The give and take of freedom: The role of involuntary hospitalization and treatment in recovery from mental illness

Factors that influence hospitalization stress in patients with chronic schizophrenia: A cross-sectional study in psychiatric hospitals

WHAT IS KNOWN ON THE SUBJECT?: Patients with chronic schizophrenia become vulnerable to stress when admitted to psychiatric wards, lacking the abilities to independently cope with stress. Therefore, it is crucial to focus on the stress associated with hospitalization. Stress increases when interpersonal functioning is impaired due to schizophrenia symptoms. Social support acts as a protective factor against stress, boosting coping skills and problem-solving abilities.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

Interpersonal relationships, marital status, having cohabited before hospitalization and hospitalization type were associated with hospitalization stress in patients with chronic schizophrenia. Patients with chronic schizophrenia continue aging (mean 55.73 ± 11.14) within closed psychiatric hospitals due to their long-term hospitalizations (mean 14.24 ± 11.37). WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses need to use a standardized nursing assessment including interpersonal relationships, family support system and hospitalization type that may affect hospitalization stress in patients with chronic schizophrenia. Mental health nurses should develop tailored interventions to reduce hospitalization stress for long-stay patients with chronic schizophrenia that consider aging, illness duration, and length of hospital stay, as well as psychiatric symptoms. Mental health nurses need to make efforts to help the families of patients with schizophrenia solidify an important support system by participating in treatment plans and intervention programs, checking on the patients' condition, and spending time with them.

ABSTRACT

INTRODUCTION: Patients with chronic schizophrenia in psychiatric hospitals often experience increased stress due to living in closed spaces and frequently lack the coping skills necessary for independent stress management.

AIM

To explore interpersonal relationships, social support and hospitalization stress, and identify the factors associated with hospitalization stress in patients with chronic schizophrenia in psychiatric hospitals.

METHOD

This cross-sectional study included 135 patients who had been diagnosed with schizophrenia for over 2 years, recruited from two psychiatric hospitals in City B, South Korea through convenience sampling. We conducted descriptive statistics and quantile regression.

RESULTS

Interpersonal relationships, marital status, cohabiting before hospitalization, and voluntary admission were significant factors influencing the hospitalization stress at the 90th percentile.

DISCUSSION

Standardized nursing assessment, active family support, and tailored stress management programs including interpersonal relationships are needed to reduce hospitalization stress in patients with chronic schizophrenia.

IMPLICATIONS FOR PRACTICE

To identify the 90th percentile group for hospitalization stress among patients with chronic schizophrenia, it is essential to consider interpersonal relationships, marital status, pre-hospitalization cohabitation, type of hospitalization, as well as aging and prolonged hospitalization. Mental health nurses should develop and implement family therapy-based interpersonal relationship programs to reduce hospitalization stress in patients with chronic schizophrenia and actively involve families in the process.

Reconsidering the ethics of compulsive treatment in light of clinical psychiatry: A selective review of literature

The ethics of compulsive treatment (CT) is a medical, social and legal discussion that reemerged after the ratification by 181 countries of the 2007 United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD). The optional protocol of the UN-CRPD was ratified by 86 countries aiming to promote, protect and ensure the full and equal enjoyment of all human rights. It also determined the need to review mental health laws as under this light treatment of persons with disabilities, particularly those with mental disorders, cannot accept the use of CT. This selective review of literature aims to clarify inputs from clinical psychiatry adding evidence to the multi-disciplinary discussion. It provides contradictory evidence on how patients experience CT and its impact on their mental health and treatment programs, also which are main reasons for the use of CT and what efforts in psychiatry have been made to reduce, replace and refine it.

Reconsidering the ethics of compulsive treatment under the light of clinical psychiatry

The ethics of compulsive treatment (CT) is a medical, social and legal discussion that reemerged after the ratification by 181 countries of the 2007 United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD). The optional protocol of the UN-CRPD was ratified by 86 countries aiming to promote, protect and ensure the full and equal enjoyment of all human rights. It also determined the need to review mental health laws as under this light treatment of persons with disabilities, particularly those with mental disorders, cannot accept the use of CT. This selective review of literature aims to clarify inputs from clinical psychiatry adding evidence to the multi-disciplinary discussion. It focuses on how patients experience CT and its impact on their mental health and treatment programs, the reasons for the use of CT versus voluntary treatment and what efforts have been made to reduce, replace and refine the presence of CT in psychiatry.

Reconsidering the ethics of compulsive treatment in light of clinical psychiatry: A selective review of literature

The ethics of compulsive treatment (CT) is a medical, social and legal discussion that reemerged after the ratification by 181 countries of the 2007 United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD). The optional protocol of the UN-CRPD was ratified by 86 countries aiming to promote, protect and ensure the full and equal enjoyment of all human rights. It also determined the need to review mental health laws as under this light treatment of persons with disabilities, particularly those with mental disorders, cannot accept the use of CT. This selective review of literature aims to clarify inputs from clinical psychiatry adding evidence to the multi-disciplinary discussion. It provides contradictory evidence on how patients experience CT and its impact on their mental health and treatment programs, also which are main reasons for the use of CT and what efforts in psychiatry have been made to reduce, replace and refine it.

Differences of mentally ill patients' satisfaction degree during their involuntary or voluntary stay in a psychiatric clinic

BACKGROUND

Mental health illness is not considered as a private matter, as it affects not only the mental patient's life and those who are considered his/her immediate family, but also the society as a whole. The involuntary examination and/or hospitalization in the field of mental health as the basic first-line therapeutic solution in Greece, calls for an immediate intervention, which is supposed to counterbalance the need for therapy and patient's rights of personal freedom and safety.

DESIGN AND METHODS

A research using questionnaire was realized, consisting of 100 hospitalized patients in psychiatric clinics (50 voluntarily and 50 involuntarily hospitalized) at the Psychiatric Hospital of Attica. The sampling scheme was the stratified sampling and the level of statistical significance was set to α=0.05.

RESULTS

The results have shown that involuntarily and voluntarily hospitalized mental patients did not differ significantly with almost the entirety of the questionnaire; however, the involuntary patients were significantly more satisfied with the conditions of hospitalization as well as assessing the overall quality of the services provided during their hospitalization.

CONCLUSIONS

For mentally ill patients, greater importance and stronger correlation with gratification, does not constitute the admission procedure to the psychiatric clinic but the development of effective communication and therapeutic relationship with the staff, full knowledge and update about patient's health condition, medication, participation in therapeutic planning and hospitalization in a regime of autonomy and respect for their rights.

Feeling coerced during psychiatric hospitalization: Impact of perceived status of admission and perceived usefulness of hospitalization

INTRODUCTION

Perceived coercion is not exclusively related to the patient's legal status at admission. Patients are not always aware of their correct status and voluntary patients often report having felt coerced. Moreover, involuntary patients commonly report that their hospitalization was justified. The first goal was to disentangle the contribution of the legal and of the perceived status of admission in predicting perceived coercion. The second goal of this study was to investigate to which extent perception of the usefulness of the hospitalization affected perceived coercion.

MATERIAL AND METHODS

152 inpatients were interviewed about their knowledge of their legal status of admission, perceived need for hospitalization and subjective improvement. They completed the MacArthur's Admission Experience Survey and the Coercion Experience Scale.

RESULTS

6.6% of voluntarily admitted patients and 30.4% of involuntarily admitted patients reported an erroneous status of admission. 88.2% of voluntarily admitted patients and 44.7% of involuntarily admitted patients felt that they needed hospitalization during their stay. Levels of perceived coercion at admission and during hospitalization were mostly predicted by their perceived legal status. While involuntary patients frequently perceived the need for hospitalization and reported subjective improvement after admission, their perception of coercion markedly differed from voluntary patients.

CONCLUSIONS

Perceived coercion was marginally related to the legal admission status, which leaves room for interventions that reduce the patients' feeling of being coerced and avoid its negative effects. If many patients revised their belief on the need for and benefits of hospitalization during their stay, their perception of coercion was left partially unchanged.

Recovery of Offenders Formerly Labeled as Not Criminally Responsible: Uncovering the Ambiguity From First-Person Narratives

The recovery paradigm is a widely accepted strength-based approach in general mental health care. Particular challenges arise when applying this paradigm in a forensic context. To address these issues, the present study examined recovery based on first-person narratives of offenders formerly labeled as not criminally responsible of whom the judicial measure was abrogated. Eleven in-depth interviews were conducted to obtain information on lived experiences and recovery resources of this hard-to-reach and understudied population. The interviews focused on recovery and elements that indicated a sense of progress in life. Key themes were derived from the collected data. Descriptions of recovery resources followed recurrent themes, including clinical, functional, social, and personal resources. Participants also reported ambiguous experiences related to features of the judicial trajectory. This was defined as forensic recovery and can be seen as an additional mechanism, besides more established recovery dimensions, that is unique to mentally ill offenders.

Interventions for involuntary psychiatric inpatients: A systematic review

Background:

Observational research has found that involuntary treatment provides limited benefits in terms of long-term clinical outcomes. Our aim was to review literature on existing interventions in order to identify helpful approaches to improve outcomes of involuntary treatment.

Methods:

This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement guidelines. Seven databases (AMED, PsycINFO, Embase Classic, Embase 1974–2017, CINAHL, MEDLINE, and BNI) were searched and the results were analysed in a narrative synthesis.

Results:

Nineteen papers describing fourteen different interventions were included. Using narrative synthesis the interventions were summarised into three categories: a) structured patient-centred care planning; b) specialist therapeutic interventions; c) systemic changes to hospital practice. The methodologies used and outcomes assessed were heterogeneous. Most studies were of low quality, although five interventions were tested in randomised controlled trials (RCTs). Preliminary evidence supports structured patient-centred care planning interventions have an effect on long-term outcomes (such as readmission), and that specialist therapeutic interventions and systemic changes to hospital practice have an effect on reducing the use of coercive measures on wards.

Conclusions:

This review shows that it is possible to conduct rigorous intervention-testing studies in involuntary patients, including RCTs. Yet, the overall evidence is limited. Structured patient-centred care planning interventions show promise for the improvement of long-term outcomes and should be further evaluated.

Trauma-Informed Care for Individuals with Serious Mental Illness: An Avenue for Community Psychology's Involvement in Community Mental Health

Individuals with serious mental illness are at particularly high risk for trauma; however, service environments with which they interact may not always be trauma-informed. While community mental health and other human services settings are moving toward trauma-informed care (TIC) service delivery, a variety of TIC frameworks exist without consensus regarding operationalization, thereby leading to challenges in implementation. TIC is principle-driven and presents substantial overlap with community psychology values and competencies, including ecological frameworks, second-order change, empowerment, and citizen participation. One way to address barriers to TIC implementation is to draw on the strengths of the field of community psychology. With a particular emphasis on the applicability of TIC to individuals with serious mental illness, this paper identifies key implementation issues and recommends future directions for community psychologists in clarifying the service framework, its adaptation to specific service contexts, and improving delivery through consultation and evaluation. Community psychologists may work with various disciplines involved in the TIC field to together promote a more conscious, actionable shift in service delivery.

Perceived coercion in psychiatric hospital admission: validation of the French-language version of the MacArthur Admission Experience Survey

BACKGROUND

The MacArthur Admission Experience Survey (AES) is a widely used tool to evaluate the level of perceived coercion experienced at psychiatric hospital admission. The French-language AES was prepared using a translation/back-translation procedure. It consists of 16 items and 3 subscores (perceived coercion, negative pressures and voice). This study aimed to assess the psychometric properties of the French-language AES.

METHODS

152 inpatients were evaluated. Reliability was estimated using internal consistency coefficients and a test-retest procedure. Internal validity was assessed using a two-parameter logistic item response model. Convergent validity was estimated using correlations between the AES scores and the Coercion Ladder (CL), the Coercion Experience Scale (CES) and the Global Assessment of Functioning (GAF) scale. Discriminatory power was evaluated by comparing the scores of patients undergoing voluntary or compulsory admission.

RESULTS

The French-language AES showed good internal consistency and test-retest reliability. Internal validity of the three-factor model was excellent. Correlations between AES and CL, CES and GAF scores suggested good convergent validity. AES scores were significantly higher among patients subject to compulsory psychiatric hospital admission than among those admitted voluntarily.

CONCLUSIONS

Overall, the French-language version of the AES demonstrated very good psychometric proprieties.