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Feeling coerced during voluntary and involuntary psychiatric hospitalisation: A review and meta-aggregation of qualitative studies. Heliyon 2023; 9:e13420. [PMID: 36820044 PMCID: PMC9937983 DOI: 10.1016/j.heliyon.2023.e13420] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/19/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Objective This review aimed to provide an aggregative synthesis of the qualitative evidence on patients' experienced coercion during voluntary and involuntary psychiatric hospitalisation. Design A qualitative review. Data sources The search was conducted, in five bibliographic databases: Embase.com, Ovid MEDLINE(R) ALL, APA PsycINFO Ovid, Web of Science Core Collection and the Cochrane Database of Systematic Reviews. Review methods Following the Joanna Briggs Institute approach, a systematized procedure was applied throughout the review process, from data search to synthesis of results. The reporting of this review was guided by the standards of the PRISMA 2020 statement. The quality of the included studies was critically appraised by two independent reviewers using the JBI Critical Appraisal Checklist. Included findings were synthesized using meta-aggregation. Confidence in the review findings was assessed following the Confidence in the Output of Qualitative research synthesis (ConQual) approach. Results A total of 423 studies were identified through the literature search and 26 were included in the meta-aggregation. Totally, 151 findings were extracted and aggregated into 27 categories and 7 synthesized findings. The synthesized findings focused on: the patients' experience of the hospitalisation and the associated feeling of coercion; the factors affecting this feeling, such as the involvement in the decision-making process, the relationships with the staff and the perception of the hospital treatment as effective and safe; the coping strategies adopted to deal with it and the patients' suggestions for alternatives. All synthesized findings reached an overall confidence score of "moderate". The seven findings were downgraded one level due to dependability limitations of the included studies. Conclusion Based on these findings, seven recommendations for clinical practice where developed, such as fostering care ethics, promoting patients' voice and shared decision-making, and enhancing patients' perceived closeness, respect and fairness. Five recommendations for future research were also prompted, for instance improving the methodological quality and cultural variation of future qualitative studies, and exploring the psychosocial impact of experienced coercion on patients. For these recommendations to be effectively implemented, a profound change in the structure and culture of the mental health system should be promoted. The involvement of patients in the design, development and scientific evaluation of this change is strongly recommended.
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Kidd IJ, Spencer L, Carel H. Epistemic injustice in psychiatric research and practice. PHILOSOPHICAL PSYCHOLOGY 2022. [DOI: 10.1080/09515089.2022.2156333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Ian James Kidd
- Department of Philosophy, University of Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Lucienne Spencer
- Institute of Mental Health, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland
| | - Havi Carel
- Department of Philosophy, University of Bristol, Bristol, United Kingdom of Great Britain and Northern Ireland
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Pariseau-Legault P, Vallée-Ouimet S, Jacob JD, Goulet MH. Intégration des droits humains dans la pratique du personnel infirmier faisant usage de coercition en santé mentale : recension systématique des écrits et méta-ethnographie. Rech Soins Infirm 2021:53-76. [PMID: 33319718 DOI: 10.3917/rsi.142.0053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction and background : The last decade has seen a steady and rising use of coercion in mental health care, as well as an increase in the number of forms it takes. The application of these measures frequently relies on the work of nurses, but few studies have analyzed the human rights issues raised by these practices.Aim : To produce a qualitative synthesis of how human rights are integrated into the practice of nurses who use coercion in mental health care.Methodology : A systematic review of qualitative scientific literature published between 2008 and 2018 was conducted and supplemented by a meta-ethnographic analysis.Results : The analysis of the forty-six selected studies revealed four distinct themes : coercion in mental health care as a socio-legal object, issues of recognition of human rights in mental health care, role conflict experienced by nurses, and the conceptualization of coercion as a necessary evil or a critical incident.Discussion and conclusion : Further research is needed to understand the specifics of the continuum of support and control that characterizes the coercive work of psychiatric nurses.
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Gerle E, Fischer A, Lundh LG. "Voluntarily Admitted Against My Will": Patient Perspectives on Effects of, and Alternatives to, Coercion in Psychiatric Care for Self-Injury. J Patient Exp 2019; 6:265-270. [PMID: 31853481 PMCID: PMC6908982 DOI: 10.1177/2374373518800811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Introduction: Various forms of coercion are used in the psychiatric care of patients with self-injurious behaviors, but there is little research on how these are perceived by the patients. The aim of this study was to investigate how 6 patients, who had received care for self-injurious behavior, perceived coercion and how they think coercion could be avoided. Methods: This study employed a qualitative design with 6 semistructured interviews and interpretative phenomenological analysis. Results: Three main themes were identified: keep voluntary care voluntary, apportioning control and responsibility, and dialogue and participation. Constant supervision was described as the most destructive form of coercion. To enable self-responsibility, a reduction of control and supervision was advocated. Calls were made for a treatment based on the assumption that there is a desire, on behalf of the patients, to get better. Conclusions: The use of coercion in the psychiatric care of patients with self-injurious behavior can be reduced by increasing predictability, by listening to the patient with genuine interest, and by involving the patient in decisions regarding their treatment.
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Affiliation(s)
- Ellen Gerle
- Department of Psychology, Lund University, Lund, Sweden
| | - Anne Fischer
- Department of Psychology, Lund University, Lund, Sweden
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Pariseau-Legault P, Vallée-Ouimet S, Goulet MH, Jacob JD. Nurses' perspectives on human rights when coercion is used in psychiatry: a systematic review protocol of qualitative evidence. Syst Rev 2019; 8:318. [PMID: 31815660 PMCID: PMC6900841 DOI: 10.1186/s13643-019-1224-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/06/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The World Health Organization describes the perpetuation of human rights violations against people with mental health problems as a global emergency. Despite this observation, recent studies suggest that coercive measures, such as seclusion, restraints, involuntary hospitalization, or involuntary treatment, are steadily or increasingly being used without proof of their effectiveness. In nursing, several literature reviews have focused on understanding nurses' perspectives on the use of seclusion and restraints. Although many studies describe the ethical dilemmas faced by nurses in this context, to this date, their perspectives on patient's rights when a broad variety of coercive measures are used are not well understood. The aim of this review is to produce a qualitative synthesis of how human rights are actually integrated into psychiatric and mental health nursing practice in the context of coercive work. METHODS Noblit and Hare's meta-ethnographic approach will be used to conduct this systematic review. The search will be conducted in CINAHL, Medline, PsycINFO, ERIC, and Scopus databases, using the PICo model (Population, phenomenon of Interest, Context) and a combination of keywords and descriptors. It will be complemented by a manual search of non-indexed articles, gray literature, and other applicable data sources, such as human rights related documents. Qualitative and mixed-method study designs will be included in this review. Empirical and peer-reviewed articles published between 2008 and 2019 will be selected. Articles will be evaluated independently by two reviewers to determine their inclusion against eligibility criteria. The quality of the selected papers will then be independently evaluated by two reviewers, using the Joanna Briggs Institute's Checklist for Qualitative Research. Data extraction and content analysis will focus on first- and second-order constructs, that is, the extraction of research participants' narratives and their interpretation. DISCUSSION This review will provide a synthesis of how psychiatric and mental health nurses integrate human rights principles into their practice, as well as it will identify research gaps in this area. The results of this review will then provide qualitative evidence to better understand how nurses can contribute to the recognition, protection, and advocate for human rights in a psychiatric context. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42019116862.
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Affiliation(s)
- Pierre Pariseau-Legault
- Department of Nursing Sciences, Université du Québec en Outaouais, 5 rue Saint-Joseph, Saint-Jerome, Québec, J7Z 0B7, Canada.
| | - Sandrine Vallée-Ouimet
- Department of Nursing Sciences, Université du Québec en Outaouais, 5 rue Saint-Joseph, Saint-Jerome, Québec, J7Z 0B7, Canada
| | | | - Jean-Daniel Jacob
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
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Brophy L, Roper C, Grant K. Risk factors for involuntary psychiatric hospitalisation. Lancet Psychiatry 2019; 6:974-975. [PMID: 31777342 DOI: 10.1016/s2215-0366(19)30442-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Lisa Brophy
- Social Work and Social Policy, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Cath Roper
- Department of Nursing, University of Melbourne, Parkville, VIC, Australia
| | - Kellie Grant
- Social Work and Social Policy, La Trobe University, Bundoora, VIC 3086, Australia
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Davidson G, Fargas M, Hamilton B, Connaughty K, Harvey K, Lynch G, McCartan D, McCosker J, Scott J. Mental health law assessments: interagency cooperation and practice complexities. J Ment Health 2019; 30:74-79. [PMID: 31240967 DOI: 10.1080/09638237.2019.1630721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Assessments under mental health law, to determine whether compulsory admission is necessary, tend to be complex, multidisciplinary and inter-agency processes. This article presents the results of a regional audit of assessments under the Mental Health (Northern Ireland) Order 1986. AIMS The aims of the audit were to examine routine practice, identify any issues and so inform how policy and practice may be developed. METHOD The audit was designed by an inter-agency advisory group and audit team. Data were collected for a sample of 189 assessments. The sample was weighted to ensure all Health and Social Care Trusts and settings were appropriately represented. RESULTS These assessments involve high levels of need, risk and complexity. There were no major issues or concerns identified in the majority of assessments. The issues that were identified were mainly due to the difficulties in coordinating professionals and in securing a bed. In 3/189 (2%) of assessments, these issues were identified as contributing to increased distress and risk. CONCLUSIONS The results highlight the complexities of these processes and confirm the need for opportunities, such as joint training and inter-agency interface groups, to further promote cooperation and identify when pressures on resources are increasing risk and distress.
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Affiliation(s)
- Gavin Davidson
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Montserrat Fargas
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | | | | | - Karen Harvey
- Northern Health and Social Care Trust, Antrim, UK
| | - Gerry Lynch
- Northern Health and Social Care Trust, Antrim, UK
| | | | - John McCosker
- Western Health and Social Care Trust, Londonderry, UK
| | - Jackie Scott
- Belfast Health and Social Care Trust, Belfast, UK
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Perry BI, Ayadurai N, Hess E, Harmer D, Curry T, Broom R, White D. Use of a proforma to aid in reducing coercion into informal admission for acute adult psychiatric inpatients in the U.K. Leg Med (Tokyo) 2019; 36:103-109. [DOI: 10.1016/j.legalmed.2018.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 09/30/2018] [Accepted: 11/22/2018] [Indexed: 11/28/2022]
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Husum TL, Legernes E, Pedersen R. "A plea for recognition" Users' experience of humiliation during mental health care. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 62:148-153. [PMID: 30616849 DOI: 10.1016/j.ijlp.2018.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 11/12/2018] [Accepted: 11/12/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Studies reveal that users of mental health care services sometimes experience humiliation during care. These experiences may influence the users' recovery process and treatment satisfaction. METHOD Thirteen informants with experience in mental health services were recruited for semi-structured interviews. Informants were recruited through collaboration with users' organisations. Modified text condensation was used for analysis of the qualitative data. RESULTS Users' experiences with humiliation in mental health care were sorted into three main themes. These are themes related to different perspectives between staff and users; themes related to violence of user autonomy; and experiences related to staff attitudes. DISCUSSION The service users in this study spoke about many different kinds of experiences with humiliation during care. It was a main finding that the feeling of not being recognized for one's own perception of the situation was experienced as a humiliation. This study is a contribution to a better understanding of the humiliation process between staff and users in mental health care services. The findings may be used to improve interaction between staff and users, improve quality of care and to prevent such experiences.
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Nicolini M, Vandenberghe J, Gastmans C. Substance use disorder and compulsory commitment to care: a care-ethical decision-making framework. Scand J Caring Sci 2017; 32:1237-1246. [DOI: 10.1111/scs.12548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 11/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Marie Nicolini
- Department of Psychiatry; University Hospitals Leuven; Leuven Belgium
- Center for Clinical Bioethics; Georgetown University Medical Center; Washington D.C. USA
| | | | - Chris Gastmans
- Center for Biomedical Ethics and Law; KU Leuven; Leuven Belgium
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Van der Meulen APS, Hermsen MA, Embregts PJ. Restraints in daily care for people with moderate intellectual disabilities. Nurs Ethics 2016; 25:54-68. [PMID: 27044928 DOI: 10.1177/0969733016638141] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Self-determination is an important factor in improving the quality of life of people with moderate intellectual disabilities. A focus on self-determination implies that restraints on the freedom of people with intellectual disabilities should be decreased. In addition, according to the Dutch Care and Coercion bill, regular restraints of freedom, such as restrictions on choice of food or whom to visit, should be discouraged. Such restraints are only allowed if there is the threat of serious harm for the clients or their surroundings. RESEARCH QUESTION What do support staff consider as restraints on freedom and how do they justify these restraints? RESEARCH DESIGN In this study, data were collected by semi-structured interviews. Participants and research context: Fifteen support staff working with clients with moderate intellectual disabilities were interviewed. All participants work within the same organisation for people with intellectual disabilities in the Eastern part of the Netherlands. Ethical considerations: The study was conducted according to good scientific inquiry guidelines and ethical approval was obtained from a university ethics committee. FINDINGS Most restraints of freedom were found to be centred around the basic elements in the life of the client, such as eating, drinking and sleeping. In justifying these restraints, support staff said that it was necessary to give clarity in what clients are supposed to do, to structure their life and to keep them from danger. DISCUSSION In the justification of restraints of freedom two ethical viewpoints, a principle-guided approach and an ethics of care approach, are opposing one other. Here, the self-determination theory can be helpful, while it combines the autonomy of the client, relatedness to others and the client's competence. CONCLUSION Despite the reasonable grounds support staff gave for restraining, it raises the question whether restraints of freedom are always in the interest of the client.
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dos Santos Mesquita C, da Costa Maia Â. When the safe place does not protect: reports of victimisation and adverse experiences in psychiatric institutions. Scand J Caring Sci 2016; 30:741-748. [DOI: 10.1111/scs.12300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Accepted: 09/07/2015] [Indexed: 11/29/2022]
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van den Hooff S, Leget C, Goossensen A. Healthcare professionals under pressure in involuntary admission processes. Nurs Philos 2015; 16:177-86. [DOI: 10.1111/nup.12096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Carlo Leget
- Ethics of Care and Spiritual Counselling; University of Humanistic Studies; Utrecht The Netherlands
| | - Anne Goossensen
- Care Ethical Aspects of Informal Care; University of Humanistic Studies; Utrecht The Netherlands
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Kalaitzidis E. Patients' decision-making experiences in the acute healthcare setting--a case study. Scand J Caring Sci 2015; 30:83-90. [PMID: 25857486 DOI: 10.1111/scs.12224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/08/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND The transition from being an ordinary citizen to a hospitalised patient can be a daunting experience particularly for the uninitiated and inexperienced. Patients are likely to have questions such as 'where do I go?', 'what should I do?', 'when?' and 'who should I ask?' The process for making practical moment-to-moment decisions is often complex and fraught with difficulties. Identifying critical points in the hospitalisation experience may provide insights into the quality of hospital management systems and professional practices from a patient perspective. OBJECTIVE This study aimed to identify institutional practices and structures in the context of acute healthcare settings which impact on patient moment-to-moment decision-making experiences. METHOD A case study approach was used as the exploratory methodology, and interviews were conducted with three former adult inpatients. In order to gain an understanding of each participant's experiences, data collecting strategies used in this research were a semistructured interview and document analysis of information documents, such as hospital supplied pamphlets, provided to the researcher by the participants. RESULTS The study identified five major themes. Identified as being critical to the participants were information sharing by healthcare professionals, professional advice and professional role identification. Less so were environment and everyday life. Associated with these themes were the participant's common experience of being confined in unfamiliar surroundings, adjusting to institutional routines and of being heavily dependent on others. CONCLUSION Findings indicate that patient moment-to-moment decision-making may be informed and enhanced in several areas: relevant and timely information sharing, varying the dress code between the different professions, reducing conflicting professional advice, clear signage around the hospital, and flexible visiting hours, telephones and clocks in patient rooms.
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Affiliation(s)
- Evdokia Kalaitzidis
- School of Nursing and Midwifery, Flinders University, Bedford Park, Adelaide, SA, Australia
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Ejneborn Looi GM, Engström Å, Sävenstedt S. A self-destructive care: self-reports of people who experienced coercive measures and their suggestions for alternatives. Issues Ment Health Nurs 2015; 36:96-103. [PMID: 25625709 DOI: 10.3109/01612840.2014.951134] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Coercive measures are commonly used as a method of intervention, despite insufficient evidence for their effectiveness and benefits. The aim of this study was to describe how people who self-harm perceive alternatives to coercive measures in relation to actual experiences of psychiatric care. A total of 19 self-reports have been analysed with qualitative content analysis, resulting in three categories: a wish for understanding instead of neglect; a wish for mutual relation instead of distrust; a wish for professionalism instead of a counterproductive care. In conclusion, if the caregivers can understand and collaborate with the patient, there is seldom any need for coercive measures.
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Hem MH, Molewijk B, Pedersen R. Ethical challenges in connection with the use of coercion: a focus group study of health care personnel in mental health care. BMC Med Ethics 2014; 15:82. [PMID: 25475895 PMCID: PMC4269949 DOI: 10.1186/1472-6939-15-82] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 11/21/2014] [Indexed: 11/17/2022] Open
Abstract
Background In recent years, the attention on the use of coercion in mental health care has increased. The use of coercion is common and controversial, and involves many complex ethical challenges. The research question in this study was: What kind of ethical challenges related to the use of coercion do health care practitioners face in their daily clinical work? Methods We conducted seven focus group interviews in three mental health care institutions involving 65 multidisciplinary participants from different clinical fields. The interviews were recorded and transcribed verbatim. We analysed the material applying a ‘bricolage’ approach. Basic ethical principles for research ethics were followed. We received permission from the hospitals’ administrations and all health care professionals who participated in the focus group interviews. Results Health care practitioners describe ethical dilemmas they face concerning formal, informal and perceived coercion. They provide a complex picture. They have to handle various ethical challenges, not seldom concerning questions of life and death. In every situation, the dignity of the patient is at stake when coercion is considered as morally right, as well as when coercion is not the preferred intervention. The work of the mental health professional is a complicated “moral enterprise”. The ethical challenges deserve to be identified and handled in a systematic way. This is important for developing the quality of health care, and it is relevant to the current focus on reducing the use of coercion and increasing patient participation. Precise knowledge about ethical challenges is necessary for those who want to develop ethics support in mental health care. Better communication skills among health care professionals and improved therapeutic relationships seem to be vital. Conclusions A systematic focus on ethical challenges when dealing with coercion is an important step forward in order to improve health care in the mental health field.
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Affiliation(s)
- Marit Helene Hem
- Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, P,O, Box 1130, Blindern, Oslo NO-0318, Norway.
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