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McGuinness D, Murphy K, Bainbridge E, Brosnan L, Keys M, Felzmann H, Hallahan B, McDonald C, Higgins A. Individuals' experiences of involuntary admissions and preserving control: qualitative study. BJPsych Open 2018; 4:501-509. [PMID: 30564446 PMCID: PMC6293449 DOI: 10.1192/bjo.2018.59] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 08/25/2018] [Accepted: 09/19/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A theoretical model of individuals' experiences before, during and after involuntary admission has not yet been established. AIMS To develop an understanding of individuals' experiences over the course of the involuntary admission process. METHOD Fifty individuals were recruited through purposive and theoretical sampling and interviewed 3 months after their involuntary admission. Analyses were conducted using a Straussian grounded theory approach. RESULTS The 'theory of preserving control' (ToPC) emerged from individuals' accounts of how they adapted to the experience of involuntary admission. The ToPC explains how individuals manage to reclaim control over their emotional, personal and social lives and consists of three categories: 'losing control', 'regaining control' and 'maintaining control', and a number of related subcategories. CONCLUSIONS Involuntary admission triggers a multifaceted process of control preservation. Clinicians need to develop therapeutic approaches that enable individuals to regain and maintain control over the course of their involuntary admission. DECLARATION OF INTEREST None.
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Affiliation(s)
- David McGuinness
- Research Nurse, School of Nursing and Midwifery, National University of Ireland, Ireland
| | - Kathy Murphy
- Professor of Nursing, School of Nursing and Midwifery, National University of Ireland, Ireland
| | - Emma Bainbridge
- Honorary Clinical Fellow, School of Medicine, National University of Ireland, Ireland
| | - Liz Brosnan
- Survivor Researcher and Consultant, Centre for Disability Law and Policy, National University of Ireland, Ireland
| | - Mary Keys
- Former Lecturer in Law, School of Law, National University of Ireland, Ireland
| | - Heike Felzmann
- Lecturer in Philosophy/Ethics, Centre of Bioethical Research and Analysis, National University of Ireland, Ireland
| | - Brian Hallahan
- Senior Lecturer in Psychiatry, School of Medicine, National University of Ireland, Ireland
| | - Colm McDonald
- Professor of Psychiatry, School of Medicine, National University of Ireland, Ireland
| | - Agnes Higgins
- Professor in Mental Health, School of Nursing and Midwifery, Trinity College, University of Dublin,Ireland
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Smyth S, Casey D, Cooney A, Higgins A, McGuinness D, Bainbridge E, Keys M, Georgieva I, Brosnan L, Beecher C, Hallahan B, McDonald C, Murphy K. Qualitative exploration of stakeholders' perspectives of involuntary admission under the Mental Health Act 2001 in Ireland. Int J Ment Health Nurs 2017; 26:554-569. [PMID: 27785894 DOI: 10.1111/inm.12270] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 12/15/2022]
Abstract
There is international interest in, and continued concern about, the potential long-term impact of involuntary admission to psychiatric institutions, and the effect this coercive action has on a person's well-being and human rights. Involuntary detention in hospital remains a controversial process that involves stakeholders with competing concerns and who often describe negative experiences of the process, which can have long-lasting effects on the therapeutic relationship with service users. The aim of the present study was to explore the perspectives of key stakeholders involved in the involuntary admission and detention of people under the Mental Health Act 2001 in Ireland. Focus groups were used to collect data. Stakeholders interviewed were service users, relatives, general practitioners, psychiatrists, mental health nurses, solicitors, tribunal members, and police. Data were analysed using a general inductive approach. Three key categories emerged: (i) getting help; (ii) detention under the Act; and (iii) experiences of the tribunal process. This research highlights gaps in information and uncertainty about the involuntary admission process for stakeholders, but particularly for service users who are most affected by inadequate processes and supports. Mental health law has traditionally focussed on narrower areas of detention and treatment, but human rights law requires a greater refocussing on supporting service users to ensure a truly voluntary approach to care. The recent human rights treaty, the UN Convention on the Rights of Persons with Disabilities, is to guarantee a broad range of fundamental rights, such as liberty and integrity, which can be affected by coercive processes of involuntary admission and treatment.
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Affiliation(s)
- Siobhán Smyth
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Dympna Casey
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Adeline Cooney
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - David McGuinness
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Emma Bainbridge
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Mary Keys
- School of Law, National University of Ireland, Galway, Ireland
| | - Irina Georgieva
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Liz Brosnan
- Centre for Disability Law and Policy, National University of Ireland, Galway, Ireland
| | - Claire Beecher
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Brian Hallahan
- School of Medicine, National University of Ireland, Galway, Ireland.,Health Research Board Clinical Research Facility Galway, National University of Ireland, Galway, Ireland
| | - Colm McDonald
- School of Medicine, National University of Ireland, Galway, Ireland.,Health Research Board Clinical Research Facility Galway, National University of Ireland, Galway, Ireland
| | - Kathy Murphy
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
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Murphy R, McGuinness D, Bainbridge E, Brosnan L, Felzmann H, Keys M, Murphy K, Hallahan B, McDonald C, Higgins A. Service Users' Experiences of Involuntary Hospital Admission Under the Mental Health Act 2001 in the Republic of Ireland. Psychiatr Serv 2017; 68:1127-1135. [PMID: 28669292 DOI: 10.1176/appi.ps.201700008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of the study was to explore the experiences of individuals admitted to the hospital involuntarily under the Mental Health Act 2001 in the Republic of Ireland. METHODS In this qualitative descriptive study, 50 individuals who had been involuntarily admitted to a hospital underwent face-to-face semistructured interviews approximately three months after revocation of the involuntary admission order. Data were analyzed by using an inductive thematic process. RESULTS Participants reported mixed experiences over the course of the admission, with both positive and challenging aspects. Participants reported feeling coerced, disempowered, and unsupported at various stages of the admission and highlighted the long-term deleterious impact on their psychological well-being. However, participants also described encounters with individuals who endeavored to initiate a collaborative, informative, and compassionate approach. Four key themes emerged consistently across the trajectory of participants' involuntary admission experiences: feeling trapped and coerced, feeling disengaged and unsupported, admission-induced distress, and person-centered encounters. CONCLUSIONS This qualitative study of service users' views across the entire trajectory of their involuntary admission identified a number of factors that should be addressed to reduce the negative impact of involuntary admission. A multifaceted strategy could include ongoing education and training of all stakeholders in the principles and practices of person-centered care, repeated provision of accessible information and emotional support to service users during all stages of involuntary admission, and a shift in culture to one that minimizes the traumatic impact of forced detention on individuals' psychological well-being.
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Affiliation(s)
- Rebecca Murphy
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - David McGuinness
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Emma Bainbridge
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Liz Brosnan
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Heike Felzmann
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Mary Keys
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Kathy Murphy
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Brian Hallahan
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Colm McDonald
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
| | - Agnes Higgins
- Dr. Rebecca Murphy and Dr. Higgins are with the School of Nursing and Midwifery, Trinity College, The University of Dublin, Dublin. The other authors are with the National University of Ireland, Galway. Dr. McGuinness and Dr. Kathy Murphy are with the School of Nursing and Midwifery; Dr. Bainbridge, Dr. Hallahan, and Dr. McDonald are with the Department of Psychiatry; Dr. Brosnan is with the Centre for Disability Law and Policy; Dr. Felzmann is with the Centre of Bioethics Research and Analysis, Department of Philosophy; and Dr. Keys is with the School of Law
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Abstract
People perceive that they have control over events to the extent that the same events do not occur outside of their control, randomly, in the environment or context. Therefore, perceived control should be enhanced if there is a large contrast between one's own control and the control that the context itself seems to exert over events. Given that depression is associated with low perceived control, we tested the hypothesis that enhanced attentional focus to context will increase perceived control in people with and without depression. A total of 106 non-depressed and mildly depressed participants completed a no control zero-contingency task with low and high outcome probability conditions. In the experimental context-focus group, participants were instructed to attend to the context, whereas in the control group, participants were instructed to attend to their thoughts. Irrespective of attentional focus, non-depressed participants displayed illusory control. However, people with mild depression responded strongly to the attention focus manipulation. In the control group, they evidenced low perceived control with classic depressive realism effects. In the experimental group, when asked to focus on the context in which events took place, participants with mild depression displayed enhanced perceived control or illusory control, similar to non-depressed participants. Findings are discussed in relation to whether depression effects on perceived control represent tendencies towards realism or attentional aspects of depressive thoughts.
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Affiliation(s)
- R M Msetfi
- a Centre for Social Issues Research, Department of Psychology , University of Limerick , Limerick , Republic of Ireland.,b Health Research Institute , University of Limerick , Limerick , Republic of Ireland
| | - L Brosnan
- a Centre for Social Issues Research, Department of Psychology , University of Limerick , Limerick , Republic of Ireland
| | - H A Cavus
- a Centre for Social Issues Research, Department of Psychology , University of Limerick , Limerick , Republic of Ireland
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