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Bartl G, Stuart R, Ahmed N, Saunders K, Loizou S, Brady G, Gray H, Grundy A, Jeynes T, Nyikavaranda P, Persaud K, Raad A, Foye U, Simpson A, Johnson S, Lloyd-Evans B. A qualitative meta-synthesis of service users' and carers' experiences of assessment and involuntary hospital admissions under mental health legislations: a five-year update. BMC Psychiatry 2024; 24:476. [PMID: 38937705 PMCID: PMC11209989 DOI: 10.1186/s12888-024-05914-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Compulsory admissions occur in psychiatric hospitals around the world. They result in coercive and sometimes traumatic experiences for service users and carers. Legal and service reforms in various countries are intended to reduce rates of detention and improve service user experience. We aimed to inform policy and service delivery by providing an up-to-date synthesis of qualitative evidence on service users' and carers' experiences of assessment and detention under mental health legislation, updating previous reviews in which we searched for literature published up to 2018. METHODS We searched five bibliographic databases for studies published between January 2018 and March 2023. We identified 24 additional studies reporting qualitative investigations of service users' or carers' experiences of assessment or detention under mental health legislation. A team including researchers with relevant personal experience analysed and synthesised data using a thematic synthesis approach. RESULTS Findings suggest that views on compulsory admissions and assessment varied: many reports highlighted its often negative, traumatic impacts on emotional well-being and self-worth, with fewer accounts of it as an opportunity to access help and support, accompanied by feelings of relief. Experiences of racial discrimination, inequality of access, and dissatisfaction with support before and after hospital stay were more prominent than in our previous reviews. CONCLUSIONS Increasing service user and carer involvement in treatment decisions, provision of timely information at key stages of the admission process, training of key personnel, addressing the issue of discrimination, and investing in community alternatives of inpatient care may contribute to and lead to better overall treatment experiences. PROTOCOL REGISTRATION The study protocol has been registered in the PROSPERO database on 30th May 2023 (CRD42023423439).
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Affiliation(s)
- Gergely Bartl
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Ruth Stuart
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Nafiso Ahmed
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Katherine Saunders
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Sofia Loizou
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Grainne Brady
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Hannah Gray
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Andrew Grundy
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
- Lived Experience Working Group, University College London, London, UK
| | - Tamar Jeynes
- Lived Experience Working Group, University College London, London, UK
| | - Patrick Nyikavaranda
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
- Lived Experience Working Group, University College London, London, UK
| | - Karen Persaud
- Lived Experience Working Group, University College London, London, UK
| | - Ari Raad
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Una Foye
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Alan Simpson
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Sonia Johnson
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
- Camden and Islington National Health Service Foundation Trust, London, UK
| | - Brynmor Lloyd-Evans
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK.
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Husum TL, Wormdahl I, Kjus SHH, Hatling T, Rugkåsa J. Something Happened with the Way We Work: Evaluating the Implementation of the Reducing Coercion in Norway (ReCoN) Intervention in Primary Mental Health Care. Healthcare (Basel) 2024; 12:786. [PMID: 38610208 PMCID: PMC11011458 DOI: 10.3390/healthcare12070786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Current policies to reduce the use of involuntary admissions are largely oriented towards specialist mental health care and have had limited success. We co-created, with stakeholders in five Norwegian municipalities, the 'Reducing Coercion in Norway' (ReCoN) intervention that aims to reduce involuntary admissions by improving the way in which primary mental health services work and collaborate. The intervention was implemented in five municipalities and is being tested in a cluster randomized control trial, which is yet to be published. The present study evaluates the implementation process in the five intervention municipalities. To assess how the intervention was executed, we report on how its different elements were implemented, and what helped or hindered implementation. METHODS We assessed the process using qualitative methods. Data included detailed notes from quarterly progress interviews with (i) intervention coordinators and representatives from (ii) user organisations and (iii) carer organisations. Finally, an end-of-intervention evaluation seminar included participants from across the sites. RESULTS The majority of intervention actions were implemented. We believe this was enabled by the co-creating process, which ensured ownership and a good fit for the local setting. The analysis of facilitators and barriers showed a high degree of interconnectedness between different parts of the intervention so that success (or lack thereof) in one area affected the success in others. Future implementation should pay attention to enhanced planning and training, clarify the role and contribution of service user and carer involvement, and pay close attention to the need for implementation support and whether this should be external or internal to services. CONCLUSIONS It is feasible to implement a complex intervention designed to reduce the use of involuntary admissions in general support services, such as the Norwegian primary mental health services. This could have implications for national and international policy aimed at reducing the use of involuntary care.
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Affiliation(s)
- Tonje Lossius Husum
- Faculty of Health Sciences, Oslo Metropolitan University, 0166 Oslo, Norway;
| | - Irene Wormdahl
- Department of Mental Health Work, NTNU Social Research, 7491 Trondheim, Norway;
| | - Solveig H. H. Kjus
- Norwegian Resource Centre for Community Mental Health, NTNU Social Research, 7491 Trondheim, Norway; (S.H.H.K.); (T.H.)
| | - Trond Hatling
- Norwegian Resource Centre for Community Mental Health, NTNU Social Research, 7491 Trondheim, Norway; (S.H.H.K.); (T.H.)
| | - Jorun Rugkåsa
- Faculty of Health Sciences, Oslo Metropolitan University, 0166 Oslo, Norway;
- Health Services Research Unit, Akershus University Hospital, 1478 Lørenskog, Norway
- Centre for Care Research, University of South-Eastern Norway, 3918 Porsgrunn, Norway
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Jäger M, Klimczyk J. [Involuntary Psychiatric Hospital Admissions According to Public Law - A Retrospective Analysis]. PSYCHIATRISCHE PRAXIS 2024; 51:122-128. [PMID: 37984357 DOI: 10.1055/a-2191-4099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
OBJECTIVE We provide an empirical survey of the current practice on involuntary psychiatric hospital admission. METHODS Bases on clinical case records, we performed a retrospective analysis of 346 cases with an involuntary hospital admission according to public law in 2020 (21.0% of all inpatient admissions in this period). RESULTS Announcement of suicide was the most frequent cause for involuntary hospital admission (45.1%). Most common diagnoses were substance-related disorders (30.1%), stress-related disorders (19.9%), and schizophrenic psychoses (18.8%). Only 12.7% of the involuntary admissions resulted in a further involuntary hospitalization, whereas 44.5% of all episodes were followed by a discharge within 24 hours. CONCLUSION In many cases, involuntary hospital admissions are reactions to suicidal crises. It will be interesting to see, if the introduction of alternative low-threshold services can help to reduce the frequency of such admissions.
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Affiliation(s)
- Markus Jäger
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Bezirkskrankenhaus(BKH) Kempten
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Magnusson E, Tuvesson H, Rask M, Hörberg U. "A Lonely Road to Walk Along" - The Experiences of Being a Next of Kin to a Woman in Need of Compulsory Psychiatric Inpatient Care. Issues Ment Health Nurs 2023; 44:1245-1253. [PMID: 37852003 DOI: 10.1080/01612840.2023.2260481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
It is seldom that it is only the patient who is affected when someone is admitted to compulsory psychiatric inpatient care, the next of kin is usually also impacted. The aim was to describe the lived experiences of being a next of kin to a woman in need of compulsory psychiatric inpatient care. Ten next of kin were interviewed and the material was analyzed with a Reflective Lifeworld Research approach. The results show loneliness and feelings that their existence has collapsed. An emotional duality is described in the realization that the care is needed but they are devastated that the woman is there. A trust exists, but it changes when the next of kin are no longer a part of the care process.
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Affiliation(s)
- Emilie Magnusson
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Hanna Tuvesson
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Mikael Rask
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Ulrica Hörberg
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
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Ma HJ, Zheng YC, Shao Y, Xie B. Status and clinical influencing factors of involuntary admission in chinese patients with schizophrenia. BMC Psychiatry 2022; 22:818. [PMID: 36544107 PMCID: PMC9769007 DOI: 10.1186/s12888-022-04480-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Though controversial for its various disadvantages, involuntary admission (IA) is necessary in providing mental health care for patients suffering from schizophrenia in China. This article examines the IA rate in a representative sample, and under which circumstances are these patients more likely to be admitted involuntarily. METHODS Adult patients consecutively admitted to two typical hospitals in Shanghai between 2013 and 2014 with a diagnosis of ICD-10 schizophrenia were included. 2167 patients were included in this study. Sociodemographic and clinical data, as well as personal information of psychiatrists who made risk assessment, were collected. The whole sample was divided into voluntary and involuntary admission groups. Group comparisons were performed with SPSS 17.0, using one-way ANOVA, Wilcoxon rank sum test, Chi-squares and Logistic regression. RESULTS Among 2167 inpatients, the majority (2003, 92.4%) were involuntarily admitted. Clinical features, including age of patients (p < 0.001, OR = 1.037), lacking of insight (p < 0.001, OR = 3.691), were statistically significant for IA. Psychiatrist's age (p < 0.001, OR = 1.042) was independently associated with IA. However, risk behaviors had dramatically affected patients' admission status, of which the strongest predictor of IA was noncompliance with treatment (p < 0.001, OR = 3.597). The areas under the curve of the ROC and accuracy for the regression model were 0.815 and 0.927, respectively. CONCLUSION IA patients account for a major proportion of all those hospitalized with schizophrenia in China. Insights and risk behaviors contributed the most reasons for admission status of patients. This research shed light on necessity of further qualitative studies learning detailed evaluation processes of IA and high-quality interventional studies aiming to limit the performance of IA among patients with schizophrenia.
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Affiliation(s)
- Hua-Jian Ma
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030 Shanghai, P. R. China
| | - Yu-Chen Zheng
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030 Shanghai, P. R. China
| | - Yang Shao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030, Shanghai, P. R. China.
| | - Bin Xie
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030, Shanghai, P. R. China.
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Wergeland NC, Fause Å, Weber AK, Fause ABO, Riley H. Health professionals' experience of treatment of patients whose community treatment order was revoked under new capacity-based mental health legislation in Norway: qualitative study. BJPsych Open 2022; 8:e183. [PMID: 36217299 PMCID: PMC9634590 DOI: 10.1192/bjo.2022.592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Norway introduced capacity-based legislation in mental healthcare on 1 September 2017 with the aim of increasing patient autonomy and legal protection and reducing the use of coercion. The new legislation was expected to be particularly important for patients under community treatment orders (CTOs). AIMS To explore health professionals' experiences of how capacity-based legislation affects healthcare services for patients whose compulsory treatment order was revoked as a result of being assessed as having capacity to consent. METHOD Nine health professionals responsible for treatment and care of patients whose CTO was revoked owing to the new legislation were interviewed in depth from September 2019 to March 2020. We used a hermeneutic approach to the interviews and analysis of the transcripts. RESULTS The participants found that capacity-based legislation raised their awareness of their responsibility for patient autonomy and involvement in treatment and care. They also felt a need for more frequent assessments of patients' condition and capacity to consent and more flexibility between levels of care. CONCLUSIONS The study shows that health professionals found that capacity-based legislation raised their awareness of their responsibility for patient autonomy and involvement in treatment and care. They sought closer dialogue with patients, providing information and advice, and more frequently assessing patients' condition to adjust treatment and care to enable them to retain their capacity to consent. This could be challenging and required competence, continuity and close collaboration between personnel in different healthcare services at primary and specialist level.
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Affiliation(s)
- Nina Camilla Wergeland
- Division of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway; and Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Åshild Fause
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Astrid Karine Weber
- Division of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway
| | | | - Henriette Riley
- Division of Mental Health and Substance Abuse, University Hospital of North Norway, Tromsø, Norway; and Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Wormdahl I, Hatling T, Husum TL, Kjus SHH, Rugkåsa J, Brodersen D, Christensen SD, Nyborg PS, Skolseng TB, Ødegård EI, Andersen AM, Gundersen E, Rise MB. The ReCoN intervention: a co-created comprehensive intervention for primary mental health care aiming to prevent involuntary admissions. BMC Health Serv Res 2022; 22:931. [PMID: 35854270 PMCID: PMC9296016 DOI: 10.1186/s12913-022-08302-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 07/05/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Reducing involuntary psychiatric admissions is a global concern. In Norway, the rate of involuntary admissions was 199 per 100,000 people 16 years and older in 2020. Individuals' paths towards involuntary psychiatric admissions usually unfold when they live in the community and referrals to such admissions are often initiated by primary health care professionals. Interventions at the primary health care level can therefore have the potential to prevent such admissions. Interventions developed specifically for this care level are, however, lacking. To enhance the quality and development of services in a way that meets stakeholders' needs and facilitates implementation to practice, involving both persons with lived experience and service providers in developing such interventions is requested. AIM To develop a comprehensive intervention for primary mental health care aiming to prevent involuntary admissions of adults. METHODS This study had an action research approach with a participatory research design. Dialogue conferences with multiple stakeholders in five Norwegian municipalities, inductive thematic analysis of data material from the conferences, and a series of feedback meetings were conducted. RESULTS The co-creation process resulted in the development of the ReCoN (Reducing Coercion in Norway) intervention. This is a comprehensive intervention that includes six strategy areas: [1] Management, [2] Involving Persons with Lived Experience and Family Carers, [3] Competence Development, [4] Collaboration across Primary and Specialist Care Levels, [5] Collaboration within the Primary Care Level, and [6] Tailoring Individual Services. Each strategy area has two to four action areas with specified measures that constitute the practical actions or tasks that are believed to collectively impact the need for involuntary admissions. CONCLUSIONS The ReCoN intervention has the potential for application to both national and international mental health services. The co-creation process with the full range of stakeholders ensures face validity, acceptability, and relevance. The effectiveness of the ReCoN intervention is currently being tested in a cluster randomised controlled trial. Given positive effects, the ReCoN intervention may impact individuals with a severe mental illness at risk of involuntary admissions, as more people may experience empowerment and autonomy instead of coercion in their recovery process.
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Affiliation(s)
- Irene Wormdahl
- grid.458589.d Norwegian Resource Centre for Community Mental Health, NTNU Social Research, Trondheim, Norway ,grid.5947.f0000 0001 1516 2393Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trond Hatling
- grid.458589.d Norwegian Resource Centre for Community Mental Health, NTNU Social Research, Trondheim, Norway
| | - Tonje Lossius Husum
- grid.5510.10000 0004 1936 8921Centre for Medical Ethics, Institute for Health & Society, University of Oslo, Oslo, Norway ,grid.412414.60000 0000 9151 4445Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Solveig Helene Høymork Kjus
- grid.458589.d Norwegian Resource Centre for Community Mental Health, NTNU Social Research, Trondheim, Norway
| | - Jorun Rugkåsa
- grid.411279.80000 0000 9637 455XHealth Service Research Unit, Akershus University Hospital, Lørenskog, Norway ,grid.463530.70000 0004 7417 509XCentre for Care Research, University of South-Eastern Norway, Porsgrunn, Norway
| | - Dorte Brodersen
- Department of Health Care, Ullensaker Municipality, Ullensaker, Norway
| | | | - Petter Sundt Nyborg
- Department of Mental Health and Addiction, Elverum Municipality, Elverum, Norway
| | | | - Eva Irene Ødegård
- Department of Mental Health and Addiction, Grimstad Municipality, Grimstad, Norway
| | | | | | - Marit B. Rise
- grid.5947.f0000 0001 1516 2393Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Morris P, McCloskey R, Bulman D. Iatrogenesis in the Context of Residential Dementia Care: A Concept Analysis. Innov Aging 2022; 6:igac028. [PMID: 35832201 PMCID: PMC9273406 DOI: 10.1093/geroni/igac028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Indexed: 11/12/2022] Open
Abstract
Background and Objectives This concept analysis aims to explore iatrogenesis within the context of residential dementia care and to distinguish this phenomenon from similar phenomena, such as abuse and inadvertent harm. Research Design and Methods Walker and Avant's method for concept analysis was used to define critical attributes of iatrogenesis within residential dementia care, and to explore antecedents and consequences of its occurrence. A review of the literature about iatrogenesis in the context of residential dementia was conducted across 4 electronic databases. Texts about iatrogenesis in surgery, medicine, social work, psychology, and other relevant disciplines were also reviewed to provide additional context for the concept. Results Iatrogenesis takes a unique form in residential dementia care. The final definition of the concept proposed in this article is habituated, forceful, hands-on care provided to residents who exhibit responsive behaviors that result in emotional, physical, spiritual, social harm, and/or gradual functional decline, that is provided with the intention of supporting the resident's safety and dignity. Discussion and Implications The definition of iatrogenesis proposed in this article is an initial step toward developing evidence-based practice for the provision of nonconsensual assistance in residential dementia care. A theoretical definition like the one proposed in this article may serve as a starting point for the operationalization of the concept, which would promote future empirical research into staff and residents' experiences of health care-inflicted harms in this context. Theoretically, it contributes to critical conversations about the narratives, myths, and misperceptions that facilitate the provision of nonconsensual care.
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Affiliation(s)
- Patricia Morris
- School of Graduate Studies, University of New Brunswick, Saint John, New Brunswick, Canada
- Geriatric Medicine Clinic, Horizon Health Network, Saint John, New Brunswick, Canada
| | - Rose McCloskey
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Donna Bulman
- Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada
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