Digital Technologies and Coercion in Psychiatry

Integration of Psychiatric Advance Directives Into the Patient-Accessible Electronic Health Record: Exploring the Promise and Limitations

Psychiatric advance directives (PAD), also known as advance statements or advance choice documents, are legal documents that enable people with mental health conditions to specify their treatment preferences in advance for possible future crises. Subtypes of PADs include crisis cards, joint crisis plans, and self-binding directives (also known as Ulysses contracts). These instruments are intended to improve service user involvement and need orientation in the care of mental crises and to avoid traumatization through unwanted treatment. The existing evidence suggests that people who complete a PAD tend to work more cooperatively with their clinician and experience fewer involuntary hospital admissions. Nevertheless, PADs have not been successfully mainstreamed into care due to multiple barriers to the implementation of PADs, mainly around the completion of PADs and their accessibility and use in crises. The reasons for this include the lack of support in the completion process and acceptance problems, especially on the part of professionals. The research to date primarily recommends support for service users from facilitators, such as peer support workers, and training for all stakeholders. In this article, we argue that while these approaches can help to solve completion and acceptance challenges, they are not sufficient to ensure access to PADs in crises. To ensure accessibility, we propose digital PADs, which offer considerable potential for overcoming these aforementioned barriers. Embedded in national health data infrastructures, PADs could be completed and accessed by service users themselves, possibly with the support of facilitators, and retrieved by any clinic in an emergency. We highlight the strengths and limitations of digital PADs and point out that the proposed solutions must be developed collaboratively and take into account digital inequalities to be effective support for people with serious mental health conditions.

Utilization and effects of security technologies in mental health: A scoping review

Violence in healthcare is an urgent and increasing issue. Mental health settings are particularly affected, with severe negative impacts on staff, patients, and organizations. Security technologies could help maintain and improve safety in this field. However, knowledge of their utilization and effectiveness in mental health is lacking. A scoping review was conducted using the methodology recommended by the Joanna Briggs Institute to map research on the utilization and effects of security technologies in mental health, identify how research is currently performed, and highlight gaps in the existing knowledge. Literature search for peer-reviewed publications was performed on PubMed, CINAHL, PsycInfo, Embase, and Scopus. Following the screening process and the eligibility criteria, 22 articles were included in this review. The publication range was 2002-2020, many studies were surveys, and European countries were the most investigated, especially the United Kingdom. Overall, the use of 10 different technologies was reported 46 times. The most represented category was alarms, followed by video cameras, other technologies (such as wearable sensors), and metal detectors. More than half of the included papers reported positive effects of these measures on safety. This review indicates that several security technologies are available in mental health settings, with encouraging positive safety outcomes for both patients and healthcare professionals, especially nurses. However, research on the topic is still emerging, with a limited number of sources and a few high-quality designed studies. Therefore, future research should focus on producing evidence on the availability and effectiveness of these measures in mental health settings across countries.

Guidelines to Establish an Equitable Mobile Health Ecosystem

Mobile health (mHealth)-that is, use of mobile devices, such as mobile phones, monitoring devices, personal digital assistants, and other wireless devices, in medical care-is a promising approach to the provision of support services. mHealth may aid in facilitating monitoring of mental health conditions, offering peer support, providing psychoeducation (i.e., information about mental health conditions), and delivering evidence-based practices. However, some groups may fail to benefit from mHealth despite a high need for mental health services, including people from racially and ethnically disadvantaged groups, rural residents, individuals who are socioeconomically disadvantaged, and people with disabilities. A well-designed mHealth ecosystem that considers multiple elements of design, development, and implementation can afford disadvantaged populations the opportunity to address inequities and facilitate access to and uptake of mHealth. This article proposes inclusion of the following principles and standards in the development of an mHealth ecosystem of equity: use a human-centered design, reduce bias in machine-learning analytical techniques, promote inclusivity via mHealth design features, facilitate informed decision making in technology selection, embrace adaptive technology, promote digital literacy through mHealth by teaching patients how to use the technology, and facilitate access to mHealth to improve health outcomes.

What evidence supports the use of Body Worn Cameras in mental health inpatient wards? A systematic review and narrative synthesis of the effects of Body Worn Cameras in public sector services

Body-Worn-Cameras (BWCs) are being introduced into Mental Health Inpatient Units. At present, minimal evidence surrounding their use in a mental health environment exists. This review examined research on the uses of BWCs in public sector services including healthcare, public transportation, and law enforcement. All eligible studies included a visible BWC, recording on a continuous loop as the main intervention. The evidence base presented high levels of bias, highly varied camera protocols, and heterogeneity of outcome measurements. This review found there is limited evidence for the efficacy of BWCs to control and manage violence within mental health inpatient wards. The technology has shown to be effective in reducing the number of public complaints in a law enforcement setting, but it is unclear how this is achieved. It appears there may be potential beneficial uses and unintended consequences of BWCs yet to be explored by mental health services.