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Cooper RA, Harwood J. Humanizing Dementia: Effects of Counter-Stereotypical Messages on Patronizing Speech toward People with a Stigmatized Health Condition. HEALTH COMMUNICATION 2024; 39:1175-1184. [PMID: 37161315 DOI: 10.1080/10410236.2023.2207281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Patronizing speech and dehumanization both have negative impacts on the health and wellbeing of the recipients of these behaviors. This experiment applied Fiske's stereotype content model, Haslam's dual model of dehumanization, and Hummert's model of patronizing speech to assess the effects of warmth- and competence-enhancing messages about a person with dementia on perceptions of humanness and patronizing speech toward people with dementia. Results supported our predictions that warmth- and competence-enhancing messages would translate into general tendencies to humanize people with dementia as a group. Predicted effects on patronizing communication did not materialize, but there were some unanticipated ways in which warmth- and competence-enhancing messages did influence intentions to use patronizing speech.
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Affiliation(s)
| | - Jake Harwood
- Department of Communication, University of Arizona
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Laureano CD, Laranjeira C, Querido A, Dixe MA, Rego F. Ethical Issues in Clinical Decision-Making about Involuntary Psychiatric Treatment: A Scoping Review. Healthcare (Basel) 2024; 12:445. [PMID: 38391820 PMCID: PMC10888148 DOI: 10.3390/healthcare12040445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
In mental health and psychiatric care, the use of involuntary psychiatric treatment for people with mental disorders is still a central and contentious issue. The main objective of this scoping review was to map and systematize the literature on ethical issues in clinical decision-making about involuntary psychiatric treatment. Five databases (Embase, PsycINFO, CINAHL, Medline, and Scopus) were searched for articles on this topic. Out of a total of 342 articles found, 35 studies from 14 countries were included based on the selection criteria. The articles were analyzed using the inductive content analysis approach. The following main categories were identified: (1) ethical foundations that guide clinical decision-making; (2) criteria for involuntary psychiatric treatment; (3) gaps, barriers, and risks associated with involuntary psychiatric treatment; (4) strategies used to reduce, replace, and improve the negative impact of involuntary treatment; and (5) evidence-based recommendations. Most of the selected articles discuss the logic underlying involuntary treatment of the mentally ill, exploring ethical principles such as autonomy, beneficence, non-maleficence, or justice, as well as how these should be properly balanced. During the process of involuntary psychiatric admission, there was a notable absence of effective communication and a significant power imbalance that disenfranchised those seeking services. This disparity was further intensified by professionals who often use coercive measures without a clear decision-making rationale and by family members who strongly depend on hospital admission. Due to the pluralistic and polarized nature of opinions regarding legal capacity and the complexity and nuance of involuntary admission, further studies should be context-specific and based on co-production and participatory research.
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Affiliation(s)
- Cláudio Domingos Laureano
- Psychiatric and Mental Health Service, Local Health Unit of the Leiria Region-Hospital of Santo André, Rua das Olhalvas, 2410-197 Leiria, Portugal
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal
| | - Carlos Laranjeira
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal
- School of Health Sciences, Polytechnic University of Leiria, Campus 2-Morro do Lena, Alto do Vieiro-Apart. 4137, 2411-901 Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-801 Évora, Portugal
| | - Ana Querido
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal
- School of Health Sciences, Polytechnic University of Leiria, Campus 2-Morro do Lena, Alto do Vieiro-Apart. 4137, 2411-901 Leiria, Portugal
- Center for Health Technology and Services Research (CINTESIS), NursID, University of Porto, 4200-450 Porto, Portugal
| | - Maria Anjos Dixe
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal
- School of Health Sciences, Polytechnic University of Leiria, Campus 2-Morro do Lena, Alto do Vieiro-Apart. 4137, 2411-901 Leiria, Portugal
| | - Francisca Rego
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
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Martínez-Martínez C, Sánchez-Martínez V, Ballester-Martínez J, Richart-Martínez M, Ramos-Pichardo JD. A qualitative emancipatory inquiry into relationships between people with mental disorders and health professionals. J Psychiatr Ment Health Nurs 2021; 28:721-737. [PMID: 33351223 DOI: 10.1111/jpm.12727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 11/27/2020] [Accepted: 12/11/2020] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: A therapeutic alliance with people with mental disorders could help increase the efficacy of treatment. The paradigm shift from a paternalistic model to one that respects the person's autonomy has led to professionals accepting the active role of people with mental disorders making decisions that affect their treatment. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: People with mental disorders perceive paternalistic and stigmatizing attitudes from health professionals, and they do not feel involved in decisions about their health, which can render effective therapeutic alliances difficult. The findings reveal that although people in Mediterranean countries are used to paternalistic treatment from health professionals due to cultural factors, people with mental disorders are increasingly critical of how they are treated and demand greater autonomy and respect in the decision to undergo drug therapy. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: In their interactions with people with mental disorders, health professionals should include efforts aimed at improving shared decision-making capabilities and avoiding paternalistic or stigmatizing attitudes. ABSTRACT: Introduction A therapeutic alliance with people is essential for the efficacy of treatments. However, the traditional paternalistic values of the Mediterranean society may be incompatible with patient autonomy. Aim To explore the therapeutic relationship from the perspective of people diagnosed with mental disorders with health professionals, including nurses. Methods This emancipatory research was performed through focus groups, with people with mental disorders who had a variety of diagnoses and experiences of acute and community-based mental health services and other healthcare services. Data were analysed using the content analysis method. Results Four main themes emerged: stereotypes and prejudice; quality of interactions and treatment; emotional and behavioural impacts; and demands. Discussion According to the participants' descriptions, health professionals are not exempt from prejudice against persons with psychiatric diagnoses. They reported experiencing abuse of power, malpractice, and overmedication. Thus, in the Mediterranean culture, professional attitudes may represent a barrier for an appropriate therapeutic alliance, and people with mental disorders do not feel involved in making decisions about their health. Implications for practice Knowing how people with mental disorders perceive their interactions with health professionals and the effects is necessary to move the care model towards more symmetric relationships that facilitate a therapeutic alliance.
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Affiliation(s)
- Concepción Martínez-Martínez
- Department of Nursing and Physiotherapy, Faculty of Health Sciences, Universidad Europea, Valencia, Spain.,Faculty of Nursing and Podiatry University of Valencia, Valencia, Spain
| | | | | | - Miguel Richart-Martínez
- Nursing Department, Health Sciences Faculty, University of Alicante, San Vicente del Raspeig, Spain
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Lee MH, Seo MK. Perceived Coercion of Persons with Mental Illness Living in a Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052290. [PMID: 33669113 PMCID: PMC7956448 DOI: 10.3390/ijerph18052290] [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: 01/24/2021] [Revised: 02/14/2021] [Accepted: 02/19/2021] [Indexed: 11/18/2022]
Abstract
Aims: The purpose of this study is to analyze the effect of the perceived coercion of people with mental illness living in a community on their therapeutic satisfaction and life satisfaction, mediated by therapeutic relationships. Methods: We evaluated several clinical variables (symptoms, psychosocial functioning, and insight), levels of perceived coercion, therapeutic relationships, therapeutic satisfaction, and life satisfaction in 185 people with mental illness (Mean age = 47.99, standard deviation (SD) = 12.72, male 53.0%, female 45.9%) who live in the community and use community-based mental health programs. The data collected were analyzed to test the proposed hypotheses using structural equation modeling (SEM). Results: The correlation analysis of all variables showed that clinical variables had statistically significant correlations with therapeutic relationship, therapeutic satisfaction, and life satisfaction, but no significant correlation with perceived coercion. Furthermore, perceived coercion was found to have significant predictive power for treatment satisfaction and life satisfaction mediated by therapeutic relationship. Specifically, the lower the perceived coercion, the better the therapeutic relationship. This, in turn, has a positive effect on the therapeutic satisfaction and life satisfaction of participants. Conclusions: Based on these findings, we suggest strategies to minimize coercion in a community.
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Affiliation(s)
- Min Hwa Lee
- Department of Social Welfare, Mokpo National University, Muan 58554, Korea;
| | - Mi Kyung Seo
- Department of Social Welfare, Gyeongsang National University, Jinju 52828, Korea
- Correspondence:
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Poremski D, Alexander M, Fang T, Tan GMY, Ong S, Su A, Fung D, Chua HC. Psychiatric Advance Directives and their relevance to improving psychiatric care in Asian countries. Asia Pac Psychiatry 2020; 12:e12374. [PMID: 31872576 PMCID: PMC7027531 DOI: 10.1111/appy.12374] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 11/07/2019] [Indexed: 12/12/2022]
Abstract
People with mental illness may be unable to provide critical input about the care they wish to receive during a psychiatric crisis because of altered mental states. It is therefore imperative that clinicians seek to understand service users' wishes for care while they are well and able to provide meaningful input into the discussion. Achieving such an end may be done by discussing and completing a psychiatric advance directive. However, very few Asian countries have legislation that supports such advance directives. The present article seeks to give physicians more information about advance psychiatric directives and the potential role they could play to improve the healthcare provided in Asia to people at risk of losing capacity due to a mental illness. The degree to which mental health legislation supports psychiatric advance directives is documented for each country of South East Asia and Eastern Asia.
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Affiliation(s)
- Daniel Poremski
- Health Intelligence Unit, Institute of Mental Health, Singapore
| | | | - Tina Fang
- Health Intelligence Unit, Institute of Mental Health, Singapore
| | - Giles Ming-Yee Tan
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore
| | - Samantha Ong
- Nursing Department, Institute of Mental Health, Singapore
| | - Alex Su
- Medical Board, Institute of Mental Health, Singapore
| | - Daniel Fung
- Medical Board, Institute of Mental Health, Singapore
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Penzenstadler L, Molodynski A, Khazaal Y. Supported decision making for people with mental health disorders in clinical practice: a systematic review. Int J Psychiatry Clin Pract 2020; 24:3-9. [PMID: 31613166 DOI: 10.1080/13651501.2019.1676452] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: The Convention on the Rights of Persons with Disabilities (CRPD) was adopted at the United Nations Assembly in 2006. The main aim of the convention is to ensure equal rights for people with disabilities including the expression of people's own "will and preferences" concerning health treatment. Article 12 demands the respect of a person's "rights, will and preferences" (CRPD) and suggests supported decision making (SDM) when possible. The aim of this review was to gather information regarding the SDM implementation from a clinical perspective for people with mental health disorders.Methods: A systematic literature search was performed on electronic databases MEDLINE, PsycARTICLES, and PsycINFO using the keywords "supported decision making" and "UN convention on the rights of persons with disabilities" in March 2018.Results: Eleven articles were included in the final review, which focussed on three themes: (1) different models of SDM, (2) stakeholder views, and (3) challenges for implementation. A limited number of papers described clinical models that had good theoretical consistency with SDM. The main challenges of implementation related to critical situations when "will and preferences" are poorly understood or appear contradictory. Future studies should assess specific models of SDM implementation, including related outcomes and process measures.
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Affiliation(s)
| | - Andrew Molodynski
- Oxford Health NHS Foundation Trust and Oxford University, Oxford, UK
| | - Yasser Khazaal
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.,Research Center, Montreal University Institute of Mental Health, Montreal, Canada.,Faculty of Biology and Medicine, Lausanne University, Lausanne, Switzerland
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Thibaut B, Dewa LH, Ramtale SC, D'Lima D, Adam S, Ashrafian H, Darzi A, Archer S. Patient safety in inpatient mental health settings: a systematic review. BMJ Open 2019; 9:e030230. [PMID: 31874869 PMCID: PMC7008434 DOI: 10.1136/bmjopen-2019-030230] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology. DESIGN Systematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to 'mental health', 'patient safety', 'inpatient setting' and 'research'. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model. RESULTS Of the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control. CONCLUSIONS Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice. PROSPERO REGISTRATION NUMBER CRD42016034057.
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Affiliation(s)
- Bethan Thibaut
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lindsay Helen Dewa
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sonny Christian Ramtale
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Danielle D'Lima
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sheila Adam
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hutan Ashrafian
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ara Darzi
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephanie Archer
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
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Felton A, Repper J, Avis M. The construction of people with mental health problems as risk objects: Findings of a case study inquiry. J Psychiatr Ment Health Nurs 2018; 25:558-568. [PMID: 30372573 DOI: 10.1111/jpm.12501] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/09/2018] [Accepted: 10/23/2018] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Risk assessment and management in mental health services are contested and perceived as problematic by both professionals and service users. There is substantial emphasis on risk as a core component of professional practice. However, recovery for people with mental health problems emphasizes self-determination which seems to conflict with risk management. A critique is emerging of risk assessment and management. However, there is a lack of empirical evidence which seeks to explore how professionals manage the conflicts between recovery orientated practice and risk management. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper reports on qualitative research which highlights people with mental health problems are objectified and frequently associated with the potential for harm. Risk dominates the work of mental health professionals and undermines individualized care. Service users are subject to increased surveillance and medication as a result. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Service users' subjective experiences need to be prioritized in mental health care by renewed focus on the relationship between professionals and service users. Mental health professionals should question the centrality of risk to their practice. ABSTRACT: Introduction The emergence of recovery, alongside significant focus on risk management, creates potential for conflicting influences in mental health care. Although evidence has critiqued risk assessment, there is a lack of research that seeks to explore how professionals make decisions within these apparently incompatible agendas. Aim To explore how practitioners, experience potential tensions arising from delivering recovery-orientated care and enforcing containment. Method This paper reports on a case study inquiry, using interviews with mental health professionals and observations in an acute ward and an assertive outreach team. Results Risk governed the practice of mental health professionals to such an extent it defined how service users were understood and treated. Service users were constructed as objects of risk, first by being objectified and secondly by creating a link between that object and harm. Discussion Hilgartner's (1992, Organizations, uncertainties and risk (pp. 39-53). Boulder, CO: Westview Press) theory of risk explains how risk dominates the identity of people with mental health problems at the cost of recovery. This results in increased monitoring, surveillance and medication to enact control. Implications for practice To undermine the dominance of risk, professionals should reconnect with the subjective experiences of people with mental health problems and challenge the acceptance of risk as central to their role.
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Affiliation(s)
- Anne Felton
- School of Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham, UK
| | - Julie Repper
- ImRoC, Nottinghamshire Healthcare NHS Foundation Trust, UK
| | - Mark Avis
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Luciano M, De Rosa C, Sampogna G, Del Vecchio V, Giallonardo V, Fabrazzo M, Catapano F, Onchev G, Raboch J, Mastrogianni A, Solomon Z, Dembinskas A, Nawka P, Kiejna A, Torres-Gonzales F, Kjellin L, Kallert T, Fiorillo A. How to improve clinical practice on forced medication in psychiatric practice: Suggestions from the EUNOMIA European multicentre study. Eur Psychiatry 2018; 54:35-40. [PMID: 30118917 DOI: 10.1016/j.eurpsy.2018.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The decision to adopt forced medication in psychiatric care is particularly relevant from a clinical and ethical viewpoint. The European Commission has funded the EUNOMIA study in order to develop European recommendations for good clinical practice on coercive measures, including forced medication. METHODS The recommendations on forced medication have been developed in 11 countries with the involvement of national clinical leaders, key-professionals and stakeholders' representatives. The national recommendations have been subsequently summarized into a European shared document. RESULTS Several cross-national differences exist in the use of forced medication. These differences are mainly due to legal and policy making aspects, rather than to clinical situations. In fact, countries agreed that forced medication can be allowed only if the following criteria are present: 1) a therapeutic intervention is urgently needed; 2) the voluntary intake of medications is consistently rejected; 3) the patient is not aware of his/her condition. Patients' dignity, privacy and safety shall be preserved at all times. CONCLUSION The results of our study show the need of developing guidelines on the use of forced medication in psychiatric practice, that should be considered as the last resort and only when other therapeutic option have failed.
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Affiliation(s)
- Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Corrado De Rosa
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Valeria Del Vecchio
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | | | - Michele Fabrazzo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Francesco Catapano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - George Onchev
- Department of Psychiatry, Medical University Sofia, Sofia, Bulgaria
| | - Jiri Raboch
- Department of Psychiatry, First Faculty of Medicine Charles University and General University Hospital, Prague, Czech Republic
| | | | - Zahava Solomon
- Bob Shapell School of Social Work, Tel-Aviv University, Tel-Aviv, Israel
| | - Algirdas Dembinskas
- Psychiatric Clinic, Vilnius Mental Health Centre, University of Vilnius, Vilnius, Lithuania
| | - Petr Nawka
- Psychiatric private practice, Dresden, Germany
| | - Andrzej Kiejna
- Institute of Psychology, University of Lower Silesia, Wroclaw, Poland
| | | | - Lars Kjellin
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Thomas Kallert
- Psychiatric Health Care Facilities of Upper Franconia (GEBO), Bayreuth, Germany
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy.
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Meijer E, Schout G, de Jong G, Abma T. Regaining ownership and restoring belongingness: impact of family group conferences in coercive psychiatry. J Adv Nurs 2017; 73:1862-1872. [PMID: 28152214 DOI: 10.1111/jan.13270] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2017] [Indexed: 11/30/2022]
Abstract
AIM This study examined the impact of family group conferences on coercive treatment in adult psychiatry. BACKGROUND Coercive treatment in psychiatry infringes the fundamental rights of clients, including the right to control their lives. A promising intervention is the family group conferences, which has the potential to prevent crises through the integration of the expertise of informal and professional networks. DESIGN A responsive evaluation, including qualitative and quantitative methods, was deployed to study the process leading up to the FGC, the proceedings and the impact of the conference. METHOD From 2013-2015, 41 family group conferences were studied in three regions in the Netherlands. The impact of every conference was examined with scales (ranging from 0-10) during interviews with attendees (clients, family members, friends, mental health professionals and family group conferences coordinators) who reflected on three outcome measures: belongingness, ownership and coercion. RESULTS After the family group conferences, respondents indicated a slight reduction in their experience of coercive treatment. They also mentioned an increase in ownership and belongingness. CONCLUSION Family group conferences seems a promising intervention to reduce coercion in psychiatry. It helps to regain ownership and restores belongingness. If mental health professionals take a more active role in the pursuit of a family group conferences and reinforce the plans with their expertise, they can strengthen the impact even further.
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Affiliation(s)
- Ellen Meijer
- Department of Medical Humanities, VU University Medical Centre, Amsterdam, The Netherlands
| | - Gert Schout
- Department of Medical Humanities, VU University Medical Centre, Amsterdam, The Netherlands
| | - Gideon de Jong
- School of Nursing and Midwifery, Edith Cowan University, WA, Australia
| | - Tineke Abma
- Department of Medical Humanities, VU University Medical Centre, Amsterdam, The Netherlands
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Community Treatment Orders-A pause for thought. Asian J Psychiatr 2016; 24:1-4. [PMID: 27931888 DOI: 10.1016/j.ajp.2016.08.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/15/2016] [Accepted: 08/17/2016] [Indexed: 11/23/2022]
Abstract
Community Treatment Orders (CTO) have been available for several decades in some countries and are being progressively introduced worldwide, with significant uptake in Asian countries as they move more mental health care into the community. However the evidence for the effectiveness of CTOs is limited. The evidence from local audits and evaluations is conflicted with some studies showing clear benefit and others not. The same is the case for uncontrolled before and after studies. The higher levels of evidence such as randomised controlled trials, systematic reviews, and Cochrane reviews have consistently failed to demonstrate benefits from CTO use on key measures such as symptom levels, functioning, and healthcare use. Despite this they are increasingly available internationally and often greeted enthusiastically by clinicians and families who want to ensure care and follow up for the mentally ill. This article briefly discusses the evidence before describing potential alternatives to the use of compulsion that do have an evidence base, such as multidisciplinary community working, housing initiatives, and employment support.
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Pelletier JF, Lesage A, Boisvert C, Denis F, Bonin JP, Kisely S. Feasibility and acceptability of patient partnership to improve access to primary care for the physical health of patients with severe mental illnesses: an interactive guide. Int J Equity Health 2015; 14:78. [PMID: 26370926 PMCID: PMC4568580 DOI: 10.1186/s12939-015-0200-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 08/11/2015] [Indexed: 11/10/2022] Open
Abstract
Introduction Even in countries with universal healthcare systems, excess mortality rates due to physical chronic diseases in patients also suffering from serious mental illness like schizophrenia is such that their life expectancy could be lessened by up to 20 years. The possible explanations for this disparity include: unhealthy habits (i.e. smoking; lack of exercise); side-effects of psychotropic medication; delays in the detection or initial presentation leading to a more advanced disease at diagnosis; and inequity of access to services. The main objective of this paper is to explore the feasibility and acceptability of patient partnership for developing an interactive guide to improve access to primary care providers for chronic diseases management and health promotion among patients with severe mental illnesses. Methods A participatory action research design was used to engage patients with mental illness as full research partners for a strategy for patient-oriented research in primary care for persons with schizophrenia who also have chronic physical illnesses. This strategy was also developed in partnership with a health and social services centre responsible for the health of the population of a territory with about 100,000 inhabitants in East-end Montreal, Canada. A new interactive guide was developed by patient research partners and used by 146 participating patients with serious mental illness who live on this territory, for them to be better prepared for their medical appointment with a General Practitioner by becoming more aware of their own physical condition. Results Patient research partners produced a series of 33 short videos depicting signs and symptoms of common chronic diseases and risk factors for the leading causes of mortality and study participants were able to complete the corresponding 33-item questionnaire on an electronic touch screen tablet. What proved to be most relevant in terms of interactivity was the dynamic that has developed among the study participants during the small group learning sessions, a training technique designed for healthcare professionals that was adapted for this project for, and with patient partners. Conclusion This research has shown the feasibility and acceptability of patient partnership and patient-oriented research approaches to the R&D process of a new medical tool and intervention for patients with serious mental illness, and its acceptability for addressing inequity of this disadvantaged population in terms of access to primary care providers.
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Affiliation(s)
- Jean-François Pelletier
- Department of Psychiatry, University of Montreal, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7401, Hochelaga Street, Montreal, QC, H1N 3M5, Canada. .,Department of Psychiatry, Yale School of Medicine, New Haven, USA. .,International Program for Participatory Action Research, Montréal, Canada.
| | - Alain Lesage
- Department of Psychiatry, University of Montreal, Centre de recherche de l'Institut universitaire en santé mentale de Montréal, 7401, Hochelaga Street, Montreal, QC, H1N 3M5, Canada.
| | - Christine Boisvert
- International Program for Participatory Action Research, Montréal, Canada.
| | - Frédéric Denis
- La Chartreuse Psychiatric Centre, Dijon, France. .,University of Franche-Comte, Besançon, France.
| | | | - Steve Kisely
- School of Medicine, The University of Queensland, Brisbane, Australia.
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Molodynski A, Turnpenny L, Rugkåsa J, Burns T, Moussaoui D. Coercion and compulsion in mental healthcare-an international perspective. Asian J Psychiatr 2014; 8:2-6. [PMID: 24655618 DOI: 10.1016/j.ajp.2013.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Revised: 07/31/2013] [Accepted: 08/04/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Coercion has always existed in psychiatry and is increasingly debated. The 'move into the community' in many countries over recent decades and the evolution of community services have substantially altered the locus of coercion. In many countries psychiatric services remain poorly funded and patchy. Substantial differences between regions and countries in the provision of services, the role of the family, and the wider economic and political climate are likely to lead to different sources and experiences of coercion. DISCUSSION This paper explores a number of factors that may affect the prevalence and type of coercion in psychiatric services and in society and their impact upon those with severe mental illnesses. Differences in service provision are explored and wider societal issues that may impact are considered along with relevant evidence. CONCLUSIONS Coercion is commonly experienced by those with severe mental illnesses but is poorly understood. The vast majority of research relates to High Income Group countries with developed community services and formal mental health legislation that adopt the so-called 'medical model'. Further research and collaboration is urgently required to increase our understanding of these issues, which are difficult to define and measure. An evidence base that is relevant worldwide, not just to a small group of countries, is needed to inform training and the care of all patients. A particular focus must be expanding our knowledge and understanding of coercion in cultures outside those where such research has traditionally taken place to date.
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Affiliation(s)
- Andrew Molodynski
- Oxford Health NHS Foundation Trust, UK; Oxford University, Department of Psychiatry, UK.
| | - Lucinda Turnpenny
- Social Psychiatry Group, Oxford University, Department of Psychiatry, UK
| | - Jorun Rugkåsa
- Social Psychiatry Group, Oxford University, Department of Psychiatry, UK
| | - Tom Burns
- Social Psychiatry Group, Oxford University, Department of Psychiatry, UK
| | - Driss Moussaoui
- Department of Psychiatry, Ibn Rushd University Psychiatric Centre, Casablanca, Morocco; World Association of Social Psychiatry (WASP), Morocco
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