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Pedersen ML, Gildberg FA, Baker J, Tingleff EB. A systematic review of interventions to reduce mechanical restraint in adult mental health inpatient settings. Int J Ment Health Nurs 2024; 33:505-522. [PMID: 38017713 DOI: 10.1111/inm.13267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/25/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023]
Abstract
Mechanical restraint is a commonly used restrictive practice worldwide, although reducing its use is an international priority. Interventions to reduce mechanical restraint are needed if reducing mechanical restraint is to succeed. Therefore, this systematic review aimed to examine evaluated evidence-based interventions that seek to reduce the incidence of and/or time in mechanical restraint in adult mental health inpatient settings. The JBI framework was used to guide this systematic review. The search strategy included peer-reviewed primary research literature published between 1999 and 2023. Two authors independently conducted the systematic search, selection process and data extraction process. Forty-one studies were included in this review. Using content analysis, we grouped interventions into four categories: (I) calm-down methods, (II) staff resources, (III) legal and policy changes and (IV) changing staff culture. Interventions to reduce mechanical restraint in adult mental health inpatient settings have shown some promise. Evidence suggests that a range of interventions can reduce the incidence of and/or time in mechanical restraint. However, controlled trials were lacking and consensus was lacking across studies. Furthermore, specific findings varied widely, and reporting was inconsistent, hampering the development of interventions for this issue. Further research is needed to strengthen the evidence base for reducing mechanical restraint in mental health inpatient settings.
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Affiliation(s)
- Martin Locht Pedersen
- Forensic Mental Health Research Unit Middelfart, Department of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Middelfart, Denmark
| | - Frederik Alkier Gildberg
- Forensic Mental Health Research Unit Middelfart, Department of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Middelfart, Denmark
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK
| | - Ellen Boldrup Tingleff
- Forensic Mental Health Research Unit Middelfart, Department of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Middelfart, Denmark
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Oeltjen LK, Schulz M, Heuer I, Knigge G, Nixdorf R, Briel D, Hamer P, Brannath W, Utschakowski J, Mahlke C, Gerhardus A. Effectiveness of a peer-supported crisis intervention to reduce the proportion of compulsory admissions in acute psychiatric crisis interventions in an outreach and outpatient setting: study protocol for an exploratory cluster randomised trial combined with qualitative methods. BMJ Open 2024; 14:e083385. [PMID: 38816053 PMCID: PMC11138285 DOI: 10.1136/bmjopen-2023-083385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/09/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION Compulsory admissions are associated with feelings of fear, humiliation and powerlessness. The number of compulsory admissions in Germany and other high-income countries has increased in recent years. Peer support has been shown to increase the self-efficacy of individuals with mental health conditions in acute crises and to reduce the use of coercive measures in clinical settings. The objective of this study is to reduce the number of compulsory admissions by involving peer support workers (PSWs) in acute mental health crises in outreach and outpatient settings. METHODS AND ANALYSIS This one-year intervention is an exploratory, cluster randomised study. Trained PSWs will join the public crisis intervention services (CIS) in two of five regions (the intervention regions) in the city of Bremen (Germany). PSWs will participate in crisis interventions and aspects of the mental health services. They will be involved in developing and conducting an antistigma training for police officers. The remaining three regions will serve as control regions. All individuals aged 18 and older who experience an acute mental health crisis during the operating hours of the regional CIS in the city of Bremen (around 2000 in previous years) will be included in the study. Semistructured interviews will be conducted with PSWs, 30 patients from control and intervention regions, as well as two focus group discussions with CIS staff. A descriptive comparison between all participants in the intervention and control regions will assess the proportion of compulsory admissions in crisis interventions during the baseline and intervention years, including an analysis of temporal changes. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of the University of Bremen (file 2022-09) on 20 June 2022. The results will be presented via scientific conferences, scientific journals and communicated to policy-makers and practitioners. TRIAL REGISTRATION NUMBER DRKS00029377.
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Affiliation(s)
- Lena Katharina Oeltjen
- Department of Health Services Research, Institute of Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Maike Schulz
- Department of Psychiatry and Psychotherapy, Hospital Bremen-Ost, Gesundheit Nord Klinikverbund Bremen gGmbH (GENO), Bremen, Germany
| | - Imke Heuer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Georg Knigge
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rebecca Nixdorf
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Denis Briel
- Department of Psychiatry and Psychotherapy, Hospital Bremen-Ost, Gesundheit Nord Klinikverbund Bremen gGmbH (GENO), Bremen, Germany
| | | | - Werner Brannath
- Competence Center for Clinical Trials Bremen, University of Bremen, Bremen, Germany
| | - Jörg Utschakowski
- Department of Mental Health and Addiction, Ministry of Health, Women and Consumer Protection, Bremen, Germany
| | - Candelaria Mahlke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar Gerhardus
- Department of Health Services Research, Institute of Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bremen, Germany
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Olivares J, Tumilty E, Campo-Engelstein L, Cunningham KA. Confidence in Care Instead of Capacity: A Feminist Approach to Opioid Overdose. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:51-53. [PMID: 38635431 DOI: 10.1080/15265161.2024.2327278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Affiliation(s)
| | - Emma Tumilty
- The University of Texas Medical Branch at Galveston
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Aragonés-Calleja M, Sánchez-Martínez V. Evidence synthesis on coercion in mental health: An umbrella review. Int J Ment Health Nurs 2024; 33:259-280. [PMID: 37908175 DOI: 10.1111/inm.13248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 10/10/2023] [Accepted: 10/15/2023] [Indexed: 11/02/2023]
Abstract
Coercion in mental healthcare is ubiquitous and affects the physical health, recovery and psychological and emotional well-being of those who experience it. Numerous studies have explored different issues related to coercion, and the present umbrella review aims to gather, evaluate and synthesise the evidence found across systematic reviews. The protocol, registered in the International Prospective Register of Systematic Reviews (PROSPERO registration number: CRD42020196713), included 46 systematic reviews and meta-analyses of primary studies whose main theme was coercion and which were obtained from databases (Medline/PubMed, PsycINFO, EMBASE and CINAHL) and repositories of systematic reviews following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. All the reviews were subjected to independent assessment of quality and risk of bias and were grouped in two categories: (1) evidence on specific coercive measures (including Community Treatment Orders, forced treatment, involuntary admissions, seclusion and restriction and informal coercion), taking into account their prevalence, related factors, effectiveness, harmful effects and alternatives to reduce their use; and (2) experiences, perceptions and attitudes concerning coercion of professionals, mental health service users and their caregivers or relatives. This umbrella review can be useful to professionals and users in addressing the wide variety of aspects encompassed by coercion and the implications for professionals' daily clinical practice in mental health units. This research received funding from two competitive calls.
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Affiliation(s)
- Miriam Aragonés-Calleja
- Mental Health Department, Hospital Padre Jofre, Valencia, Spain
- Department of Nursing, Faculty of Nursing and Chiropody, University of Valencia, Valencia, Spain
| | - Vanessa Sánchez-Martínez
- Department of Nursing, Faculty of Nursing and Chiropody, University of Valencia, Valencia, Spain
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Zielinski-Gussen IM, Herpertz-Dahlmann B, Dahmen B. Involuntary Treatment for Child and Adolescent Anorexia Nervosa-A Narrative Review and Possible Advances to Move Away from Coercion. Healthcare (Basel) 2023; 11:3149. [PMID: 38132039 PMCID: PMC10742854 DOI: 10.3390/healthcare11243149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/01/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Children and adolescents with psychiatric disorders frequently experience hospital treatment as coercive. In particular, for patients with severe anorexia nervosa (AN), clinical and ethical challenges often arise if they do not voluntarily agree to hospital admission, often due to the ego-syntonic nature of the disorder. In these cases, involuntary treatment (IVT) might be life-saving. However, coercion can cause patients to experience excruciating feelings of pressure and guilt and might have long-term consequences. METHODS This narrative review aimed to summarize the current empirical findings regarding IVT for child and adolescent AN. Furthermore, it aimed to present alternative treatment programs to find a collaborative method of treatment for young AN patients and their families. RESULTS Empirical data on IVT show that even though no inferiority of IVT has been reported regarding treatment outcomes, involuntary hospital treatment takes longer, and IVT patients seem to struggle significantly more with weight restoration. We argue that more patient- and family-oriented treatment options, such as home treatment, might offer a promising approach to shorten or even avoid involuntary hospital admissions and further IVT. Different home treatment approaches, either aiming at preventing hospitalization or at shortening hospital stays, and the results of pilot studies are summarized in this article.
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Affiliation(s)
- Ingar M. Zielinski-Gussen
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital RWTH Aachen, 52074 Aachen, Germany
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Brekke E, Clausen H, Brodahl M, Landheim AS. Patients' experiences with coercive mental health treatment in Flexible Assertive Community Treatment: a qualitative study. BMC Psychiatry 2023; 23:764. [PMID: 37853402 PMCID: PMC10585822 DOI: 10.1186/s12888-023-05264-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/08/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Flexible Assertive Community Treatment (FACT) teams have been implemented in Norwegian health and social services over the last years, partly aiming to reduce coercive mental health treatment. We need knowledge about how service users experience coercion within the FACT context. The aim of this paper is to explore service user experiences of coercive mental health treatment in the context of FACT and other treatment contexts they have experienced. Are experiences of coercion different in FACT than in other treatment contexts? If this is the case, which elements of FACT lead to a different experience? METHOD Within a participatory approach, 24 qualitative interviews with service users in five different FACT teams were analyzed with thematic analysis. RESULTS Participants described negative experiences with formal and informal coercion. Three patterns of experiences with coercion in FACT were identified: FACT as clearly a change for the better, making the best of FACT, and finding that coercion is just as bad in FACT as it was before. Safety, improved quality of treatment, and increased participation were described as mechanisms that can prevent coercion. CONCLUSION Results from this study support the argument that coercion is at odds with human rights and therefore should be avoided as far as possible. Results suggest that elements of the FACT model may prevent the use of coercion by promoting safety, improved quality of treatment and increased participation.
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Affiliation(s)
- Eva Brekke
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Postbox 104, Brumunddal, 2381, Norway.
| | - Hanne Clausen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Postbox 104, Brumunddal, 2381, Norway
- Department of Research and Development, Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
| | - Morten Brodahl
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Postbox 104, Brumunddal, 2381, Norway
| | - Anne S Landheim
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Inland Hospital Trust, Postbox 104, Brumunddal, 2381, Norway
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Wullschleger A, Vandamme A, Mielau J, Heinz A, Bermpohl F, Mahler L, Montag C. Relationship between perceived coercion and perceived justification of coercive measures - secondary analysis of a randomized-controlled trial. BMC Psychiatry 2023; 23:712. [PMID: 37784077 PMCID: PMC10546675 DOI: 10.1186/s12888-023-05192-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Subjective perception of coercion has gained attention as an important outcome. However, little is known about its relation to patients' appraisal of the justification of coercive measures. The present study aims to analyze the relationship between patients' appraisal of the justification of coercive measures and their level of perceived coercion. METHODS This study presents a secondary analysis of the results of a multi-center RCT conducted to evaluate the effects of post-coercion review. Patients who experienced at least one coercive measure during their hospital stay were included in the trial. Participants' appraisal of the justification of coercive measures was categorized into patient-related and staff-related justifications. Subjective coercion was assessed using the Coercion Experience Scale (CES) and used as dependent variable in a multivariate regression model. RESULTS 97 participants who completed the CES were included in the analysis. CES scores were significantly associated with the perception of the coercive measure as justified by staff-related factors (B = 0,540, p < 0,001), as well as with higher level of negative symptoms (B = 0,265, p = 0,011), and with mechanical restraint compared to seclusion (B=-0,343, p = 0,017). CONCLUSIONS Patients' perceptions of coercive measures as justified by staff-related factors such as arbitrariness or incompetence of staff are related to higher levels of perceived coercion. Multiprofessional efforts must be made to restrict the use of coercive measures and to ensure a transparent and sustainable decision-making process, particularly with patients showing high levels of negative symptoms. Such key elements should be part of all coercion reduction programs.
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Affiliation(s)
- Alexandre Wullschleger
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany.
- Division of Adult Psychiatry, Department of Psychiatry, Geneva University Hospitals, Ch. Du Petit-Bel-Air 2, Thônex, 1226, Switzerland.
| | - Angelika Vandamme
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Juliane Mielau
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Lieselotte Mahler
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
- Department of Psychiatry, Clinics in the Theodor-Wenzel-Werk, Berlin, Germany
| | - Christiane Montag
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität Zu Berlin, Campus Charité Mitte, Berlin, Germany
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Silva B, Bachelard M, Bonsack C, Golay P, Morandi S. Exploring Patients' Feeling of Being Coerced During Psychiatric Hospital Admission: A Qualitative Study. Psychiatr Q 2023; 94:411-434. [PMID: 37452928 PMCID: PMC10460343 DOI: 10.1007/s11126-023-10039-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/18/2023]
Abstract
Various coercive measures can be used to legally compel a person suffering from psychiatric disorder to undergo treatment. However, evidence suggests that patients' feeling of being coerced is not determined solely by their being submitted to formal coercion. This study aimed to explore voluntary and involuntary patients' experience of coercion during psychiatric hospitalisation and to identify which factors, from their perspective, most affected it. We chose a qualitative design inspired by a hermeneutic-phenomenological approach. Participants were purposively selected from six psychiatric hospitals in Switzerland. Maximum variation sampling was used to ensure the inclusion of patients with different levels of perceived coercion and different admission statuses. In-depth, semi-structured interviews were co-conducted by a research psychologist and a service-user researcher. The transcribed data underwent thematic analysis. All twelve interviewed patients described the hospitalisation as an experience of loss of control over their life due to either external or internal pressures. During the process, perceptions of these pressures varied and sometimes overlapped, leading some patients to describe their admission as a form of simultaneous protection and violation. The balance between these two contradictory feelings was affected by a variety of contextual and relational factors, as well as by the meaningfulness of the experience and the patient's subsequent satisfaction with it. Increasing policy-makers' and clinicians' awareness about the main factors influencing patients' experience of loss of control is of paramount importance in order to develop skills and strategies able to address them, reinforcing patients' empowerment, reducing their feeling of coercion and improving their well-being.
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Affiliation(s)
- Benedetta Silva
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
- Cantonal Medical Office, General Directorate for Health, Canton of Vaud Department of Health and Social Action, Lausanne, Switzerland.
| | - Mizué Bachelard
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Charles Bonsack
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Philippe Golay
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- General Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of Psychology, Faculty of Social and Political Sciences, University of Lausanne, Lausanne, Switzerland
| | - Stéphane Morandi
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Cantonal Medical Office, General Directorate for Health, Canton of Vaud Department of Health and Social Action, Lausanne, Switzerland
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Martinelli L, Siegrist-Dreier S, Schlup N, Hahn S. ["If certain tensions are present, it affects everyone": Multiple case study on processes of coercive measures.]. Pflege 2023; 36:319-325. [PMID: 37594227 DOI: 10.1024/1012-5302/a000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
"If certain tensions are present, it affects everyone": Multiple case study on processes of coercive measures. Abstract: Background: There is an urgent need to reduce coercive measures in psychiatric care. The interaction between patients, nursing staff and medical professionals influences the course of a coercive measure. Aim: The interaction before, during and after coercive measures will be described and compared from the perspectives of the parties involved in order to identify a potential for prevention and quality improvement. Methods: A multiple case study of three coercive measures was conducted, each consisting of interviews with three participants, case documentation, photos, and observation. The data material was analysed thematically with subsequent single-case and cross-case analysis. Results: The thematic analysis revealed three areas of tension: tension and relaxation, humaneness and dehumanisation, as well as safety and autonomy. The stage before coercion was characterised by interacting tensions and the influence of emotions and stress. In all cases, a verbal communication gap was present. During the coercive measure, the quality of interactions between patients and nurses determined their experience. After coercion, the impacts of the measure on the persons and their relationships as well as reflections were the focus. Conclusions: De-escalation techniques turn out to be a key issue, whereby special attention should be paid to emotional and nonverbal aspects in the future. The results underline the relevance of empathy and respect throughout the process for prevention as well as for quality of care. Debriefings of coercive measures should be conducted routinely.
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Affiliation(s)
| | | | - Nanja Schlup
- Universitäre Psychiatrische Dienste Bern, Schweiz
| | - Sabine Hahn
- Angewandte Forschung & Entwicklung Pflege, Berner Fachhochschule, Schweiz
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Berring LL, Georgaca E. A Call for Transformation: Moving Away from Coercive Measures in Mental Health Care. Healthcare (Basel) 2023; 11:2315. [PMID: 37628513 PMCID: PMC10454462 DOI: 10.3390/healthcare11162315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Coercion is common practice in mental health care [...].
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Affiliation(s)
- Lene Lauge Berring
- Psychiatric Research Unit, Psychiatry Region Zealand, 4200 Slagelse, Denmark
- Department of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark
| | - Eugenie Georgaca
- School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
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Lacambre M, Péchillon É, Fovet T. [Isolation and mechanical restraint in psychiatry]. REVUE DE L'INFIRMIERE 2023; 72:16-19. [PMID: 37364969 DOI: 10.1016/j.revinf.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Since 2016, there has been a succession of legal texts aimed at framing the use of seclusion and mechanical restraint in psychiatric services. These legal evolutions are not without consequence on the practice of caregivers. We propose here a practical summary of this issue.
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Affiliation(s)
- Mathieu Lacambre
- Unité de soins intensifs de psychiatrie, Filière de psychiatrie légale, CHU Montpellier, 191 avenue du Doyen-Gaston-Giraud, 34295 Montpellier, cedex 5, France; Section psychiatrie légale, Association française de psychiatrie biologique et de neuropsychopharmacologie (AFPBN), Centre hospitalier Sainte-Anne, 1 rue Cabanis, 75674 Paris, France.
| | - Éric Péchillon
- Faculté DSEG de Vannes, Lab-LEX/UR 7480, Université Bretagne Sud, rue André-Lwoff, 56000 Vannes, France
| | - Thomas Fovet
- Section psychiatrie légale, Association française de psychiatrie biologique et de neuropsychopharmacologie (AFPBN), Centre hospitalier Sainte-Anne, 1 rue Cabanis, 75674 Paris, France; University Lille, Inserm, CHU Lille, U1172-Lille Neuroscience & Cognition, 59000 Lille, France
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Chong Y, Wang C, Zhi T, Fang S, Min H, Zhang L, Wu X, Wang Y. Psychiatric Nurses' Knowledge, Attitudes, and Practice Regarding Physical Restraint in China: A Multicentre Cross-Sectional Study. J Multidiscip Healthc 2023; 16:1475-1489. [PMID: 37274425 PMCID: PMC10237330 DOI: 10.2147/jmdh.s412485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/19/2023] [Indexed: 06/06/2023] Open
Abstract
Background Physical restraint is widely used in mental health services to address safety concerns. However, studies have shown that improper physical restraint can result in adverse effects. Nurses are the main practitioners of physical restraint and play a crucial role in physical restraint decisions and nursing. In China, there is a lack of large-scale investigations into the current status of psychiatric physical restraint use. Aim This study aims to explore the situation and influencing factors of the psychiatric nurses' knowledge, attitudes and practices regarding physical restraint in China. Methods A cross-sectional multicenter descriptive study was conducted from December 2022 to February 2023, consecutively. A convenience sampling method was used to recruit 345 staff from three psychiatric hospitals in Shanghai. A psychiatric nurses' physical restraint use status questionnaire was administered to examine their knowledge, attitude, and practice regarding physical restraint. The data were analyzed using the Mann-Whitney U-test and the Kruskal-Wallis test. Multivariate linear stepwise regression analysis was used for multi-factor analysis. Results Overall, nurses had a good level of knowledge with positive attitudes and adequate practices. However, they had some misunderstandings and undesirable practices. Multiple linear regression analysis revealed that educational background, position and training experience were the main factors influencing physical restraint knowledge, attitudes and practice among psychiatric nurses (p<0.05). Conclusion This study highlights some important misconceptions and improper practices of psychiatric nurses about using physical restraint. It is necessary to strengthen education and training on physical restraint for nursing staff to reduce unnecessary physical restraint use.
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Affiliation(s)
- Yue Chong
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Can Wang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Tingting Zhi
- Shanghai Psychological Consultation Center, Shanghai Baoshan Mental Health Center, Shanghai, 201900, People’s Republic of China
| | - Shihan Fang
- Affiliated Mental Health Center, Zhejiang University School of Medicine, Hangzhou Seventh People’s Hospital, Hangzhou, 310005, People’s Republic of China
| | - Haiying Min
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Lei Zhang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Xiaoning Wu
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
| | - Yanbo Wang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China
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Venturini P, Bassi G, Salcuni S, Kotzalidis GD, Telesforo CL, Salustri E, Trevisi M, Roselli V, Tarsitani L, Infante V, Niolu C, Polselli G, Boldrini T. Psychometric properties of the Italian version of the staff attitude to coercion scale: an exploratory factor analysis. Front Psychiatry 2023; 14:1172803. [PMID: 37293405 PMCID: PMC10244557 DOI: 10.3389/fpsyt.2023.1172803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/09/2023] [Indexed: 06/10/2023] Open
Abstract
Aims The current study aimed to validate the Italian version of the Staff Attitude to Coercion Scale (SACS), which assesses mental health care staff's attitudes to the use of coercion in treatment. Methods The original English version of the SACS was translated into Italian, according to the back-translation procedure. Subsequently, it was empirically validated by performing an exploratory factor analysis on a sample of 217 mental health professionals (Mean = 43.40 years, SD = 11.06) recruited form Italian general hospital (acute) psychiatric wards (GHPWs), with at least 1 year of work experience (i.e., inclusion criteria). Results Results confirmed the three-factor solution of the original version for the Italian version of the SACS, though three items loaded on different factors, compared to the original. The three extracted factors, explained 41% of total variance, and were labeled similarly to the original scale and according to their respective item content, i.e., Factor 1 "Coercion as offending" (items: 3, 13, 14, and 15), Factor 2 "Coercion as care and security" (items: 1, 2, 4, 5, 7, 8, and 9), and Factor 3 "Coercion as treatment" (items: 6, 10, 11, and 12). The internal consistency of the three-factor model of the Italian version of the SACS was assessed through Cronbach's α and yielded acceptable indexes, ranging from 0.64 to 0.77. Conclusion The present findings suggest that the Italian version of the SACS is a valid and reliable tool that can be used to assess healthcare professionals' attitudes toward coercion.
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Affiliation(s)
| | - Giulia Bassi
- Department of Developmental Psychology and Socialization, University of Padova, Padua, Italy
| | - Silvia Salcuni
- Department of Developmental Psychology and Socialization, University of Padova, Padua, Italy
| | - Georgios D. Kotzalidis
- Department of NESMOS, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’Andrea University Hospital, Rome, Italy
| | | | | | | | - Valentina Roselli
- Department of Human Neurosciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Lorenzo Tarsitani
- Department of Human Neurosciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
| | - Vittorio Infante
- U.O.C. Psichiatria e Psicologia Clinica, Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | - Cinzia Niolu
- U.O.C. Psichiatria e Psicologia Clinica, Policlinico Tor Vergata, Università di Roma Tor Vergata, Rome, Italy
| | | | - Tommaso Boldrini
- Department of Developmental Psychology and Socialization, University of Padova, Padua, Italy
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Donald BM, Bulik CM, Larsen JT, Carlsen AH, Clausen L, Petersen LV. Involuntary treatment in patients with anorexia nervosa: utilization patterns and associated factors. Psychol Med 2023; 53:1999-2007. [PMID: 37310331 PMCID: PMC10811565 DOI: 10.1017/s003329172100372x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND A subgroup of patients with anorexia nervosa (AN) undergoing involuntary treatment (IT) seems to account for most of the IT events. Little is known about these patients and their treatment including the temporal distribution of IT events and factors associated with subsequent utilization of IT. Hence, this study explores (1) utilization patterns of IT events, and (2) factors associated with subsequent utilization of IT in patients with AN. METHODS In this nationwide Danish register-based retrospective exploratory cohort study patients were identified from their first (index) hospital admission with an AN diagnosis and followed up for 5 years. We explored data on IT events including estimated yearly and total 5-year rates, and factors associated with subsequent increased IT rates and restraint, using regression analyses and descriptive statistics. RESULTS IT utilization peaked in the initial few years starting at or following the index admission. A small percentage (1.0%) of patients accounted for 67% of all IT events. The most frequent measures reported were mechanical and physical restraint. Factors associated with subsequent increased IT utilization were female sex, lower age, previous admissions with psychiatric disorders before index admission, and IT related to those admissions. Factors associated with subsequent restraint were lower age, previous admissions with psychiatric disorders, and IT related to these. CONCLUSIONS High IT utilization in a small percentage of individuals with AN is concerning and can lead to adverse treatment experiences. Exploring alternative approaches to treatment that reduce the need for IT is an important focus for future research.
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Affiliation(s)
- Benjamin Mac Donald
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Janne T. Larsen
- The National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Anders H. Carlsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Loa Clausen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Liselotte V. Petersen
- The National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-based Research (CIRRAU), Aarhus University, Aarhus, Denmark
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15
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Mac Donald B, Gustafsson SA, Bulik CM, Clausen L. Living and leaving a life of coercion: a qualitative interview study of patients with anorexia nervosa and multiple involuntary treatment events. J Eat Disord 2023; 11:40. [PMID: 36915181 PMCID: PMC10010243 DOI: 10.1186/s40337-023-00765-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/02/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND A small but significant group of patients with anorexia nervosa (AN) undergo multiple involuntary treatment (IT) events. To enhance our understanding of IT and potentially inform treatment, we explored experiences and perspectives on IT of these patients. METHODS We designed a qualitative semi-structured interview study and used reflexive thematic analysis. Participants were at least 18 years of age, had multiple past IT events (≥ 5) related to AN over a period of at least one month of which the last IT event happened within the preceding five years. Participants had no current IT, intellectual disability, acute psychosis, or severe developmental disorder. We adopted an inductive approach and constructed meaning-based themes. RESULTS We interviewed seven participants. The data portrayed a process of living and leaving a life of coercion with a timeline covering three broad themes: living with internal coercion, coercive treatment, and leaving coercion; and five subthemes: helping an internal battle, augmenting suffering, feeling trapped, a lasting imprint, and changing perspectives. We highlighted that patients with AN and multiple IT events usually experienced internal coercion from the AN prior to external coercion from the health care system. IT evoked significant negative affect when experienced, and often left an adverse imprint. Moreover, IT could help an internal battle against AN and perspectives on IT could change over time. CONCLUSIONS Our study suggests that feeling internally coerced by AN itself sets the stage for IT. Clinicians should be conscious of the potential iatrogenic effects of IT, and reserve IT for potentially life-threatening situations.
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Affiliation(s)
- Benjamin Mac Donald
- Department of Clinical Medicine, Aarhus University, Palle Juul Jensens-Boulevard 99, 8200, Aarhus, Denmark. .,Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 175, Entrance K, 8200, Aarhus, Denmark.
| | - Sanna A Gustafsson
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Loa Clausen
- Department of Clinical Medicine, Aarhus University, Palle Juul Jensens-Boulevard 99, 8200, Aarhus, Denmark.,Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 175, Entrance K, 8200, Aarhus, Denmark
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16
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Villena-Jimena A, Morales-Asencio JM, Quemada C, Hurtado MM. "It's That They Treated Me Like an Object": A Qualitative Study on the Participation of People Diagnosed with Psychotic Disorders in Their Health Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4614. [PMID: 36901624 PMCID: PMC10002244 DOI: 10.3390/ijerph20054614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/18/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Abstract
The mental health recovery model is based on shared decision making, in which patients' preferences and perceptions of the care received are taken into account. However, persons with psychosis usually have very few opportunities to participate in this process. The present study explores the experiences and perceptions of a group of patients with psychosis-in some cases longstanding, in others more recently diagnosed-concerning their participation in the decisions taken about the approach to their condition and about the attention received from healthcare professionals and services. For this purpose, we performed a qualitative analysis of the outcomes derived from five focus groups and six in-depth interviews (36 participants). Two major themes, with five sub-themes, were identified: shared decision-making (drug-centred approach, negotiation process, and lack of information) and the care environment and styles of clinical practice as determinants (aggressive versus person-centred environments, and styles of professional practice). The main conclusions drawn are that users want to participate more in decision making, they want to be offered a range of psychosocial options from the outset and that their treatment should be based on accessibility, humanity and respect. These findings are in line with the guidelines for clinical practice and should be taken into account in the design of care programmes and the organisation of services for persons with psychosis.
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Affiliation(s)
- Amelia Villena-Jimena
- Mental Health Unit, Regional University Hospital, 29009 Málaga, Spain
- Faculty of Heath Sciences, University of Málaga, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Málaga, Spain
| | - José Miguel Morales-Asencio
- Faculty of Heath Sciences, University of Málaga, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Málaga, Spain
| | - Casta Quemada
- Mental Health Unit, Regional University Hospital, 29009 Málaga, Spain
- Faculty of Heath Sciences, University of Málaga, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Málaga, Spain
| | - María M. Hurtado
- Mental Health Unit, Regional University Hospital, 29009 Málaga, Spain
- Faculty of Heath Sciences, University of Málaga, 29071 Málaga, Spain
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, 29590 Málaga, Spain
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17
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Feeling coerced during voluntary and involuntary psychiatric hospitalisation: A review and meta-aggregation of qualitative studies. Heliyon 2023; 9:e13420. [PMID: 36820044 PMCID: PMC9937983 DOI: 10.1016/j.heliyon.2023.e13420] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/19/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Objective This review aimed to provide an aggregative synthesis of the qualitative evidence on patients' experienced coercion during voluntary and involuntary psychiatric hospitalisation. Design A qualitative review. Data sources The search was conducted, in five bibliographic databases: Embase.com, Ovid MEDLINE(R) ALL, APA PsycINFO Ovid, Web of Science Core Collection and the Cochrane Database of Systematic Reviews. Review methods Following the Joanna Briggs Institute approach, a systematized procedure was applied throughout the review process, from data search to synthesis of results. The reporting of this review was guided by the standards of the PRISMA 2020 statement. The quality of the included studies was critically appraised by two independent reviewers using the JBI Critical Appraisal Checklist. Included findings were synthesized using meta-aggregation. Confidence in the review findings was assessed following the Confidence in the Output of Qualitative research synthesis (ConQual) approach. Results A total of 423 studies were identified through the literature search and 26 were included in the meta-aggregation. Totally, 151 findings were extracted and aggregated into 27 categories and 7 synthesized findings. The synthesized findings focused on: the patients' experience of the hospitalisation and the associated feeling of coercion; the factors affecting this feeling, such as the involvement in the decision-making process, the relationships with the staff and the perception of the hospital treatment as effective and safe; the coping strategies adopted to deal with it and the patients' suggestions for alternatives. All synthesized findings reached an overall confidence score of "moderate". The seven findings were downgraded one level due to dependability limitations of the included studies. Conclusion Based on these findings, seven recommendations for clinical practice where developed, such as fostering care ethics, promoting patients' voice and shared decision-making, and enhancing patients' perceived closeness, respect and fairness. Five recommendations for future research were also prompted, for instance improving the methodological quality and cultural variation of future qualitative studies, and exploring the psychosocial impact of experienced coercion on patients. For these recommendations to be effectively implemented, a profound change in the structure and culture of the mental health system should be promoted. The involvement of patients in the design, development and scientific evaluation of this change is strongly recommended.
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18
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Haig S, Hallett N. Use of sensory rooms in adult psychiatric inpatient settings: A systematic review and narrative synthesis. Int J Ment Health Nurs 2023; 32:54-75. [PMID: 36082841 DOI: 10.1111/inm.13065] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 01/14/2023]
Abstract
Reducing the use of restrictive interventions within psychiatric inpatient settings is a global priority. There are many strategies which may support the prevention of violence before escalation into more severe incidences. Sensory rooms have been identified as one such intervention, aiding patients to emotionally regulate and reduce distress, with a growing body of academic literature interested in whether sensory rooms can ultimately impact incidences of patient violence and the use of restraint, seclusion, and other restrictive practices. A systematic literature review was conducted to identify how effective sensory rooms are at reducing patient violence and restrictive interventions within adult psychiatric inpatient settings. Eighteen studies met the eligibility criteria and were included in the review. There is a lack of evidence as to whether sensory rooms are effective at reducing seclusion, restraint, or violence. They are, however, likely to support a reduction in patient distress. Patient and staff experiences suggest sensory rooms support emotional regulation, promote self-management, and positively impact the overall patient admission experience and ward environment. Further research is needed to identify what works, for who and in what circumstances in relation to the design of sensory rooms.
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Affiliation(s)
| | - Nutmeg Hallett
- School of Nursing, University of Birmingham, Birmingham, UK
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19
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Smith GM, Altenor A, Altenor RJ, Davis RH, Steinmetz W, Adair DK, Ashbridge DM, Deegan J, Clement K, Hepner M, Markley DB, Smith EW. Effects of Ending the Use of Seclusion and Mechanical Restraint in the Pennsylvania State Hospital System, 2011-2020. Psychiatr Serv 2023; 74:173-181. [PMID: 35855620 DOI: 10.1176/appi.ps.202200004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The Pennsylvania State Hospital System's use of containment procedures has been studied for >30 years. This prospective study assessed the effects of ending the use of seclusion and mechanical restraint in the system's six civil hospitals and two forensic centers from 2011 to 2020. The study examined the effect of this change on key safety measures: physical restraint, assaults, aggression, and self-injurious behavior. In total, 68,153 incidents, including 9,518 episodes of physical restraint involving 1,811 individuals, were entered into a database along with patients' demographic and diagnostic information. All data were calculated per 1,000 days to control for census changes. During the study, mechanical restraint was used 128 times and seclusion four times. Physical restraint use decreased from a high of 2.62 uses per 1,000 days in 2013 to 2.02 in 2020. The average length of time a person was held in physical restraint was reduced by 64%, from 6.6 minutes in 2011 to 2.4 minutes in 2020 (p<0.001). All safety measures improved or were unchanged. Use of unscheduled medication did not change. The hospital system safely ended the use of mechanical restraint and seclusion by using a recovery approach and by following the six core strategies for seclusion and restraint reduction.
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Affiliation(s)
- Gregory M Smith
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
| | - Aidan Altenor
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
| | - Roberta J Altenor
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
| | - Robert H Davis
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
| | - William Steinmetz
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
| | - Dale K Adair
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
| | - Donna M Ashbridge
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
| | - John Deegan
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
| | - Kristen Clement
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
| | - Marcia Hepner
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
| | - David B Markley
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
| | - Elizabeth W Smith
- Allentown State Hospital, Allentown, Pennsylvania (G. M. Smith, Steinmetz); Wernersville State Hospital, Wernersville, Pennsylvania (A. Altenor, R. J. Altenor, Deegan); Pennsylvania Office of Mental Health and Substance Abuse Services, Harrisburg (Davis, Adair); Danville State Hospital, Danville, Pennsylvania (Ashbridge); Norristown State Hospital, Norristown, Pennsylvania (Clement); Torrance State Hospital, Torrance, Pennsylvania (Hepner); Warren State Hospital, Warren, Pennsylvania (Markley); Department of Education, Wilkes University, Wilkes-Barre, Pennsylvania (E. W. Smith)
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20
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Berg J, Lipponen E, Sailas E, Soininen P, Varpula J, Välimäki M, Lahti M. Nurses' perceptions of nurse-patient communication in seclusion rooms in psychiatric inpatient care: A focus group study. J Psychiatr Ment Health Nurs 2023. [PMID: 36718606 DOI: 10.1111/jpm.12907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 12/16/2022] [Accepted: 01/18/2023] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Communication between nurses and patients is essential in mental health nursing. In coercive situations (e.g. seclusion), the importance of nurse-patient communication is highlighted. However, research related to nurses' perceptions of nurse-patient communication during seclusion is scant. AIM The aim of this study was to describe nurses' perceptions of nurse-patient communication during patient seclusion and the ways nurse-patient communication can be improved. METHOD A qualitative study design using focus group interviews was adopted. Thirty-two nurses working in psychiatric wards were recruited to participate. The data were analysed using inductive qualitative content analysis. RESULTS Nurses aimed to communicate in a patient-centred way in seclusion events, and various issues affected the quality of communication. Nurses recognized several ways to improve communication during seclusion. DISCUSSION Treating patients in seclusion rooms presents highly demanding care situations for nurses. Seclusion events require nurses to have good communication skills to provide ethically sound care. CONCLUSION Improved nurse-patient communication may contribute to shorter seclusion times and a higher quality of care. Improving nurses' communication skills may help support the dignity of the secluded patients. Safewards practices, such as respectful communication and recognizing the effect of non-verbal behaviour, could be considered when developing nurse-patient communication in seclusion events. RELEVANCE STATEMENT This study deepens the understanding of nurse-patient communication during seclusion events from the perspective of nurses. Caring for patients in seclusion presents challenging situations for nurses and demands that they have good communication skills. To enhance their communication skills in seclusion events, nurses require opportunities to take part in further training after education related to communication skills for demanding care situations. Knowing the appropriate ways to interact with individual patients during seclusion can help nurses create and maintain communication with patients. For mental health nursing, nurses' enhanced communication may promote increased use of noncoercive practices in psychiatric settings. For patients, improving nurses' communication skills may help support dignity and autonomy during seclusion and shorten the time spent in seclusion, resulting in a better quality of care and more positive patient experiences related to care offered in seclusion. In this, the perspectives of people with lived experience of mental health problems should be acknowledged. Components of Safewards practices, such as using respectful and individual communication and paying attention to one's non-verbal communication (Soft Words), could be useful when developing nurse-patient communication in seclusion events.
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Affiliation(s)
- Johanna Berg
- Turku University of Applied Sciences, Turku, Finland
| | | | - Eila Sailas
- Helsinki University Hospital, Kellokoski Hospital, Kellokoski, Finland
| | - Päivi Soininen
- Helsinki University Hospital, Kellokoski Hospital, Kellokoski, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
| | - Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,Xiangya Nursing School, Central South University, Changsha, China
| | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, University of Turku, Turku, Finland
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21
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Tsiandoulas K, McSheffrey G, Fleming L, Rawal V, Fadel MP, Katzman DK, McCradden MD. Ethical tensions in the treatment of youth with severe anorexia nervosa. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:69-76. [PMID: 36206789 DOI: 10.1016/s2352-4642(22)00236-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 12/23/2022]
Abstract
Treatment of anorexia nervosa poses a moral quandary for clinicians, particularly in paediatrics. The challenges of appropriately individualising treatment while balancing prospective benefits against concomitant harms are best highlighted through exploration and discussion of the ethical issues. The purpose of this Viewpoint is to explore the ethical tensions in treating young patients (around ages 10-18 years) with severe anorexia nervosa who are not capable of making treatment-based decisions and describe how harm reduction can reasonably be applied. We propose the term AN-PLUS to refer to the subset of patients with a particularly concerning clinical presentation-poor quality of life, lack of treatment response, medically severe and unstable, and severe symptomatology-who might benefit from a harm reduction approach. From ethics literature, qualitative studies, and our clinical experience, we identify three core ethical themes in making treatment decisions for young people with AN-PLUS: capacity and autonomy, best interests, and person-centred care. Finally, we consider how a harm reduction approach can provide direction for developing a personalised treatment plan that retains a focus on best interests while attempting to mitigate the harms of involuntary treatment. We conclude with recommendations to operationalise a harm reduction approach in young people with AN-PLUS.
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Affiliation(s)
- Kate Tsiandoulas
- Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada; Health Science Research Program, University of Toronto, Toronto, ON, Canada
| | - Gordon McSheffrey
- Department of Pediatrics, Scarborough Health Network, Toronto, ON, Canada; Child, Youth, Family Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Lindsay Fleming
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Vandana Rawal
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Marc P Fadel
- Department of Psychiatry, The Hospital for Sick Children, Toronto, ON, Canada; Division of Child and Youth Mental Health, Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Debra K Katzman
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada; The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Melissa D McCradden
- Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Genetics & Genome Biology, Peter Gilgan Centre for Research & Learning, Toronto, ON, Canada.
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22
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Badouin J, Bechdolf A, Bermpohl F, Baumgardt J, Weinmann S. Preventing, reducing, and attenuating restraint: A prospective controlled trial of the implementation of peer support in acute psychiatry. Front Psychiatry 2023; 14:1089484. [PMID: 36824670 PMCID: PMC9941159 DOI: 10.3389/fpsyt.2023.1089484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/20/2023] [Indexed: 02/10/2023] Open
Abstract
INTRODUCTION The use of restraint as a means of managing patients is considered a critical factor that interferes with recovery. Strategies to create a less restrictive environment within psychiatric facilities are therefore eagerly sought. Peer support workers (PSWs) are increasingly employed in mental health settings. The prevailing theory is that PSWs have the potential to contribute to conflict and restraint prevention efforts in acute psychiatric wards. However, to date, research in support of this claim remains limited. OBJECTIVE The present study aimed at assessing the effectiveness of employing peer support workers with regard to reducing the use of restraint. METHODS This prospective controlled pre-post study sought to evaluate the implementation of peer support in one locked ward compared to treatment as usual (TAU) with no implementation of peer support in a second locked ward of a psychiatry department in Berlin, Germany. The pre-post comparison was planned to consist of two assessment periods of 3 months each, taking place directly before and after peer support implementation or TAU. Both assessments were extended to a period of 6 months, before and after the initially planned 12-month implementation process, in order to balance the effects of disruptions and of the COVID-19 pandemic. Using routine data, the proportion, frequency, and duration of mechanical restraint, forced medication as well as mechanical restraint in combination with forced medication, were evaluated. RESULTS In the control group, an increase in the proportion of patients subjected to measures of restraint was found between pre- and post-assessment, which was accompanied by a further increase in the mean number of events of restraint per patient within this group. In the intervention group, no significant change in the application of restraint was observed during the study period. DISCUSSION There is some indication that peer support may be protective with regard to restraint in acute wards. However, our study faced major challenges during the implementation process and the post-assessment period, such as COVID-19 and staff reorganization. This may have led to peer support not reaching its full potential. The relationship between the implementation of peer support and the use of restraint therefore merits further investigation.
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Affiliation(s)
- Julia Badouin
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban, Vivantes Hospital im Friedrichshain, Academic Hospital, Charité-University Medicine Berlin, Berlin, Germany.,Department of Psychiatry and Neuroscience, Charité Campus Mitte Charité-University Medicine Berlin, Berlin, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban, Vivantes Hospital im Friedrichshain, Academic Hospital, Charité-University Medicine Berlin, Berlin, Germany.,ORYGEN, National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Felix Bermpohl
- Department of Psychiatry and Neuroscience, Charité Campus Mitte Charité-University Medicine Berlin, Berlin, Germany
| | - Johanna Baumgardt
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban, Vivantes Hospital im Friedrichshain, Academic Hospital, Charité-University Medicine Berlin, Berlin, Germany.,Wissenschaftliches Institut der AOK (WIdO), Berlin, Germany
| | - Stefan Weinmann
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban, Vivantes Hospital im Friedrichshain, Academic Hospital, Charité-University Medicine Berlin, Berlin, Germany.,Psychiatric Hospital, Theodor-Wenzel-Werk, Berlin, Germany.,University Psychiatric Clinic (UPK), University Basel, Basel, Switzerland
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23
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Valtis YK, Stevenson KE, Murphy EM, Hong JY, Ali M, Shah S, Taylor A, Sivashanker K, Shannon EM. Race and Ethnicity and the Utilization of Security Responses in a Hospital Setting. J Gen Intern Med 2023; 38:30-35. [PMID: 35556213 PMCID: PMC9849525 DOI: 10.1007/s11606-022-07525-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/28/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Security emergency responses (SERs) are utilized by hospitals to ensure the safety of patients and staff but can cause unintended morbidity. The presence of racial and ethnic inequities in SER utilization has not been clearly elucidated. OBJECTIVE To determine whether Black and Hispanic patients experience higher rates of SER and physical restraints in a non-psychiatric inpatient setting. DESIGN Retrospective cohort study. PARTICIPANTS All patients discharged from September 2018 through December 2019. EXPOSURE Race and ethnicity, as reported by patients at time of registration. MAIN OUTCOMES The primary outcome was whether a SER was called on a patient. The secondary outcome was the incidence of physical restraints among patients who experienced a SER. KEY RESULTS Among 24,212 patients, 18,755 (77.5%) patients identified as white, 2,346 (9.7%) as Black, and 2,425 (10.0%) identified with another race. Among all patients, 1,827 (7.6%) identified as Hispanic and 21,554 (89.0%) as non-Hispanic. Sixty-six (2.8%) Black patients had a SER activated during their first admission, compared to 295 (1.6%) white patients. In a Firth logit multivariable model, Black patients had higher adjusted odds of a SER than white patients (adjusted odds ratio (aOR) 1.37 [95% confidence interval: 1.02, 1.81], p = 0.037). Hispanic patients did not have higher odds of having a SER called than non-Hispanic patients. In a Poisson multivariable model among patients who had a SER called, race and ethnicity were not found to be significant predictors of restraint. CONCLUSION Black patients had higher odds of a SER compared to white patients. No significant differences were found between Hispanic and non-Hispanic patients. Future efforts should focus on assessing the generalizability of these findings, the underlying mechanisms driving these inequities, and effective interventions to address them.
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Affiliation(s)
- Yannis K Valtis
- Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
| | | | - Emily M Murphy
- Division of Hospital Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer Y Hong
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Mohsin Ali
- Division of Infectious Diseases, Department of Paediatrics, Hospital for Sick Children, Toronto, Canada
| | - Sejal Shah
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Adrienne Taylor
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Karthik Sivashanker
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
- American Medical Association, Chicago, IL, USA
| | - Evan M Shannon
- Division of General Internal Medicine and Health Services Research, University of California Los Angeles, Los Angeles, CA, USA
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Mac Donald B, Bulik CM, Petersen LV, Clausen L. Influence of eating disorder psychopathology and general psychopathology on the risk of involuntary treatment in anorexia nervosa. Eat Weight Disord 2022; 27:3157-3172. [PMID: 35864298 PMCID: PMC9805523 DOI: 10.1007/s40519-022-01446-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/03/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE We explored associations between clinical factors, including eating disorder psychopathology and more general psychopathology, and involuntary treatment in patients with anorexia nervosa. Our intention was to inform identification of patients at risk of involuntary treatment. METHODS This was a retrospective cohort study combining clinical data from a specialized eating disorder hospital unit in Denmark with nationwide Danish register-based data. A sequential methodology yielding two samples (212 and 278 patients, respectively) was adopted. Descriptive statistics and regression analyses were used to explore associations between involuntary treatment and clinical factors including previous involuntary treatment, patient cooperation, and symptom-level psychopathology (Eating Disorder Inventory-2 (EDI-2) and Symptom Checklist-90-Revised (SCL-90-R)). RESULTS Somatization (SCL-90-R) (OR = 2.60, 95% CI 1.16-5.81) and phobic anxiety (SCL-90-R) (OR = 0.43, 95% CI 0.19-0.97) were positively and negatively, respectively, associated with the likelihood of involuntary treatment. Furthermore, somatization (HR = 1.77, 95% CI 1.05-2.99), previous involuntary treatment (HR = 5.0, 95% CI 2.68-9.32), and neutral (HR = 2.92, 95% CI 1.20-7.13) or poor (HR = 3.97, 95% CI 1.49-10.59) patient cooperation were associated with decreased time to involuntary treatment. Eating disorder psychopathology measured by the EDI-2 was not significantly associated with involuntary treatment. CONCLUSIONS Clinical questionnaires of psychopathology appear to capture specific domains relevant to involuntary treatment. Poor patient cooperation and previous involuntary treatment being associated with shorter time to involuntary treatment raise important clinical issues requiring attention. Novel approaches to acute anorexia nervosa care along with unbiased evaluation upon readmission could mitigate the cycle of repeat admissions with involuntary treatment. LEVEL OF EVIDENCE Level III, cohort study.
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Affiliation(s)
- Benjamin Mac Donald
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark.
| | - Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Liselotte V Petersen
- The National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
- Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-Based Research (CIRRAU), Aarhus University, Aarhus, Denmark
| | - Loa Clausen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
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25
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Pedersen ML, Gildberg F, Baker J, Damsgaard JB, Tingleff EB. Ethnic disparities in the use of restrictive practices in adult mental health inpatient settings: a scoping review. Soc Psychiatry Psychiatr Epidemiol 2022; 58:505-522. [PMID: 36454269 PMCID: PMC9713127 DOI: 10.1007/s00127-022-02387-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE To identify and summarise extant knowledge about patient ethnicity and the use of various types of restrictive practices in adult mental health inpatient settings. METHODS A scoping review methodological framework recommended by the JBI was used. A systematic search was conducted in APA PsycINFO, CINAHL with Full Text, Embase, PubMed and Scopus. Additionally, grey literature searches were conducted in Google, OpenGrey and selected websites, and the reference lists of included studies were explored. RESULTS Altogether, 38 studies were included: 34 were primary studies; 4, reviews. The geographical settings were as follows: Europe (n = 26), Western Pacific (n = 8), Americas (n = 3) and South-East Asia (n = 1). In primary studies, ethnicity was reported according to migrant/national status (n = 16), mixed categories (n = 12), indigenous vs. non-indigenous (n = 5), region of origin (n = 1), sub-categories of indigenous people (n = 1) and religion (n = 1). In reviews, ethnicity was not comparable. The categories of restrictive practices included seclusion, which was widely reported across the studies (n = 20), multiple restrictive practices studied concurrently (n = 17), mechanical restraint (n = 8), rapid tranquillisation (n = 7) and manual restraint (n = 1). CONCLUSIONS Ethnic disparities in restrictive practice use in adult mental health inpatient settings has received some scholarly attention. Evidence suggests that certain ethnic minorities were more likely to experience restrictive practices than other groups. However, extant research was characterised by a lack of consensus and continuity. Furthermore, widely different definitions of ethnicity and restrictive practices were used, which hampers researchers' and clinicians' understanding of the issue. Further research in this field may improve mental health practice.
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Affiliation(s)
- Martin Locht Pedersen
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark. .,Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Østre Hougvej 70, 5500, Middelfart, Denmark. .,Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Østre Hougvej 70, 5500, Middelfart, Denmark.
| | - Frederik Gildberg
- grid.10825.3e0000 0001 0728 0170Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark ,grid.425874.80000 0004 0639 1911Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark
| | - John Baker
- grid.9909.90000 0004 1936 8403School of Healthcare, University of Leeds, Baines Wing, Woodhouse Lane, Leeds, LS2 9JT UK
| | - Janne Brammer Damsgaard
- grid.7048.b0000 0001 1956 2722Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Ellen Boldrup Tingleff
- grid.10825.3e0000 0001 0728 0170Forensic Mental Health Research Unit Middelfart (RFM), Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark ,grid.425874.80000 0004 0639 1911Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Østre Hougvej 70, 5500 Middelfart, Denmark ,grid.10825.3e0000 0001 0728 0170OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 9 A, 5000 Odense C, Denmark
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26
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Linkhorst T, Birkeland SF, Gildberg FA, Mainz J, Torp-Pedersen C, Bøggild H. Use of the least intrusive coercion at Danish psychiatric wards: A register-based cohort study of 131,632 first and subsequent coercive episodes within 35,812 admissions. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2022; 85:101838. [PMID: 36208564 DOI: 10.1016/j.ijlp.2022.101838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Psychiatric legislation in Denmark implies a principle of using the least intrusive types of coercion first. The intrusiveness is not universally agreed upon. We examined the order in which coercive measures during admission were used, implying that the first used should be less intrusive than the following types. METHODS For coercive episodes reported to the national administrative register for the period 2011-16, the order of 12 legal coercive interventions during each admission was examined. Comparing with mechanical restraint, the odds ratio (OR) and confidence interval (95%CI) of being first or subsequent used types were estimated using conditioned (96,611 episodes) and unconditioned (131,632 episodes) logistic regression models, stratified on sex. RESULTS Totally 17,796 patients aged 18+ were subjected to at least one coercive episode. The median time between admission and the first episode was 4 days in men and 6 for women. For females, involuntary detention, forced feeding, coercive treatment of somatic disorder, locking of doors and close observations in females were used before mechanical restraint, and forced follow-up, involuntary electro convulsive therapy (ECT), forced treatment, use of gloves and straps, physical restraint and forced intramuscular medication was used later. In men, only involuntary detention was used before mechanical restraint, while involuntary ECT, close observations, administration of drugs, use of gloves and straps, physical restraint and forced intramuscular medication was used after mechanical restraint. CONCLUSION The order of used coercive measures is not consistent with the international ranking of the least intrusive types, especially in men and in younger adults.
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Affiliation(s)
- Thea Linkhorst
- Odense University Hospital, Region of Southern Denmark, 5000 Odense, Denmark; Forensic Mental Health Research Unit Middelfart, Department of Regional Health Research, University of Southern Denmark, 5500 Middelfart, Denmark
| | | | - Frederik Alkier Gildberg
- Forensic Mental Health Research Unit Middelfart, Department of Regional Health Research, University of Southern Denmark, 5500 Middelfart, Denmark; Department of Psychiatry, Middelfart, Mental Health Services, Region of Southern Denmark, 5500 Middelfart, Denmark.
| | - Jan Mainz
- Department of Psychiatry, North Denmark Region, 9000 Aalborg, Denmark; Danish Center for Clinical Health Services Research (DACS), Aalborg University Hospital, Aalborg University, 9000 Aalborg, Denmark; Department of Community Mental Health, University of Haifa, Mount Carmel, Haifa, Israel; DaCHE, University of Southern Denmark, 5000 Odense, Denmark.
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, 9000 Aalborg, Denmark; Department of Cardiology, Nordsjællands Hospital, 3400 Hillerød, Denmark; Department of Public Health, University of Copenhagen, 2100 Copenhagen, Denmark.
| | - Henrik Bøggild
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, E, Denmark; Unit of Clinical Biostatistics, Aalborg University Hospital, 9000 Aalborg, Denmark.
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Mullen A, Browne G, Hamilton B, Skinner S, Happell B. Safewards: An integrative review of the literature within inpatient and forensic mental health units. Int J Ment Health Nurs 2022; 31:1090-1108. [PMID: 35365947 PMCID: PMC9544259 DOI: 10.1111/inm.13001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 03/14/2022] [Accepted: 03/18/2022] [Indexed: 11/27/2022]
Abstract
Mental health inpatient units are complex and challenging environments for care and treatment. Two imperatives in these settings are to minimize restrictive practices such as seclusion and restraint and to provide recovery-oriented care. Safewards is a model and a set of ten interventions aiming to improve safety by understanding the relationship between conflict and containment as a means of reducing restrictive practices. To date, the research into Safewards has largely focused on its impact on measures of restrictive practices with limited exploration of consumer perspectives. There is a need to review the current knowledge and understanding around Safewards and its impact on consumer safety. This paper describes a mixed-methods integrative literature review of Safewards within inpatient and forensic mental health units. The aim of this review was to synthesize the current knowledge and understanding about Safewards in terms of its implementation, acceptability, effectiveness and how it meets the needs of consumers. A systematic database search using Medline, CINAHL, Embase and PsychInfo databases was followed by screening and data extraction of findings from 19 articles. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of empirical articles, and the Johanna Brigg's Institute (JBI's) Narrative, Opinion, Text-Assessment and Review Instrument (NOTARI) was used to undertake a critical appraisal of discussion articles. A constant comparative approach was taken to analysing the data and six key categories were identified: training, implementation strategy, staff acceptability, fidelity, effectiveness and consumer perspectives. The success of implementing Safewards was variously determined by a measured reduction of restrictive practices and conflict events, high fidelity and staff acceptability. The results highlighted that Safewards can be effective in reducing containment and conflict within inpatient mental health and forensic mental health units, although this outcome varied across the literature. This review also revealed the limitations of fidelity measures and the importance of involving staff in the implementation. A major gap in the literature to date is the lack of consumer perspectives on the Safewards model, with only two papers to date focusing on the consumers point of view. This is an important area that requires more research to align the Safewards model with the consumer experience and improved recovery orientation.
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Affiliation(s)
- Antony Mullen
- University of Newcastle, Callaghan, New South Wales, Australia.,Hunter New England Mental Health, Newcastle, New South Wales, Australia
| | - Graeme Browne
- University of Newcastle, Callaghan, New South Wales, Australia
| | - Bridget Hamilton
- Centre for Mental Health Nursing, Department of Nursing, School of Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Stephanie Skinner
- Hunter New England Mental Health, C/- Centre for Psychotherapy, James Fletcher Hospital, Newcastle, New South Wales, Australia
| | - Brenda Happell
- University of Newcastle, Callaghan, New South Wales, Australia
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28
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O'Donovan D, Boland C, Carballedo A. Current trends in restrictive interventions in psychiatry: a European perspective. BJPSYCH ADVANCES 2022. [DOI: 10.1192/bja.2022.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARY
This article reviews current evidence on the use of coercive measures, including seclusion and restraint, in psychiatric in-patient settings in Europe. There is a particular focus on evidence regarding the use of mechanical restraint. The review seeks to describe when the use of restrictive interventions such as restraint may be necessary, to explore the use of restraint in certain specialist settings and to investigate current laws and European policies on seclusion and restraint. The current rates of restraint in European psychiatric settings are explored, with a discussion of the limitations of the evidence currently available. The article discusses various consequences of seclusion and restraint, potential alternatives to their use and strategies to minimise their use and harm to patients. The use of coercive measures from an international context is considered, to provide context.
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Lynge MC, Dixen ST, Johansen KS, Düring SW, U-Parnas A, Nordgaard J. Patients' experiences with physical holding and mechanical restraint in the psychiatric care: an interview study. Nord J Psychiatry 2022; 77:247-255. [PMID: 35732037 DOI: 10.1080/08039488.2022.2087001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND In the continuous work to reduce the use of coercion in psychiatric care, attention in Denmark has especially been directed towards mechanical restraint. While the use of mechanical restraint is currently decreasing, an increase in other types of coercion is observed (e.g. medication and hour-long episodes of physical holding). Physical holding has, in this cultural context, been considered less intrusive to a patient's autonomy than the use of mechanical restraint. However, no study has yet compared the experiences of the patients on these two types of coercion in the same population. The objective of this study was to explore patients' perspectives on physical holding and mechanical restraint, respectively. METHODS Audio-recorded, semi-structured interviews following an interview guide were conducted with patients sharing their experiences with both types of coercion. The interviews were transcribed verbatim. The analytical approach was based on the principles of thematic content analysis. RESULTS Nine informants were interviewed between September 2020 and April 2021. Four main themes were identified: experiences with physical holding, experiences with mechanical restraint, the effects of coercion on patients and their relation to mental health care, and improved mental health care. CONCLUSION It is inconclusive which type of restraint the patients preferred. This challenges the present hierarchy of coercive measures. To avoid coercion in the first place more communication and time with the patient are needed.
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Affiliation(s)
| | | | - Katrine S Johansen
- Head of Competence Centre for Dual Diagnosis, Mental Health Centre Sct. Hans, Roskilde, Denmark.,University of Southern Denmark National Institute of Public Health, Copenhagen, Denmark
| | - Signe W Düring
- Mental Health Centre Amager, Denmark.,University of Copenhagen, Competence Centre for Dual Diagnosis, Mental Health Centre Sct. Hans, Roskilde, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Annick U-Parnas
- Mental Health Centre Amager, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Julie Nordgaard
- Mental Health Centre Amager, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Aragonés-Calleja M, Sánchez-Martínez V. Current State of Research on Coercion in Mental Health: Umbrella Review Protocol. J Psychosoc Nurs Ment Health Serv 2022; 60:49-55. [PMID: 35522935 DOI: 10.3928/02793695-20220428-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In recent years, international organizations, professionals, and representatives of mental health service users have expressed the need to regulate, limit, and even eliminate coercive measures in psychiatric treatment. The main objective of the current review is to provide a comprehensive synthesis of existing evidence on coercion in mental health care through a protocol for an umbrella review of systematic reviews. This protocol was designed according to the Joanna Briggs Institute guide for methodological development, conduct, and reporting of umbrella reviews. To minimize bias in the process, two independent reviewers selected the studies to be included, extracted, and synthesized; analyzed the data; and assessed risk of bias of each review. The review protocol was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines. This review offers a comprehensive compilation of systematic reviews on coercion developed to date. Coercion causes adverse physical and psychological effects and is an emotional stressor for individuals with psychiatric diagnoses and health care workers. Characterization of coercion across care settings, its impact on clinical outcomes, the perception of those involved, and how coercion could be reduced will also be discussed. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].
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31
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Shields MC, Trinh NHT, Borba CPC, Chen R, Reddy AK, Singer SJ. Former Inpatient Psychiatric Patients' Past Experiences With Traditional Frontline Staff and Their Thoughts on the Benefits of Peers as Part of Frontline Staff. J Psychosoc Nurs Ment Health Serv 2022; 60:15-22. [PMID: 34590985 PMCID: PMC10182870 DOI: 10.3928/02793695-20210916-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Little is known about how integrating peers into frontline staff might improve the quality of inpatient psychiatric care. In the current study, we interviewed 18 former adult patients of inpatient psychiatric facilities using semi-structured interviews. We first asked about positive and negative past experiences with traditional staff. We then asked participants to share their opinions on the potential benefits of peers as part of frontline staff. We identified themes through a joint inductive and deductive approach. Participants reported past positive experiences with traditional staff as being (a) personable and caring, (b) validating feelings and experiences, (c) de-escalating, and (d) providing agency. Past negative experiences included (a) not sharing information, (b) being inattentive, (c) not providing agency, (d) being dehumanizing/disrespectful, (e) incompetency, (f) escalating situations, and (g) being apathetic. Participants believed that peers as part of frontline staff could champion emotional needs in humanizing and nonjudgmental ways, help navigate the system, and disrupt power imbalances between staff and patients. Further research is needed to understand financial, organizational, and cultural barriers to integrating peers into frontline staff. [Journal of Psychosocial Nursing and Mental Health Services, 60(3), 15-22.].
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Baumann LA, Brütt AL. Participation preferences of health service users in health care decision-making regarding rehabilitative care in Germany-A cross-sectional study. Health Expect 2021; 25:125-137. [PMID: 34519382 PMCID: PMC8849223 DOI: 10.1111/hex.13356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/12/2021] [Accepted: 08/19/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Involving patients and citizens in health care decision-making is considered increasingly important in Germany. Participatory structures have been implemented, especially in rehabilitative care. However, it is unknown whether and to what extent German patients and citizens want to participate in decisions that exceed their own medical treatment. OBJECTIVE This study aimed to survey participation preferences and associated factors of health service users in decisions regarding rehabilitative care at micro, meso and macro levels. METHODS A questionnaire was sent to 3872 former rehabilitants. We collected participation preferences using the Control Preference Scale or an adapted form. Possible influencing factors were examined using logistic regression models. RESULTS The response rate was 5.7% (n = 217). At all decision-making levels, joint decision-making was preferred. At the macro level, preferences for actively participating were the highest. Preferences were significantly interrelated between decision-making levels. At the micro level, an orthopaedic indication significantly decreased the desire for participation compared to psychosomatic indications (odds ratio = 0.44, p = .019). DISCUSSION Participants wanted to be equally involved in decision-making as experts. Higher preferences for active participation at the macro level might be due to dissatisfaction with the current health care organisation and lack of trust in politicians. Compared to the general public, our study sample was older (73.3% between 50 and 69 years) and more often chronically ill-factors associated with increased participation preferences in the literature. CONCLUSION Contrary to the identified preferences, participation opportunities in the German health care system are rare. Further research on participation preferences and structures that enable meaningful involvement are needed.
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Affiliation(s)
- Lisa A Baumann
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Anna L Brütt
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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Martínez-Martínez C, Sánchez-Martínez V, Ballester-Martínez J, Richart-Martínez M, Ramos-Pichardo JD. A qualitative emancipatory inquiry into relationships between people with mental disorders and health professionals. J Psychiatr Ment Health Nurs 2021; 28:721-737. [PMID: 33351223 DOI: 10.1111/jpm.12727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 11/27/2020] [Accepted: 12/11/2020] [Indexed: 12/01/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: A therapeutic alliance with people with mental disorders could help increase the efficacy of treatment. The paradigm shift from a paternalistic model to one that respects the person's autonomy has led to professionals accepting the active role of people with mental disorders making decisions that affect their treatment. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: People with mental disorders perceive paternalistic and stigmatizing attitudes from health professionals, and they do not feel involved in decisions about their health, which can render effective therapeutic alliances difficult. The findings reveal that although people in Mediterranean countries are used to paternalistic treatment from health professionals due to cultural factors, people with mental disorders are increasingly critical of how they are treated and demand greater autonomy and respect in the decision to undergo drug therapy. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: In their interactions with people with mental disorders, health professionals should include efforts aimed at improving shared decision-making capabilities and avoiding paternalistic or stigmatizing attitudes. ABSTRACT: Introduction A therapeutic alliance with people is essential for the efficacy of treatments. However, the traditional paternalistic values of the Mediterranean society may be incompatible with patient autonomy. Aim To explore the therapeutic relationship from the perspective of people diagnosed with mental disorders with health professionals, including nurses. Methods This emancipatory research was performed through focus groups, with people with mental disorders who had a variety of diagnoses and experiences of acute and community-based mental health services and other healthcare services. Data were analysed using the content analysis method. Results Four main themes emerged: stereotypes and prejudice; quality of interactions and treatment; emotional and behavioural impacts; and demands. Discussion According to the participants' descriptions, health professionals are not exempt from prejudice against persons with psychiatric diagnoses. They reported experiencing abuse of power, malpractice, and overmedication. Thus, in the Mediterranean culture, professional attitudes may represent a barrier for an appropriate therapeutic alliance, and people with mental disorders do not feel involved in making decisions about their health. Implications for practice Knowing how people with mental disorders perceive their interactions with health professionals and the effects is necessary to move the care model towards more symmetric relationships that facilitate a therapeutic alliance.
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Affiliation(s)
- Concepción Martínez-Martínez
- Department of Nursing and Physiotherapy, Faculty of Health Sciences, Universidad Europea, Valencia, Spain.,Faculty of Nursing and Podiatry University of Valencia, Valencia, Spain
| | | | | | - Miguel Richart-Martínez
- Nursing Department, Health Sciences Faculty, University of Alicante, San Vicente del Raspeig, Spain
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Cutler NA, Sim J, Halcomb E, Stephens M, Moxham L. Understanding how personhood impacts consumers' feelings of safety in acute mental health units: a qualitative study. Int J Ment Health Nurs 2021; 30:479-486. [PMID: 33179361 DOI: 10.1111/inm.12809] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/08/2020] [Accepted: 10/14/2020] [Indexed: 12/26/2022]
Abstract
Being admitted to an acute mental health unit can lead to feelings of shame, and loss of personhood for some consumers. Promoting safety for consumers is a function of acute mental health units. This paper explores how consumers' personhood influences their perception and experience of safety in acute mental health units. Semi-structured interviews were conducted with 15 participants who had previously been admitted to an acute mental health unit. Thematic analysis was used to analyse the data. Participants perceived safety as being intrinsically linked to their personhood. When participants' innate worth was affirmed in their interactions with staff, participants felt safe. Three subthemes were identified: 'Seen as an equal', 'Being respected', and 'Able to make choices'. These findings can be used to inform nursing practices that enhance consumers' sense of personhood and, in so doing, promote consumers' safety and recovery in acute mental health units.
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Affiliation(s)
- Natalie Ann Cutler
- School of Nursing, University of Wollongong, Illawarra Health & Medical Research Institute, Wollongong, New South Wales, Australia
| | - Jenny Sim
- School of Nursing, University of Wollongong, Illawarra Health & Medical Research Institute, Wollongong, New South Wales, Australia
| | - Elizabeth Halcomb
- School of Nursing, University of Wollongong, Illawarra Health & Medical Research Institute, Wollongong, New South Wales, Australia
| | - Moira Stephens
- School of Nursing, University of Wollongong, Illawarra Health & Medical Research Institute, Wollongong, New South Wales, Australia
| | - Lorna Moxham
- School of Nursing, University of Wollongong, Illawarra Health & Medical Research Institute, Wollongong, New South Wales, Australia
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Guzman-Parra J, Aguilera-Serrano C, Huizing E, Bono Del Trigo A, Villagrán JM, García-Sánchez JA, Mayoral-Cleries F. A regional multicomponent intervention for mechanical restraint reduction in acute psychiatric wards. J Psychiatr Ment Health Nurs 2021; 28:197-207. [PMID: 32667113 DOI: 10.1111/jpm.12669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 06/04/2020] [Accepted: 06/22/2020] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: A relevant number of restraint prevention programmes have been developed internationally. In Spain, there is no harmonized policy to prevent the use of restraint. More studies are necessary to establish which programmes and components are necessary to prevent restraint. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: There was a significant decreasing trend in the total number of mechanical restraint hours during the implementation of the intervention. There was no significant decreasing trend in the number of mechanical restraint episodes. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Interventions at a regional level aimed at preventing mechanical restraint are feasible in the Spanish context. All components of the Six Core Strategies could be necessary to prevent episodes of mechanical restraint. ABSTRACT: Introduction Mechanical restraint (MR) is used in many countries, including Spain, where non-harmonized policies between autonomous communities exist. There is a lack of research about interventions at regional levels to reduce their use. Aim To analyse data on key outcomes during the implementation of a multicomponent intervention in Andalusia (Spain) to reduce the use of MR. Method Episodes in a period of 30 months in all wards (N = 20) were analysed. The intervention consisted of five strategies: (a) leadership, (b) analysis of the situation, (c) awareness training for the heads of the wards, (d) unified record of MR and (e) staff training. We analysed the monthly trend of restraint hours and restraint episodes/1,000 bed days using segmented regression. Results There were 206.32 restraint hours and 12.96 restraint episodes/1,000 bed days during the study period. A significant decreasing trend was observed in restraint hours (-1.79%, p < .001), but not in the number of restraint episodes (-0.45%; p = .149). Discussion The results coincide with other international studies; however, studies with better designs are required to evaluate the effectiveness of the intervention. Implications for Practice Interventions at a regional level aimed at preventing MR are feasible in the Spanish context.
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Affiliation(s)
- Jose Guzman-Parra
- Department of Mental Health, University General Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
| | - Carlos Aguilera-Serrano
- Community Mental Health Unit of Motril, South Health Management Area of Granada, Motril, Spain
| | | | | | - José María Villagrán
- Mental Health Hospitalization Unit, Jerez de la Frontera Hospital, Jerez de la Frontera, Spain
| | - Juan Antonio García-Sánchez
- Department of Mental Health, University General Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
| | - Fermín Mayoral-Cleries
- Department of Mental Health, University General Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
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Heumann K, Stückle L, Jung A, Bock T, Mahlke C, Lincoln TM. [Do we Choose the Right Measures to Avoid Coercion? - A Survey of Service Users who Experienced Coercion About Potentially Helpful Milder Measures]. PSYCHIATRISCHE PRAXIS 2021; 48:301-308. [PMID: 33773501 DOI: 10.1055/a-1347-5184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM We investigated which milder measures service users perceive as helpful to prevent coercive measures and in which extent these measures are offered. METHODS A sample of 155 former service users who experienced coercion was recruited and questioned via online or paper pencil survey. RESULTS On average, participants reported to have received 4.7 from a total of 25 milder measures. The measures, which where most frequent rated as potentially helpful where "crisis talks", "considering needs" and "showing interest". The analysis showed a negative relation between the frequency of offered measures and the frequency these measures where rated as potentially helpful. 86 % of the participants reported low satisfaction with treatment overall. CONCLUSION It seems, that in escalating situations service users do not receive the measures they perceive as helpful. In order to prevent the use of coercive measures staff members should focus on crisis talks and a need-orientated, empathic interaction.
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Affiliation(s)
- Kolja Heumann
- Arbeitsbereich Klinische Psychologie und Psychotherapie, Universität Hamburg.,Hochschulklinik für Psychiatrie und Psychotherapie der Medizinischen Hochschule Brandenburg, Immanuel Klinik Rüdersdorf
| | - Luise Stückle
- Arbeitsbereich Klinische Psychologie und Psychotherapie, Universität Hamburg
| | | | - Thomas Bock
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf
| | - Candelaria Mahlke
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf
| | - Tania M Lincoln
- Arbeitsbereich Klinische Psychologie und Psychotherapie, Universität Hamburg
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Hurtado MM, Villena-Jimena A, Quemada C, Morales-Asencio JM. 'I do not know where it comes from, I am suspicious of some childhood trauma' association of trauma with psychosis according to the experience of those affected. Eur J Psychotraumatol 2021; 12:1940759. [PMID: 34367524 PMCID: PMC8312611 DOI: 10.1080/20008198.2021.1940759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Trauma-related symptoms are often experienced after a first psychotic episode. OBJECTIVE In this study, we conduct a qualitative analysis of referred traumatic experiences of outpatients diagnosed with psychotic disorders. METHOD Focus groups were formed and in-depth interviews conducted with 30 participants, focusing on their experience with the disorder and the health care received. Given the frequency with which trauma and psychosis have been associated in the scientific literature, the nature of this relation is addressed as a secondary objective, via a qualitative analysis. RESULTS Analysis revealed two main themes in the patients' discourse. On many occasions, traumatic experiences were related to the development of the disorder. Although most participants referred to traumatic experiences during childhood, episodes during adult life were also reported, which may have triggered the disorder. The second theme was that of the interlocking relationship between the psychotic experience and certain coercive practices undergone during the provision of health care for psychosis, and the traumatic effects thus generated. CONCLUSIONS The participants considered both themes to be highly important. Accordingly, these issues should be carefully assessed and managed in order to provide appropriate person-centred care.
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Affiliation(s)
- María M Hurtado
- Mental Health Unit, Regional University Hospital, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | | | - Casta Quemada
- Mental Health Unit, Regional University Hospital, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | - José Miguel Morales-Asencio
- Instituto de Investigación Biomédica de Málaga (IBIMA), Spain.,Faculty of Health Sciences, Universidad de Málaga, Málaga, Spain
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Khalily MT, Rehman AU, Bhatti MM, Hallahan B, Ahmad I, Mehmood MI, Khan SH, Khan BA. Stakeholders' perspective on mental health laws in Pakistan: A mixed method study. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2021; 74:101647. [PMID: 33246231 DOI: 10.1016/j.ijlp.2020.101647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/20/2020] [Accepted: 11/05/2020] [Indexed: 06/11/2023]
Abstract
The present study explored awareness and opinions pertaining to mental health legislation in Pakistan in the context of the United Nation Convention on Rights of People with Disabilities (UNCRPD) through a mixed method research design. In the quantitative arm of the study, a structured questionnaire examined awareness and opinions of key stakeholders pertaining to national mental health legislation. In the qualitative arm, face-to-face interviews further elaborated stakeholders perspectives pertaining to these topics with thematic analysis conducted. Stakeholders demonstrated a good awareness of legislation pertaining to guardianship (83.0 %) appointment of property managers (89.7%) and salary or pension entitlements (89.2%). Compared to other stakeholders, patients had less understanding of processes pertaining to involuntary admission (χ2 = 20.54, p = 0.02) and appointing a guardian (χ2 = 34.67, p < 0.01). High consensus across stakeholders was noted for processes of involuntary detention (83.5%) and appointment of guardians or property managers (80.0%) albeit patients demonstrated less agreement on these topics (p <0.01). Minimal support was noted for an involuntary patient to be discharged solely on a psychiatrist's recommendation (25.4%). Thematic analysis indicated fifteen emergent themes: 1) Alienation/ Seclusion; 2) Capacity building; 3) Communication Gap; 4) Conflict of interests; 5) Discomfort at hospital; 6) Economic burden; 7) Government's liability; 8) Family involvement; 9) Imbalance; 10) Acceptance of Legal Incapacity; 11) Legal reforms; 12) Patient centred environment; 13) Quality assurance; 14) Under developed infrastructure and 15) Potential unethical practices. This study advocates for increased patient involvement in collaborative decision making with mental health professionals and the creation of more appropriate inpatient treatment environments.
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Affiliation(s)
| | - Aziz Ur Rehman
- Department of Law, International Islamic University, Islamabad, Pakistan
| | - Mujeeb Masud Bhatti
- Department of Psychology, International Islamic University, Islamabad, Pakistan
| | - Brian Hallahan
- Department of Psychiatry, National University of Ireland, Galway, Ireland
| | - Irshad Ahmad
- Department of Psychology, International Islamic University, Islamabad, Pakistan.
| | | | - Shamsher Hayat Khan
- Department of Psychology, International Islamic University, Islamabad, Pakistan
| | - Bilal Ahmed Khan
- Department of Psychology, International Islamic University, Islamabad, Pakistan
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Ercis M, Seçkin M, Ayık B, Üçok A. Correlates of Patient Satisfaction in Psychiatric Inpatient Care: A Survey Study from a Tertiary Hospital in Turkey. J Psychosoc Nurs Ment Health Serv 2020; 59:38-47. [PMID: 33301044 DOI: 10.3928/02793695-20201203-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In the current study, a questionnaire to evaluate satisfaction levels and related factors upon discharge was completed by 100 patients receiving care for mental illness in a tertiary care hospital in Turkey. The relationships among sociodemographic variables, nonpharmacological interventions, and participants' views about the treatment course and quality of care they received were investigated. Overall satisfaction levels of participants were good. Older participants reported more positive opinions. Involuntary hospitalization, use of restraints/seclusion, or electroconvulsive therapy did not change overall satisfaction. Participants who were hospitalized for the first time were more afraid of other patients, which may imply that this population needs special care from the treatment team. Spending an adequate amount of time and providing necessary information about their treatment plan impact patients' treatment experience positively. [Journal of Psychosocial Nursing and Mental Health Services, 59(4), 38-47.].
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Muir-Cochrane E, Oster C, Grimmer K. Interrogating systematic review recommendations for effective chemical restraint. J Eval Clin Pract 2020; 26:1768-1779. [PMID: 32059065 DOI: 10.1111/jep.13363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 01/12/2020] [Accepted: 01/16/2020] [Indexed: 02/01/2023]
Affiliation(s)
- Eimear Muir-Cochrane
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Candice Oster
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Karen Grimmer
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
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Goh YS, Seetoh YTM, Chng ML, Ong SL, Li Z, Hu Y, Ho CMR, Ho SHC. Using Empathetic CAre and REsponse (ECARE) in improving empathy and confidence among nursing and medical students when managing dangerous, aggressive and violent patients in the clinical setting. NURSE EDUCATION TODAY 2020; 94:104591. [PMID: 32932056 DOI: 10.1016/j.nedt.2020.104591] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/18/2020] [Accepted: 08/09/2020] [Indexed: 05/23/2023]
Abstract
BACKGROUND The use of physical restraint to curtail dangerous or extremely disruptive behaviours in patients has been an established practice to help ensuring safety in healthcare providers' work environment. However, many have deemed it unnecessary and overused with reported negligence on patients' basic needs during its implementation. Studies have shown that having empathy and non-judgmental attitudes are vital in reducing and eliminating the use of restraint. OBJECTIVES To explore whether experiential learning will improve empathy and confidence, among nursing and medical students when managing dangerous, aggressive, and violent patients. DESIGN A pre- and post-test, same group quasi-experimental design was used to explore the effectiveness of using the Empathetic CAre and REsponse (ECARE), an experiential learning session to equip nursing and medical students on managing dangerous, aggressive, and violent patients. Outcome measures include students' confidence when using verbal de-escalation, physical and chemical restraint techniques. Empathy scores were also compared. SETTINGS A University offering both medical and nursing program from undergraduate to postgraduate level. PARTICIPANTS 249 nursing and 50 medical students undergoing the mental health nursing module in Year 2 of their nursing program and psychiatry rotation in Year 3 of their medical education. RESULTS Results showed that, for both student populations, the empathy and confidence scores significantly improved after attending ECARE. ANCOVA conducted on the post-intervention Jefferson empathy score between the populations with an adjusted baseline score revealed a statistically significant adjusted mean difference between them. CONCLUSIONS This study demonstrated that experiential learning could improve the learners' empathy through the integration of hands-on learning. This in turn could enhance future healthcare professionals' care quality. Experiential learning opportunities should be incorporated into existing pedagogies as this helps to improve students' confidence in managing dangerous, aggressive and violent patients, reducing the use of physical restraint, thereby enhancing the quality of patient care.
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Affiliation(s)
- Yong-Shian Goh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Alice Lee Centre for Nursing Studies, National University Health System, Singapore.
| | - Yu-Ting Michelle Seetoh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Alice Lee Centre for Nursing Studies, National University Health System, Singapore
| | - Mui-Lee Chng
- National University Hospital, National University Health System, Singapore
| | - Siang Loong Ong
- National University Hospital, National University Health System, Singapore
| | | | - Yanan Hu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Alice Lee Centre for Nursing Studies, National University Health System, Singapore
| | - Chun-Man Roger Ho
- National University Hospital, National University Health System, Singapore
| | - Su Hui Cyrus Ho
- National University Hospital, National University Health System, Singapore
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Asikainen J, Louheranta O, Vehviläinen-Julkunen K, Repo-Tiihonen E. Use of coercion prevention tools in Finnish psychiatric wards. Arch Psychiatr Nurs 2020; 34:412-420. [PMID: 33032767 DOI: 10.1016/j.apnu.2020.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/13/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
Inpatient violence is a widespread problem in psychiatric wards and has often serious consequences. Literature indicates that de-escalation techniques are the recommended first-line intervention for managing violence, are widely used to reduce it, and restrictive practices in mental health settings. However, these techniques and models are not used at the optimum frequency and/or important factors are limiting their use and effectiveness. We aimed to determine what kind of de-escalation methods are used to reduce violence and coercion in Finnish psychiatric hospitals. Descriptive qualitative research using semi-structured questionnaires and Framework Analysis was used. The results of the study are reported in quantitative terms. A survey of psychiatric wards (N = 65) in Finland's hospital districts (n = 16) was conducted in the Autumn of 2019 to find out which de-escalation models are used. Finnish psychiatric wards use both the Safewards and Six Core Strategies models to reduce violence and the use of restrictive practices. Half of the hospitals used interventions and strategies from both models. Violence preventive methods are widely used in mental health settings in Finland. These interventions and models cover the organization, leadership, and patient perspectives to improve safety and decrease coercion actions in psychiatric wards.
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Affiliation(s)
- Jaana Asikainen
- Niuvanniemi Hospital, Department of Forensic Psychiatry, University of Eastern Finland, Niuvankuja 65, FI-70240 Kuopio, Finland.
| | - Olavi Louheranta
- Niuvanniemi Hospital, Department of Forensic Psychiatry, University of Eastern Finland, Niuvankuja 65, FI-70240 Kuopio, Finland.
| | | | - Eila Repo-Tiihonen
- Niuvanniemi Hospital, Department of Forensic Psychiatry, University of Eastern Finland, Niuvankuja 65, FI-70240 Kuopio, Finland
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Hawsawi T, Power T, Zugai J, Jackson D. Nurses' and consumers' shared experiences of seclusion and restraint: A qualitative literature review. Int J Ment Health Nurs 2020; 29:831-845. [PMID: 32198811 DOI: 10.1111/inm.12716] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/19/2020] [Accepted: 02/22/2020] [Indexed: 11/28/2022]
Abstract
Seclusion and restraint are coercive practices associated with physical and psychological harm. International bodies have called for an end to these practices. However, these practices continue to be used. Elimination programmes have had some success in reducing the rates of these practices. Understanding coercive practices through the perspectives of involved individuals may facilitate a complete cessation of seclusion and restraint from the practice. Therefore, this qualitative review explored how nurses and consumers experienced seclusion and restraint events in mental health care. Five databases were searched. The search strategy resulted in the inclusion of fourteen qualitative papers. A thematic analysis was used to synthesize the findings. Six themes emerged under three main categories; shared experiences: disruption in care, disruption in the therapeutic relationship and shared negative impacts; nurses' experiences: Absence of less coercive alternatives; and consumers' experiences: overpowered, humiliated and punished. Considering these experiences during planning for seclusion and restraint prevention might facilitate more effective implementation of seclusion and restraint elimination programmes. Our findings suggested that consumers should receive recovery-oriented, trauma-informed and consumer-centred care; while nurses should be better supported through personal, professional and organizational developmental strategies. Further research should focus on investigating shared interventions among consumers and nurses and exploring carers' experiences with coercive practices.
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Affiliation(s)
- Tahani Hawsawi
- Faculty of Nursing, King Abdul-Aziz University, Jeddah, Saudi Arabia
| | - Tamara Power
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Joel Zugai
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Debra Jackson
- Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
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Varpula J, Välimäki M, Lantta T, Berg J, Lahti M. Nurses' perceptions of risks for occupational hazards in patient seclusion and restraint practices in psychiatric inpatient care: A focus group study. Int J Ment Health Nurs 2020; 29:703-715. [PMID: 32086881 DOI: 10.1111/inm.12705] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 11/28/2022]
Abstract
Seclusion and restraint are regularly used to manage patient aggression events in psychiatric inpatient care, despite occupational safety concerns. There is currently a lack of information on how nurses perceive the use of patient seclusion and restraint as a risk for occupational safety. The aim of this study is to describe the risks for occupational hazards in patient seclusion and mechanical restraint practices as well as ideas for improvement identified by nurses. A qualitative descriptive design was adopted, using focus groups comprising nurses (N = 32) working in psychiatric inpatient care. The data were analysed using inductive content analysis, and the results were reported using the consolidated criteria for reporting qualitative studies (COREQ). Four themes of risk for occupational hazards were identified: patient-induced, staff-induced, organization-induced, and environment-induced risks. One significant finding was that nurses described that their actions can strongly contribute to occupational hazards during seclusion and mechanical restraint practices. The nurses gave various ideas for how occupational safety could be improved during seclusion and mechanical restraint events, ideas involving staff, the organization, and environmental enhancements.
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Affiliation(s)
- Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,School of Nursing, Hong Kong Polytechnic University, Hong Kong, China (SAR)
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Johanna Berg
- Turku University of Applied Science, Turku, Finland
| | - Mari Lahti
- Department of Nursing Science, University of Turku, Turku, Finland.,Turku University of Applied Science, Turku, Finland
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Hammervold UE, Norvoll R, Vevatne K, Sagvaag H. Post-incident reviews-a gift to the Ward or just another procedure? Care providers' experiences and considerations regarding post-incident reviews after restraint in mental health services. A qualitative study. BMC Health Serv Res 2020; 20:499. [PMID: 32493391 PMCID: PMC7268524 DOI: 10.1186/s12913-020-05370-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 05/26/2020] [Indexed: 12/14/2022] Open
Abstract
Abstract Public guidelines in many western countries recommend post-incident reviews (PIRs) with patients after restraint use in mental health care. PIRs are one of several elements of seclusion and restraint reduction in internationally used programmes. PIRs may improve restraint prevention, patients’ recovery processes and care providers’ ethical mindfulness. The knowledge base on PIRs is, however, vague. This qualitative study explores professional care providers’ experiences and considerations regarding PIRs that included patients after restraint use in a Norwegian context. Methods Within a phenomenological hermeneutical framework, 19 multidisciplinary care providers were interviewed about their experiences and views regarding PIRs that included patients after restraint events. The interviews were performed over the period 2015–2016. Data analysis followed a data-driven stepwise approach in line with thematic content analysis. A group of two patient consultants in mental health services, and one patient’s next of kin, contributed with input regarding the interview guide and analysis process. Results Care providers experienced PIRs as having the potential to improve the quality of care through a) knowledge of other perspectives and solutions; b) increased ethical and professional awareness; and c) emotional and relational processing. However, the care providers considered that PIRs’ potential could be further exploited as they struggled to get hold on the patients’ voices in the encounter. The care providers considered that issue to be attributable to the patients’ conditions, the care providers’ safety and skills and the characteristics of institutional and cultural conditions. Conclusion Human care philosophies and a framework of care ethics seem to be preconditions for promoting patients’ active participation in PIRs after restraints. Patients’ voices strengthen PIRs’ potential to improve care and may also contribute to restraint prevention. To minimise the power imbalance in PIRs, patients’ vulnerability, dependency and perceived dignity must be recognised. Patients’ individual needs and preferences should be assessed and mapped when planning PIRs, particularly regarding location, time and preferred participants. Care providers must receive training to strengthen their confidence in conducting PIRs in the best possible way. Patients’ experiences with PIRs should be explored, especially if participation by trusted family members, peers or advocates may support the patients in PIRs.
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Affiliation(s)
- Unn Elisabeth Hammervold
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway.
| | - Reidun Norvoll
- Work Research Institute, Oslo Metropolitan University, Oslo, Norway
| | - Kari Vevatne
- Department of care and ethics, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Hildegunn Sagvaag
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
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46
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Muir-Cochrane E, Oster C, Grimmer K. International research into 22 years of use of chemical restraint: An evidence overview. J Eval Clin Pract 2020; 26:927-956. [PMID: 31318109 DOI: 10.1111/jep.13232] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chemical restraint (CR) (also known as rapid tranquilisation) is the forced (non-consenting) administration of medications to manage uncontrolled aggression, anxiety, or violence in people who are likely to cause harm to themselves or others. Our population of interest was adults with mental health disorders (with/without substance abuse). There has been a growing international movement over the past 22 years towards reducing/eliminating restrictive practices such as CR. It is appropriate to summarise the research that has been published over this time, identify trends and gaps in knowledge, and highlight areas for new research to inform practice. AIMS To undertake a comprehensive systematic search to identify, and describe, the volume and nature of primary international research into CR published since 1995. METHODS This paper reports the processes and overall findings of a systematic search for all available primary research on CR published between 1 January 1996 and 31 July 2018. It describes the current evidence base by hierarchy of evidence, country (ies) producing the research, CR definitions, study purpose, and outcome measures. RESULTS This review identified 311 relevant primary studies (21 RCTs; 46 non-controlled experimental or prospective observational studies; 77 cross-sectional studies; 69 retrospective studies; 67 opinion pieces, position or policy statements; and 31 qualitative studies). The USA, UK, and Australia contributed over half the research, whilst cross-country collaborations comprised 6% of it. The most common research settings comprised acute psychiatric wards (23.3%), general psychiatric wards (21.6%), and general hospital emergency departments (19.0%). DISCUSSION A key lesson learnt whilst compiling this database of research into CR was to ensure that all papers described non-consenting administration of medications to manage adults with uncontrolled aggression, anxiety, or violence. There were tensions in the literature between using effective CR without producing adverse events, and how to decide when CR was needed (compared with choosing non-chemical intervention for behavioural emergencies), respecting patients' dignity whilst safeguarding their safety, and preserving safe workplaces for staff, and care environments for other patients. The range of outcome measures suggests opportunities to standardise future research.
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Affiliation(s)
- Eimear Muir-Cochrane
- College of Nursing and Health Sciences, Flinders University, South Australia, Australia, 5042
| | - Candice Oster
- On-Line Education and Development, Flinders Human Behaviour and Health Research Unit (FHBHRU), College of Medicine and Public Health, Flinders University, South Australia, Australia, 5042
| | - Karen Grimmer
- College of Nursing and Health Sciences, Flinders University, South Australia, Australia, 5042.,Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Muir-Cochrane E, Oster C, Gerace A, Dawson S, Damarell R, Grimmer K. The effectiveness of chemical restraint in managing acute agitation and aggression: A systematic review of randomized controlled trials. Int J Ment Health Nurs 2020; 29:110-126. [PMID: 31498960 DOI: 10.1111/inm.12654] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2019] [Indexed: 12/26/2022]
Abstract
One approach to manage people with behaviours of concern including agitated or aggressive behaviours in health care settings is through the use of fast-acting medication, called chemical restraint. Such management often needs to be delivered in crisis situations to patients who are at risk of harm to themselves or others. This paper summarizes the available evidence on the effectiveness and safety of chemical restraint from 21 randomized controlled trials (RCTs) involving 3788 patients. The RCTs were of moderate to high quality and were conducted in pre-hospital, hospital emergency department, or ward settings. Drugs used in chemical restraint included olanzapine, haloperidol, droperidol, risperidol, flunitrazepam, midazolam, promethazine, ziprasidone, sodium valproate, or lorazepam. There was limited comparability between studies in drug choice, combination, dose, method of administration (oral, intramuscular, or intravenous drip), or timing of repeat administrations. There were 31 outcome measures, which were inconsistently reported. They included subjective measures of behaviours, direct measures of treatment effect (time to calm; time to sleep), indirect measures of agitation (staff or patient injuries, duration of agitative or aggressive episodes, subsequent violent episodes), and adverse events. The most common were time to calm and adverse events. There was little clarity about the superiority of any chemical method of managing behaviours of concern exhibited by patients in Emergency Departments or acute mental health settings. Not only is more targeted research essential, but best practice recommendations for such situations requires integrating expert input into the current evidence base.
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Affiliation(s)
- Eimear Muir-Cochrane
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Candice Oster
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Adam Gerace
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia.,School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Suzanne Dawson
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Raechel Damarell
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Karen Grimmer
- College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
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Jordan JT, McNiel DE. Perceived Coercion During Admission Into Psychiatric Hospitalization Increases Risk of Suicide Attempts After Discharge. Suicide Life Threat Behav 2020; 50:180-188. [PMID: 31162700 DOI: 10.1111/sltb.12560] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 05/09/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE There is an elevated risk for suicide in the year following psychiatric hospitalization. The present study examined whether perceived coercion during admission into psychiatric hospitalization increases risk for postdischarge suicide attempts. METHODS Participants were 905 psychiatric inpatients from the MacArthur Violence Risk Assessment Study that were assessed every 10 weeks during the year following discharge. Perceived coercion during admission was assessed while hospitalized, and suicide attempts were assessed following discharge. Analyses adjusted for nonrandom assignment of groups via propensity score weighting and for established correlates of postdischarge suicidal behavior. RESULTS Of 905 participants, 67% endorsed perception of coercion into psychiatric hospitalization, and 168 (19%) made a postdischarge suicide attempt. Patients who perceived coercion during hospitalization admission were more likely to make a suicide attempt after discharge than those who did not, even after adjusting for established covariates (OR = 1.29, |z| = 2.87, p = .004, 95% CI = 1.08, 1.54). There was no interaction between recent self-harm or suicidal ideation at time of admission and perceived coercion on postdischarge suicide attempts. CONCLUSIONS Patients' perception of the context in which they were hospitalized is associated with a small but significant increase in their likelihood of postdischarge suicide attempts.
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Affiliation(s)
- Joshua T Jordan
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Dale E McNiel
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
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Clausen L. Perspectives on Involuntary Treatment of Anorexia Nervosa. Front Psychiatry 2020; 11:533288. [PMID: 33192651 PMCID: PMC7641604 DOI: 10.3389/fpsyt.2020.533288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 09/16/2020] [Indexed: 01/12/2023] Open
Abstract
Involuntary treatment of anorexia nervosa is an option in cases in which the patient's life or other people's lives are at risk or, in some countries, to prevent the deterioration of the illness. Involuntary treatment is often regarded as controversial and has been intensely debated, although typically with few references to documented knowledge. This paper provides a research perspective of the topic by examine data in the field of the involuntary treatment of anorexia nervosa to pinpoint present knowledge as well as areas demanding clinical action or research attention. The prevalence of involuntary treatment in general as well as specific measures is described and possible early markers of patients at risk of involuntary treatment are discussed. Studies including patients' perspectives of involuntary treatment show the complexity of this treatment, its initiation, and its consequences. To qualify future discussions, improve current practice, and minimize involuntary treatment in general as well as on an individual level, at least four areas need attention: (i) the present specific symptoms of anorexia nervosa and their imminent consequences, (ii) illness history, (iii) overall psychiatric symptoms and general functioning, and (iv) contextual sphere of the patient. In particular, the last two require attention from both clinicians and researchers. Furthermore, critical evaluation of the attitudes of both patients and health care professionals toward each other and the treatment is recommended.
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Affiliation(s)
- Loa Clausen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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50
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Sashidharan SP, Mezzina R, Puras D. Reducing coercion in mental healthcare. Epidemiol Psychiatr Sci 2019; 28:605-612. [PMID: 31284895 PMCID: PMC7032511 DOI: 10.1017/s2045796019000350] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/31/2019] [Accepted: 06/01/2019] [Indexed: 11/07/2022] Open
Abstract
AIMS To examine the extent and nature of coercive practices in mental healthcare and to consider the ethical, human rights challenges facing the current clinical practices in this area. We consider the epidemiology of coercion in mental health and appraise the efficacy of attempts to reduce coercion and make specific recommendations for making mental healthcare less coercive and more consensual. METHODS We identified references through searches of MEDLINE, EMBASE, PsycINFO and CINAHL Plus. Search was limited to articles published from January 1980 to May 2018. Searches were carried out using the terms mental health (admission or detain* or detention or coercion) and treatment (forcible or involuntary or seclusion or restraint). Articles published during this period were further identified through searches in the authors' personal files and Google Scholar. Articles resulting from searches and relevant references cited in those articles were reviewed. Articles and reviews of non-psychiatric population, children under 16 years, and those pertaining exclusively to people with dementia were excluded. RESULTS Coercion in its various guises is embedded in mental healthcare. There is very little research in this area and the absence of systematic and routinely collected data is a major barrier to research as well as understanding the nature of coercion and attempts to address this problem. Examples of good practice in this area are limited and there is hardly any evidence pertaining to the generalisability or sustainability of individual programmes. Based on the review, we make specific recommendations to reduce coercive care. Our contention is that this will require more than legislative tinkering and will necessitate a fundamental change in the culture of psychiatry. In particular, we must ensure that clinical practice never compromises people's human rights. It is ethically, clinically and legally necessary to address the problem of coercion and make mental healthcare more consensual. CONCLUSION All forms of coercive practices are inconsistent with human rights-based mental healthcare. This is global challenge that requires urgent action.
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Affiliation(s)
| | - Roberto Mezzina
- Dipartimento di Salute Mentale, WHO Collaborating Centre for Research and Training, ASUI Trieste, Italy
| | - Dainius Puras
- Clinic of Psychiatry, Faculty of Medicine, Vilnius University, Lithuania
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