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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kös T, Bräunig P, Hausam J. The predictive validity of the V-RISK-10 and BVC among involuntarily admitted patients. Front Psychiatry 2024; 15:1342445. [PMID: 38476613 PMCID: PMC10929738 DOI: 10.3389/fpsyt.2024.1342445] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 11/21/2023] [Accepted: 02/08/2024] [Indexed: 03/14/2024] Open
Abstract
Although endangerment towards others is a criterion for an involuntary admission in many countries, research on risk assessment of endangerment among involuntarily admitted individuals is limited. In this retrospective case-control study, we calculated scores for a German-translated version of the Violence Risk Screening-10 (V-RISK-10) and the Brøset Violence Checklist (BVC) in a sample of 111 people undergoing an involuntary admission in Reinickendorf, Berlin. Outcomes were violence, coercive measures, and readmission. In line with our hypotheses, the BVC demonstrated stronger predictive validities for short-term, and V-RISK-10 for long-term events. There was an incremental validity for both instruments for restraint 24 hours after admission and any violence until discharge. These findings support the evidence that structured risk assessment instruments may be useful for individuals undergoing an involuntary admission. Ethical considerations about screening procedures are discussed.
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Affiliation(s)
- Tilmann Kös
- Vivantes Humboldt-Klinikum, Vivantes Netzwerk GmbH, Berlin, Germany
- Institut für Forensische Psychiatrie, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität, Berlin, Germany
| | - Peter Bräunig
- Vivantes Humboldt-Klinikum, Vivantes Netzwerk GmbH, Berlin, Germany
| | - Joscha Hausam
- Institut für Forensische Psychiatrie, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität, Berlin, Germany
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3
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Aluh DO, Ayilara O, Onu JU, Pedrosa B, Silva M, Grigaitė U, Santos-Dias M, Cardoso G, Caldas-de-Almeida JM. Use of coercion in mental healthcare services in Nigeria: Service providers' perspective. J Ment Health 2024; 33:75-83. [PMID: 36850036 DOI: 10.1080/09638237.2023.2182426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 11/02/2022] [Indexed: 03/01/2023]
Abstract
BACKGROUND There is increasing advocacy to reduce coercive practices in mental healthcare. Little research has been done on the topic in developing countries. AIMS To explore what mental health professionals in Nigeria think about coercion, why it is used, and what contextual factors influence its use in mental healthcare services. METHODS Semi-structured interviews were carried out with 16 doctors and 14 nurses from two psychiatric hospitals in two regions of Nigeria. The audio-recorded interviews were analyzed thematically with the aid of MAXQDA software. RESULTS Three broad categories relating to the perception of, reasons for, and barriers/facilitators to the use of coercion were derived. Coercion was viewed as being for the best interests of patients, a means to an end, and effective for achieving desired outcomes. Safety was both a reason to use a coercive measure and a deterrent to using specific coercive measures thought to be unsafe. The socio-cultural context, obsolete mental health legislation, staff shortages, and attitudes were factors influencing the use of coercion in mental healthcare. CONCLUSION Coercion was perceived to be ultimately beneficial in mental health practice. There is need for a new mental health legislation and more resources for mental health care in Nigeria to address the problem of coercion.
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Affiliation(s)
- Deborah Oyine Aluh
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nigeria
| | - Olaniyi Ayilara
- Department of Clinical Services, Federal Neuropsychiatric Hospital, Uselu, Edo state, Nigeria
| | - Justus Uchenna Onu
- Department of Mental Health, Nnamdi Azikiwe University- Nnewi Campus, Awka, Anambra State, Nigeria
| | - Barbara Pedrosa
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - Manuela Silva
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - Ugnė Grigaitė
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - Margarida Santos-Dias
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - Graça Cardoso
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - José Miguel Caldas-de-Almeida
- Comprehensive Health Research Centre (CHRC), Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
- Lisbon Institute of Global Mental Health, Lisbon, Portugal
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4
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Jäger M, Hotzy F, Traber R, Morandi S, Schneeberger AR, Spiess M, Ruflin R, Theodoridou A. [Cantonal Differences in The Implementation of Involuntary Admission in Switzerland]. Psychiatr Prax 2024; 51:24-30. [PMID: 37683673 PMCID: PMC10789520 DOI: 10.1055/a-2133-4084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 06/30/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE To examine sociodemographic and clinical characteristics of persons hospitalized in five psychiatric hospitals from regions with different structural characteristics compared with persons hospitalized voluntarily. METHODS Descriptive analyses of routine data on approximately 57000 cases of 33000 patients treated for a primary ICD-10 psychiatric diagnosis at one of the participating hospitals from 2016 to 2019. RESULTS Admission rates, length of stay, rates of further coercive measures, sociodemographic and clinical characteristics of the affected persons differ between the different regions. CONCLUSION There are considerable regional differences between regulations and implementation of the admission procedures and the sample. Causal relationships between regional specifics and the results cannot be inferred.
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Affiliation(s)
- Matthias Jäger
- Erwachsenenpsychiatrie, Psychiatrie Baselland, Liestal,
Schweiz
| | - Florian Hotzy
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik,
Psychiatrische Universitätsklinik Zürich, Zurich,
Schweiz
| | - Rafael Traber
- Privatklinik für Psychiatrie und Psychotherapie, Clienia
Littenheid AG, Littenheid, Schweiz
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Fellinger M, Waldhör T, Vyssoki B, Amering M, Leutgeb L, Gschaider A, Rappert B, König D, Fugger G, Knasmüller P, Gmeiner A. A country report: impact of COVID-19 lockdowns on involuntary psychiatric treatment in Austria. BJPsych Open 2023; 10:e9. [PMID: 38083863 PMCID: PMC10755558 DOI: 10.1192/bjo.2023.610] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 12/07/2022] [Revised: 09/11/2023] [Accepted: 10/14/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Coercive measures such as involuntary psychiatric admission are considered a last resort in the treatment of people with psychiatric disorders. So far, numerous factors have been identified that influence their use. However, the link between a pandemic - in particular, restrictions such as lockdowns - and the use of involuntary psychiatric admission is unclear. AIM To examine the association between COVID-19 lockdowns and involuntary psychiatric admissions in Austria. METHOD This retrospective exploratory study assessed all involuntary psychiatric admissions and use of mechanical restraint in Austria, except for the federal state of Vorarlberg, between 1 January 2018 and 31 December 2020. Descriptive statistics and regression models were used. RESULTS During the 3-year study period, 40 012 individuals (45.9% females, mean age 51.3 years) had 66 124 involuntary psychiatric admissions for an average of 10.9 days. Mechanical restraint was used during 33.9% of these admissions. In weeks of nationwide COVID-19 lockdowns (2020 v. 2018/2019), involuntary psychiatric admissions were significantly fewer (odds ratio = 0.93, P = 0.0001) but longer (11.6 (s.d.: 16) v. 10.9 (s.d.: 15.8) days). The likelihood of involuntary admission during lockdowns was associated with year (2020 v. 2018-2019; adjusted odds ratio = 0.92; P = 0.0002) but not with sex (P = 0.814), age (P = 0.310), use of mechanical restraint (P = 0.653) or type of ward (P = 0.843). CONCLUSIONS Restrictions such as lockdowns affect coercive measures and resulted in fewer but longer involuntary psychiatric admissions during weeks of lockdown in Austria. These results strengthen previous findings that showed the dependence of coercive measures on external factors, highlighting the need to further clarify causality and desired prevention effects when using coercive measures.
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Affiliation(s)
- Matthäus Fellinger
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Thomas Waldhör
- Centre for Public Health, Department of Epidemiology, Medical University of Vienna, Austria
| | - Benjamin Vyssoki
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Michaela Amering
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Lisa Leutgeb
- Clinic Floridsdorf, Department of General Psychiatry, Vienna Healthcare Group, Vienna, Austria
| | | | | | - Daniel König
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Gernot Fugger
- Clinical Division of General Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Philipp Knasmüller
- Clinic Landstraße, Department of General Psychiatry, Vienna Healthcare Group, Vienna, Austria
| | - Andrea Gmeiner
- Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
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van der Post LFM, Nusselder KJ, Peen J, Nabitz U, Dekker JM. Effect of coercive measures on treatment outcome in involuntarily admitted patients in Amsterdam. Front Psychiatry 2023; 14:1240129. [PMID: 37810601 PMCID: PMC10556454 DOI: 10.3389/fpsyt.2023.1240129] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 06/14/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Objective The prevalence of involuntary admissions rose the last forty years in European countries, including the Netherlands. Involuntary admissions result in seclusion, physical restraint and forced medication in approximately 40% of patients. We looked at whether treatment outcomes differ in patients with and without coercive measures. Methods Using The Health of the Nation Outcome Scales (HoNOS) to measure treatment outcomes, we studied the files of 786 patients admitted involuntarily to an Amsterdam clinic. We applied Generalised Linear Models to determine whether the use, or not, of coercive measures during treatment was associated with a difference in outcomes. Results 19% of the cohort were secluded in a High Security Room (HSR); 24% were secluded in their own room and/or received forced medication. After adjustment for the influence of diagnosis, disorder severity (initial HoNOS score) and treatment duration, the HSR group had, on average, a HoNOS difference score that was 2.4 points lower than patients without coercive measures (CI -4.0 to -0.8.; p 0.003). In the seclusion in own room group, this score was 2.6 points lower (CI -4.0 to -1.1; p 0.001), corresponding to an effect size of 0.35 and 0.40, respectively. Conclusion Seclusion, whether or not in combination with forced medication, was applied to two-fifths of patients. The HoNOS scores of the group without coercion improved by nearly two and a half points more on average than those of the two groups with coercion. A causal relationship between coercion and treatment outcome could neither be confirmed nor excluded on the basis of our results.
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Affiliation(s)
| | - K. J. Nusselder
- Research Department, ARKIN Mental Health Care, Amsterdam, Netherlands
| | - J. Peen
- Research Department, ARKIN Mental Health Care, Amsterdam, Netherlands
| | - U. Nabitz
- Research Department, ARKIN Mental Health Care, Amsterdam, Netherlands
| | - J. M. Dekker
- Research Department, ARKIN Mental Health Care, Amsterdam, Netherlands
- Department of Psychology, Faculty of Psychology and Pedagogy, Vrije Universiteit, Amsterdam, Netherlands
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7
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Aluh DO, Aigbogun O, Ukoha-Kalu BO, Silva M, Grigaitė U, Pedrosa B, Santos-Dias M, Cardoso G, Caldas-de-Almeida JM. Beyond Patient Characteristics: A Narrative Review of Contextual Factors Influencing Involuntary Admissions in Mental Health Care. Healthcare (Basel) 2023; 11:1986. [PMID: 37510426 PMCID: PMC10379438 DOI: 10.3390/healthcare11141986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/29/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Variations in the rates of involuntary admission (IA) reflect the influence of unexplained contextual variables that are typically too heterogeneous to be included in systematic reviews. This paper attempts to gather and analyze factors unrelated to the patients that have been linked to IA. The articles included in this review were selected by iteratively searching four electronic databases (PubMed, PsychINFO, EMBASE, and Web of Science). A total of 54 studies from 19 different countries and regions, including 14 European countries, the United States, Canada, China, Vietnam, and Taiwan, were selected. The factors were categorized as service-related factors, impactful events, seasonal and temporal factors, mental health legislation, staff factors, and public attitudes. The factors rarely act in isolation but rather interact and reinforce each other, causing a greater influence on IA. This paper explains how these factors present opportunities for robust and sustainable interventions to reduce IAs. The paper also identifies future directions for research, such as examining the effects of economic recessions. Enhancing global reporting standards is essential to validate future research and support further in-depth studies. The complexity of the factors influencing IA and the implicit role of society suggest that resolving it will require social change.
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Affiliation(s)
- Deborah Oyine Aluh
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nsukka 410105, Nigeria
| | - Osaro Aigbogun
- Department of Management, Marketing and Digital Business, Curtin University, Miri 98009, Malaysia
| | | | - Manuela Silva
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - Ugnė Grigaitė
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - Barbara Pedrosa
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - Margarida Santos-Dias
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
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8
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Carbone A, Knapp M. Involuntary psychiatric treatment during the COVID-19 pandemic. An international qualitative study. Front Psychiatry 2023; 14:1200888. [PMID: 37304426 PMCID: PMC10248441 DOI: 10.3389/fpsyt.2023.1200888] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 04/05/2023] [Accepted: 05/02/2023] [Indexed: 06/13/2023] Open
Abstract
Background During the COVID-19 pandemic, studies report that in the first few months of the lockdown there was a decrease in requests for mandatory psychiatric treatment, while, in contrast, following the second wave, the number of cases increased. This study investigates the use of compulsory psychiatric treatments internationally in the first and subsequent phases of the pandemic. Methods Sixteen key people were interviewed: eight mental health care professionals and eight scholars in Italy, Greece, China and Chile. Participants were asked to discuss their experience of the motivations, diagnoses and management of patients undergoing an involuntary psychiatric hospitalization. Results The analysis through Grounded Theory highlighted four themes: (a) the culture of psychiatric care services, (b) the effect of the pandemic on involuntary hospitalizations, (c) exceptional management of hospitalization, and (d) policies and suggestions for more inclusive mental health treatments. Conclusion During the first wave, respondents reported a decrease in the use of involuntary treatments, while a gradual increase was seen in the following months. Italy extended compulsory psychiatric treatment to a group of new users, including young people and adolescents with acute crises; in other contexts, the main users are chronic psychiatric patients.
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9
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O'Callaghan AK, Plunkett R, Kelly BD. What is the role of gender in perceived coercion during psychiatric admission? Ir J Psychol Med 2023:1-5. [PMID: 36803581 DOI: 10.1017/ipm.2023.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 02/22/2023]
Abstract
OBJECTIVES This paper explores factors linking gender with increased perceived coercion, perceived negative pressures and procedural injustice during psychiatric admission. METHODS We used validated tools to perform detailed assessments of 107 adult psychiatry inpatients admitted to acute psychiatry admission units at two general hospitals in Dublin, Ireland, between September 2017 and February 2020. RESULTS Among female inpatients (n = 48), perceived coercion on admission was associated with younger age and involuntary status; perceived negative pressures were associated with younger age, involuntary status, seclusion, and positive symptoms of schizophrenia; and procedural injustice was associated with younger age, involuntary status, fewer negative symptoms of schizophrenia, and cognitive impairment. Among females, restraint was not associated with perceived coercion on admission, perceived negative pressures, procedural injustice, or negative affective reactions to hospitalisation; seclusion was associated with negative pressures only. Among male inpatients (n = 59), not being born in Ireland appeared more relevant than age, and neither restraint nor seclusion were associated with perceived coercion on admission, perceived negative pressures, procedural injustice, or negative affective reactions to hospitalisation. CONCLUSIONS Factors other than formal coercive practices are primarily linked with perceived coercion. Among female inpatients, these include younger age, involuntary status, and positive symptoms. Among males, not being born in Ireland appears more relevant than age. Further research is needed on these correlations, along with gender-aware interventions to minimise coercive practices and their consequences among all patients.
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Affiliation(s)
- Aoife K O'Callaghan
- Department of Psychiatry, Trinity Centre for Health Sciences, Tallaght University Hospital, Tallaght, Dublin 24, D24 NR0A, Ireland
| | - Róisín Plunkett
- Psychological Medicine Department, St James's Hospital, Dublin 8, Ireland
| | - Brendan D Kelly
- Department of Psychiatry, Trinity Centre for Health Sciences, Tallaght University Hospital, Tallaght, Dublin 24, D24 NR0A, Ireland
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O'Donoghue B, Collett H, Boyd S, Zhou Y, Castagnini E, Brown E, Street R, Nelson B, Thompson A, McGorry P. The incidence and admission rate for first-episode psychosis in young people before and during the COVID-19 pandemic in Melbourne, Australia. Aust N Z J Psychiatry 2022; 56:811-817. [PMID: 34651504 DOI: 10.1177/00048674211053578] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [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: 12/20/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has had a profound effect on global mental health, with one-third of infected individuals developing a psychiatric or neurological disorder 6 months after infection. The risk of infection and the associated restrictions introduced to reduce the spread of the virus have also impacted help-seeking behaviours. Therefore, this study aimed to determine whether there was a difference during the COVID-19 pandemic in the treated incidence of psychotic disorders and rates of admission to hospital for psychosis (including involuntary admission). METHODS Incident cases of first-episode psychosis in young people, aged 15 to 24, at an early intervention service in Melbourne from an 8-month period before the pandemic were compared with rates during the pandemic. Hospital admission rates for these periods were also compared. RESULTS Before the pandemic, the annual incidence of first-episode psychosis was 104.5 cases per 100,000 at-risk population, and during the pandemic it was 121.9 (incidence rate ratio = 1.14, 95% confidence interval = [0.92, 1.42], p = 0.24). Immediately after the implementation of restrictions, there was a non-significant reduction in the treated incidence (incidence rate ratio = 0.80, 95% confidence interval = [0.58, 1.09]), which was followed by a significant increase in the treated incidence in later months (incidence rate ratio = 1.94, 95% confidence interval = [1.52, 2.49]; incidence rate ratio = 1.64, 95% confidence interval = [1.25, 2.16]). Before the pandemic, 37.3% of young people with first-episode psychosis were admitted to hospital, compared to 61.7% during the pandemic (odds ratio = 2.71, 95% confidence interval = [1.73, 4.24]). Concerning the legal status of the admissions, before the pandemic, 27.3% were admitted involuntarily to hospital, compared to 42.5% during the pandemic (odds ratio = 1.97, 95% confidence interval = [1.23, 3.14]). CONCLUSION There was a mild increase, which did not reach statistical significance, in the overall incidence of first-episode psychosis; however, the pattern of presentations changed significantly, with nearly twice as many cases presenting in the later months of the restrictions. There was a significant increase in both voluntary and involuntary admissions, and the possible explanations for these findings are discussed.
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Affiliation(s)
- Brian O'Donoghue
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Hannah Collett
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Sophie Boyd
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Yuanna Zhou
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Emily Castagnini
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Ellie Brown
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Rebekah Street
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrew Thompson
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Patrick McGorry
- Orygen, Parkville, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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11
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Tamai S. Involuntary Psychiatric Admission: Arbitrary Deprivation of Liberty or a Human Right? Front Psychiatry 2022; 13:879093. [PMID: 35898628 PMCID: PMC9313521 DOI: 10.3389/fpsyt.2022.879093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022] Open
Abstract
In 2008 Brazil ratified The United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD) an international legal instrument specifically tailored to stipulate the rights of persons with disabilities and include those with serious mental disorders. United Nations Committee set up to monitor the implementation of the Convention (CRPD Committee) lead to an insistence that involuntary detention and treatment of people with mental health (or "psychosocial") disabilities are prohibited. There is a debate about this topic that poses an impossibility of involuntary psychiatric admission in hospital.
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Affiliation(s)
- Sergio Tamai
- Department of Psychiatry, University of São Paulo, São Paulo, Brazil.,Department of Psychiatry and Medical Psychology, Santa Casa São Paulo Medical School, São Paulo, Brazil
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12
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Lin CH, Chan HY, Wang FC, Hsu CC. Time to rehospitalization in involuntarily hospitalized individuals suffering from schizophrenia discharged on long-acting injectable antipsychotics or oral antipsychotics. Ther Adv Psychopharmacol 2022; 12:20451253221079165. [PMID: 35340566 PMCID: PMC8949740 DOI: 10.1177/20451253221079165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 10/23/2021] [Accepted: 01/14/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Involuntarily hospitalized individuals suffering from schizophrenia often have a poorer prognosis after discharge. OBJECTIVE This study aimed to analyze time to rehospitalization within 6 months of discharge in involuntarily hospitalized individuals suffering from schizophrenia discharged on long-acting injectable antipsychotics (LAIs) or oral antipsychotics (OAPs). In addition, temporal trends in LAI use at discharge were explored. METHODS Involuntarily hospitalized individuals suffering from schizophrenia discharged from the study hospital between 2006 and 2019 (n = 806) were included in the analysis. Survival analysis was used to compare time to rehospitalization within 6 months of discharge between individuals discharged on LAIs and OAPs, and between first-generation antipsychotic (FGA) LAIs and second-generation antipsychotic (SGA) LAIs. The Cochran-Armitage trend test was used to test whether a temporal trend existed for LAIs use at discharge during the study period. RESULTS The LAIs group (n = 231) had a significantly lower rate of rehospitalization and a significantly longer time to rehospitalization than the OAPs group (n = 575). Rehospitalization rate and time to rehospitalization were not significantly different between individuals discharged on FGA-LAIs and SGA-LAIs. LAIs use at discharge grew significantly from 16.77% in 2006 to 50.00% in 2019 (Z = 6.81, p < 0.0001). Among all LAIs, only use of SGA-LAIs at discharge increased significantly (Z = 5.74, p < 0.0001), but not FGA-LAIs. CONCLUSIONS LAIs were superior to OAPs in preventing rehospitalization. However, SGA-LAIs were comparable with FGA-LAIs in reducing rehospitalization risk. Use of LAIs increased significantly in discharged involuntarily hospitalized individuals during the study period, especially SGA-LAIs.
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Affiliation(s)
- Ching-Hua Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung
| | - Hung-Yu Chan
- Department of General Psychiatry, Taoyuan Psychiatric Center, No. 71, Long-Show Street, Taoyuan City 33058
| | - Fu-Chiang Wang
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung
| | - Chun-Chi Hsu
- Department of General Psychiatry, Taoyuan Psychiatric Center, Taoyuan City
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13
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Stone K, McCusker P, Davidson G, Vicary S. An Exploratory Survey of Mental Health Social Work in Europe. Int J Environ Res Public Health 2021; 18:ijerph181910462. [PMID: 34639762 PMCID: PMC8507626 DOI: 10.3390/ijerph181910462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/30/2021] [Accepted: 09/30/2021] [Indexed: 11/16/2022]
Abstract
This article reports on an exploratory study comparing mental health social work (MHSW) in Europe. There has been very limited previous research comparing approaches to MHSW in Europe and so the aim of the study was to develop a better understanding of the similarities and differences between and, where relevant, within countries (referred to as jurisdictions). An online survey was distributed mainly through existing European networks and social media to seek information on the role, nature, extent and context of MHSW in a range of European jurisdictions. Conducted during the COVID-19 pandemic, there were 158 responses from 10 jurisdictions. Data were analyzed using thematic analysis. From this analysis, four main themes were identified, relating to: role; law, policy and education; the distinctive contribution made by MHSW; and the key challenges for MHSW. The study demonstrates that MHSW, although it is described and provided in different ways and is confined by a range of factors, plays an important role in mental health services across jurisdictions. There are also interesting differences between contexts, especially in the balance of therapeutic, legal and specialist/generic approaches, some of which reflect the World Health Organisation's vision and objectives for mental health. Lastly, the study illustrates a need and provides a valuable basis for further comparative and collaborative work to define MHSW and enhance the contributions it makes.
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Affiliation(s)
- Kevin Stone
- School of Health Professions, Faculty of Health, Drake Circus Campus, Plymouth University, Plymouth PL4 8AA, UK
- Correspondence:
| | - Pearse McCusker
- School of Social and Political Science, University of Edinburgh, Edinburgh EH1 2QL, UK;
| | - Gavin Davidson
- School of Social Sciences Education and Social Work, Faculty of Arts Humanities and Social Sciences, Queen’s University Belfast, Belfast BT7 1NN, UK;
| | - Sarah Vicary
- School of Health Wellbeing and Social Care, Faculty of Wellbeing Education and Languages, The Open University, Walton Hall, Milton Keynes MK7 6AA, UK;
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14
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Krieger E, Moritz S, Lincoln TM, Fischer R, Nagel M. Coercion in psychiatry: A cross-sectional study on staff views and emotions. J Psychiatr Ment Health Nurs 2021; 28:149-162. [PMID: 32348607 DOI: 10.1111/jpm.12643] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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] [Received: 03/20/2019] [Revised: 04/12/2020] [Accepted: 04/17/2020] [Indexed: 01/03/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Coercive interventions (CI) in emergency psychiatry face increasing criticism, as they can be an emotional, even traumatic event for all persons involved. They are thus considered the last resort. The use of coercive interventions differs widely with regard to type and frequency of measures across different countries and institutions. Individual staff characteristics, such as attitudes towards coercion, may play a vital role in the management of aggression. Little is known about the influence of emotions of staff members on CI, but they are likely to play an important role. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Most staff members surveyed had a rather critical view of coercion and considered it a "necessary evil." Staff members with the most work experience had a more critical view of coercion in comparison with less experienced staff. Nurses rated coercion more positively than did psychiatrists or psychologists. Emotions play an important role in decision-making processes. The current study systematically asked for accompanying emotions during the application of CI and looked for individual differences. A majority of the participants experienced compassion; about half felt helplessness, grief or anxiety. Almost 20% stated that they felt a sense of power. Older staff members more often felt anger or guilt; women felt less power than men did. Nurses felt more desperation than other occupational groups. Staff members consider reflective interventions, such as team supervisions or post-seclusion/restraint debriefings with the patient, as important. Nevertheless, only half reported that these interventions are carried out routinely. Staff members believe that certain risk factors (including stress, low staffing, a fully occupied ward and the presence of particular staff members) enhance the probability of CI. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: To reduce the use of coercive interventions, we recommend that psychiatric teams include highly experienced staff members as work experience has a positive effect on the attitudes towards coercive interventions. Structured post-seclusion/restraint debriefings and team supervisions are considered helpful by staff members and are relatively easy to implement on acute wards. Enhancing staff members' ability to reflect on their own attitudes, emotions and actions is likely to reduce coercive interventions. ABSTRACT: Introduction Little is known about staff attitudes towards coercive interventions (CI) and emotions accompanying these measures. Aim The current study assessed attitudes, views on reflective interventions and accompanying emotions of different occupational groups towards CI, as well as factors, that increase the probability of CI. Method Staff members (N = 138) of a large psychiatric hospital in Germany were assessed using the Staff Attitude to Coercion Scale (SACS) and newly developed items assessing staff members' emotions and views on coercion. Results Experienced staff members were most critical of coercion. Nurses rated coercion significantly more positively than other staff. A majority experienced compassion; about half felt helplessness, grief or anxiety. Almost 20% felt a sense of power. Nurses felt the most desperation. Participants strongly desired reflective measures such as post-seclusion/restraint debriefings with patients. According to staff members, stress on the wards and low staffing increases the probability of CI. Discussion The study assessed accompanying emotions during the application of CI. Attitudes towards coercion and emotions are associated with individual staff characteristics (e.g. profession, work experience). Implications The presence of experienced staff members may help prevent CI. Staff consider reflective interventions helpful in reducing CI.
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Affiliation(s)
- Eva Krieger
- Department of Psychiatry and Psychotherapy, Asklepios Clinic Nord - Wandsbek, Hamburg, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Human Movement, Universität Hamburg, Hamburg, Germany
| | - Rabea Fischer
- Department of Psychiatry and Psychotherapy, Asklepios Clinic Nord - Wandsbek, Hamburg, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Nagel
- Department of Psychiatry and Psychotherapy, Asklepios Clinic Nord - Wandsbek, Hamburg, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Schleswig-Holstein, Luebeck, Germany
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15
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Wormdahl I, Husum TL, Kjus SHH, Rugkåsa J, Hatling T, Rise MB. Between No Help and Coercion: Toward Referral to Involuntary Psychiatric Admission. A Qualitative Interview Study of Stakeholders' Perspectives. Front Psychiatry 2021; 12:708175. [PMID: 34484000 PMCID: PMC8415795 DOI: 10.3389/fpsyt.2021.708175] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/11/2021] [Accepted: 07/13/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: Paths toward referral to involuntary psychiatric admission mainly unfold in the contexts where people live their everyday lives. Modern health services are organized such that primary health care services are often those who provide long-term follow-up for people with severe mental illness and who serve as gatekeepers to involuntary admissions at the secondary care level. However, most efforts to reduce involuntary admissions have been directed toward the secondary health care level; interventions at the primary care level are sparse. To adapt effective measures for this care level, a better understanding is needed of the contextual characteristics surrounding individuals' paths ending in referrals for involuntary admission. This study aims to explore what characterizes such paths, based on the personal experiences of multiple stakeholders. Method: One hundred and three participants from five Norwegian municipalities participated in individual interviews or focus groups. They included professionals from the primary and secondary care levels and people with lived experience of severe mental illness and/or involuntary admission and carers. Data was subject to constant comparison in inductive analysis inspired by grounded theory. Results: Four main categories emerged from the analysis: deterioration and deprivation, difficult to get help, insufficient adaptation of services provided, and when things get acute. Combined, these illustrate typical characteristics of paths toward referral for involuntary psychiatric admission. Conclusion: The results demonstrate the complexity of individuals' paths toward referral to involuntary psychiatric admission and underline the importance of comprehensive and individualized approaches to reduce involuntary admissions. Furthermore, the findings indicate a gap in current practice between the policies to reduce involuntary admissions and the provision of, access to, and adaptation of less restrictive services for adults with severe mental illness at risk of involuntary admissions. To address this gap, further research is needed on effective measures and interventions at the primary care level.
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Affiliation(s)
- Irene Wormdahl
- NTNU Social Research, Norwegian Resource Centre for Community Mental Health, Trondheim, Norway.,Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tonje Lossius Husum
- Centre for Medical Ethics, Institute for Health and Society, University of Oslo, Oslo, Norway.,Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | | | - Jorun Rugkåsa
- Health Service Research Unit, Akershus University Hospital, Lørenskog, Norway.,Centre for Care Research, University of South-Eastern Norway, Porsgrunn, Norway
| | - Trond Hatling
- NTNU Social Research, Norwegian Resource Centre for Community Mental Health, Trondheim, Norway
| | - Marit B Rise
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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16
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Go DS, Shin KC, Paik JW, Kim KA, Yoon SJ. A Review of the Admission System for Mental Disorders in South Korea. Int J Environ Res Public Health 2020; 17:ijerph17249159. [PMID: 33302454 PMCID: PMC7764686 DOI: 10.3390/ijerph17249159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/02/2020] [Accepted: 12/05/2020] [Indexed: 11/16/2022]
Abstract
This study presents a comprehensive overview of the characteristics of mental health problems and admission system in South Korea. We compared the mental health-related indicators data from South Korea to data from other Organization for Economic Cooperation and Development (OECD) countries. South Korea was identified as the country with the highest suicide rate, the longest length of stay in hospitals for mental disorders, and the highest number of psychiatric care beds. These results can be explained by considering the admission system for mental disorders. We reviewed the admission system and the Mental Health Promotion and Welfare Act, providing direction for improving the system.
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Affiliation(s)
- Dun-Sol Go
- Department of Health Care Policy Research, Korea Institute for Health and Social Affairs, Sejong 30147, Korea;
| | - Kwon-Chul Shin
- University of Seoul Law School, Seoul 02592, Korea;
- The National Mental Health and Welfare Commission, Seoul 04933, Korea;
| | - Jong-Woo Paik
- The National Mental Health and Welfare Commission, Seoul 04933, Korea;
- Department of Psychiatry, School of Medicine, Kyung Hee University, Seoul 02453, Korea
| | - Keun-A Kim
- Department of Public Health, Graduate School, Korea University, Seoul 02841, Korea;
| | - Seok-Jun Yoon
- The National Mental Health and Welfare Commission, Seoul 04933, Korea;
- Department of Preventive Medicine, Korea University College of Medicine, Seoul 02841, Korea
- Correspondence: ; Tel.: +82-2-2286-1412
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17
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Abstract
Background: Patient satisfaction (PS) with treatment is one of different outcome- and quality measures used by health care providers worldwide to improve service. We report from a study of patients admitted to the Department of Acute Psychiatry at the Oslo University Hospital where we investigated PS and difference between genders, days of hospital stay, diagnostic groups, voluntary-and involuntary admitted patients according to hospital records and perceived voluntary-and involuntary admittance.Materials and methods: All admitted patients during a 9-month period in 2014 were asked to participate by written consent. We used The Psychiatric Inpatient Questionnaire (PIPEQ), a self-report survey validated for assessment post-discharge. Analyses were conducted for a general dimension of PS and individual questions. A user representative was a part of the study from the beginning.Results: A total of 357 patients were asked and 256 consented. Results show that 68% were over all satisfied and 14% dissatisfied. Highest PS was found for cooperation with relatives and lowest for influence on choice of treatment and medication. We found no significant difference in PS between men and women, but patients with a personality disorder and with short stay were less satisfied. PS was significantly less for those perceiving involuntary admission regardless of legal status.Conclusion: The PIPEQ gives important input of patient's experience with the delivery of care. Answers range from very much satisfied to not at all depending on what was asked for. Exploring PS provides valuable information for quality improvements for different patient groups.
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Affiliation(s)
- Ann Færden
- Division of Mental Health and Addiction, Department of Acute Psychiatry, Oslo University Hospital, Oslo, Norway
| | | | - Lars Løvhaug
- Division of Mental Health and Addiction, Department of Acute Psychiatry, Oslo University Hospital, Oslo, Norway
| | | | - Ingrid Dieset
- Division of Mental Health and Addiction, Department of Acute Psychiatry, Oslo University Hospital, Oslo, Norway
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18
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Reid N, Chartier LB, Orkin A, Klaiman M, Naidoo K, Stergiopoulos V. Rethinking involuntary admission for individuals presenting to Canadian emergency departments with life-threatening substance use disorders. CAN J EMERG MED 2020; 22:629-32. [PMID: 32538339 DOI: 10.1017/cem.2020.385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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19
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Wasserman D, Apter G, Baeken C, Bailey S, Balazs J, Bec C, Bienkowski P, Bobes J, Ortiz MFB, Brunn H, Bôke Ö, Camilleri N, Carpiniello B, Chihai J, Chkonia E, Courtet P, Cozman D, David M, Dom G, Esanu A, Falkai P, Flannery W, Gasparyan K, Gerlinger G, Gorwood P, Gudmundsson O, Hanon C, Heinz A, Dos Santos MJH, Hedlund A, Ismayilov F, Ismayilov N, Isometsä ET, Izakova L, Kleinberg A, Kurimay T, Reitan SK, Lecic-Tosevski D, Lehmets A, Lindberg N, Lundblad KA, Lynch G, Maddock C, Malt UF, Martin L, Martynikhin I, Maruta NO, Matthys F, Mazaliauskiene R, Mihajlovic G, Peles AM, Miklavic V, Mohr P, Ferrandis MM, Musalek M, Neznanov N, Ostorharics-Horvath G, Pajević I, Popova A, Pregelj P, Prinsen E, Rados C, Roig A, Kuzman MR, Samochowiec J, Sartorius N, Savenko Y, Skugarevsky O, Slodecki E, Soghoyan A, Stone DS, Taylor-East R, Terauds E, Tsopelas C, Tudose C, Tyano S, Vallon P, Van der Gaag RJ, Varandas P, Vavrusova L, Voloshyn P, Wancata J, Wise J, Zemishlany Z, Öncü F, Vahip S. Compulsory admissions of patients with mental disorders: State of the art on ethical and legislative aspects in 40 European countries. Eur Psychiatry 2020; 63:e82. [PMID: 32829740 PMCID: PMC7576531 DOI: 10.1192/j.eurpsy.2020.79] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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] [Indexed: 01/03/2023] Open
Abstract
Background. Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care. Methods. The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions. Results. We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures. Conclusions. We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
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Affiliation(s)
- D Wasserman
- European Psychiatric Association, Committee on Ethical Issues, Strasbourg, France.,National Centre for Suicide Research and Prevention of Mental-Ill Health, Karolinska Institute, Stockholm, Sweden
| | - G Apter
- French Federation of Psychiatry, Paris, France.,Groupe Hospitalier du Havre, Université de Rouen, Rouen, France
| | - C Baeken
- Flemish Association of Psychiatry, Kortenberg, Belgium.,Department of Psychiatry and Medical Psychiatry, Ghent University, Gent, Belgium
| | - S Bailey
- European Psychiatric Association, Committee on Ethical Issues, Strasbourg, France.,University of Central Lancashire, Preston, United Kingdom
| | - J Balazs
- Hungarian Psychiatric Association, Budapest, Hungary.,Department of Developmental and Clinical Child Psychology at the Institute Psychology Eotvos Lorand University, Budapest, Hungary
| | - C Bec
- National Centre for Suicide Research and Prevention of Mental-Ill Health, Karolinska Institute, Stockholm, Sweden
| | - P Bienkowski
- Polish Psychiatric Association, Warsaw, Poland.,Department of Psychiatry, Warsaw Medical University, Warsaw, Poland
| | - J Bobes
- Spanish Society of Psychiatry, Madrid, Spain.,Department of Psychiatry, School of Medicine, University of Oviedo, Oviedo, Spain
| | - M F Bravo Ortiz
- Association of Psychiatrists of Spanish Association of Neuropsychiatry, Madrid, Spain.,Department of Psychiatry, Clinical Psychology and Mental Health, La Paz University Hospital, Universidad Autónoma de Madrid, Madrid, Spain
| | - H Brunn
- European Psychiatric Association, Committee on Ethical Issues, Strasbourg, France.,Danish Psychiatric Association, Copenhagen, Denmark.,Institute of regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Ö Bôke
- Psychiatric Association of Turkey, Ankara, Turkey.,Ondokuz Mayıs Üniversitesi, Samsun, Turkey
| | - N Camilleri
- Maltese Association of Psychiatry, Attard, Malta.,University of Malta, Msida, Malta
| | - B Carpiniello
- European Psychiatric Association Council of National Psychiatric Associations, Strasbourg, France.,Italian Psychiatric Association, Roma, Italy.,Department of Public Health, Clinical and Molecular Medicine, Università degli studi di Cagliari, Sardinia, Italy
| | - J Chihai
- Society of Psychiatrists, Narcologists, Psychotherapists, and Clinical Psychologists from the Republic of Moldova, Chișinău, Moldova.,Department of State Medical and Pharmaceutical University "Nicolae Testemitanu", Chișinău, Republic of Moldova
| | - E Chkonia
- Society of Georgian Psychiatrists, Tbilisi, Georgia.,Department of Psychiatry, Tbilisi State Medical University, Tbilisi, Georgia
| | - P Courtet
- French Congress of Psychiatry, Paris, France.,University of Montpellier, CHRU Montpellier, Montpellier, France.,Department of Emergency Psychiatry and Acute Care, Lapeyronie Hospital, Montpellier, France
| | - D Cozman
- Romanian Association of Psychiatry and Psychotherapy, Bucharest, Romania.,Medical Psychology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-NapocaRomania
| | - M David
- French Federation of Psychiatry, Paris, France.,Fondation Bon Sauveur, Bégard, France
| | - G Dom
- Belgium Professional Association of Medical Specialists in Psychiatry, Brussel, Belgium.,Department of Psychiatry, Antwerp University (UA), Antwerpen, Belgium
| | - A Esanu
- Society of Psychiatrists, Narcologists, Psychotherapists, and Clinical Psychologists from the Republic of Moldova, Chișinău, Moldova.,Department of Psychiatry, Narcology and Medical Psychology, State University of Medicine and Pharmacy, Chișinău, Republic of Moldova
| | - P Falkai
- German Association for Psychiatry, Psychotherapy and Psychosomatics, Berlin, Germany.,Clinic for Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Munich, Germany
| | - W Flannery
- College of Psychiatrists of Ireland, Dublin, Ireland.,Department of Adult Psychiatry, Mater Misericordiae University Hospital, Dublin, Ireland
| | - K Gasparyan
- Armenian Psychiatric Association, Yerevan, Armenia.,Medical Psychology Department, Yerevan State Mkhitar Herats Medical University, Yerevan, Armenia
| | - G Gerlinger
- German Association for Psychiatry, Psychotherapy and Psychosomatics, Berlin, Germany
| | - P Gorwood
- French Congress of Psychiatry, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), University of ParisParis, France
| | - O Gudmundsson
- Icelandic Psychiatric Association, Kopavogur, Iceland.,Psychiatric Department, Landspitali, University Hospital of Iceland, Reykjavík, Iceland
| | - C Hanon
- European Psychiatric Association, Committee on Ethical Issues, Strasbourg, France.,Regional Resource Center of old age Psychiatry, AP-HP Centre - Université de Paris, Corentin-Celton Hospital, Paris, France
| | - A Heinz
- German Association for Psychiatry, Psychotherapy and Psychosomatics, Berlin, Germany.,Clinic for Psychiatry and Psychotherapy, Charité - Universitätsmedizin, Berlin, Germany
| | - M J Heitor Dos Santos
- Portuguese Society of Psychiatry and Mental Health, Lisbon, Portugal.,Institute of Environmental Health (ISAMB) of the Faculty of Medicine of the University of Lisbon (FMUL), Lisbon, Portugal
| | - A Hedlund
- Swedish Psychiatry Association, Sundsvall, Sweden.,North Stockholm Psychiatry, Stockholm County Medical Area (SLSO), Stockholm, Sweden
| | - F Ismayilov
- Azerbaijan Psychiatric Association, Baku, Azerbaijan.,National Mental Health Centre, Baku, Azerbaijan
| | - N Ismayilov
- Azerbaijan Psychiatric Association, Baku, Azerbaijan.,Department of Psychiatry, Azerbaijan Medical University, Baku, Azerbaijan
| | - E T Isometsä
- Finnish Psychiatric Association, Helsinki, Finland.,Department of Psychiatry, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - L Izakova
- Slovak Psychiatric Association, Bratislava, Slovakia.,Department of Psychiatry, Faculty of Medicine Comenius University and University Hospital, Bratislava, Slovakia
| | - A Kleinberg
- Estonian Psychiatric Association, Tartu, Estonia.,Children Mental Health Centre of Tallinn Children Hospital, Tallinn, Estonia
| | - T Kurimay
- European Psychiatric Association Council of National Psychiatric Associations, Strasbourg, France.,Department of Psychiatry and Psychiatric Rehabilitation, Teaching Department of Semmelweis University, Budapest, Hungary
| | - S Klæbo Reitan
- Department of Psychiatry and Psychiatric Rehabilitation, Teaching Department of Semmelweis University, Budapest, Hungary.,Norwegian Psychiatric Association, Oslo, Norway.,Department of Mental Health, Faculty of Medicine and Health Sciences, Norweigan University of Science and Technology, Trondheim, Norway
| | - D Lecic-Tosevski
- Serbian Psychiatric Association, Belgrade, Serbia.,Psychiatric Association of Eastern Europe and the Balkans, Athens, Greece.,Department of Medical Sciences, Serbian Academy of Sciences and Arts, Belgrade, Serbia
| | - A Lehmets
- Estonian Psychiatric Association, Tartu, Estonia.,Psychiatric Centre of the Tallinn West Central Hospital, Tallinn, Estonia
| | - N Lindberg
- Finnish Psychiatric Association, Helsinki, Finland.,Forensic Psychiatry, Helsinki University and Helsinki University Hospital, Helsinski, Finland
| | - K A Lundblad
- Swedish Psychiatry Association, Sundsvall, Sweden.,Adult Psychiatry, Stockholm County Medical Area (SLSO), Stockholm, Sweden
| | - G Lynch
- Royal College of Psychiatrists, London, United Kingdom
| | - C Maddock
- Royal College of Psychiatrists, London, United Kingdom
| | - U F Malt
- Norwegian Psychiatric Association, Oslo, Norway.,Faculty of Medicine, Psychiatry and Psychosomatic Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - L Martin
- College of Psychiatrists of Ireland, Dublin, Ireland.,St Loman's Hospital, Mullingar, Ireland
| | - I Martynikhin
- Russian Society of Psychiatrists, Moscow, Russian Federation.,First Pavlov State Medical University of St Petersburg, Saint Petersburg, Russian Federation
| | - N O Maruta
- Association of Neurologists, Psychiatrists and Narcologists of Ukraine, Kharkiv, Ukraine.,Institute of Neurology, Psychiatry and Narcology of the NAMS of Ukraine State Insitution, Kharkiv, Ukraine
| | - F Matthys
- Flemish Association of Psychiatry, Kortenberg, Belgium.,Department of Psychiatry, Universitair Ziekenhuis, Brussel, Belgium
| | - R Mazaliauskiene
- Lithuanian Psychiatric Association, Vilnius, Lithuania.,Lithuanian University of Health Sciences, Psychiatric Clinic, Kaunas, Lithuania
| | - G Mihajlovic
- Serbian Psychiatric Association, Belgrade, Serbia.,Clinic for Psychiatry, University of Kragujevac, Kragujevac, Serbia
| | - A Mihaljevic Peles
- Croatian Psychiatric Association, Zagreb, Croatia.,Zagreb School of Medicine and Zagreb University Hospital Centre, Zagreb, Croatia
| | - V Miklavic
- Slovenian Psychiatric Association, Ljubljana, Slovenia.,Ljubljana University Medical Centre, Ljubljana, Slovenia
| | - P Mohr
- Czech Psychiatric Association, Prague, Czech Republic.,Third Faculty of Medicine, Charles University Prague, Prague, Czech Republic
| | - M Munarriz Ferrandis
- Association of Psychiatrists of Spanish Association of Neuropsychiatry, Madrid, Spain
| | - M Musalek
- European Psychiatric Association, Committee on Ethical Issues, Strasbourg, France.,Institute for Social Aesthetics and Mental Health, Vienna, Austria.,Sigmund Freud University, Vienna, Austria
| | - N Neznanov
- Russian Society of Psychiatrists, Moscow, Russian Federation.,St. Petersburg V.M. Bekhterev Psychoneurological Research Institute, St. Petersburg, Russian Federation
| | | | - I Pajević
- Psychiatric Association of Bosnia-Herzegovina, Tuzla, Bosnia and Herzegovina.,Department of Psychiatry, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - A Popova
- European Psychiatric Association, Committee on Ethical Issues, Strasbourg, France.,College Private Psychiatry of Bulgaria, Sofia, Bulgaria.,Nikola Shipkovenski Mental Health Centre, Sofia, Bulgaria
| | - P Pregelj
- Slovenian Psychiatric Association, Ljubljana, Slovenia.,Department of Psychiatry, University of Ljubljana, Ljubljana, Slovenia
| | - E Prinsen
- Netherlands Psychiatric Association, Utrecht, Netherlands
| | - C Rados
- Austrian Society for Psychiatry and Psychotherapy, Vienna, Austria.,Department of Psychiatry and Psychotherapeutic Medicine, Villach State Hospital, Villach, Austria
| | - A Roig
- Association of Psychiatrists of Spanish Association of Neuropsychiatry, Madrid, Spain.,Mental Health Centre, Horta-Guinardó, Barcelona, Spain
| | - M Rojnic Kuzman
- Croatian Psychiatric Association, Zagreb, Croatia.,Zagreb School of Medicine and Zagreb University Hospital Centre, Zagreb, Croatia
| | - J Samochowiec
- Polish Psychiatric Association, Warsaw, Poland.,European Psychiatric Association Council of National Psychiatric Associations, Strasbourg, France.,Department of Psychiatry Pomeranian Medical University, Szczecin, Poland
| | - N Sartorius
- European Psychiatric Association, Committee on Ethical Issues, Strasbourg, France.,Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
| | - Y Savenko
- Independent Psychiatric Association of Russia, Moscow, Russian Federation
| | - O Skugarevsky
- Belarusian Psychiatric Association, Minsk, Belarus.,Psychiatry and Medical Psychology Department, Belarusian State Medical University, Minsk, Belarus
| | - E Slodecki
- Royal College of Psychiatrists, London, United Kingdom
| | - A Soghoyan
- Armenian Psychiatric Association, Yerevan, Armenia.,Center of Psychosocial Recovery, Yerevan State Medical University, Yerevan, Armenia
| | - D S Stone
- National Centre for Suicide Research and Prevention of Mental-Ill Health, Karolinska Institute, Stockholm, Sweden
| | - R Taylor-East
- Maltese Association of Psychiatry, Attard, Malta.,University of Malta, Msida, Malta
| | - E Terauds
- Latvian Psychiatric Association, Riga, Latvia.,Department of Psychiatry and Narcology, Rīga Stradiņš University, Riga, Latvia
| | - C Tsopelas
- Psychiatric Association of Eastern Europe and the Balkans, Athens, Greece.,Department of Psychiatry, Psychiatric Hospital of Athens, Athens, Greece
| | - C Tudose
- Romanian Association of Psychiatry and Psychotherapy, Bucharest, Romania.,Department of Psychiatry "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - S Tyano
- European Psychiatric Association, Committee on Ethical Issues, Strasbourg, France
| | - P Vallon
- Swiss Society of Psychiatry and Psychotherapy, Bern, Switzerland
| | - R J Van der Gaag
- European Psychiatric Association, Committee on Ethical Issues, Strasbourg, France.,Psychosomatics and Psychotherapy Stradina Department, University of Riga, Riga, Latvia
| | - P Varandas
- Portuguese Society of Psychiatry and Mental Health, Lisbon, Portugal.,Casa de Saúde da Idanha and San José Psychiatric Clinic Instituto das Irmãs Hospitaleiras do Sagrado Coração de Jesus, Belas, Portugal
| | - L Vavrusova
- European Psychiatric Association, Committee on Ethical Issues, Strasbourg, France.,Slovak Psychiatric Association, Bratislava, Slovakia
| | - P Voloshyn
- Association of Neurologists, Psychiatrists and Narcologists of Ukraine, Kharkiv, Ukraine.,Department of Neurology and Neurosurgery of Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
| | - J Wancata
- Austrian Society for Psychiatry and Psychotherapy, Vienna, Austria.,Clinical Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - J Wise
- European Psychiatric Association, Committee on Ethical Issues, Strasbourg, France.,CNWL NHS Foundation Trust, London, United Kingdom
| | - Z Zemishlany
- Israel Psychiatric Association, Ramat Gan, Israel
| | - F Öncü
- Psychiatric Association of Turkey, Ankara, Turkey.,Forensic Psychiatry Department, Bakirkoy Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey
| | - S Vahip
- European Psychiatric Association Council of National Psychiatric Associations, Strasbourg, France.,Department of Psychiatry, Ege University School of Medicine, Izmir, Turkey
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20
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Ueberberg B, Efkemann SA, Hoffmann K, Haußleiter IS, Juckel G. The social-psychiatric service and its role in compulsory hospitalization. Health Soc Care Community 2020; 28:467-474. [PMID: 31657072 DOI: 10.1111/hsc.12879] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 06/10/2023]
Abstract
Coercive measures are a sensitive, much-discussed ethical and legal issue in the psychiatric context. Hence, the identification of their predictors and ways of prevention are of utmost importance. The present study aimed to determine the impact of the social-psychiatric services (SPS) in North Rhine Westphalia (NRW) on involuntary admissions according to the German Mental Health Act and to identify predictors for the reduction of these involuntary admissions. A dataset including details from 31 districts and 23 towns in NRW over a time period of 10 years (2005-2014) was analysed regarding the number of involuntary admissions, gender and age of admitted patients, and person/institution initiating the compulsory act. All 56 SPS in NRW were contacted for information on the number of clients/contacts, home visits, areas of responsibility and their involvement in involuntary admissions. Thirty SPS participated in the survey. We found a significant increase of involuntary admissions over time with significantly higher proportions of male patients and patients younger than 60 years in every year. Regarding the characteristics of SPS, a negative correlation between the number of clients contacting the SPS on their own initiative and low-income households was observed. Additionally, the number of clients contacting the SPS on their own initiative was significantly higher in districts/towns associated with lower involuntary admission rates. These data suggest that patient-based factors were of great importance in the context of involuntary admissions. Furthermore, the SPS and home treatment should be strengthened and intensified to achieve lower involuntary admission rates.
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Affiliation(s)
- Bianca Ueberberg
- Ruhr University Bochum, LWL-University Hospital Bochum, LWL-Institute of Mental Health, Bochum, Germany
| | - Simone Agnes Efkemann
- Ruhr University Bochum, LWL-University Hospital Bochum, LWL-Institute of Mental Health, Bochum, Germany
| | - Knut Hoffmann
- Ruhr University Bochum, LWL-University Hospital Bochum, LWL-Institute of Mental Health, Bochum, Germany
- Department of Psychiatry, Ruhr University Bochum, LWL-University Hospital Bochum, Bochum, Germany
| | - Ida Sibylle Haußleiter
- Ruhr University Bochum, LWL-University Hospital Bochum, LWL-Institute of Mental Health, Bochum, Germany
- Department of Psychiatry, Ruhr University Bochum, LWL-University Hospital Bochum, Bochum, Germany
| | - Georg Juckel
- Ruhr University Bochum, LWL-University Hospital Bochum, LWL-Institute of Mental Health, Bochum, Germany
- Department of Psychiatry, Ruhr University Bochum, LWL-University Hospital Bochum, Bochum, Germany
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21
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Stuart R, Akther SF, Machin K, Persaud K, Simpson A, Johnson S, Oram S. Carers' experiences of involuntary admission under mental health legislation: systematic review and qualitative meta-synthesis. BJPsych Open 2020; 6:e19. [PMID: 32043435 PMCID: PMC7176830 DOI: 10.1192/bjo.2019.101] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Carers are key providers of care and support to mental health patients and mental health policies consistently mandate carer involvement. Understanding carers' experiences of and views about assessment for involuntary admission and subsequent detention is crucial to efforts to improve policy and practice. AIMS We aimed to synthesise qualitative evidence of carers' experiences of the assessment and detention of their family and friends under mental health legislation. METHOD We searched five bibliographic databases, reference lists and citations. Studies were included if they collected data using qualitative methods and the patients were aged 18 or older; reported on carer experiences of assessment or detention under mental health legislation anywhere in the world; and were published in peer-reviewed journals. We used meta-synthesis. RESULTS The review included 23 papers. Themes were consistent across time and setting and related to the emotional impact of detention; the availability of support for carers; the extent to which carers felt involved in decision-making; relationships with patients and staff during detention; and the quality of care provided to patients. Carers often described conflicting feelings of relief coupled with distress and anxiety about how the patient might cope and respond. Carers also spoke about the need for timely and accessible information, supportive and trusting relationships with mental health professionals, and of involvement as partners in care. CONCLUSIONS Research is needed to explore whether and how health service and other interventions can improve the involvement and support of carers prior to, during and after the detention of family members and friends.
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Affiliation(s)
- Ruth Stuart
- Research Assistant, Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | | | - Karen Machin
- Visiting Lecturer, School of Health and Social Work, University of Hertfordshire, UK
| | - Karen Persaud
- Honorary Research Associate, NIHR Mental Health Policy Research Unit, Division of Psychiatry, Faculty of Brain Sciences, University College London, UK
| | - Alan Simpson
- Professor of Mental Health Nursing, Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London; and Director (KCL), NIHR Mental Health Policy Research Unit, UK
| | - Sonia Johnson
- Professor of Social and Community Psychiatry, Division of Psychiatry, Faculty of Brain Sciences, University College London; Director (UCL), NIHR Mental Health Policy Research Unit; and Consultant Clinical Psychiatrist, Camden and Islington NHS Foundation Trust, UK
| | - Sian Oram
- Lecturer and Head of the Section of Women's Mental Health, Health Service & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London; Deputy Director (KCL), NIHR Mental Health Policy Research Unit, UK
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22
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Efkemann SA, Scholten M, Bottlender R, Juckel G, Gather J. A German Version of the Staff Attitude to Coercion Scale. Development and Empirical Validation. Front Psychiatry 2020; 11:573240. [PMID: 33536947 PMCID: PMC7847975 DOI: 10.3389/fpsyt.2020.573240] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/16/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Individual staff factors, such as personality traits and attitudes, are increasingly seen as an important factor in the reduction of coercion in mental health services. At the same time, only a few validated instruments exist to measure those factors and examine their influence on the use of coercion. Aim: The present study aimed to develop and validate a German version of the Staff Attitude to Coercion Scale (SACS). Methods: The original English version of the SACS published was translated into German. Subsequently, it was empirically validated on a sample of N = 209 mental health professionals by conducting an exploratory factor analysis. Results: The three-factor structure in the original version of the SACS, consisting of critical, pragmatic and positive attitudes toward the use of coercion, could not be replicated. Instead, the German version revealed one factor ranging from rejecting to approving the use of coercion. Conclusion: The SACS is one of the first instruments created to assess staff attitudes toward coercion in a validated way. The version of the instrument developed in this study allows for a validated assessment of those attitudes in German. Our results highlight the ethical importance of using validated measurements in studies on the role of staff factors in the reduction of coercion.
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Affiliation(s)
- Simone A Efkemann
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Matthé Scholten
- Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
| | - Ronald Bottlender
- Klinik für Psychiatrie und Psychotherapie, Klinikum Lüdenscheid, Märkische Klinken, Lüdenscheid, Germany
| | - Georg Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jakov Gather
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Bochum, Germany.,Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Bochum, Germany
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23
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Yang Y, Li W, An FR, Wang YY, Ungvari GS, Balbuena L, Xiang YT. Voluntary and Involuntary Admissions for Severe Mental Illness in China: A Systematic Review and Meta-Analysis. Psychiatr Serv 2020; 71:83-86. [PMID: 31575350 DOI: 10.1176/appi.ps.201900106] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/01/2022]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to examine the prevalence of voluntary and involuntary psychiatric admissions for severe mental illness in China and explore their associated factors. METHODS The PubMed, Cochrane Library, PsycINFO, EMBASE, CNKI, CQVIP, and WanFang databases were systematically searched for the span since their inception to October 2018. Meta-analyses were conducted with the random-effects model. RESULTS Fourteen studies with 94,305 patients were included in the analyses. The voluntary and involuntary admission rates were 30.3% (95% confidence interval [CI]=18.06% to 46.23%) and 32.3% (95% CI=10.39% to 66.21%), respectively, for severe mental illness and 19.6% (95% CI=14.09% to 26.54%) and 44.3% (95% CI=5.98% to 90.88%), respectively, for schizophrenia. Meta-regression analyses found an increase in the voluntary admission rate between 1998 and 2018. CONCLUSIONS The voluntary admission rate for severe mental illness has increased in China, whereas the involuntary admission rate has remained high, particularly for schizophrenia. Concerted efforts should be made to further decrease the rate of involuntary admissions.
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Affiliation(s)
- Yuan Yang
- Unit of Psychiatry, Faculty of Health Sciences and Center for Cognition and Brain Sciences, University of Macau, Macao Special Administrative Region, China (Yang, Li, Xiang); Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brian Science and Brain-Inspired Intelligence, Guangdong, China (Yang); National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing (An); Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom (Wang); Department of Psychiatry, University of Notre Dame Australia, Fremantle, and Division of Psychiatry, School of Medicine, University of Western Australia, Perth (Ungvari); Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada (Balbuena)
| | - Wen Li
- Unit of Psychiatry, Faculty of Health Sciences and Center for Cognition and Brain Sciences, University of Macau, Macao Special Administrative Region, China (Yang, Li, Xiang); Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brian Science and Brain-Inspired Intelligence, Guangdong, China (Yang); National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing (An); Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom (Wang); Department of Psychiatry, University of Notre Dame Australia, Fremantle, and Division of Psychiatry, School of Medicine, University of Western Australia, Perth (Ungvari); Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada (Balbuena)
| | - Feng-Rong An
- Unit of Psychiatry, Faculty of Health Sciences and Center for Cognition and Brain Sciences, University of Macau, Macao Special Administrative Region, China (Yang, Li, Xiang); Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brian Science and Brain-Inspired Intelligence, Guangdong, China (Yang); National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing (An); Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom (Wang); Department of Psychiatry, University of Notre Dame Australia, Fremantle, and Division of Psychiatry, School of Medicine, University of Western Australia, Perth (Ungvari); Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada (Balbuena)
| | - Yuan-Yuan Wang
- Unit of Psychiatry, Faculty of Health Sciences and Center for Cognition and Brain Sciences, University of Macau, Macao Special Administrative Region, China (Yang, Li, Xiang); Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brian Science and Brain-Inspired Intelligence, Guangdong, China (Yang); National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing (An); Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom (Wang); Department of Psychiatry, University of Notre Dame Australia, Fremantle, and Division of Psychiatry, School of Medicine, University of Western Australia, Perth (Ungvari); Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada (Balbuena)
| | - Gabor S Ungvari
- Unit of Psychiatry, Faculty of Health Sciences and Center for Cognition and Brain Sciences, University of Macau, Macao Special Administrative Region, China (Yang, Li, Xiang); Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brian Science and Brain-Inspired Intelligence, Guangdong, China (Yang); National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing (An); Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom (Wang); Department of Psychiatry, University of Notre Dame Australia, Fremantle, and Division of Psychiatry, School of Medicine, University of Western Australia, Perth (Ungvari); Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada (Balbuena)
| | - Lloyd Balbuena
- Unit of Psychiatry, Faculty of Health Sciences and Center for Cognition and Brain Sciences, University of Macau, Macao Special Administrative Region, China (Yang, Li, Xiang); Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brian Science and Brain-Inspired Intelligence, Guangdong, China (Yang); National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing (An); Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom (Wang); Department of Psychiatry, University of Notre Dame Australia, Fremantle, and Division of Psychiatry, School of Medicine, University of Western Australia, Perth (Ungvari); Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada (Balbuena)
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences and Center for Cognition and Brain Sciences, University of Macau, Macao Special Administrative Region, China (Yang, Li, Xiang); Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangdong-Hong Kong-Macao Greater Bay Area Center for Brian Science and Brain-Inspired Intelligence, Guangdong, China (Yang); National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, and the Advanced Innovation Center for Human Brain Protection, School of Mental Health, Capital Medical University, Beijing (An); Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom (Wang); Department of Psychiatry, University of Notre Dame Australia, Fremantle, and Division of Psychiatry, School of Medicine, University of Western Australia, Perth (Ungvari); Department of Psychiatry, University of Saskatchewan, Saskatoon, Canada (Balbuena)
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24
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Noppes F, Savaskan E, Riese F. Compulsory Psychiatric Admission in a Patient With Metastatic Breast Cancer: From Palliative Care to Assisted Suicide. Front Psychiatry 2020; 11:454. [PMID: 32523553 PMCID: PMC7261911 DOI: 10.3389/fpsyt.2020.00454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 05/05/2020] [Indexed: 11/13/2022] Open
Abstract
The provision of palliative care in psychiatry and the use of coercion in palliative care are underexplored areas. We report the case of a 65-year-old woman with cerebral metastatic breast cancer who was compulsorily admitted from a specialized palliative care ward to a psychiatric inpatient ward in Zurich, Switzerland. While in specialized inpatient palliative care, the patient had resisted palliative care but was found to lack decision-making capacity for her treatment due to disordered thought process and paranoid delusions. Under our care, which involved coercive treatment in the form of concealed administration of an antipsychotic, the patient's psychiatric symptoms improved. She regained decision-making capacity, was granted discharge from hospital, and ended her life by assisted suicide on the day of discharge.
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Affiliation(s)
- Felix Noppes
- Department of Geriatric Psychiatry, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Egemen Savaskan
- Department of Geriatric Psychiatry, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Florian Riese
- Department of Geriatric Psychiatry, Psychiatric University Hospital Zurich, Zurich, Switzerland.,University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland
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25
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Huber CG, Schneeberger AR. Editorial: Compulsory Interventions in Psychiatry: An Overview on the Current Situation and Recommendations for Prevention and Adequate Use. Front Psychiatry 2020; 11:622373. [PMID: 33364991 PMCID: PMC7750427 DOI: 10.3389/fpsyt.2020.622373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/10/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
- Christian G Huber
- Universitäre Psychiatrische Kliniken (UPK) Basel, Klinik für Erwachsene, University of Basel, Basel, Switzerland
| | - Andres R Schneeberger
- Psychiatric Services Grisons, Chur, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York, NY, United States
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26
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Akther SF, Molyneaux E, Stuart R, Johnson S, Simpson A, Oram S. Patients' experiences of assessment and detention under mental health legislation: systematic review and qualitative meta-synthesis. BJPsych Open 2019; 5:e37. [PMID: 31530313 PMCID: PMC6520528 DOI: 10.1192/bjo.2019.19] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [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] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Understanding patient experiences of detention under mental health legislation is crucial to efforts to reform policy and practice. AIMS To synthesise qualitative evidence on patients' experiences of assessment and detention under mental health legislation. METHOD Five bibliographic databases were searched, supplemented by reference list screening and citation tracking. Studies were included if they reported on patient experiences of assessment or detention under mental health legislation; reported on patients aged 18 years or older; collected data using qualitative methods; and were reported in peer-reviewed journals. Findings were analysed and synthesised using thematic synthesis. RESULTS The review included 56 papers. Themes were generally consistent across studies and related to information and involvement in care, the environment and relationships with staff, as well as the impact of detention on feelings of self-worth and emotional state. The emotional impact of detention and views of its appropriateness varied, but a frequent theme was fear and distress during detention, including in relation to the use of force and restraint. Where staff were perceived as striving to form caring and collaborative relationships with patients despite the coercive nature of treatment, and when clear information was delivered, the negative impact of involuntary care seemed to be reduced. CONCLUSIONS Findings suggest that involuntary in-patient care is often frightening and distressing, but certain factors were identified that can help reduce negative experiences. Coproduction models may be fruitful in developing new ways of working on in-patient wards that provide more voice to patients and staff, and physical and social environments that are more conducive to recovery. DECLARATION OF INTEREST None.
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Affiliation(s)
| | - Emma Molyneaux
- Research Associate and Honorary Lecturer, Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Ruth Stuart
- Research Assistant, Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Sonia Johnson
- Professor of Social and Community Psychiatry, Division of Psychiatry, Faculty of Brain Sciences, University College London, and Camden and Islington NHS Foundation Trust, UK
| | - Alan Simpson
- Professor of Collaborative Mental Health Nursing, Division of Nursing, School of Health Sciences, City University, UK
| | - Sian Oram
- Lecturer in Women's Mental Health, Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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27
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Ma H, Shao Y. Commentary: The Implementation of China's Mental Health Law-Defined Risk Criteria for Involuntary Admission: A National Cross-Sectional Study of Involuntarily Hospitalized Patients. Front Psychiatry 2019; 10:121. [PMID: 30914981 PMCID: PMC6422891 DOI: 10.3389/fpsyt.2019.00121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 02/18/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Huajian Ma
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Shao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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28
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Sampogna G, Luciano M, Del Vecchio V, Pocai B, Palummo C, Fico G, Giallonardo V, De Rosa C, Fiorillo A. Perceived Coercion Among Patients Admitted in Psychiatric Wards: Italian Results of the EUNOMIA Study. Front Psychiatry 2019; 10:316. [PMID: 31164841 PMCID: PMC6536685 DOI: 10.3389/fpsyt.2019.00316] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/24/2019] [Indexed: 11/18/2022] Open
Abstract
The decision to use coercive measures (restraint, seclusion and forced medication) in psychiatric practice is controversial in mental health care. The EUNOMIA study was funded by the European Commission and carried out in 11 countries in order to develop European recommendations for good clinical practice on the use of coercive measures. The aim of the study is to identify sociodemographic and clinical predictors of the levels of perceived coercion in a sample of Italian patients with severe mental disorders at hospital admission. A total of 294 patients were recruited in five Italian psychiatric hospitals and screened with the MacArthur Perceived Coercion Scale to explore the levels of perceived coercion. Patients were assessed three times: within the first seven days after admission as well as after 1 and 3 months. At each time point, data on changes of perceived coercion, assessed by the Cantril Ladder of Perceived Coercion Scale, information on coercive measures received during hospitalization and the levels of satisfaction with the received treatments were collected. According to the multivariable regression model, being compulsorily admitted (OR: 2.5; 95% CI: 1.3-3.3, p < .000), being male (OR: 0.7; 95% CI: 0.9-1.4; p < .01), being older (OR: 0.03; 95% CI: 0.01-0.06) and less satisfied with received treatments (OR: -0.2; 95% CI: -0.3 to -0.1; p < .05) are all associated with higher levels of perceived coercion, even after controlling for the use of any coercive measure during hospitalization. Satisfaction with received treatment predicts the levels of perceived coercion and this should represent an important challenge for mental health professionals.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Valeria Del Vecchio
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Benedetta Pocai
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Carmela Palummo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Giovanna Fico
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Vincenzo Giallonardo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Corrado De Rosa
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Napoli, Italy
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Bolsinger J, Jaeger M, Hoff P, Theodoridou A. Challenges and Opportunities in Building and Maintaining a Good Therapeutic Relationship in Acute Psychiatric Settings: A Narrative Review. Front Psychiatry 2019; 10:965. [PMID: 32009995 PMCID: PMC6974619 DOI: 10.3389/fpsyt.2019.00965] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/06/2019] [Indexed: 12/22/2022] Open
Abstract
Background: The therapeutic relationship and its importance for psychotherapy outcome have been the subject of extensive research over the last decades. An acute psychiatric inpatient setting is a unique environment where severely ill patients receive intensive treatment over a limited, relatively short, period of time. This renders establishing a good therapeutic relationship difficult for various reasons. It seems likely, however, that the therapeutic relationship in such a setting plays a vital role on factors such as clinical outcome, patient satisfaction, and rehospitalization rates. Little information is available on special attributes and caveats of building and maintaining a good therapeutic relationship in an acute psychiatric setting, neither on its influence on therapy success. Methods: An extensive systematic literature search was performed using PubMed, science direct, psyc info, and google scholar databases. Keywords used were therapeutic alliance, therapeutic relationship, psychiatry, emergency, acute, coercion, autonomy, involuntary, closed ward. RCTs, observational studies, reviews, meta-analyses, and economic evaluations were included, case reports and opinion papers were excluded. Factors specific to an acute psychiatric setting were identified, and the available information was categorized and analyzed accordingly. The PRISMA statement guidelines were followed closely upon research and preparation of the present review. Results: A total of 48 studies were selected based on their relevance as well as design. They demonstrated that several factors related to setting, patient attributes, staff attributes, admission circumstances, and general situation, render building and maintaining a good therapeutic relationship difficult in an acute psychiatric setting compared to scheduled, long-term therapeutic sessions. The available literature on how to overcome this dilemma is scarce. Interventions involving staff and/or patients have been shown to be effective in terms of relevant outcome parameters. Conclusions: Increasing research efforts, as well as raising awareness and providing specific competencies amongst clinicians and patients in terms of nurturing a good therapeutic relationship in acute settings, are necessary to improve clinical outcome, economic factors, quality of patient care and patient as well as staff satisfaction.
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Affiliation(s)
- Julia Bolsinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Matthias Jaeger
- Department of Adult Psychiatry, Psychiatrie Baselland, Liestal, Switzerland
| | - Paul Hoff
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland
| | - Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland
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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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Bainbridge E, Hallahan B, McGuinness D, Gunning P, Newell J, Higgins A, Murphy K, McDonald C. Predictors of involuntary patients' satisfaction with care: prospective study. BJPsych Open 2018; 4:492-500. [PMID: 30564445 PMCID: PMC6293452 DOI: 10.1192/bjo.2018.65] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 12/20/2017] [Revised: 09/12/2018] [Accepted: 10/07/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Involuntary admission can be traumatic and is associated with negative attitudes that persist after the episode of illness has abated. AIMS We aimed to prospectively assess satisfaction with care at the points of involuntary admission and symptomatic recovery, and identify their sociodemographic, clinical and service experience predictors. METHOD Levels of satisfaction with care, and clinical and sociodemographic variables were obtained from a representative cohort of 263 patients at the point of involuntary admission and from 155 of these patients 3 months after termination of the involuntary admission. Data were analysed with multiple linear regression modelling. RESULTS Higher baseline awareness of illness (B = 0.19, P < 0.001) and older age (B = 0.05, P = 0.001) were associated with more satisfaction with care at baseline and follow-up. Transition to greater satisfaction with care was associated with improvements in awareness of illness (B = 0.13, P < 0.001) and in symptoms (B = 0.05, P = 0.02), as well as older age (B = 0.04, P = 0.01). Objective coercive experiences were not associated with variation in satisfaction with care. CONCLUSIONS There is wide variation in satisfaction with coercive care. Greater satisfaction with care is positively associated with clinical variables such as increased awareness of illness. DECLARATION OF INTEREST None.
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Affiliation(s)
- Emma Bainbridge
- Honorary Clinical Fellow, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Ireland
| | - Brian Hallahan
- Senior Lecturer in Psychiatry, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Ireland
| | - David McGuinness
- Research Nurse, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Ireland
| | - Patricia Gunning
- Clinical Research Biostatistician, HRB Clinical Research Facility, National University of Ireland Galway, Ireland
| | - John Newell
- Professor of Biostatistics, HRB Clinical Research Facility, National University of Ireland Galway and School of Mathematics, Statistics and Applied Mathematics, National University of Ireland Galway, Ireland
| | - Agnes Higgins
- Professor in Mental Health, School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | - Kathy Murphy
- Professor of Nursing, School of Nursing and Midwifery, National University of Ireland Galway, Ireland
| | - Colm McDonald
- Professor of Psychiatry, College of Medicine, Nursing and Health Sciences, National University of Ireland Galway and HRB Clinical Research Facility, National University of Ireland Galway, Ireland
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Lay B, Kawohl W, Rössler W. Outcomes of a psycho-education and monitoring programme to prevent compulsory admission to psychiatric inpatient care: a randomised controlled trial. Psychol Med 2018; 48:849-860. [PMID: 28805175 DOI: 10.1017/s0033291717002239] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is a need for interventions that effectively reduce compulsory admission to psychiatry. We conducted a randomised controlled trial to investigate whether an innovative intervention programme prevents compulsory re-admission in people with serious mental illness. METHODS The programme addresses primarily patients' self-management skills. It consists of individualised psychoeducation focusing on behaviours prior to and during illness-related crises, crisis cards and, after discharge from the psychiatric hospital, a 24-month preventive monitoring. A total of 238 inpatients with compulsory admission(s) in the past were randomised to the intervention group or to treatment as usual (TAU). RESULTS Fewer participants who completed the 24-month programme were compulsorily readmitted to psychiatry (28%), compared with those receiving TAU (43%). Likewise, the number of compulsory readmissions per patient was significantly lower (0.6 v. 1.0) and involuntary episodes were shorter (15 v. 31 days), compared with TAU. A negative binomial regression model showed a significant intervention effect (RR 0.6; 95% confidence interval 0.3-0.9); further factors linked to the risk of compulsory readmission were the number of compulsory admissions in the patient's history (RR 2.8), the diagnosis of a personality disorder (RR 2.8), or a psychotic disorder (RR 1.9). Dropouts (37% intervention group; 22% TAU) were characterised by a high number of compulsory admissions prior to the trial, younger age and foreign nationality. CONCLUSIONS This study suggests that this intervention is a feasible and valuable option to prevent compulsory re-hospitalisation in a high-risk group of people with severe mental health problems, social disabilities, and a history of hospitalisations.
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Affiliation(s)
- B Lay
- Department of Psychiatry,Psychotherapy and Psychosomatics,University Hospital of Psychiatry Zurich,Switzerland
| | - W Kawohl
- Department of Psychiatry,Psychotherapy and Psychosomatics,University Hospital of Psychiatry Zurich,Switzerland
| | - W Rössler
- Department of Psychiatry,Psychotherapy and Psychosomatics,University Hospital of Psychiatry Zurich,Switzerland
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Marty S, Jaeger M, Moetteli S, Theodoridou A, Seifritz E, Hotzy F. Characteristics of Psychiatric Emergency Situations and the Decision-Making Process Leading to Involuntary Admission. Front Psychiatry 2018; 9:760. [PMID: 30713511 PMCID: PMC6345710 DOI: 10.3389/fpsyt.2018.00760] [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: 07/20/2018] [Accepted: 12/20/2018] [Indexed: 12/29/2022] Open
Abstract
Introduction: Involuntary admissions to psychiatric hospitals, regardless of their beneficial effects, violate the patients' autonomy. To keep such measures at a minimum and develop less restricting and coercive alternatives, a better understanding of the psychiatric emergency situations which end up in involuntary admissions is needed. This descriptive and exploratory study investigates the consultations leading to involuntary admission and the decision-making process of the referring physicians. Methods: We developed an online questionnaire to collect data on the characteristics of the consultation leading to an involuntary admission, including influencing factors from the referring physicians' perspective, as well as their professional background. We included 107 physicians who completed the questionnaire after they had referred patients for involuntary admission to one major psychiatric hospital in Switzerland. Results: The referring physicians were heterogeneous regarding their medical background and experience with psychiatric emergency situations. The consultations were time consuming and took place in various locations. Clinical findings, third-party anamnesis and a known psychiatric diagnosis contributed strongest to the decision to admit involuntarily. "Protection from danger to self" was named most frequently as purpose of the admission. Discussion: This study emphasizes the variety of psychiatric emergency situations leading to involuntary admissions. In most cases, several parties are involved and influence the decision together with medical and social factors. To reduce the number of involuntary admissions, alternatives for patients with a high symptom load and at risk of harming themselves are needed. Possible approaches to achieve that reduction and recommendations for further research are provided.
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Affiliation(s)
- Silvan Marty
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Matthias Jaeger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland.,Psychiatrie Baselland, Liestal, Switzerland
| | - Sonja Moetteli
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Anastasia Theodoridou
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Florian Hotzy
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
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Jiang F, Zhou H, Rakofsky JJ, Hu L, Liu T, Liu H, Liu Y, Tang YL. The Implementation of China's Mental Health Law-Defined Risk Criteria for Involuntary Admission: A National Cross-Sectional Study of Involuntarily Hospitalized Patients. Front Psychiatry 2018; 9:560. [PMID: 30459656 PMCID: PMC6232607 DOI: 10.3389/fpsyt.2018.00560] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/17/2018] [Indexed: 12/02/2022] Open
Abstract
Objective: Involuntary admission is one of the most controversial issues in psychiatry in China. This study aimed to examine the implementation of the new risk criteria for involuntary admission, as defined by the new Mental Health Law (MHL), in major psychiatric hospitals; and to explore factors associated with the implementation. Method: We selected 32 psychiatric hospitals in 29 provincial capital cities in mainland China. We included all involuntarily admitted psychiatric inpatients who were discharged from December 25 to 27, 2017. Patients' demographic and clinical data and reasons for admission were retrieved. Hospitals' information was also collected. Multilevel logistic regression was applied to explore factors associated with the implementation. Results: We collected valid data from 814 inpatients. Rates of risk criteria implementation ranged from 7.9 to 88.5% in these hospitals. Only 369 inpatients (45.3%) met the MHL-defined risk criteria. Overall, between 62.2 and 78.5% of the variance in risk criteria implementation was at the patient level, and between 21.5 and 37.8% of the variance was at the hospital level. Patients with higher Global Assessment of Functioning (GAF) scores at admission were less likely to meet the risk criteria (OR 1.02, 95% CI 1.01-1.03). No statistically significant association was found between risk criteria implementation and other patient level or hospital level factors. Conclusion: Our findings show the implementation rate of the MHL's risk criteria overall was low, with only 45.3% of involuntary admissions meeting the MHL-defined criteria. This suggests that some patients' civil rights might have been violated.
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Affiliation(s)
- Feng Jiang
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huixuan Zhou
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jeffrey J Rakofsky
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States
| | - Linlin Hu
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tingfang Liu
- Institute for Hospital Management, Tsinghua University, Beijing, China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Yuanli Liu
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States.,Atlanta VA Medical Center, Decatur, GA, United States
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Abstract
OBJECTIVE The aim of this study is to assess the prevalence of involuntary admissions with regard to seasonality and clinical associated features, in a sample of patients admitted to a psychiatric unit in a period of 24 months. METHODS All subjects consecutively admitted to the Psychiatric Inpatient Unit of the San Luigi Gonzaga Hospital, Orbassano (University of Turin, Italy) from September 2013 to August 2015 were recruited. Socio-demographic and clinical characteristics were collected. RESULTS Seven hundred and thirty admissions in psychiatric ward were recognized. The prevalence of involuntary admission was 15.4%. Patients with involuntary hospitalizations showed a higher education level, a higher prevalence of admission in spring/summer with a significant peak in June, a longer duration of hospitalization and a lower suicide ideation. Among involuntary admissions, physical restraint and suicide attempts were more prevalent during spring compared to the other seasons. CONCLUSIONS Seasonality has an important role in the psychopathology of psychiatric disorders, particularly in bipolar and related disorder, and may represent an influencing factor in hospital admissions and hospitalizations. Seasonal pattern must be considered while managing diagnosis and treatment of mental disorders, with regard to prevention and psychoeducation of patients.
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Affiliation(s)
- Andrea Aguglia
- a Department of Neuroscience, Psychiatric Unit, S Luigi Gonzaga Hospital , University of Turin , Turin , Italy
| | - Marta Moncalvo
- a Department of Neuroscience, Psychiatric Unit, S Luigi Gonzaga Hospital , University of Turin , Turin , Italy
| | - Francesca Solia
- a Department of Neuroscience, Psychiatric Unit, S Luigi Gonzaga Hospital , University of Turin , Turin , Italy
| | - Giuseppe Maina
- a Department of Neuroscience, Psychiatric Unit, S Luigi Gonzaga Hospital , University of Turin , Turin , Italy
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Setkowski K, van der Post LF, Peen J, Dekker JJ. Changing patient perspectives after compulsory admission and the risk of re-admission during 5 years of follow-up: The Amsterdam Study of Acute Psychiatry IX. Int J Soc Psychiatry 2016; 62:578-88. [PMID: 27411986 DOI: 10.1177/0020764016655182] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 11/16/2022]
Abstract
OBJECTIVE Given increasing numbers of compulsory admissions, it is important to assess patient risk profiles and identify factors that are appropriate for intervention. METHODS A sample of 116 patients who were compulsorily admitted was studied. Socio-demographic and clinical characteristics were recorded. Patients were interviewed twice using the Verona Service Satisfaction Scale and the Birchwood Insight Scale. Changes in insight and satisfaction during 2 years were linked to the incidence of involuntary re-admissions in the next three follow-up years. RESULTS A higher mean score for patient satisfaction was found (mean=3.77, standard deviation (SD)=0.56; p⩽.001) in the second interview than in the baseline interview (mean=3.26, SD=0.65). There was also an improvement in insight (in the second interview: mean=7.22, SD=2.86 and in the baseline interview: mean=6.34, SD=3.18; p=.027). There was an inverse correlation between increasing satisfaction (in years 1-2) and the incidence of involuntary admission in years 3-5 (odds ratio (OR)=0.445, 95% confidence interval (CI)=0.252-0.793; p=.006). This association proved to be dependent on a history of involuntary admission. CONCLUSION Increasing patient satisfaction in the first 2 years was associated with a lower risk of compulsory re-admission in the subsequent follow-up period, but this association proved to be dependent on a history of involuntary admissions in these first two follow-up years. Increase in insight during the same period did not show any effect whatsoever.
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Affiliation(s)
- Kim Setkowski
- Research Department, ARKIN Mental Health Care, Amsterdam, The Netherlands
| | | | - Jaap Peen
- Research Department, ARKIN Mental Health Care, Amsterdam, The Netherlands
| | - Jack Jm Dekker
- Research Department, ARKIN Mental Health Care, Amsterdam, The Netherlands Department of Clinical Psychology, Faculty of Psychology and Pedagogy, VU University Amsterdam, Amsterdam, The Netherlands
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Donisi V, Tedeschi F, Salazzari D, Amaddeo F. Differences in the use of involuntary admission across the Veneto Region: which role for individual and contextual variables? Epidemiol Psychiatr Sci 2016; 25:49-57. [PMID: 25487132 DOI: 10.1017/S2045796014000663] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS The first aim of this study is to compare involuntary admissions across the Veneto Region in Italy. The second aim is to explore the relation between mental health services provision, characteristics of population, individual factors and involuntary admissions. METHODS For 21 Mental Health Departments (MHDs) in the Veneto Region (Italy), the average population prevalence rate of involuntary admissions between 2000 and 2007 and the percentage of involuntary admissions were calculated. Chi-square tests for equality of proportions were used to test hypotheses. Variables at the individual, contextual and organisational levels were used in multiple regressions, with the involuntary admission data as dependent variables. RESULTS The average prevalence rate of involuntary commitment was 12.75 ranging from 1.96 to 27.59 across MHDs . About 75% of the involuntary admissions referred to psychotic patients, and almost half of patients were aged 25-44. Significant differences among MHDs emerged; higher percentages of involuntary admissions were generally found in densely populated areas. Higher ageing indices and rates of social workers were found as predictors of the prevalence rate. In the multilevel regression, being males and psychotic significantly increased involuntary admissions, while the percentage of singles in population decreased it. CONCLUSIONS This study contributes to define the specific contribution of each factor predicting the use of involuntary admission, even within areas under the same legislation. It shows how the inclusion of both individual and contextual factors may lead to better predictions and provides precious data for the services improvement.
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Braam AW, van Ommeren OWHR, van Buuren ML, Laan W, Smeets HM, Engelhard IM. Local Geographical Distribution of Acute Involuntary Psychiatric Admissions in Subdistricts In and Around Utrecht, the Netherlands. J Emerg Med 2015; 50:449-57. [PMID: 26717792 DOI: 10.1016/j.jemermed.2015.06.057] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 06/20/2015] [Accepted: 06/23/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Acute involuntary psychiatric admissions (AIPA) tend to be applied more often in urban areas. OBJECTIVE The current study aims to describe AIPA prevalence differences between the subdistricts in an urban area, and to identify which district characteristics are associated with a higher AIPA district density. METHODS Information was collected on consecutive AIPAs over a 64-month period (2005-2010) in 49 subdistricts in and around the city of Utrecht, the Netherlands, including 1098 AIPAs. District characteristics included several demographic and economical factors and health care characteristics such as number of sheltered living facilities. RESULTS The AIPA density (mean 4.4/10,000 inhabitants/y) was four to five times higher in the most urbanized subdistrict (around 12) compared to the suburban subdistricts (2.5-3). On the district level, the main correlates with AIPA density per district were unemployment rate and small household size. Other correlates were percentage of non-Western immigrants and number of facilities of sheltered living. CONCLUSIONS The considerable AIPA density variation between subdistricts in this urban environment reflects that people who are prone to psychiatric admissions live in economically less prosperous environments. Impaired social networks and economic concerns may also contribute to an environment representing social defeat, increased demoralization, or social fragmentation.
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Affiliation(s)
- Arjan W Braam
- Department of Emergency Psychiatry and Department of Specialist Training, Altrecht Mental Health Care, Utrecht, The Netherlands
| | - Omar W H R van Ommeren
- Faculty of Social Sciences, Department of Psychology, Utrecht University, Utrecht, The Netherlands; Palier Forensic Psychiatry, The Hague, The Netherlands
| | - Melissa L van Buuren
- Faculty of Social Sciences, Department of Psychology, Utrecht University, Utrecht, The Netherlands; Psychologiepraktijk Van Buuren, Barneveld, The Netherlands
| | - Wijnand Laan
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hugo M Smeets
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Iris M Engelhard
- Department of Emergency Psychiatry and Department of Specialist Training, Altrecht Mental Health Care, Utrecht, The Netherlands; Faculty of Social Sciences, Department of Psychology, Utrecht University, Utrecht, The Netherlands
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Shao Y, Xie B. Approaches to involuntary admission of the mentally ill in the People's Republic of China: changes in legislation from 2002 to 2012. J Am Acad Psychiatry Law 2015; 43:35-44. [PMID: 25770277 PMCID: PMC4379039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A systematic analysis of laws on involuntary commitment of mentally ill individuals in China has never been undertaken. In this article, we explore the trajectory of the legislation and discuss the social and cultural factors underlying the changes in the laws. In this description and analysis of the differences and similarities in the current legal framework and procedures for involuntary commitment of the mentally ill across the mental health regulations of seven localities and the National Mental Health Law, one can see a gradual trend toward more stringent legislation during the past 10 years. The compromises, reversals, and circuitous course of the legislative process reflect the difficulties that the government faced in achieving a balance between benefits to society and the individual as it attempted to revamp the delivery of mental health services. The 2012 National Mental Health Law, despite some weaknesses, is an important step toward standardizing the diverse practices in involuntary admission of mentally ill persons in China. Further research on the influence of the National Law on mental health services is clearly needed.
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Affiliation(s)
- Yang Shao
- Dr. Shao is a psychiatrist and Dr. Xie is Medical Director, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Xie
- Dr. Shao is a psychiatrist and Dr. Xie is Medical Director, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Abstract
OBJECTIVE International figures for involuntary admissions vary widely. Differences in legislation, professionals' ethics and public attitudes towards risk have been known to influence this rate. Comparing involuntary admission rates in different parts of the same country can help control for variability found between international studies. This study assessed the rates of involuntary admissions in the Dublin South West Mental Health Service compared with the rest of Ireland. METHODS We examined the demographic and clinical profiles of all involuntary patients admitted to the acute psychiatric inpatient unit in Tallaght Hospital between 2007 and 2011. We compared the rate of admission in Tallaght with the rest of Ireland. Data gathered included all patients detained on Form 6 and Form 13 (change of status) looking at age, gender, diagnosis and number of patients who had a Mental Health Tribunal. Form 7 (renewal orders) was also examined We calculated the rate per 100 000 population per year of Form 6 admissions, Form 13 and Form 7 (certificate and renewal order by responsible consultant psychiatrist) using figures from the 2006 Census. All data were analysed using SPSS. RESULTS The rate of involuntary admission in Tallaght Hospital was significantly lower compared with the rest of Ireland (Form 6: t=-11.2; p<0.001, Form 13: t=-3.1; p=0.04, Form 7: t=-13.9; p=0.001). This difference was evident for all methods of involuntary detention and was also the case for Form 7 (renewal orders). Mental Health Tribunals were held for 59% of patients, a rate comparable with earlier findings described in publications, following the introduction of the new Mental Health Act. CONCLUSIONS Rates per 100 000 population were lower in Dublin South West compared with the rest of Ireland. The reasons for this are not clear. Further research comparing similar services in Ireland could explain these findings.
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Emons B, Haussleiter IS, Kalthoff J, Schramm A, Hoffmann K, Jendreyschak J, Schaub M, Armgart C, Juckel G, Illes F. Impact of social-psychiatric services and psychiatric clinics on involuntary admissions. Int J Soc Psychiatry 2014; 60:672-80. [PMID: 24336088 DOI: 10.1177/0020764013511794] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 11/16/2022]
Abstract
BACKGROUND Germany provides a wide range of highly developed mental health care to its citizens. The aim of this study was to identify factors influencing the voluntariness of admissions to psychiatric hospitals. Especially the impact of demographic factors of the region, characteristics of the psychiatric hospitals and characteristics of the psychosocial services was analyzed. METHOD A retrospective analysis of hospital admission registers from 13 German adult psychiatric hospitals in 2009 was conducted. Public data on the regional psychiatric accommodation and demographic situation were added. Hospitals were dichotomously divided according to their index of involuntary admissions. Group comparisons were performed between the clinics with low and high involuntary admission indices. Analysis was conducted with clinical, psychiatric provision and demographic data related to inpatients in the Landschaftsverbands Westfalen-Lippe (LWL)-PsychiatryNetwork. RESULTS Especially the range of services provided by the social-psychiatric services in the region such as number of supervised patients and home visits had an influence on the proportion of involuntary admissions to a psychiatric hospital. Some demographic characteristics of the region such as discretionary income showed further influence. Contrary to our expectations, the characteristics of the individual hospital seem to have no influence on the admission rate. CONCLUSION Social-psychiatric services show a preventive impact on involuntary acute psychiatry interventions. Sociodemographic factors and patient variables play a role with regard to the number of involuntary hospitalizations, whereas characteristics of hospitals seemed to play no role.
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Affiliation(s)
- Barbara Emons
- LWL-Institute of Mental Health, LWL-University Hospital Bochum, Germany
| | | | - Jörg Kalthoff
- Social-Psychiatric Service, Health Authority Bochum, Germany
| | - Anja Schramm
- Department of Psychiatry, LWL-University Hospital Bochum, Germany
| | - Knut Hoffmann
- Department of Psychiatry, LWL-University Hospital Bochum, Germany
| | | | - Markus Schaub
- LWL-Institute of Mental Health, LWL-University Hospital Bochum, Germany
| | - Carina Armgart
- Department of Psychiatry, LWL-University Hospital Bochum, Germany
| | - Georg Juckel
- LWL-Institute of Mental Health, LWL-University Hospital Bochum, Germany Department of Psychiatry, LWL-University Hospital Bochum, Germany
| | - Franciska Illes
- Department of Psychiatry, LWL-University Hospital Bochum, Germany
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van den Hooff SL, Goossensen A. Ethical considerations on the value of patient knowledge in long-term care: a qualitative study of patients suffering from Korsakoff 's syndrome. Nurs Ethics 2014; 22:377-88. [PMID: 24917267 DOI: 10.1177/0969733014534876] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM This study explores experiences of patients suffering from Korsakoff's syndrome. It contributes to improved reflection on the value of patient knowledge. BACKGROUND An ethics of care perspective states the importance of moving to patients in their vulnerable state of being, and to figure out patients' individual needs necessary to provide good care. The information given by patients suffering from Korsakoff's syndrome might be mistaken, invented and even not true. The value of these patients' experiences and knowledge had not been researched to date. METHOD Data from six in-depth interviews were analysed concurrently through the constant comparative method. ETHICAL CONSIDERATIONS The principles of voluntariness, confidentiality and anonymity were respected during the research process. FINDINGS Four important themes within patients' knowledge emerged: health condition, involuntary admission into the nursing home, the daily routine and interpretation of the caring abilities of healthcare professionals. The findings show that our respondents were able to provide a window into their inner perspective. CONCLUSION This study deepens our understanding of the value of patient knowledge in situations where patients see the world in a different manner as do healthcare professionals. The conversations revealed personal subjective knowledge which our respondents create and live by. Healthcare professionals are encouraged to discover and affirm the understandings of these patients, and not be prepossessed due to the diagnosis or general nursing home rules. Understanding patients' unique knowledge through appreciation of the complexity and richness of different views on the situation can assist to give a more humane response to individual needs and pain. Health staff in healthcare institutions are encouraged to evaluate the - unintended - effect of rigidly applied nursing home rules, and the government is challenged to rethink its policy about care, and provide more resources permitting relational care that nurtures the dignity of patients suffering from Korsakoff's syndrome.
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Abstract
SUBJECT This study aims at investigating the formal and content-related quality of medical certificates directing compulsory hospital admissions before the scheduled alteration of the Swiss civil legislation in January 2013. A comparison between physicians with different professional backgrounds concerning certificates and patients was conducted. METHODS Retrospective investigation of medical records of involuntary inpatients at the University Hospital of Psychiatry in Zurich during a period of six months (N=489). RESULTS Considerable deficits concerning formal and particularly content-related aspects of the certificates were found. Psychiatrists issued certificates of the highest quality followed by emergency physicians, hospital doctors and general practitioners. Patients differed with respect to several sociodemographic and clinical variables. CONCLUSIONS The quality of certificates directing involuntary hospital admission has to be improved considering the impact on the individual concerned. The consequences of the new legislation on the quality of the admission practices should be inquired in order to improve professional training on the issue.
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Affiliation(s)
- Matthias Jäger
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich
| | - Isabelle Ospelt
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich
| | - Wolfram Kawohl
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich
| | - Anastasia Theodoridou
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich
| | - Wulf Rössler
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich
| | - Paul Hoff
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik Zürich
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Myklebust LH, Sørgaard K, Wynn R. Local psychiatric beds appear to decrease the use of involuntary admission: a case-registry study. BMC Health Serv Res 2014; 14:64. [PMID: 24506810 PMCID: PMC3923252 DOI: 10.1186/1472-6963-14-64] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 02/06/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Studies on the effect of organizational factors on the involuntary admission of psychiatric patients have been few and yielded inconclusive results. The objective was to examine the importance of type of service-system, level of care, length of inpatient stay, gender, age, and diagnosis on rates of involuntary admission, by comparing one deinstitutionalized and one locally institutionalized service-system, in a naturalistic experiment. METHODS 5538 admissions to two specialist psychiatric service-areas in North Norway were studied, covering a four-year period (2003-2006). The importance of various predictors on involuntary admission were analyzed in a logistic regression model. RESULTS Involuntary admission to the services was associated with the diagnosis of psychosis, male sex, being referred to inpatient treatment, as well as type of service-system. Patients from the deinstitutionalized system were more likely to be involuntarily admitted. CONCLUSIONS Several factors predicted involuntary status, including male sex, the diagnosis of psychosis, and type of service-system. The results suggests that having psychiatric beds available locally may be more favourable than a traditional deinstitutionalized service system with local outpatient clinics and central mental hospitals, with respect to the use of involuntary admission.
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Affiliation(s)
- Lars Henrik Myklebust
- Psychiatric Research Centre of Northern Norway, Nordland Hospital Trust, Bodø N-8092, Norway
| | - Knut Sørgaard
- Psychiatric Research Centre of Northern Norway, Nordland Hospital Trust, Bodø N-8092, Norway
- Department of Clinical Medicine, University of Tromsø, Tromsø N-9037, Norway
| | - Rolf Wynn
- Department of Clinical Medicine, University of Tromsø, Tromsø N-9037, Norway
- Division of Addictions and Specialized Psychiatric Services, University Hospital of North Norway, Tromsø N-9291, Norway
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Barbeito S, Vega P, Ruiz de Azúa S, Saenz M, Martinez-Cengotitabengoa M, González-Ortega I, Bermudez C, Hernanz M, Corres BFD, González-Pinto A. Cannabis use and involuntary admission may mediate long-term adherence in first-episode psychosis patients: a prospective longitudinal study. BMC Psychiatry 2013; 13:326. [PMID: 24289797 PMCID: PMC3866475 DOI: 10.1186/1471-244x-13-326] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 11/19/2013] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND This study aimed to examine factors associated with treatment adherence in first-episode psychosis (FEP) patients followed up over 8 years, especially involuntary first admission and stopping cannabis use. METHODS This prospective, longitudinal study of FEP patients collected data on symptoms, adherence, functioning, and substance use. Adherence to treatment was the main outcome variable and was categorized as 'good' or 'bad'. Cannabis use during follow-up was stratified as continued use, stopped use, and never used. Bivariate and logistic regression models identified factors significantly associated with adherence and changes in adherence over the 8-year follow-up period. RESULTS Of the 98 FEP patients analyzed at baseline, 57.1% had involuntary first admission, 74.4% bad adherence, and 52% cannabis use. Good adherence at baseline was associated with Global Assessment of Functioning score (p = 0.019), Hamilton Depression Rating Scale score (p = 0.017) and voluntary admission (p < 0.001). Adherence patterns over 8 years included: 43.4% patients always bad, 26.1% always good, 25% improved from bad to good. Among the improved adherence group, 95.7% had involuntary first admission and 38.9% stopped cannabis use. In the subgroup of patients with bad adherence at baseline, involuntary first admission and quitting cannabis use during follow up were associated with improved adherence. CONCLUSIONS The long-term association between treatment adherence and type of first admission and cannabis use in FEP patients suggest targets for intervention to improve clinical outcomes.
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Affiliation(s)
- Sara Barbeito
- Biomedical Research Centre in Mental Health Net (CIBERSAM), University Hospital of Álava, Olaguibel Street, Vitoria, Spain
| | - Patricia Vega
- Biomedical Research Centre in Mental Health Net (CIBERSAM), University Hospital of Álava, Olaguibel Street, Vitoria, Spain
| | - Sonia Ruiz de Azúa
- Biomedical Research Centre in Mental Health Net (CIBERSAM), University Hospital of Álava, Olaguibel Street, Vitoria, Spain,Basque Country University, Sarrienas/n, 48940 Leioa, Bizkaia, Spain
| | - Margarita Saenz
- Biomedical Research Centre in Mental Health Net (CIBERSAM), University Hospital of Álava, Olaguibel Street, Vitoria, Spain
| | - Mónica Martinez-Cengotitabengoa
- Biomedical Research Centre in Mental Health Net (CIBERSAM), University Hospital of Álava, Olaguibel Street, Vitoria, Spain,National University of Distance Education (Universidad Nacional de Educación a Distancia; UNED), Madrid, Spain
| | - Itxaso González-Ortega
- Biomedical Research Centre in Mental Health Net (CIBERSAM), University Hospital of Álava, Olaguibel Street, Vitoria, Spain,Basque Country University, Sarrienas/n, 48940 Leioa, Bizkaia, Spain
| | - Cristina Bermudez
- Biomedical Research Centre in Mental Health Net (CIBERSAM), University Hospital of Álava, Olaguibel Street, Vitoria, Spain
| | - Margarita Hernanz
- Biomedical Research Centre in Mental Health Net (CIBERSAM), University Hospital of Álava, Olaguibel Street, Vitoria, Spain
| | - Blanca Fernández de Corres
- Biomedical Research Centre in Mental Health Net (CIBERSAM), University Hospital of Álava, Olaguibel Street, Vitoria, Spain
| | - Ana González-Pinto
- Biomedical Research Centre in Mental Health Net (CIBERSAM), University Hospital of Álava, Olaguibel Street, Vitoria, Spain.
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Abstract
BACKGROUND In order to protect the rights of the mentally ill, legislation on the standards and procedures of compulsory detention has been made at the local and national level in China. AIMS This study aims to examine psychiatrists' attitudes towards seeking involuntary admission in mainland China. METHOD Three hundred and fourteen (314) qualified members of the Chinese Psychiatrist Association (CPA) were surveyed using a questionnaire to assess their attitudes about the procedure of involuntary admission to mental hospitals. Data were analysed using χ(2) and logistic regression. RESULTS Some psychiatrists in the CPA had several arbitrary attitudes towards the process of admission. Females, aged under 35, with a low education level and a low position in the institution showed stricter attitudes in the procedure of involuntary admission. Areas with mental health legislation showed significant positive relationships with stricter attitudes. CONCLUSIONS Every effort needs to be made to minimize these arbitrary attitudes to prevent potential negative outcomes. There is still a long way to go in protecting the rights of people diagnosed with mental illness.
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Affiliation(s)
- Yang Shao
- Department of Forensic Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wan Ping Road, Shanghai 200030, P. R. China, Tel: 86 021 54254021, Fax: 86 021 64387986
| | - Bin Xie
- Department of Forensic Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wan Ping Road, Shanghai 200030, P. R. China, Tel: 86 021 54254021, Fax: 86 021 64387986
| | - Zhiguo Wu
- Department of Forensic Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wan Ping Road, Shanghai 200030, P. R. China, Tel: 86 021 54254021, Fax: 86 021 64387986
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Abstract
Despite a long-standing tradition of the use of coercion in psychiatric care, such as involuntary admission and treatment, few have systematically addressed this issue. In recent years, more research has been carried out, suggesting that the use of coercion has important and complex legal, ethical, and clinical implications. In the present article, types and rates of coercion are presented and central topics including competency, ethics, and the reasons given for the use of coercion, are critically discussed.
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Affiliation(s)
- Rolf Wynn
- Department of Clinical Psychiatry, University of Tromsø, Tromsø, Norway
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Kallert TW, Glöckner M, Onchev G, Raboch J, Karastergiou A, Solomon Z, Magliano L, Dembinskas A, Kiejna A, Nawka P, Torres-González F, Priebe S, Kjellin L. The EUNOMIA project on coercion in psychiatry: study design and preliminary data. World Psychiatry 2005; 4:168-72. [PMID: 16633543 PMCID: PMC1414770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Previous national research has shown significant variation in several aspects of coercive treatment measures in psychiatry. The EUNOMIA project, an international study funded by the European Commission, aims to assess the clinical practice of these measures and their outcomes. Its naturalistic and epidemiological design is being implemented at 13 centres in 12 European countries. This article describes the design of the study and provides preliminary data on the catchment areas, staff, available facilities and modalities of care at the participating centres.
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Affiliation(s)
- Thomas W Kallert
- Department of Psychiatry and Psychotherapy, University of Technology, Fetscherstraße 74, Dresden, Germany
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