Moral Experiences of Crisis Management in a Child Mental Health Setting: A Participatory Hermeneutic Ethnographic Study

Examining Systemic and Interpersonal Bias in Violence Risk Assessments of Patients in Acute Psychiatric Care

OBJECTIVE

The assessment and management of inpatient risk for violence in acute psychiatric care are challenges that introduce the potential for bias. This study aimed to examine inequities based on social determinants of health (SDoH) (e.g., race-ethnicity, gender, or mode of admission to acute care) that may lead to unfair assessment of psychiatric patients.

METHODS

The authors analyzed electronic health records of 7,424 acute care patients across 12,650 stays (2016-2022) at a large Canadian psychiatric hospital. Risk ratios (RRs) were calculated by SDoH for staff assessments of high risk (perceived risk), for violent incidents (actual risk), and for potentially biased risk assessment (particularly when a patient was assessed as high risk but did not become violent).

RESULTS

In univariate analyses, patients assessed as high risk who did not become violent were more likely to be male than female and to be Black, Indigenous, or Middle Eastern than White. When RRs were mutually adjusted for all variables, the associations for gender and race-ethnicity were attenuated or were no longer statistically significant. Associations with potentially biased risks that remained significant included most psychiatric diagnoses (vs. a depressive or anxiety disorder), supportive or unstable housing (vs. owning a home), and admission by police (vs. self-admission; RR=2.14, 95% CI=1.92-2.40).

CONCLUSIONS

Systemic factors, such as admission by police and housing status, and having severe mental illness were the primary drivers of observed inequities in risk assessments of patients from racial-ethnic minority groups. Addressing these systemic factors might be key to improving acute psychiatric care.

Perceptions about children and adolescents' mental health crisis intervention: a qualitative systematic review

This review aimed to identify and synthesize the perceptions of mental healthcare professionals, family members, and users about mental health crisis interventions for children and adolescents at hospitals and community mental health services. A qualitative systematic review was conducted following the Joanna Briggs Institution guidelines. The search was performed in 15 databases, with no temporal delimitation, and included studies in Portuguese, English, and Spanish. All works were assessed regarding methodological quality, credibility, and dependability according to the ConQual score and the recommendations were assessed following the Joanna Briggs Institution guidelines. In total, two independent reviewers screened and assessed the studies, extracted their data, developed categories, and conducted the thematic synthesis. A total of 13 studies met the inclusion and exclusion criteria. From these, five syntheses were developed: importance of relationships; importance of procedures during treatment; positive emotional responses to treatment; negative emotional responses to treatment; and issues with health professionals and health services. All five syntheses presented high dependability; two syntheses presented high credibility; and three presented moderate credibility. Mental healthcare professionals, family members and users had convergent perceptions about crisis intervention provided at healthcare services. Understanding their perceptions to improve care and the user experience in this vulnerable situation is crucial.

Enhancing children's participation in dental research: A commentary

The concept of childhood has evolved over the years, inspired by the United Nations Convention on the Rights of the Child in 1989, shifting from developmental models to a conception of childhood that recognizes children as moral agents. This evolution highlights the importance of respecting children's agency and their right to be heard in matters that are related to them. In conventional health research, however, children's voices are often inadequately accessed. In this commentary, we discuss the imperative to recognize children's agency in dental research and a shift from research on children to research with and by children. Moreover, we underscore the importance of actively seeking and listening to children's voices and recognizing their agency in shaping research and healthcare practices in the field of dentistry. Further, we explore the application of participatory research approaches in dental research and provide examples of studies that have involved children in various capacities. We conclude this commentary by emphasizing the potential benefits of participatory research in both qualitative and quantitative dental studies to promote deeper understanding, clearer communication, and stronger advocacy regarding children's interests. Primarily, we call for greater recognition of children's agency in dental research and advocate for more inclusive and child-centred research methodologies.

I Didn't Want the Psychotic Thing to Get Out to Anyone at All: Adolescents with Early Onset Psychosis Managing Stigma

The impact of stigmatisation on adults with mental illnesses has been thoroughly demonstrated. However, little is known about experiences of stigmatisation among adolescents with mental illness. Through semi-structured interviews with 34 Danish adolescents (14-19 years) diagnosed with psychosis, this study explores adolescents' experiences of psychosis stigma. On the basis of phenomenological analysis, we find that stigmatisation is widely experienced, and psychosis is generally regarded as more stigmatising than co-morbid mental illnesses. The participants engage in different strategies to manage possible stigma, especially strategies of (non-)disclosure. Disclosure is experienced as both therapeutic and normative, but also bears the risk of stigmatisation, and is therefore associated with numerous considerations. Being understood when disclosing is central to the participants, and lack of understanding from others is a continuous challenge. Nevertheless, participants experience benefits when feeling understood by people they confide in and can to a degree create the grounds for this through centralising aspects of their experiences of psychosis and mental illness. We argue that disclosure is both a stigma management strategy and a normative imperative, and that being understood or not is a challenge transcending stigma definitions.Clinical trial registration: Danish Health and Medicines Authority: 2612-4168. The Ethics Committee of Capital Region: H-3-2009-123. ClinicalTrials.gov: NCT01119014. Danish Data Protection Agency: 2009-41-3991.

The Use of Chemical Control Within Coercive Controlling Intimate Partner Violence and Abuse

This paper explores the use of chemical control by perpetrators as part of coercive controlling intimate partner violence and abuse, defined as the nonconsenting use of prescribed and nonprescribed medication (including vaccines), and/or other substances to coerce or control, reducing the victim-survivor's capacity for independence, freedom, and health. Based on testimonies of 37 victims-survivors and nine domestic abuse practitioners in the UK we identify varying tactics used to chemically coerce and control, deepening our understanding about the continually changing forms of domestic violence and abuse and enhancing the potential for a more robust response through better informed policy and practice.

Predictive care: a protocol for a computational ethnographic approach to building fair models of inpatient violence in emergency psychiatry

INTRODUCTION

Managing violence or aggression is an ongoing challenge in emergency psychiatry. Many patients identified as being at risk do not go on to become violent or aggressive. Efforts to automate the assessment of risk involve training machine learning (ML) models on data from electronic health records (EHRs) to predict these behaviours. However, no studies to date have examined which patient groups may be over-represented in false positive predictions, despite evidence of social and clinical biases that may lead to higher perceptions of risk in patients defined by intersecting features (eg, race, gender). Because risk assessment can impact psychiatric care (eg, via coercive measures, such as restraints), it is unclear which patients might be underserved or harmed by the application of ML.

METHODS AND ANALYSIS

We pilot a computational ethnography to study how the integration of ML into risk assessment might impact acute psychiatric care, with a focus on how EHR data is compiled and used to predict a risk of violence or aggression. Our objectives include: (1) evaluating an ML model trained on psychiatric EHRs to predict violent or aggressive incidents for intersectional bias; and (2) completing participant observation and qualitative interviews in an emergency psychiatric setting to explore how social, clinical and structural biases are encoded in the training data. Our overall aim is to study the impact of ML applications in acute psychiatry on marginalised and underserved patient groups.

ETHICS AND DISSEMINATION

The project was approved by the research ethics board at The Centre for Addiction and Mental Health (053/2021). Study findings will be presented in peer-reviewed journals, conferences and shared with service users and providers.

Children's Lived Experiences of Wellbeing at School in England: a Phenomenological Inquiry

This phenomenological inquiry investigated children's wellbeing experiences at school, including their hedonic (feeling good) and eudaimonic (doing good) accounts, a distinction often overlooked. Further, while phenomenological inquiries of children's mental ill-health exist, wellbeing, a fundamental part of mental health, is neglected. This is at odds with positive psychology which favours strengths-based approaches to studying human development. Phenomenology provides rich detail, facilitating deeper understanding of why and how certain factors affect wellbeing, as described by children themselves. A sample of 15 children (aged 9-11), attending one English primary school broadly representative of the national socio-demographic, engaged in interviews. Children's experiences of 'feeling good' at school were characterised by: an interdependence on peers' emotional states (described as 'a domino effect'), a need to feel cared for by, and trust, adults, and desire for autonomy over their time. Children attributed mistrust in adults to adults disregarding seemingly incidental events which felt significant to children. Children experienced 'doing well' as equating to academic attainment, conveying a fixation with test scores, using language of 'correctness' and efficiency. Shame pervaded when 'correctness' was not achieved, with children describing being ridiculed for poor test scores. Recommendations for schools to support children's hedonia include prioritising wellbeing curricula and emotional literacy, greater staff reflexivity, and prioritisation of pupil voice. To foster children's eudaimonia, recommendations include the need for teachers to provide formative, personalised feedback for pupils focused on the learning process, and the need for Government to embrace a range of ways pupils can feel successful beyond academic attainment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12187-023-10016-2.

Inclusion of children with disabilities in qualitative health research: A scoping review

BACKGROUND

Children with disabilities have the right to participate in health research so their priorities, needs, and experiences are included. Health research based primarily on adult report risks misrepresenting children with disabilities and their needs, and contributes to exclusion and a lack of diversity in the experiences being captured. Prioritizing the participation of children with disabilities enhances the relevance, meaningfulness, and impact of research.

METHODS

A scoping review was conducted to critically examine the participation of children with disabilities in qualitative health research. The electronic databases PubMed, PsychInfo, Embase, and Google Scholar were searched. Inclusion criteria included qualitative health studies conducted with children with disabilities, published between 2007 and 2020, and written in English. Articles were screened by two reviewers and the synthesis of data was performed using numeric and content analysis.

RESULTS

A total of 62 studies met inclusion criteria. Rationales for including children with disabilities included child-focused, medical model of disability, and disability rights rationales. Participation of children with disabilities in qualitative health research was limited, with the majority of studies conducting research on rather than in partnership with or by children. Findings emphasize that children with disabilities are not participating in the design and implementation of health research.

CONCLUSION

Further effort should be made by health researchers to incorporate children with a broad range of impairments drawing on theory and methodology from disability and childhood studies and collaborating with people who have expertise in these areas. Furthermore, an array of multi-method inclusive, accessible, adaptable, and non-ableist methods should be available to enable different ways of expression.