negative effects, the use of compulsion is still very common around Europe, with important variations among different countries. These variations have been partially explained by the different legal frameworks, but also by several individual-related, system-related and area-related characteristics, identified as predictors of the use of coercive measures. This study aimed to compare the socio-demographic and clinical profile as well as the referral and hospitalisation process of people voluntarily and involuntarily hospitalized in order to identify which factors could be associated with the use of coercion. METHODS All psychiatric admissions occurred between the 1st January 2015 and the 31st December 2015 were included in this retrospective study (n = 5027). The whole sample was split into two subgroups accordingly to the hospitalisation legal status at admission (voluntary vs involuntary) and differences between the two groups were examined. In order to identify the factors associated with coercion, all the variables reaching a p < .01 level of significance when comparing the two groups were included as independent variables into a multivariate logistic regression model. RESULTS Globally, 62% of the admissions were voluntary and 38% were involuntary. Compared to the voluntary group, involuntary patients were significantly older, more frequently widowed and living in one specific district, and had a main diagnosis of schizophrenia (F20-F29) or organic mental disorders (F00-F09). People affected by organic mental disorders (F00-F09), with higher levels of psychotic symptoms, aggression and problems with medication adherence, were more likely to be involuntarily admitted. Moreover, living in District 1, being referred by a general practitioner, a general hospital or a psychiatric hospital and being involuntarily admitted during the previous 12 months, was associated with a higher risk of coercion. CONCLUSIONS This study identified several individual-related, as well as system-related factors associated with the use of coercion. These results allowed us to trace a clearer profile of high-risk patients and to provide several inputs that could help local authorities, professionals and researchers to develop better-targeted alternative interventions reducing the use of coercion.
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Affiliation(s)
- Benedetta Silva
- Social Psychiatry Section, Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland.
| | - Philippe Golay
- Social Psychiatry Section, Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland
| | - Stéphane Morandi
- Social Psychiatry Section, Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland
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Bainbridge E, Hallahan B, McGuinness D, Gunning P, Newell J, Higgins A, Murphy K, McDonald C. Predictors of involuntary patients' satisfaction with care: prospective study. BJPsych Open 2018; 4:492-500. [PMID: 30564445 PMCID: PMC6293452 DOI: 10.1192/bjo.2018.65] [Citation(s) in RCA: 6] [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: 12/20/2017] [Revised: 09/12/2018] [Accepted: 10/07/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Involuntary admission can be traumatic and is associated with negative attitudes that persist after the episode of illness has abated. AIMS We aimed to prospectively assess satisfaction with care at the points of involuntary admission and symptomatic recovery, and identify their sociodemographic, clinical and service experience predictors. METHOD Levels of satisfaction with care, and clinical and sociodemographic variables were obtained from a representative cohort of 263 patients at the point of involuntary admission and from 155 of these patients 3 months after termination of the involuntary admission. Data were analysed with multiple linear regression modelling. RESULTS Higher baseline awareness of illness (B = 0.19, P < 0.001) and older age (B = 0.05, P = 0.001) were associated with more satisfaction with care at baseline and follow-up. Transition to greater satisfaction with care was associated with improvements in awareness of illness (B = 0.13, P < 0.001) and in symptoms (B = 0.05, P = 0.02), as well as older age (B = 0.04, P = 0.01). Objective coercive experiences were not associated with variation in satisfaction with care. CONCLUSIONS There is wide variation in satisfaction with coercive care. Greater satisfaction with care is positively associated with clinical variables such as increased awareness of illness. DECLARATION OF INTEREST None.
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Affiliation(s)
- Emma Bainbridge
- Honorary Clinical Fellow, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Ireland
| | - Brian Hallahan
- Senior Lecturer in Psychiatry, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Ireland
| | - David McGuinness
- Research Nurse, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Ireland
| | - Patricia Gunning
- Clinical Research Biostatistician, HRB Clinical Research Facility, National University of Ireland Galway, Ireland
| | - John Newell
- Professor of Biostatistics, HRB Clinical Research Facility, National University of Ireland Galway and School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, Ireland
| | - Agnes Higgins
- Professor in Mental Health, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Kathy Murphy
- Professor of Nursing, School of Nursing and Midwifery, National University of Ireland Galway, Ireland
| | - Colm McDonald
- Professor of Psychiatry, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway and HRB Clinical Research Facility, National University of Ireland Galway, Ireland
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