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Pedersen ML, Gildberg F, Baker J, Damsgaard JB, Tingleff EB. Ethnic disparities in the use of restrictive practices in adult mental health inpatient settings: a scoping review. Soc Psychiatry Psychiatr Epidemiol 2022; 58:505-522. [PMID: 36454269 PMCID: PMC9713127 DOI: 10.1007/s00127-022-02387-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE To identify and summarise extant knowledge about patient ethnicity and the use of various types of restrictive practices in adult mental health inpatient settings. METHODS A scoping review methodological framework recommended by the JBI was used. A systematic search was conducted in APA PsycINFO, CINAHL with Full Text, Embase, PubMed and Scopus. Additionally, grey literature searches were conducted in Google, OpenGrey and selected websites, and the reference lists of included studies were explored. RESULTS Altogether, 38 studies were included: 34 were primary studies; 4, reviews. The geographical settings were as follows: Europe (n = 26), Western Pacific (n = 8), Americas (n = 3) and South-East Asia (n = 1). In primary studies, ethnicity was reported according to migrant/national status (n = 16), mixed categories (n = 12), indigenous vs. non-indigenous (n = 5), region of origin (n = 1), sub-categories of indigenous people (n = 1) and religion (n = 1). In reviews, ethnicity was not comparable. The categories of restrictive practices included seclusion, which was widely reported across the studies (n = 20), multiple restrictive practices studied concurrently (n = 17), mechanical restraint (n = 8), rapid tranquillisation (n = 7) and manual restraint (n = 1). CONCLUSIONS Ethnic disparities in restrictive practice use in adult mental health inpatient settings has received some scholarly attention. Evidence suggests that certain ethnic minorities were more likely to experience restrictive practices than other groups. However, extant research was characterised by a lack of consensus and continuity. Furthermore, widely different definitions of ethnicity and restrictive practices were used, which hampers researchers' and clinicians' understanding of the issue. Further research in this field may improve mental health practice.
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Affiliation(s)
- Martin Locht Pedersen
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark. .,Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Østre Hougvej 70, 5500, Middelfart, Denmark. .,Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Østre Hougvej 70, 5500, Middelfart, Denmark.
| | - Frederik Gildberg
- grid.10825.3e0000 0001 0728 0170Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark ,grid.425874.80000 0004 0639 1911Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark
| | - John Baker
- grid.9909.90000 0004 1936 8403School of Healthcare, University of Leeds, Baines Wing, Woodhouse Lane, Leeds, LS2 9JT UK
| | - Janne Brammer Damsgaard
- grid.7048.b0000 0001 1956 2722Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Ellen Boldrup Tingleff
- grid.10825.3e0000 0001 0728 0170Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark ,grid.425874.80000 0004 0639 1911Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark ,grid.10825.3e0000 0001 0728 0170OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 9 A, 5000 Odense C, Denmark
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Beames L, Onwumere J. Risk factors associated with use of coercive practices in adult mental health inpatients: A systematic review. J Psychiatr Ment Health Nurs 2022; 29:220-239. [PMID: 33835622 DOI: 10.1111/jpm.12757] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/19/2021] [Accepted: 03/18/2021] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Coercive practices such as restraint (physically holding a person) or seclusion (containing a person in locked room) are frequently used in mental health care. How often and which specific practices are used is not consistent across different healthcare systems, hospitals or wards. Internationally, there is agreement on the need to monitor and reduce the use of coercive practices. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The reviewed evidence suggests a number of different factors affect a person's risk of experiencing coercive practices, while admitted to a mental health ward. However, there is currently not enough high-quality research evidence to say which factors are most important or how they work to influence the likelihood of a person experiencing coercive practice. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: When carrying out risk assessments, mental health professionals must take into account that a number of different factors are important and explore these with the patient. Care plans aimed at minimizing the use of coercive practices, such as restraint, must be personalized and developed with the individual. ABSTRACT: Introduction Coercive practices, such as physical restraint and seclusion, are a common feature of all mental healthcare systems. However, there is considerable variation in their use, concern about their iatrogenic potential and agreement internationally on the need to monitor and reduce their use. Aims To examine the evidence concerning risk factors associated with use of coercive practices in adults admitted to inpatient psychiatric services. Method A systematic review, consistent with PRIMSA guidelines, of four databases (PsychINFO, Medline, CINHAL and Embase). Peer-reviewed, English language articles from database inception to February 2020 were included. Methodological quality was assessed using the Quality Assessment Tool for Quantitative Studies. Results Twenty studies met inclusion criteria. Risk factors examined in the studies organized around four categories: patient socio-demographic; patient clinical; staff; and organizational factors. Overall, methodological quality of papers was deemed weak, and there was insufficient evidence to support any singular risk factor. Discussion The reviewed evidence suggests risk of coercive practice in inpatient mental health settings is multifactorial. Further research to standardize concept definitions and elucidate the mechanisms behind variance in use is required. Implications for Practice Assessment of patients at risk of coercive practice must take a multifactorial approach.
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Affiliation(s)
- Lewys Beames
- South London and Maudsley NHS Foundation Trust, London, Bethlem Royal Hospital, Beckenham, UK
| | - Juliana Onwumere
- South London and Maudsley NHS Foundation Trust, London, Bethlem Royal Hospital, Beckenham, UK.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Payne-Gill J, Whitfield C, Beck A. The relationship between ethnic background and the use of restrictive practices to manage incidents of violence or aggression in psychiatric inpatient settings. Int J Ment Health Nurs 2021; 30:1221-1233. [PMID: 34180128 PMCID: PMC9292244 DOI: 10.1111/inm.12873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2021] [Indexed: 11/30/2022]
Abstract
Restrictive practices raise considerable concern in mental health inpatient care. Previous studies suggest there are disparities in the use of restrictive practices to manage service users of different ethnic groups. The present study analyses the relationship between ethnicity and the use of restrictive practices to manage incidents of violence or aggression in inpatient settings across an NHS Mental Health Trust. Three years' worth of routinely collected incident data were analysed using multilevel multiple logistic regression to assess the relationship between ethnic group and four types of restrictive practices: physical restraint (without prone), physical restraint (with prone), seclusion, and rapid tranquilization. We controlled for a range of demographic variables and the type and severity of the incident. Adjusted analyses showed that service users with a Black African [Odds Ratio = 1.96, 95% CI: 1.36-2.83, P < 0.001], Black Caribbean [Odds Ratio = 1.76, 95% CI: 1.08-2.85, P = 0.022], Black Other [Odds Ratio = 1.76, 95% CI: 1.27-2.44, P = 0.001], and Mixed [Odds Ratio = 1.88, 95% CI: 1.11-3.18, P = 0.019] ethnic background were more likely to be secluded, and Black Caribbean [Odds Ratio = 1.45, 95% CI: 1.02-2.07, P = 0.040] service users were more likely to be restrained in prone position. We did not detect differences in the use of physical restraints without prone or in the use of rapid tranquilization. Our findings illustrate the need to focus on outcomes for different ethnic groups when implementing restraint reduction programmes.
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Affiliation(s)
| | - Corin Whitfield
- South London and Maudsley NHS Mental Health Trust, London, UK
| | - Alison Beck
- South London and Maudsley NHS Mental Health Trust, London, UK
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Hollander AC, Mackay E, Sjöqvist H, Kirkbride JB, Bäärnhielm S, Dalman C. Psychiatric care use among migrants to Sweden compared with Swedish-born residents: a longitudinal cohort study of 5 150 753 people. BMJ Glob Health 2021; 5:bmjgh-2020-002471. [PMID: 32972966 PMCID: PMC7517566 DOI: 10.1136/bmjgh-2020-002471] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 11/24/2022] Open
Abstract
Background To investigate differences in psychiatric care use over time between Swedish born and those born abroad who migrate to Sweden. Methods Population-based cohort study analysing linked population and health registers, following individuals born 1944–1990 from 1 January 2005 to 31 December 2016. Time-stratified survival analysis using Cox regression estimated time to psychiatric care use. Population included 5 150 753 individuals with 78.1% Swedish born. Migrant status was coded as Swedish born or migrant. Migrants were grouped by year of immigration and region of origin. The main outcome: psychiatric care use, defined as any psychiatric care; psychiatric inpatient or outpatient care; or use of psychotropics. Results Migrants arriving before 2005 had a higher use of any psychiatric care relative to Swedish born but migrants arriving 2005 onwards had lower use. Migrants from sub-Saharan Africa and Asia had a lower use of any psychiatric care during the first decade in Sweden whereas migrants from Middle East and North Africa had a higher use, driven by use of psychotropics. Conclusions The lower use of psychiatric care during the first decade contrasts with higher use among migrants with a longer duration of stay. Psychiatric care use among migrants should be analysed multi-dimensionally, taking duration of stay, region of origin and type of care into account.
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Affiliation(s)
| | - Euan Mackay
- Global Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Hugo Sjöqvist
- Global Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - Sofie Bäärnhielm
- Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.,Transkulturellt Centrum, Stockholm Region, Stockholm, Sweden
| | - Christina Dalman
- Global Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centrum för epidemiologi och samhällsmedicin, Stockholm Region, Stockholm, Sweden
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Race, History of Abuse, and Homelessness Are Associated With Forced Medication Administration During Psychiatric Inpatient Care. J Psychiatr Pract 2020; 26:294-304. [PMID: 32692126 DOI: 10.1097/pra.0000000000000485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Although previous research has suggested that racial disparities exist in the administration of forced medication (FM) in psychiatric inpatients, data remain scarce regarding other contributing variables. Therefore, this study examined sociodemographic and clinical variables associated with FM administration in psychiatric inpatients. METHODS Electronic medical records from 57,615 patients admitted to an academic psychiatric hospital between 2010 and 2018 were reviewed to identify patients who received FM. These records indicated that FM petitions were requested and approved for ∼6200 patients. Patients were excluded from the analysis if they met the following exclusion criteria: under 18 years of age, presence of intellectual/developmental disability, dementia, or other neurological condition, or primary diagnosis of a nonpsychiatric medical condition or a substance-induced mood or psychotic disorder. After data on those patients were excluded, the final sample included records from 2569 patients (4.5% of the total records) in which the administration of FM was petitioned for and approved. The FM group was compared with a control group of 2569 patients matched in terms of age, sex, and admission date (no-forced medication group; NFM) via propensity scoring matching. Group comparisons (FM vs. NFM group) examined sociodemographic factors (race, age, sex, living situation), clinical features (diagnosis, substance abuse, history of abuse), and outcomes (length of stay, readmission rate). Regression analyses examined the association between FM and sociodemographic, clinical, and outcome variables. RESULTS Compared with the NFM group, the FM group contained significantly more African Americans (P<0.001), homeless individuals (P<0.001), and individuals with histories of abuse (P<0.001). Having received FM was a significant predictor of a longer length of stay (P<0.001) and higher readmission rates (P<0.001). DISCUSSION These results suggest that FM is more likely to be instituted in psychiatric inpatients who are of a minority race (African American), are in a homeless living situation, and/or have a history of abuse. Moreover, FM may be associated with poorer clinical outcomes at least as measured by the length of stay and higher readmission rates. We discuss possible reasons for these results and the importance of culturally competent and trauma-focused care.
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Muir-Cochrane E, Oster C, Grimmer K. International research into 22 years of use of chemical restraint: An evidence overview. J Eval Clin Pract 2020; 26:927-956. [PMID: 31318109 DOI: 10.1111/jep.13232] [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] [Received: 05/28/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chemical restraint (CR) (also known as rapid tranquilisation) is the forced (non-consenting) administration of medications to manage uncontrolled aggression, anxiety, or violence in people who are likely to cause harm to themselves or others. Our population of interest was adults with mental health disorders (with/without substance abuse). There has been a growing international movement over the past 22 years towards reducing/eliminating restrictive practices such as CR. It is appropriate to summarise the research that has been published over this time, identify trends and gaps in knowledge, and highlight areas for new research to inform practice. AIMS To undertake a comprehensive systematic search to identify, and describe, the volume and nature of primary international research into CR published since 1995. METHODS This paper reports the processes and overall findings of a systematic search for all available primary research on CR published between 1 January 1996 and 31 July 2018. It describes the current evidence base by hierarchy of evidence, country (ies) producing the research, CR definitions, study purpose, and outcome measures. RESULTS This review identified 311 relevant primary studies (21 RCTs; 46 non-controlled experimental or prospective observational studies; 77 cross-sectional studies; 69 retrospective studies; 67 opinion pieces, position or policy statements; and 31 qualitative studies). The USA, UK, and Australia contributed over half the research, whilst cross-country collaborations comprised 6% of it. The most common research settings comprised acute psychiatric wards (23.3%), general psychiatric wards (21.6%), and general hospital emergency departments (19.0%). DISCUSSION A key lesson learnt whilst compiling this database of research into CR was to ensure that all papers described non-consenting administration of medications to manage adults with uncontrolled aggression, anxiety, or violence. There were tensions in the literature between using effective CR without producing adverse events, and how to decide when CR was needed (compared with choosing non-chemical intervention for behavioural emergencies), respecting patients' dignity whilst safeguarding their safety, and preserving safe workplaces for staff, and care environments for other patients. The range of outcome measures suggests opportunities to standardise future research.
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Affiliation(s)
- Eimear Muir-Cochrane
- College of Nursing and Health Sciences, Flinders University, South Australia, Australia, 5042
| | - Candice Oster
- On-Line Education and Development, Flinders Human Behaviour and Health Research Unit (FHBHRU), College of Medicine and Public Health, Flinders University, South Australia, Australia, 5042
| | - Karen Grimmer
- College of Nursing and Health Sciences, Flinders University, South Australia, Australia, 5042.,Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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O’Donoghue B, Lyne J, Hill M, Larkin C, Feeney L, O’Callaghan E. Physical coercion, perceived pressures and procedural justice in the involuntary admission and future engagement with mental health services. Eur Psychiatry 2020; 26:208-14. [DOI: 10.1016/j.eurpsy.2010.01.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 01/09/2010] [Accepted: 01/09/2010] [Indexed: 11/30/2022] Open
Abstract
AbstractObjectivesWe sought to determine the level of procedural justice experienced by individuals at the time of involuntary admission and whether this influenced future engagement with the mental health services.MethodsOver a 15-month period, individuals admitted involuntarily were interviewed prior to discharge and at one-year follow-up.ResultsEighty-one people participated in the study and 81% were interviewed at one-year follow-up. At the time of involuntary admission, over half of individuals experienced at least one form of physical coercion and it was found that the level of procedural justice experienced was unrelated to the use of physical coercive measures. A total of 20% of participants intended not to voluntarily engage with the mental health services upon discharge and they were more likely to have experienced lower levels of procedural justice at the time of admission. At one year following discharge, 65% of participants were adherent with outpatient appointments and 18% had been readmitted involuntarily. Insight was associated with future engagement with the mental health services; however, the level of procedural justice experienced at admission did not influence engagement.ConclusionsThis study demonstrates that the use of physical coercive measures is a separate entity from procedural justice and perceived pressures.
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Weich S, Fenton SJ, Staniszewska S, Canaway A, Crepaz-Keay D, Larkin M, Madan J, Mockford C, Bhui K, Newton E, Croft C, Foye U, Cairns A, Ormerod E, Jeffreys S, Griffiths F. Using patient experience data to support improvements in inpatient mental health care: the EURIPIDES multimethod study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
All NHS providers collect data on patient experience, although there is limited evidence about what to measure or how to collect and use data to improve services. We studied inpatient mental health services, as these are important, costly and often unpopular services within which serious incidents occur.
Aims
To identify which approaches to collecting and using patient experience data are most useful for supporting improvements in inpatient mental health care.
Design
The study comprised five work packages: a systematic review to identify evidence-based patient experience themes relevant to inpatient mental health care (work package 1); a survey of patient experience leads in NHS mental health trusts in England to describe current approaches to collecting and using patient experience data in inpatient mental health services, and to populate the sampling frame for work package 3 (work package 2); in-depth case studies at sites selected using the work package 2 findings, analysed using a realist approach (work package 3); a consensus conference to agree on recommendations about best practice (work package 4); and health economic modelling to estimate resource requirements and potential benefits arising from the adoption of best practice (work package 5). Using a realist methodology, we analysed and presented our findings using a framework based on four stages of the patient experience data pathway, for which we coined the term CRAICh (collecting and giving, receiving and listening, analysing, and quality improvement and change). The project was supported by a patient and public involvement team that contributed to work package 1 and the development of programme theories (work package 3). Two employed survivor researchers worked on work packages 2, 3 and 4.
Setting
The study was conducted in 57 NHS providers of inpatient mental health care in England.
Participants
In work package 2, 47 NHS patient experience leads took part and, in work package 3, 62 service users, 19 carers and 101 NHS staff participated, across six trusts. Forty-four individuals attended the work package 4 consensus conference.
Results
The patient experience feedback cycle was rarely completed and, even when improvements were implemented, these tended to be environmental rather than cultural. There were few examples of triangulation with patient safety or outcomes data. We identified 18 rules for best practice in collecting and using inpatient mental health experience data, and 154 realist context–mechanism–outcome configurations that underpin and explain these.
Limitations
The study was cross-sectional in design and we relied on examples of historical service improvement. Our health economic models (in work package 5) were therefore limited in the estimation and modelling of prospective benefits associated with the collection and use of patient experience data.
Conclusions
Patient experience work is insufficiently embedded in most mental health trusts. More attention to analysis and interpretation of patient experience data is needed, particularly to ways of triangulating these with outcomes and safety data.
Future work
Further evaluative research is needed to develop and evaluate a locally adapted intervention based on the 18 rules for best practice.
Study registration
The systematic review (work package 1) is registered as PROSPERO CRD42016033556.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 21. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Scott Weich
- Warwick Medical School, University of Warwick, Coventry, UK
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Sarah-Jane Fenton
- Warwick Medical School, University of Warwick, Coventry, UK
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Sophie Staniszewska
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Michael Larkin
- School of Life and Health Sciences, Aston University, Birmingham, UK
| | - Jason Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventative Medicine – Barts and The London, Queen Mary University of London, London, UK
| | | | - Charlotte Croft
- Warwick Business School, University of Warwick, Coventry, UK
| | - Una Foye
- Centre for Psychiatry, Wolfson Institute of Preventative Medicine – Barts and The London, Queen Mary University of London, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Aimee Cairns
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Stephen Jeffreys
- Mental Health Foundation, London, UK
- National Survivor User Network, London, UK
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Staniszewska S, Mockford C, Chadburn G, Fenton SJ, Bhui K, Larkin M, Newton E, Crepaz-Keay D, Griffiths F, Weich S. Experiences of in-patient mental health services: systematic review. Br J Psychiatry 2019; 214:329-338. [PMID: 30894243 DOI: 10.1192/bjp.2019.22] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In-patients in crisis report poor experiences of mental healthcare not conducive to recovery. Concerns include coercion by staff, fear of assault from other patients, lack of therapeutic opportunities and limited support. There is little high-quality evidence on what is important to patients to inform recovery-focused care.AimsTo conduct a systematic review of published literature, identifying key themes for improving experiences of in-patient mental healthcare. METHOD A systematic search of online databases (MEDLINE, PsycINFO and CINAHL) for primary research published between January 2000 and January 2016. All study designs from all countries were eligible. A qualitative analysis was undertaken and study quality was appraised. A patient and public reference group contributed to the review. RESULTS Studies (72) from 16 countries found four dimensions were consistently related to significantly influencing in-patients' experiences of crisis and recovery-focused care: the importance of high-quality relationships; averting negative experiences of coercion; a healthy, safe and enabling physical and social environment; and authentic experiences of patient-centred care. Critical elements for patients were trust, respect, safe wards, information and explanation about clinical decisions, therapeutic activities, and family inclusion in care. CONCLUSIONS A number of experiences hinder recovery-focused care and must be addressed with the involvement of staff to provide high-quality in-patient services. Future evaluations of service quality and development of practice guidance should embed these four dimensions.Declaration of interestK.B. is editor of British Journal of Psychiatry and leads a national programme (Synergi Collaborative Centre) on patient experiences driving change in services and inequalities.
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Affiliation(s)
- Sophie Staniszewska
- Professor of Patient and Public Involvement and Experiences of Care,Division of Health Sciences, Warwick Medical School,University of Warwick,UK
| | - Carole Mockford
- Senior Research Fellow,Division of Health Sciences,Warwick Medical School,University of Warwick,UK
| | - Greg Chadburn
- Researcher,Surrey and Sussex Healthcare National Health Service Trust,UK
| | - Sarah-Jane Fenton
- Comparative Social Policy,PGCert Advanced Research Methods and Skills,PhD Social Policy,Research Fellow,Division of Health Sciences,Warwick Medical School,University of Warwick,UK
| | - Kamaldeep Bhui
- Professor of Psychiatry,Centre for Psychiatry,Wolfson Institute of Preventive Medicine,Barts and The London School of Medicine and Dentistry,Queen Mary University of London,East London National Health Service Foundation Trust,UK
| | - Michael Larkin
- Reader in Psychology,School of Life and Health Sciences,Aston University,UK
| | - Elizabeth Newton
- Consultant Clinical Psychologist,Research Fellow, School of Psychology,University of Birmingham,UK
| | - David Crepaz-Keay
- Head of Empowerment and Social Inclusion,Mental Health Foundation,UK
| | - Frances Griffiths
- Professor of Medicine in Society,Division of Health Sciences,Warwick Medical School,University of Warwick,UK
| | - Scott Weich
- Professor of Mental Health,Division of Health Sciences,Warwick Medical School,University of Warwick;and School of Health and Related Research (ScHARR),University of Sheffield,UK
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Miodownik C, Friger MD, Orev E, Gansburg Y, Reis N, Lerner V. Clinical and demographic characteristics of secluded and mechanically restrained mentally ill patients: a retrospective study. Isr J Health Policy Res 2019; 8:9. [PMID: 30704513 PMCID: PMC6357475 DOI: 10.1186/s13584-018-0274-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 12/11/2018] [Indexed: 11/30/2022] Open
Abstract
Background Restraint or seclusion measures in acute psychiatric care are used as a last resort when all other methods for removal of physical threat have failed. The purpose of this study is to find a correlation between coercive measures, demographic characteristics within this patient group, and factors associated with shortened periods of restriction. Methods This is a one-year retrospective study conducted in a male acute closed ward of a psychiatric hospital in Israel. The data from January 1, 2014 to December 31, 2014 were retrieved from the records of patients who underwent restraint and/or seclusion interventions during this period. The analyzed data included age, psychiatric diagnosis, marital status, education, race, ethnicity, length of hospital stay, legal status during admission, type of coercive measure (mechanical restraint, seclusion), number and duration of coercive episodes, reasons for coercion, time of event, number of previous hospitalizations, aggression in past and present treatment, and treatment during events. Results During this time period, there were 563 admissions in the study ward. Over this period, 176 subjects (31.3%) underwent 488 restraints and/or seclusions. 98% were aggressive in the past. (Although some results reached statistical significance, we prefer to emphasize here only the most important results, while the others will be presented in the text.) Patients with personality disorders were physically limited for the longest time, while schizophrenia patients were restricted for the shortest time compared with other diagnoses (p = 0.007). A negative correlation was found between the length of coercion and the number of academic female nurses on duty (p = 0.005), as well as the administration of sedative medications during the restricting procedure. Conclusions We believe that the presence of registered, academic female nurses on duty and medication administration during coercive measures can reduce the length of restriction.
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Affiliation(s)
- Chanoch Miodownik
- Be'er Sheva Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Box 4600, 84170, Be'er-Sheva, PO, Israel
| | - Michael D Friger
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Eyal Orev
- Be'er Sheva Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Box 4600, 84170, Be'er-Sheva, PO, Israel
| | - Yisroel Gansburg
- Be'er Sheva Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Box 4600, 84170, Be'er-Sheva, PO, Israel
| | - Nadav Reis
- Be'er Sheva Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Box 4600, 84170, Be'er-Sheva, PO, Israel
| | - Vladimir Lerner
- Be'er Sheva Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Box 4600, 84170, Be'er-Sheva, PO, Israel.
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Wharewera-Mika JP, Cooper EP, Wiki NR, Field TR, Haitana J, Toko M, Edwards E, McKenna BRBMHSP. Strategies to reduce the use of seclusion with tāngata whai i te ora (Māori mental health service users). Int J Ment Health Nurs 2016; 25:258-65. [PMID: 27219838 DOI: 10.1111/inm.12219] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 12/03/2015] [Accepted: 01/06/2016] [Indexed: 11/27/2022]
Abstract
Māori, the indigenous people of New Zealand, have the highest crude population-based rate of seclusion events reported internationally (McLeod et al. ). This qualitative study explored Māori clinical, cultural and consumer perspectives on potential strategies and initiatives considered likely to facilitate prevention of, and reduction in, the use of seclusion, with tāngata whai i te ora (Māori mental health service users) in mental health inpatient services. A hui (gathering) over 2 days was held with 16 Māori participants with high levels of clinical, cultural and consumer expertise. The gathering was taped and the tapes transcribed. A thematic analysis of the hui data generated three key categories: Te Ao Māori (access to a Māori worldview); Te Ao Hurihuri (transforming practice); and Rangatiratanga (leadership, power, and control). The findings of this study align with the "six core strategies" for best practice to reduce the use of seclusion (Huckshorn ). A comprehensive approach to the reduction of the use of seclusion with tāngata whai i te ora is required, which is clearly based on a Māori model of care and a vision for transformation of practice in mental health inpatient services, which involves Māori leadership.
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Affiliation(s)
| | | | - Nick Rn Wiki
- Auckland Regional Forensic Psychiatry Services, Auckland, New Zealand
| | - Trudie Rn Field
- Auckland Regional Forensic Psychiatry Services, Auckland, New Zealand
| | - Jason Haitana
- Auckland Regional Forensic Psychiatry Services, Auckland, New Zealand
| | - Mike Toko
- Auckland Regional Forensic Psychiatry Services, Auckland, New Zealand
| | - Erika Edwards
- Auckland Regional Forensic Psychiatry Services, Auckland, New Zealand
| | - Brian Rn Ba MHSc PhD McKenna
- Auckland Regional Forensic Psychiatry Services, Auckland, New Zealand.,School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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Asthana S, Gibson A, Bailey T, Moon G, Hewson P, Dibben C. Equity of utilisation of cardiovascular care and mental health services in England: a cohort-based cross-sectional study using small-area estimation. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BackgroundA strong policy emphasis on the need to reduce both health inequalities and unmet need in deprived areas has resulted in the substantial redistribution of English NHS funding towards deprived areas. This raises the question of whether or not socioeconomically disadvantaged people continue to be disadvantaged in their access to and utilisation of health care.ObjectivesTo generate estimates of the prevalence of cardiovascular disease (CVD) and common mental health disorders (CMHDs) at a variety of scales, and to make these available for public use via Public Health England (PHE). To compare these estimates with utilisation of NHS services in England to establish whether inequalities of use relative to need at various stages on the health-care pathway are associated with particular sociodemographic or other factors.DesignCross-sectional analysis of practice-, primary care trust- and Clinical Commissioning Group-level variations in diagnosis, prescribing and specialist management of CVD and CMHDs relative to the estimated prevalence of those conditions (calculated using small-area estimation).ResultsThe utilisation of CVD care appears more equitable than the utilisation of care for CMHDs. In contrast to the reviewed literature, we found little evidence of underutilisation of services by older populations. Indeed, younger populations appear to be less likely to access care for some CVD conditions. Nor did deprivation emerge as a consistent predictor of lower use relative to need for either CVD or CMHDs. Ethnicity is a consistent predictor of variations in use relative to need. Rates of primary management are lower than expected in areas with higher percentages of black populations for diabetes, stroke and CMHDs. Areas with higher Asian populations have higher-than-expected rates of diabetes presentation and prescribing and lower-than-expected rates of secondary care for diabetes. For both sets of conditions, there are pronounced geographical variations in use relative to need. For instance, the North East has relatively high levels of use of cardiac care services and rural (shire) areas have low levels of use relative to need. For CMHDs, there appears to be a pronounced ‘London effect’, with the number of people registered by general practitioners as having depression, or being prescribed antidepressants, being much lower in London than expected. A total of 24 CVD and 41 CMHD prevalence estimates have been provided to PHE and will be publicly available at a range of scales, from lower- and middle-layer super output areas through to Clinical Commissioning Groups and local authorities.ConclusionsWe found little evidence of socioeconomic inequality in use for CVD and CMHDs relative to underlying need, which suggests that the strong targeting of NHS resources to deprived areas may well have addressed longstanding concerns about unmet need. However, ethnicity has emerged as a significant predictor of inequality, and there are large and unexplained geographical variations in use relative to need for both conditions which undermine the principle of equal access to health care for equal needs. The persistence of ethnic variations and the role of systematic factors (such as rurality) in shaping patterns of utilisation deserve further investigation, as does the fact that the models were far better at explaining variation in use of CVD than mental health services.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Sheena Asthana
- School of Government, University of Plymouth, Plymouth, UK
| | - Alex Gibson
- School of Government, University of Plymouth, Plymouth, UK
| | - Trevor Bailey
- College of Mathematics and Physical Sciences, University of Exeter, Exeter, UK
| | - Graham Moon
- School of Geography and the Environment, University of Southampton, Southampton, UK
| | - Paul Hewson
- School of Computing and Mathematics, University of Plymouth, Plymouth, UK
| | - Chris Dibben
- School of Geosciences, University of Edinburgh, Edinburgh, UK
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Farrelly S, Clement S, Gabbidon J, Jeffery D, Dockery L, Lassman F, Brohan E, Henderson RC, Williams P, Howard LM, Thornicroft G. Anticipated and experienced discrimination amongst people with schizophrenia, bipolar disorder and major depressive disorder: a cross sectional study. BMC Psychiatry 2014; 14:157. [PMID: 24885144 PMCID: PMC4045950 DOI: 10.1186/1471-244x-14-157] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 05/15/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The unfair treatment of individuals with severe mental illness has been linked to poorer physical and mental health outcomes. Additionally, anticipation of discrimination may lead some individuals to avoid participation in particular life areas, leading to greater isolation and social marginalisation. This study aimed to establish the levels and clinical and socio-demographic associations of anticipated and experienced discrimination amongst those diagnosed with a schizophrenia and comparator severe mental illnesses (bipolar and major depressive disorders). METHODS This study was a cross-sectional analysis of anticipated and experienced discrimination from 202 individuals in South London (47% with schizophrenia, 32% with depression and 20% with bipolar disorder). RESULTS 93% of the sample anticipated discrimination and 87% of participants had experienced discrimination in at least one area of life in the previous year. There was a significant association between the anticipation and the experience of discrimination. Higher levels of experienced discrimination were reported by those of a mixed ethnicity, and those with higher levels of education. Women anticipated more discrimination than men. Neither diagnosis nor levels of functioning were associated with the extent of discrimination. Clinical symptoms of anxiety, depression and suspiciousness were associated with more experienced and anticipated discrimination respectively. CONCLUSIONS The unfair treatment of individuals with severe mental illnesses remains unacceptably common. Population level interventions are needed to reduce levels of discrimination and to safeguard individuals. Interventions are also required to assist those with severe mental illness to reduce internalised stigma and social avoidance.
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Affiliation(s)
- Simone Farrelly
- Section of Community Mental Health, Health Service and Population Research Department, King's College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK.
| | - Sarah Clement
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Jheanell Gabbidon
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Debra Jeffery
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Lisa Dockery
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Francesca Lassman
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Elaine Brohan
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK,Adelphi Values, Adelphi Mill, Grimshaw Lane, SK10 5JB Bollington, Cheshire, UK
| | - R Claire Henderson
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Paul Williams
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Louise M Howard
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
| | - Graham Thornicroft
- Section of Community Mental Health, Health Service and Population Research Department, King’s College London, Institute of Psychiatry, De Crespigney Park, Box PO29, SE5 8AF London, UK
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Singh SP, Burns T, Tyrer P, Islam Z, Parsons H, Crawford MJ. Ethnicity as a predictor of detention under the Mental Health Act. Psychol Med 2014; 44:997-1004. [PMID: 23795603 DOI: 10.1017/s003329171300086x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There has been major concern about the 'over-representation' of Black and ethnic minority groups amongst people detained under the Mental Health Act (MHA). We explored the effect of patient ethnicity on detention following an MHA assessment, once confounding variables were controlled for. METHOD Prospective data were collected for all MHA assessments over 4-month periods in the years 2008, 2009, 2010 and 2011 each in three regions in England: Birmingham, West London and Oxfordshire. Logistic regression modelling was conducted to predict the outcome of MHA assessments - either resulting in 'detention' or 'no detention'. RESULTS Of the 4423 MHA assessments, 2841 (66%) resulted in a detention. A diagnosis of psychosis, the presence of risk, female gender, level of social support and London as the site of assessment predicted detention under the MHA. Ethnicity was not an independent predictor of detention. CONCLUSIONS There is no evidence for that amongst those assessed under the MHA, ethnicity has an independent effect on the odds of being detained.
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Affiliation(s)
- S P Singh
- Mental Health and Wellbeing, Warwick Medical School, Coventry, UK
| | - T Burns
- University of Oxford, Warneford Hospital, Oxford, UK
| | - P Tyrer
- Imperial College London, Claybrook Centre, London, UK
| | - Z Islam
- Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - H Parsons
- Division of Health Sciences, Warwick Medical School, UK
| | - M J Crawford
- Imperial College London, Claybrook Centre, London, UK
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Singh SP, Islam Z, Brown LJ, Gajwani R, Jasani R, Rabiee F, Parsons H. Ethnicity, detention and early intervention: reducing inequalities and improving outcomes for black and minority ethnic patients: the ENRICH programme, a mixed-methods study. PROGRAMME GRANTS FOR APPLIED RESEARCH 2013. [DOI: 10.3310/pgfar01030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundBlack and minority ethnic (BME) service users experience adverse pathways into care. Ethnic differences are evident even at first-episode psychosis (FEP); therefore, contributory factors must operate before first presentation to psychiatric services. The ENRICH programme comprised three interlinked studies that aimed to understand ethnic and cultural determinants of help-seeking and pathways to care.Aims and objectivesStudy 1: to understand ethnic differences in pathways to care in FEP by exploring cultural determinants of illness recognition, attribution and help-seeking among different ethnic groups. Study 2: to evaluate the process of detention under the Mental Health Act (MHA) and determine predictors of detention. Study 3: to determine the appropriateness, accessibility and acceptability of generic early intervention services for different ethnic groups.MethodsStudy 1: We recruited a prospective cohort of FEP patients and their carers over a 2-year period and assessed the chronology of symptom emergence, attribution and help-seeking using semistructured tools: the Nottingham Onset Schedule (NOS), the Emerging Psychosis Attribution Schedule and the ENRICH Amended Encounter Form. A stratified subsample of user–carer NOS interviews was subjected to qualitative analyses. Study 2: Clinical and sociodemographic data including reasons for detention were collected for all MHA assessments conducted over 1 year (April 2009–March 2010). Five cases from each major ethnic group were randomly selected for a qualitative exploration of carer perceptions of the MHA assessment process, its outcomes and alternatives to detention. Study 3: Focus groups were conducted with service users, carers, health professionals, key stakeholders from voluntary sector and community groups, commissioners and representatives of spiritual care with regard to the question: ‘How appropriate and accessible are generic early intervention services for the specific ethnic and cultural needs of BME communities in Birmingham?’ResultsThere were no ethnic differences in duration of untreated psychosis (DUP) and duration of untreated illness in FEP. DUP was not related to illness attribution; long DUP was associated with patients being young (< 18 years) and living alone. Black patients had a greater risk of MHA detention, more criminal justice involvement and more crisis presentations than white and Asian groups. Asian carers and users were most likely to attribute symptoms to faith-based or supernatural explanations and to seek help from faith organisations. Faith-based help-seeking, although offering comfort and meaning, also risked delaying access to medical care and in some cases also resulted in financial exploitation of this vulnerable group. The BME excess in MHA detentions was not because of ethnicity per se; the main predictors of detention were a diagnosis of mental illness, presence of risk and low level of social support. Early intervention services were perceived to be accessible, supportive, acceptable and culturally appropriate. There was no demand or perceived need for separate services for BME groups or for ethnic matching between users and clinicians.ConclusionsStatutory health-care organisations need to work closely with community groups to improve pathways to care for BME service users. Rather than universal public education campaigns, researchers need to develop and evaluate public awareness programmes that are specifically focused on BME groups.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- SP Singh
- Division of Mental Health and Wellbeing, Warwick Medical School, Warwick University, Coventry, UK
- Research and Innovation Department, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Z Islam
- Division of Mental Health and Wellbeing, Warwick Medical School, Warwick University, Coventry, UK
- Research and Innovation Department, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - LJ Brown
- Division of Mental Health and Wellbeing, Warwick Medical School, Warwick University, Coventry, UK
- Research and Innovation Department, Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - R Gajwani
- School of Psychology, University of Birmingham, Birmingham, UK
| | - R Jasani
- Humanitarian and Conflict Response Institute (HCRI), University of Manchester, Manchester, UK
| | - F Rabiee
- Centre for Health and Social Care Research, Faculty of Health, Birmingham City University, Birmingham, UK
| | - H Parsons
- Division of Health Sciences, Warwick Medical School, Warwick University, Coventry, UK
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16
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Barrett B, Waheed W, Farrelly S, Birchwood M, Dunn G, Flach C, Henderson C, Leese M, Lester H, Marshall M, Rose D, Sutherby K, Szmukler G, Thornicroft G, Byford S. Randomised controlled trial of joint crisis plans to reduce compulsory treatment for people with psychosis: economic outcomes. PLoS One 2013; 8:e74210. [PMID: 24282495 PMCID: PMC3839936 DOI: 10.1371/journal.pone.0074210] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 11/02/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Compulsory admission to psychiatric hospitals may be distressing, disruptive to patients and families, and associated with considerable cost to the health service. Improved patient experience and cost reductions could be realised by providing cost-effective crisis planning services. METHODS Economic evaluation within a multi-centre randomised controlled trial comparing Joint Crisis Plans (JCP) plus treatment as usual (TAU) to TAU alone for patients aged over 16, with at least one psychiatric hospital admission in the previous two years and on the Enhanced Care Programme Approach register. JCPs, containing the patient's treatment preferences for any future psychiatric emergency, are a form of crisis intervention that aim to mitigate the negative consequences of relapse, including hospital admission and use of coercion. Data were collected at baseline and 18-months after randomisation. The primary outcome was admission to hospital under the Mental Health Act. The economic evaluation took a service perspective (health, social care and criminal justice services) and a societal perspective (additionally including criminal activity and productivity losses). FINDINGS The addition of JCPs to TAU had no significant effect on compulsory admissions or total societal cost per participant over 18-months follow-up. From the service cost perspective, however, evidence suggests a higher probability (80%) of JCPs being the more cost-effective option. Exploration by ethnic group highlights distinct patterns of costs and effects. Whilst the evidence does not support the cost-effectiveness of JCPs for White or Asian ethnic groups, there is at least a 90% probability of the JCP intervention being the more cost-effective option in the Black ethnic group. INTERPRETATION The results by ethnic group are sufficiently striking to warrant further investigation into the potential for patient gain from JCPs among black patient groups. TRIAL REGISTRATION Current Controlled Trials ISRCTN11501328.
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Affiliation(s)
- Barbara Barrett
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Waquas Waheed
- Division of Psychiatry, School of Medicine, University of Manchester, Manchester, United Kingdom
| | - Simone Farrelly
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Max Birchwood
- Department of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Graham Dunn
- Institute of Population Health, University of Manchester, Manchester, United Kingdom
| | - Clare Flach
- Institute of Population Health, University of Manchester, Manchester, United Kingdom
| | - Claire Henderson
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Morven Leese
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Helen Lester
- School of Health and Population Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Max Marshall
- Division of Psychiatry, School of Medicine, University of Manchester, Manchester, United Kingdom
| | - Diana Rose
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Kim Sutherby
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - George Szmukler
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Graham Thornicroft
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Sarah Byford
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom
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17
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Stewart D, Bowers L. Inpatient verbal aggression: content, targets and patient characteristics. J Psychiatr Ment Health Nurs 2013; 20:236-43. [PMID: 22486899 DOI: 10.1111/j.1365-2850.2012.01905.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Verbally aggressive behaviour on psychiatric wards is more common than physical violence and can have distressing consequences for the staff and patients who are subjected to it. Previous research has tended to examine incidents of verbal aggression in little detail, instead combining different types of aggressive behaviour into a single measure. This study recruited 522 adult psychiatric inpatients from 84 acute wards. Data were collected from nursing and medical records for the first 2 weeks of admission. Incidents of verbal aggression were categorized and associations with patient characteristics examined. There were 1398 incidents of verbal aggression in total, reported for half the sample. Types of verbal aggression were, in order of prevalence: abusive language, shouting, threats, expressions of anger and racist comments. There were also a large number of entries in the notes which did not specify the form of verbal aggression. Staff members were the most frequent target of aggression. A history of violence and previous drug use were consistently associated with verbal aggression. However, there were also some notable differences in patient variables associated with specific types of verbal aggression. Future studies should consider using multidimensional measures of verbal aggression.
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Affiliation(s)
- D Stewart
- Institute of Psychiatry, Kings College London, London, UK.
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18
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Norum J, Bjerke FE, Nybrodahl I, Olsen A. Admission and stay in psychiatric hospitals in northern Norway among Sami and a control group: a registry-based study. Nord J Psychiatry 2012; 66:422-7. [PMID: 22452323 DOI: 10.3109/08039488.2012.668936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this study was analyze the admission and inpatient stay at psychiatric hospital in northern Norway among people from the Sami-speaking municipalities (Sami group) and a control group (non-Sami group). Are they treated equally? METHODS All admissions and inpatient stay from the administration area of the Sami language law (eight municipalities) was matched with a control group of 11 municipalities. All adult patients treated during the 2-year time period 2009-2010 and registered by the Norwegian Patient Registry (NPR) were included in the study. Population data as of 2009 was accessed from Statistics Norway. The admission rate and the days in hospital (DiH) rate per 10,000 inhabitants/year were set as 1.0. RESULTS Both study groups had a significantly higher admission and DiH-rate than northern Norwegians in general. The median annual admission rate/10,000 inhabitants was 284 (Sami) and 307 (non-Sami), respectively (P = 0.23). Whereas there were no difference between groups with regard to DiH/10,000 inhabitants/year (P = 0.24), the males of the Sami group spent significantly fewer DiH when any form of coercion was used (RR = 0.41). CONCLUSIONS Sami did not experience significantly more or fewer admissions (voluntary and compulsory) to psychiatric hospitals than the control group. There were significant intergroup variations in both groups.
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Affiliation(s)
- Jan Norum
- Northern Norway Regional Health Authority, Bodø, Norway and Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
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19
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Hatch SL, Thornicroft G. Report from England I: innovative approaches to reducing mental health disparities related to ethnicity. J Nerv Ment Dis 2012; 200:843-6. [PMID: 23034573 DOI: 10.1097/nmd.0b013e31826b6d34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Stephani L Hatch
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, England.
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20
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Weich S, Griffith L, Commander M, Bradby H, Sashidharan SP, Pemberton S, Jasani R, Bhui KS. Experiences of acute mental health care in an ethnically diverse inner city: qualitative interview study. Soc Psychiatry Psychiatr Epidemiol 2012; 47:119-28. [PMID: 21046068 DOI: 10.1007/s00127-010-0314-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 10/18/2010] [Indexed: 09/29/2022]
Abstract
PURPOSE Ethnic inequalities in experiences of mental health care persist in the UK, although most evidence derives from in-patient settings. We aimed to explore service users' and carers' accounts of recent episodes of severe mental illness and of the care received in a multi-cultural inner city. We sought to examine factors impacting on these experiences, including whether and how users and carers felt that their experiences were mediated by ethnicity. METHODS Forty service users and thirteen carers were recruited following an acute psychotic episode using typical case sampling. In-depth interviews explored illness and treatment experiences. Ethnicity was allowed to emerge in participants' narratives and was prompted if necessary. RESULTS Ethnicity was not perceived to impact significantly on therapeutic relationships, and nor were there ethnic differences in care pathways, or in the roles of families and friends. Ethnic diversity was commonplace among both service users and mental health professionals. This was tolerated in community settings if efforts were made to ensure high-quality care. Home Treatment was rated highly, irrespective of service users' ethnicity. In-patient care was equally unpopular and was the one setting where ethnicity appeared to mediate unsatisfactory care experiences. These findings highlight the risks of generalising from reports of (dis)satisfaction with care based predominantly on in-patient experiences. CONCLUSIONS Home treatment was popular but hard to deliver in deprived surroundings and placed a strain on carers. Interventions to enhance community treatments in deprived areas are needed, along with remedial interventions to improve therapeutic relationships in hospital settings.
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Affiliation(s)
- Scott Weich
- Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
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21
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Keown P, Weich S, Bhui KS, Scott J. Association between provision of mental illness beds and rate of involuntary admissions in the NHS in England 1988-2008: ecological study. BMJ 2011; 343:d3736. [PMID: 21729994 PMCID: PMC3130113 DOI: 10.1136/bmj.d3736] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine the rise in the rate of involuntary admissions for mental illness in England that has occurred as community alternatives to hospital admission have been introduced. DESIGN Ecological analysis. SETTING England, 1988-2008. DATA SOURCE Publicly available data on provision of beds for people with mental illness in the National Health Service from Hospital Activity Statistics and involuntary admission rates from the NHS Information Centre. MAIN OUTCOME MEASURES Association between annual changes in provision of mental illness beds in the NHS and involuntary admission rates, using cross correlation. Partial correlation coefficients were calculated and regression analysis carried out for the time lag (interval) over which the largest association between these variables was identified. RESULTS The rate of involuntary admissions per annum in the NHS increased by more than 60%, whereas the provision of mental illness beds decreased by more than 60% over the same period; these changes seemed to be synchronous. The strongest association between these variables was observed when a time lag of one year was introduced, with bed reductions preceding increases in involuntary admissions (cross correlation -0.60, 95% confidence interval -1.06 to -0.15). This association increased in magnitude when analyses were restricted to civil (non-forensic) involuntary admissions and non-secure mental illness beds. CONCLUSION The annual reduction in provision of mental illness beds was associated with the rate of involuntary admissions over the short to medium term, with the closure of two mental illness beds leading to one additional involuntary admission in the subsequent year. This study provides a method for predicting rates of involuntary admissions and what may happen in the future if bed closures continue.
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Affiliation(s)
- Patrick Keown
- Tranwell Unit, Queen Elizabeth Hospital, Gateshead, UK.
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22
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Dumais A, Larue C, Drapeau A, Ménard G, Giguère Allard M. Prevalence and correlates of seclusion with or without restraint in a Canadian psychiatric hospital: a 2-year retrospective audit. J Psychiatr Ment Health Nurs 2011; 18:394-402. [PMID: 21539684 DOI: 10.1111/j.1365-2850.2010.01679.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Seclusion with or without restraint is a measure used to manage patients with challenging behaviours. Although controversial, the intervention remains poorly documented, especially in Canadian psychiatric hospitals. The purpose of this study is to assess the prevalence of the measure and identify any correlated demographic characteristics and psychiatric disorders. Episodes of seclusion with or without restraint were extracted from a computerized, hospital-based system introduced specifically to track such interventions. Of 2721 patients hospitalized during that time, 23.2% (n = 632) were secluded with or without restraint, and 17.5% (n = 476) were secluded with restraint. Younger age, schizophrenia or other psychosis, bipolar and personality disorder, and longer stay in hospital are predictors of an episode of seclusion with or without restraint. Younger age, bipolar and personality disorders and a longer stay in hospital are predictors of an episode of seclusion with restraint. For patients who spent longer in seclusion and under restraint, there is a positive association with longer stay in hospital. In this inpatient psychiatric facility, seclusion with or without restraint thus appears to be common. More research is warranted to better identify the principal factors associated with seclusion and restraint and help reduce resort to these measures.
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Affiliation(s)
- A Dumais
- Montreal University, Fernand-Seguin Research Center, Philippe-Pinel Institute of Montreal, Montreal, QC, Canada.
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23
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Katsakou C, Marougka S, Garabette J, Rost F, Yeeles K, Priebe S. Why do some voluntary patients feel coerced into hospitalisation? A mixed-methods study. Psychiatry Res 2011; 187:275-82. [PMID: 21272940 DOI: 10.1016/j.psychres.2011.01.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Revised: 09/22/2010] [Accepted: 01/06/2011] [Indexed: 01/12/2023]
Abstract
This study aimed to investigate factors linked to perceived coercion at admission and during treatment among voluntary inpatients. Quantitative and qualitative methods were used. Two hundred seventy patients were screened for perceived coercion at admission. Those who felt coerced into admission rated their perceived coercion during treatment a month after admission. Patient characteristics and experiences were tested as predictors of coercion. In-depth interviews on experiences leading to perceived coercion were conducted with 36 participants and analysed thematically. Thirty-four percent of patients felt coerced into admission and half of those still felt coerced a month later. No patient characteristics were associated with perceived coercion. Those whose satisfaction with treatment increased more markedly between baseline and a month later were less likely to feel coerced a month after admission. In the qualitative interviews three themes leading to perceived coercion were identified: viewing the hospital as ineffective and other treatments as more appropriate, not participating in the admission and treatment and not feeling respected. Involving patients in the decision-making and treating them with respect may reduce perceived coercion.
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Affiliation(s)
- Christina Katsakou
- Barts and the London School of Medicine, Queen Mary University of London, London, UK.
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24
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The effect of ethnicity on prescribing practice and treatment outcome in inpatients suffering from schizophrenia in Greece. BMC Psychiatry 2011; 11:66. [PMID: 21507225 PMCID: PMC3111345 DOI: 10.1186/1471-244x-11-66] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 04/20/2011] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND No studies have been conducted in Greece with the aim of investigating the influence of ethnicity on the prescribing and treatment outcome of voluntarily admitted inpatients. Most studies conducted in the UK and the US, both on inpatients and outpatients, focus on the dosage of antipsychotics for schizophrenic patients and many suffer from significant methodological limitations. Using a simple design, we aimed to assess negative ethnic bias in psychotropic medication prescribing by comparing discrepancies in use between native and non-native psychiatric inpatients. We also aimed to compare differences in treatment outcome between the two groups. METHODS In this retrospective study, the prescribing of medication was compared between 90 Greek and 63 non-Greek inpatients which were consecutively admitted into the emergency department of a hospital covering Athens, the capital of Greece. Participants suferred from schizophrenia and other psychotic disorders. Overall, groups were compared with regard to 12 outcomes, six related to prescribing and six related to treatment outcome as assesed by standardised psychometric tools. RESULTS No difference between the two ethnic groups was found in terms of improvement in treatment as measured by GAF and BPRS-E. Polypharmacy, use of first generation antipsychotics, second generation antipsychotics and use of mood stabilizers were not found to be associated with ethnicity. However, non-Greeks were less likely to receive SSRIs-SNRIs and more likely to receive benzodiazepines. CONCLUSIONS Our study found limited evidence for ethnic bias. The stronger indication for racial bias was found in benzodiazepine prescribing. We discuss alternative explanations and give arguments calling for future research that will focus on disorders other than schizophrenia and studying non-inpatient populations.
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25
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Abstract
This article describes my developing interest in cultural psychiatry. This is both a challenging and yet a privileged opportunity to reflect on my research and clinical work over the last 25 years. I describe cultural and interpersonal influences on my thinking and interests, and the development of my research career moving from health services research of specialist services, to primary care research to public mental health research. Specifically, social and cultural influences on risks and responses to mental illness are discussed, as are pathways to care, the recognition of mental illness, and public health and cultural psychiatry research.
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Affiliation(s)
- Kamaldeep Bhui
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary, University of London.
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