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Aragonés-Calleja M, Sánchez-Martínez V. Current State of Research on Coercion in Mental Health: Umbrella Review Protocol. J Psychosoc Nurs Ment Health Serv 2022; 60:49-55. [PMID: 35522935 DOI: 10.3928/02793695-20220428-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In recent years, international organizations, professionals, and representatives of mental health service users have expressed the need to regulate, limit, and even eliminate coercive measures in psychiatric treatment. The main objective of the current review is to provide a comprehensive synthesis of existing evidence on coercion in mental health care through a protocol for an umbrella review of systematic reviews. This protocol was designed according to the Joanna Briggs Institute guide for methodological development, conduct, and reporting of umbrella reviews. To minimize bias in the process, two independent reviewers selected the studies to be included, extracted, and synthesized; analyzed the data; and assessed risk of bias of each review. The review protocol was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines. This review offers a comprehensive compilation of systematic reviews on coercion developed to date. Coercion causes adverse physical and psychological effects and is an emotional stressor for individuals with psychiatric diagnoses and health care workers. Characterization of coercion across care settings, its impact on clinical outcomes, the perception of those involved, and how coercion could be reduced will also be discussed. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].
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de Waardt DA, van Melle AL, Widdershoven GAM, Bramer WM, van der Heijden FMMA, Rugkåsa J, Mulder CL. Use of compulsory community treatment in mental healthcare: An integrative review of stakeholders' opinions. Front Psychiatry 2022; 13:1011961. [PMID: 36405930 PMCID: PMC9669570 DOI: 10.3389/fpsyt.2022.1011961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Multiple studies have examined the effects of compulsory community treatment (CCT), amongst them there were three randomized controlled trials (RCT). Overall, they do not find that CCT affects clinical outcomes or reduces the number or duration of hospital admissions more than voluntary care does. Despite these negative findings, in many countries CCT is still used. One of the reasons may be that stakeholders favor a mental health system including CCT. AIM This integrative review investigated the opinions of stakeholders (patients, significant others, mental health workers, and policy makers) about the use of CCT. METHODS We performed an integrative review; to include all qualitative and quantitative manuscripts on the views of patients, significant others, clinicians and policy makers regarding the use of CCT, we searched MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science Core Collection, Cochrane CENTRAL Register of Controlled Trials (via Wiley), and Google Scholar. RESULTS We found 142 studies investigating the opinion of stakeholders (patients, significant others, and mental health workers) of which 55 were included. Of these 55 studies, 29 included opinions of patients, 14 included significant others, and 31 included mental health care workers. We found no studies that included policy makers. The majority in two of the three stakeholder groups (relatives and mental health workers) seemed to support a system that used CCT. Patients were more hesitant, but they generally preferred CCT over admission. All stakeholder groups expressed ambivalence. Their opinions did not differ clearly between those who did and did not have experience with CCT. Advantages mentioned most regarded accessibility of care and a way to remain in contact with patients, especially during times of crisis or deterioration. The most mentioned disadvantage by all stakeholder groups was that CCT restricted autonomy and was coercive. Other disadvantages mentioned were that CCT was stigmatizing and that it focused too much on medication. CONCLUSION Stakeholders had mixed opinions regarding CCT. While a majority seemed to support the use of CCT, they also had concerns, especially regarding the restrictions CCT imposed on patients' freedom and autonomy, stigmatization, and the focus on medication.
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Affiliation(s)
| | | | - Guy Antoine Marie Widdershoven
- Department of Ethics, Law, and Humanities, Amsterdam University Medical Centers (Location VUmc), Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | | | - Jorun Rugkåsa
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.,Centre for Care Research, University of South-Eastern Norway, Porsgrunn, Norway
| | - Cornelis Lambert Mulder
- Parnassia Psychiatric Institute, Rotterdam, Netherlands.,Department of Psychiatry, Epidemiological and Social Psychiatric Research institute (ESPRi), Erasmus MC, Erasmus University Medical Center, Rotterdam, Netherlands
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Zhu J, Huang Q, Lu W, Chen Y, Li B, Xu Y, Xi R, Li D. Do Community Free-Medication Service Policy Improve Patient Medication Adherence? A Cross-Sectional Study of Patients With Severe Mental Disorders in Beijing Community. Front Public Health 2021; 9:714374. [PMID: 34381755 PMCID: PMC8351906 DOI: 10.3389/fpubh.2021.714374] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Nowadays, mental health problems have become a major concern affecting economic and social development, with severe mental health disorders being the top priority. In 2013, Beijing began to implement the Community Free-Medication Service policy (CFMS). This article aims to evaluate the effect of the policy on medication adherence. Methods: In this study, multi-stage sampling was used to select representative patients as samples. Some of the baseline data were obtained by consulting the archives, and information about patient medication adherence measured by Brooks Medication Adherence Scale was obtained through face-to-face interviews. Logistic regression was used to examine the impact of the policy. Results: Policy participation had a significant positive impact on medication adherence (OR = 1.557). The effect of policy participation on medication adherence in the Medication-only mode and Subsidy-only mode were highly significant, but it was not significant in the Mixed mode. Conclusion: This study found that the CFMS in Beijing as an intervention is effective in improving the medication adherence of community patients. However, the impact of the policy is not consistent among service modes. Reinforcement magnitude and frequency should be considered when designing reinforcement interventions.
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Affiliation(s)
- Junli Zhu
- School of Public Health, Capital Medical University, Beijing, China.,Research Center for Capital Health Management and Policy, Beijing, China
| | - Qingzhi Huang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Beijing Institute of Mental Health, Beijing, China
| | - Wei Lu
- School of Public Health, Capital Medical University, Beijing, China.,Research Center for Capital Health Management and Policy, Beijing, China
| | - Yun Chen
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Beijing Institute of Mental Health, Beijing, China
| | - Bin Li
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Beijing Institute of Mental Health, Beijing, China
| | - Ying Xu
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Beijing Institute of Mental Health, Beijing, China
| | - Rui Xi
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.,Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.,Beijing Institute of Mental Health, Beijing, China
| | - Dan Li
- School of Public Health, Capital Medical University, Beijing, China.,Research Center for Capital Health Management and Policy, Beijing, China
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Løvsletten M, Lossius Husum T, Haug E, Granerud A. Cooperation in the mental health treatment of patients with outpatient commitment. SAGE Open Med 2020; 8:2050312120926410. [PMID: 32537158 PMCID: PMC7268555 DOI: 10.1177/2050312120926410] [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: 10/16/2019] [Accepted: 04/16/2020] [Indexed: 01/10/2023] Open
Abstract
Background: Patients with outpatient commitment have a decision on coercive treatment
from the specialist health services even if they are in their own home and
receive municipal health services. Objective: The aim of this study is to gain more knowledge about how the outpatient
commitment system works in the municipal health service and specialist
health services, and how they collaborate with patients and across service
levels from the perspectives of healthcare professionals. Methods: This is a qualitative study collecting data through focus group interviews
with health personnel from the municipal health service and specialist
health services. Results: The results describe the health personnel’s experiences with follow-up and
interactions with the patients with outpatient commitment decisions, and
their experiences with collaboration between service levels. Conclusion: The study show that outpatient commitment makes a difference in the way
patients with this decision are followed up. The legislative amendment with
new requirements for consent competence was challenging. Collaboration
between services levels was also challenging.
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Affiliation(s)
- Maria Løvsletten
- Division of Mental Health Care, Innlandet Hospital Trust, Brumunddal, Norway.,Faculty of Public Health, Inland Norway University of Applied Science, Elverum, Norway.,Institute for Health & Society, Universitet I Oslo, Oslo, Norway
| | - Tonje Lossius Husum
- Centre for Medical Ethics, Institute for Health & Society, University of Oslo, Oslo, Norway
| | - Elisabeth Haug
- Division of Mental Health Care, Innlandet Hospital Trust, Reinsvoll, Norway
| | - Arild Granerud
- Faculty of Public Health, Inland Norway University of Applied Science, Elverum, Norway
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Løvsletten M, Husum TL, Granerud A, Haug E. Outpatient commitment in mental health services from a municipal view. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2020; 69:101550. [PMID: 32241457 DOI: 10.1016/j.ijlp.2020.101550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/01/2020] [Accepted: 02/05/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Outpatient commitment (OC) is a legal decision for compulsory mental health care when the patient stays in his or her own home. Municipal health-care workers have a key role for patients with OC decision, but little is known about how the legislation system with OC works from the municipality's point of view. METHOD The present study has a quantitative descriptive design using an electronic questionnaire sent to health-care workers in the municipalities that participated. The study included health-care workers from the mental health services in two counties in Norway who have experience with psychosis and OC decisions. RESULTS There were 230 people who received the questionnaire. The sample consisted of various health professionals from both small and large municipalities.The results show which tasks they have in follow-up of patients in the municipalities. CONCLUSION From the municipality's point of view, there are no significant differences in follow-up for patients with or without an OC decision, apart from conversations about medication. An individual plan is rarely used to facilitate follow-up, although this is the statutory right of patients with OC decisions. The health-care workers lack knowledge and education about the OC scheme. The cooperation between municipalities and the specialist health-care services is not clearly defined.
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Affiliation(s)
- Maria Løvsletten
- Innlandet Hospital Trust, Division Psykisk Helsevern, Postboks 104, NO-2381 Brumunddal, Norway; Faculty of Public Health, Inland Norway University of Applied Science, Elverum, Norway; Helsam, Universitet I, Oslo, Norway.
| | - Tonje Lossius Husum
- Centre for Medical Ethics, Institute for Health & Society, University of Oslo, Norway
| | - Arild Granerud
- Faculty of Public Health, Inland Norway University of Applied Science, Elverum, Norway
| | - Elisabeth Haug
- Division of Mental Health Care, Innlandet Hospital Trust, 2840 Reinsvoll, Norway
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