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Zhao J, Bolshaw-Walker H, Hilton NZ. Engaging forensic psychiatry patients in health-care decision making. Lancet Psychiatry 2024; 11:165-167. [PMID: 38237617 DOI: 10.1016/s2215-0366(23)00427-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 02/17/2024]
Affiliation(s)
- Junqiang Zhao
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, ON, L9M 1G3, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - Helen Bolshaw-Walker
- Patient, Client and Family Council, Waypoint Centre for Mental Health Care, ON, L9M 1G3, Canada
| | - N Zoe Hilton
- Waypoint Research Institute, Waypoint Centre for Mental Health Care, ON, L9M 1G3, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Cameron J, Thurlin M, Hilton NZ, Ball LC, Marshall L, Kolla NJ. Privacy and safety: Issues of dual compliance in high-secure and other forensic psychiatric hospitals. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2022; 82:101780. [PMID: 35279456 DOI: 10.1016/j.ijlp.2022.101780] [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: 05/18/2021] [Revised: 01/30/2022] [Accepted: 02/11/2022] [Indexed: 06/14/2023]
Abstract
Health care organizations are obligated to provide safe and effective treatment to their patients and also protect the safety of their workers. This paper analyzes the tensions arising from legislative regimes that, respectively, protect privacy and workplace safety, using a large, tertiary high-secure forensic psychiatric hospital in Ontario, Canada, as an example. In Ontario, the Personal Health Information Protection Act (PHIPA) prohibits personal health information (PHI) from being disclosed to individuals who fall outside the "circle of care," including nonclinical employees who have direct involvement with patients and may be at risk of violence. PHIPA permits the disclosure of information where there is a risk of violence, but the statute's scheme for privacy protection was not designed to address, and may not be compatible with, the operations and requirements of high-secure forensic and other psychiatric hospitals. At the same time, the Occupational Health and Safety Act (OHSA) creates a regulatory framework that sets health and safety standards, including an employer's duty to disclose the risk of violence. OHSA prosecutions and proceedings demonstrate how these duties have been enforced against psychiatric hospitals. We examine this regulatory backdrop, explaining that PHIPA provides little guidance to psychiatric hospitals, where the risk of violence is elevated. We also discuss issues of dual compliance that arise from a hospital's legal obligations under PHIPA and OHSA. Finally, we turn to the ongoing clinical and operational challenges, suggesting strategies for increasing staff safety. These include strengthening the therapeutic alliance and providing patients with the option of consenting to disclosure of PHI to those outside the circle of care.
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Affiliation(s)
- Jamie Cameron
- Professor Emerita, Osgoode Hall Law School, York University, Toronto, Ontario, Canada
| | - Matti Thurlin
- Osgoode Hall Law School, York University, Toronto, Ontario, Canada
| | - N Zoe Hilton
- Waypoint Centre for Mental Health Care, Penetaguishene, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Laura C Ball
- Waypoint Centre for Mental Health Care, Penetaguishene, Ontario, Canada
| | - Liam Marshall
- Waypoint Centre for Mental Health Care, Penetaguishene, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nathan J Kolla
- Waypoint Centre for Mental Health Care, Penetaguishene, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Waypoint/University of Toronto Research Chair in Forensic Mental Health Science, Penetanguishene, Ontario, Canada.
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van Heesch B, Boucké J, De Somer J, Dekkers I, Jacob E, Jeandarme I. The use of coercive measures in a high security setting in Belgium: Prevalence and risk factors. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2022; 82:101792. [PMID: 35439661 DOI: 10.1016/j.ijlp.2022.101792] [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: 01/10/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 06/14/2023]
Abstract
Coercive measures are often used in forensic psychiatric settings as a strategy to manage violent and other problematic behavior. Few studies have been published regarding the use of coercive measures in high security populations. This is the first empirical study on this subject in Belgium. The aim of the present study was to examine the prevalence rates of coercive measures in Flanders' two high security settings and to identify individual patient risk factors for being subjected to a coercive measure. The study included all patients (N = 654) who were admitted in the Forensic Psychiatric Centres of Antwerp or Ghent over a six-year period. Data on the use of coercive measures (seclusion, mechanical restraint, and chemical restraint) were registered prospectively. Several regression analyses were conducted with multiple independent variables. The results show that half of the population (50.3%) was subjected to at least one coercive measure during admission in one of the high security settings. A small subgroup of patients (6.4%) was the subject of half of all coercive measures (50,4%). Seclusion was the most frequently used coercive measure (48.3%), followed by chemical restraint (20.2%). The prevalence rate of mechanical restraint was very low (0.8%) compared to previous research in similar populations. Various individual risk factors were significantly associated with a higher use of coercive measures. Clinical implications are discussed and the importance of developing international standards on recording and reporting on coercive measures is highlighted.
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Affiliation(s)
- Ben van Heesch
- Forensic Psychiatric Center Ghent, Hurstweg 9, 9000 Ghent, Belgium
| | - Jan Boucké
- Forensic Psychiatric Center, Beatrijslaan 96, 2050 Antwerp, Belgium.
| | - Johanna De Somer
- Forensic Psychiatric Center Ghent, Hurstweg 9, 9000 Ghent, Belgium.
| | - Ingrid Dekkers
- Forensic Psychiatric Center, Beatrijslaan 96, 2050 Antwerp, Belgium.
| | - Elise Jacob
- Forensic Psychiatric Center Ghent, Hurstweg 9, 9000 Ghent, Belgium.
| | - Inge Jeandarme
- Forensic Psychiatric Center, Beatrijslaan 96, 2050 Antwerp, Belgium; KU Leuven, Belgium.
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Goulet MH, Lessard-Deschênes C. Le Modèle de prévention de l’utilisation des mesures de contrôle en santé mentale : une revue intégrative. SANTÉ MENTALE AU QUÉBEC 2022. [DOI: 10.7202/1094149ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Lau S, Brackmann N, Mokros A, Habermeyer E. Aims to Reduce Coercive Measures in Forensic Inpatient Treatment: A 9-Year Observational Study. Front Psychiatry 2020; 11:465. [PMID: 32536881 PMCID: PMC7267051 DOI: 10.3389/fpsyt.2020.00465] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 05/06/2020] [Indexed: 11/13/2022] Open
Abstract
Protecting the human rights is particularly important within the forensic context because patients in forensic psychiatry are not admitted voluntarily and so the treatment itself is of a coercive nature. Coercive measures (i.e., actions against the will of the patient such as forced medication, seclusion or restraint) form an additional incision of personal rights. Although the use of coercion within forensic psychiatric institutions remains controversial, little empirical research has been conducted on the use of coercive measures within forensic settings. The study presented here can contribute to close this research gap by informing about rates of coercive measures within the present institution. National and international organizations on the prevention of torture or inhuman or degrading treatment have emphasized the need to keep the incidents of coercive measures to a minimum. Criticisms by such organizations on high rates of seclusion, restraint, and compulsory medication have led to organizational changes within the present institution which is Switzerland's largest forensic clinic with an average of 124 patients per year. After a first visit of such a committee, e.g., the detailed documentation of coercive measures became obligatory and part of special reports. Changes in the use of coercive measures are presented here. Data on coercive measures was analyzed for years 2010 to 2018. With respect to the most invasive coercive measurement, restraint, a minimum of four patients in 2017 and a maximum of 14 patients in 2010 have been subject to this form of coercive measurement. A minimum of sixteen patients in 2012 and a maximum of 40 patients in 2010 were secluded. Though total number and duration show a trend towards a reduction in severity of coercive measures on average, a few patients are not responsive to deescalating interventions. Preventive mechanisms, documentation standards, and efforts to ensure humane and adequate treatment are discussed under ethical considerations of coercive measures within court mandated treatment.
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Affiliation(s)
- Steffen Lau
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Nathalie Brackmann
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Andreas Mokros
- Department of Psychology, Fern Universität in Hagen, Hagen, Germany
| | - Elmar Habermeyer
- Department of Forensic Psychiatry, University Hospital of Psychiatry Zurich, Zurich, Switzerland
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