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Baker J, Kendal S, Bojke C, Louch G, Halligan D, Shafiq S, Sturley C, Walker L, Brown M, Berzins K, Brierley-Jones L, O'Hara JK, Blackwell K, Wormald G, Canvin K, Vincent C. A service-user digital intervention to collect real-time safety information on acute, adult mental health wards: the WardSonar mixed-methods study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-182. [PMID: 38794956 DOI: 10.3310/udbq8402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Background Acute inpatient mental health services report high levels of safety incidents. The application of patient safety theory has been sparse, particularly concerning interventions that proactively seek patient perspectives. Objective(s) Develop and evaluate a theoretically based, digital monitoring tool to collect real-time information from patients on acute adult mental health wards about their perceptions of ward safety. Design Theory-informed mixed-methods study. A prototype digital monitoring tool was developed from a co-design approach, implemented in hospital settings, and subjected to qualitative and quantitative evaluation. Setting and methods Phase 1: scoping review of the literature on patient involvement in safety interventions in acute mental health care; evidence scan of digital technology in mental health contexts; qualitative interviews with mental health patients and staff about perspectives on ward safety. This, alongside stakeholder engagement with advisory groups, service users and health professionals, informed the development processes. Most data collection was virtual. Phase 1 resulted in the technical development of a theoretically based digital monitoring tool that collected patient feedback for proactive safety monitoring. Phase 2: implementation of the tool in six adult acute mental health wards across two UK NHS trusts; evaluation via focused ethnography and qualitative interviews. Statistical analysis of WardSonar data and routine ward data involving construction of an hour-by-hour data set per ward, permitting detailed analysis of the use of the WardSonar tool. Participants A total of 8 patients and 13 mental health professionals participated in Phase 1 interviews; 33 staff and 34 patients participated in Phase 2 interviews. Interventions Patients could use a web application (the WardSonar tool) to record real-time perceptions of ward safety. Staff could access aggregated, anonymous data to inform timely interventions. Results Coronavirus disease 2019 restrictions greatly impacted the study. Stakeholder engagement permeated the project. Phase 1 delivered a theory-based, collaboratively designed digital tool for proactive patient safety monitoring. Phase 2 showed that the tool was user friendly and broadly acceptable to patients and staff. The aggregated safety data were infrequently used by staff. Feasibility depended on engaged staff and embedding use of the tool in ward routines. There is strong evidence that an incident leads to increased probability of further incidents within the next 4 hours. This puts a measure on the extent to which social/behavioural contagion persists. There is weak evidence to suggest that an incident leads to a greater use of the WardSonar tool in the following hour, but none to suggest that ward atmosphere predicts future incidents. Therefore, how often patients use the tool seems to send a stronger signal about potential incidents than patients' real-time reports about ward atmosphere. Limitations Implementation was limited to two NHS trusts. Coronavirus disease 2019 impacted design processes including stakeholder engagement; implementation; and evaluation of the monitoring tool in routine clinical practice. Higher uptake could enhance validity of the results. Conclusions WardSonar has the potential to provide a valuable route for patients to communicate safety concerns. The WardSonar monitoring tool has a strong patient perspective and uses proactive real-time safety monitoring rather than traditional retrospective data review. Future work The WardSonar tool can be refined and tested further in a post Coronavirus disease 2019 context. Study registration This study is registered as ISRCTN14470430. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128070) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 14. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- John Baker
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | - Sarah Kendal
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | - Chris Bojke
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Gemma Louch
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Daisy Halligan
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | - Saba Shafiq
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | | | - Lauren Walker
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Mark Brown
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Kathryn Berzins
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | | | - Jane K O'Hara
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | | | - Gemma Wormald
- Department of Health Sciences, University of York, York, UK
| | - Krysia Canvin
- School of Healthcare, Baines Wing, University of Leeds, Leeds, UK
| | - Charles Vincent
- Social Spider CIC, The Mill (Community Centre), London, UK
- Thrive by Design, Leeds, UK
- University of Oxford Medical Sciences Division, Oxford, UK
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Rodríguez-Labajos L, Kinloch J, Grant S, O’Brien G. The Role of the Built Environment as a Therapeutic Intervention in Mental Health Facilities: A Systematic Literature Review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024; 17:281-308. [PMID: 38385552 PMCID: PMC11080396 DOI: 10.1177/19375867231219031] [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: 02/23/2024]
Abstract
OBJECTIVES This systematic literature review synthesizes and assesses empirical research concerning the use of the built environment as a therapeutic intervention in adult mental health inpatient facilities. The review explores the impact of facility design on patient outcomes. BACKGROUND There is a growing recognition that the built environment in mental health facilities must strike a balance between ensuring safety and providing a therapeutic atmosphere. A review addressing how facility design contributes to this therapeutic environment is warranted. METHODS Database searches were conducted in CINAHL, Embase, PsychInfo, PubMed, and Web of Science from inception up to March 10, 2022. The Scottish Intercollegiate Guidelines Network (SIGN50) critical appraisal checklists were used to assess the quality of included studies. RESULTS Of the 44 peer-reviewed studies identified from nine countries, several factors emerged as vital for the therapeutic environment in mental health inpatient facilities. These included personal spaces prioritizing privacy and control of the environment, daylight-optimized spaces, versatile communal areas promoting activities and interaction, designated areas for visits and spiritual/contemplative reflection, homelike environments, the inclusion of artwork in units, open nursing stations, and dedicated female-only areas. Yet, there is a need for research yielding stronger evidence-based designs harmonizing with therapeutic needs. CONCLUSION This review offers initial guidance on designing mental health facilities that foster a therapeutic environment, while highlighting that the influence of facility design on mental health inpatients is considerably under-researched.
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Affiliation(s)
| | - Joanne Kinloch
- Research Service, NHSScotland Assure, NHS National Services Scotland, Glasgow, Scotland
| | - Susan Grant
- Procurement, Commissioning and Facilities, NHSScotland Assure, NHS National Services Scotland, Glasgow, Scotland
| | - Geraldine O’Brien
- Research Service, NHSScotland Assure, NHS National Services Scotland, Glasgow, Scotland
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O'Donoghue J, Young M. Impact of a high observation ward on seclusion and restraint episodes. Ir J Psychol Med 2024; 41:159-160. [PMID: 36081189 DOI: 10.1017/ipm.2022.42] [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] [Indexed: 11/07/2022]
Affiliation(s)
- J O'Donoghue
- Basic Specialist Training with University College Cork Deanery, Cork, Ireland
| | - M Young
- Kerry Mental Health Services, Tralee, Kerry, Ireland
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Dauriac-Le Masson V, El-Khoury Lesueur F, Lahaye J, Launay C, Christodoulou A, Boiteux C, Maman J, Bonnemaison X, Perquier F, Vacheron MN. Characteristics and correlates of seclusion and mechanical restraint measures in a Parisian psychiatric hospital group. Front Psychiatry 2024; 15:1296356. [PMID: 38445090 PMCID: PMC10913196 DOI: 10.3389/fpsyt.2024.1296356] [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: 09/18/2023] [Accepted: 02/02/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Seclusion or restraint (S/R) are last-resort measures used in psychiatry to ensure the safety of the patient and the staff. However, they have harmful physical and psychological effects on patients, and efforts to limit their use are needed. We describe the characteristics and correlates of S/R events in four Parisian psychiatric centers. Methods Within a 3-month period, November 5, 2018 to February 3, 2019, we recorded data for patients experiencing an S/R measure as well as characteristics of the measures. We studied the mean duration of a S/R event, the time between hospital admission and the occurrence of the event, as well as correlates of these durations. We also examined factors associated with use of a restraint versus a seclusion measure. Results For the 233 patients included, we recorded 217 seclusion measures and 64 mechanical restraints. Seclusion measures mostly occurred after the patient's transfer from the emergency department. The duration of a seclusion measure was about 10 days. Patients considered resistant to psychotropic treatments more frequently had a longer seclusion duration than others. The mean duration of a mechanical restraint measure was 4 days. Male sex and younger age were associated with experiencing mechanical restraint. Discussion S/R measures mostly occur among patients perceived as resistant to psychotropic drugs who are arriving from the emergency department. Developing specific emergency department protocols might be useful in limiting the use of coercive measures.
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Affiliation(s)
| | - Fabienne El-Khoury Lesueur
- Cellule épidémiologie, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Sorbonne Universite, INSERM UMRS_1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, Paris, France
| | - Justine Lahaye
- Cellule épidémiologie, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Corinne Launay
- Pôle Psychiatrie Précarité, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | | | | | | | | | - Florence Perquier
- Cellule épidémiologie, GHU Paris Psychiatrie et Neurosciences, Paris, France
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Whittington R, Aluh DO, Caldas-de-Almeida JM. Zero Tolerance for Coercion? Historical, Cultural and Organisational Contexts for Effective Implementation of Coercion-Free Mental Health Services around the World. Healthcare (Basel) 2023; 11:2834. [PMID: 37957978 PMCID: PMC10650021 DOI: 10.3390/healthcare11212834] [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: 06/28/2023] [Revised: 10/10/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023] Open
Abstract
Coercion of service users/patients when receiving care and treatment has been a serious dilemma for mental health services since at least the 18th century, and the debate about how best to minimise or even eradicate compulsion remains intense. Coercion is now, once again and rightly, at the top of the international policy agenda and the COST Action 'FOSTREN' is one example of a renewed commitment by service user advocates, practitioners and researchers to move forward in seriously addressing this problem. The focus of service improvement efforts has moved from pure innovation to practical implementation of effective interventions based on an understanding of the historical, cultural and political realities in which mental health services operate. These realities and their impact on the potential for change vary between countries across Europe and beyond. This article provides a novel overview by focusing on the historical, cultural and political contexts which relate to successful implementation primarily in Europe, North America and Australasia so that policy and practice in these and other regions can be adopted with an awareness of these potentially relevant factors. It also outlines some key aspects of current knowledge about the leading coercion-reduction interventions which might be considered when redesigning mental health services.
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Affiliation(s)
- Richard Whittington
- Centre for Research & Education in Security, Prisons and Forensic Psychiatry, Forensic Department Østmarka, St. Olav’s Hospital, 7030 Trondheim, Norway
- Department of Mental Health, Norwegian University of Science & Technology (NTNU), 7034 Trondheim, Norway
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool L69 3BX, UK
| | - Deborah Oyine Aluh
- Lisbon Institute of Global Mental Health, Comprehensive Health Research Centre, Nova Medical School, 1169-056 Lisbon, Portugal
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nsukka 410105, Nigeria
| | - Jose-Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health, Comprehensive Health Research Centre, Nova Medical School, 1169-056 Lisbon, Portugal
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Wilson RL, Hutton A, Foureur M. Promoting mental health recovery by design: Physical, procedural, and relational security in the context of the mental health built environment. Int J Ment Health Nurs 2023; 32:147-161. [PMID: 36097405 DOI: 10.1111/inm.13070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 01/14/2023]
Abstract
The rates of mental health hospitalisations in Australia are rising. This paper presents the findings of a study undertaken in a regional mental health unit. The aim of the study was to obtain user perspectives to inform the redesign of the unit, which provides inpatient mental health services to rural and regional adults. A qualitative descriptive study with data collected via focus groups and in-depth interviews was undertaken with 38 participants, including current inpatients, carers and 27 staff members of a single regional inpatient mental health unit. The 25-bed mental health inpatient unit accommodates adults from 18+ years of age. The mental health unit sits within a referral hospital precinct and is associated with community-based mental health services within a large regional and rural Australian public health service. The analysis of interviews and focus groups with patients, carers and mental health professionals revealed three major themes congruent with the literature These were: Firstly, Theme 1: Rooms should be designed to promote physical security. Next, Theme 2: Purposeful planning to support interactions between users and systems will promote relational security. And finally, Theme 3: Optimizing service integrity should promote procedural security. Based on the themes arising from the study, a list of recommendations was produced to inform the design of a new build for a regional mental health unit. In particular, all users of the space should expect that the built environment will promote their physical security and psychological safety and accommodate a wide range of diversity and acuity. The aesthetics should align with the promotion of recovery in the context of person-centred and trauma-informed models of care. Designers should plan to alleviate boredom and accommodate meaningful wayfinding. Mental health nurses should have spaces that support their work without compromising their relational security with consumers. Building designers should optimize therapeutic environments to facilitate dignified intensive and stabilizing treatments and eliminate vicarious stigma associated with caring for people with mental illness. This study provides valuable insights from a community of users who have experienced receiving and delivering mental health care within a regional and rural mental health unit.
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Affiliation(s)
- Rhonda L Wilson
- School of Nursing and Midwifery, University of Newcastle, Gosford, New South Wales, Australia.,School of Nursing, Massey University, Auckland, New Zealand
| | - Alison Hutton
- School of Nursing and Midwifery, University of Newcastle, Gosford, New South Wales, Australia
| | - Maralyn Foureur
- School of Nursing and Midwifery, University of Newcastle, Gosford, New South Wales, Australia
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Vahidi M, Namdar Areshtanab H, Ebrahimi H, Asghari Jafarabadi M. Development of "The Safe Psychiatric Ward Battery". Clin Nurs Res 2023; 32:375-383. [PMID: 35440215 DOI: 10.1177/10547738221085614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study reports the development process and psychometric testing of the safe environment in psychiatric wards instrument. In this mixed-methods study, the concept of a safe environment was explained with a qualitative study by performing semi-structured interviews with patients and staff and ward observation. Then, the items of the instrument were designed using qualitative data and a literature review. Content and construct validity, internal consistency, stability, and inter-rater agreement were evaluated. This study produced an instrument consisting of two sections. The first section was a scale (α = .920). Exploratory factor analysis of the scale identified two dimensions of "engagement" (α = .931) and "perception" of the physical environment (α = .760). The second section was a checklist with two dimensions, "accident-free living environment" and "staff empowerment." The intra-class correlation coefficients for the scale and checklist were .912 and .809, respectively. This study suggests that this instrument is a valid and reliable tool to assess safety in psychiatric wards.
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Faerden A, Rosenqvist C, Håkansson M, Strøm-Gundersen E, Stav Å, Svartsund J, Røssæg T, Davik N, Kvarstein E, Pedersen G, Dieset I, Nyrud AQ, Weedon-Fekjær H, Kistorp KM. Environmental Transformations Enhancing Dignity in an Acute Psychiatric Ward: Outcome of a User-Driven Service Design Project. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2022; 16:55-72. [PMID: 36567605 PMCID: PMC10133780 DOI: 10.1177/19375867221136558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The goal of the current project was to enhance the feeling of dignity for patients in the seclusion unit in an acute psychiatric ward through environmental design changes and to evaluate the effect of the refurbishment. BACKGROUND Treating people with dignity is essential in all health-related work and important for our mental health. Hospital architecture and design signal values that can promote dignity. Patients who must spend time in seclusion are at their most vulnerable mental state and the often worn-down like environment can challenge the feeling of dignity. How environmental design can promote dignity in seclusion units have not been studied. METHODS To reach suggestions for design changes enhancing dignity, we used service design that included a broad user group. The effect of design changes was evaluated by a questionnaire answered by the nursing staff during a 4-week period pre- and post refurbishment and included a control group. RESULTS The design concepts agreed upon were a welcoming atmosphere, contact with nature, room for privacy, close contact with staff, and a designated smoking area inside the unit. The evaluation found that the environmental design changes significantly supported the patients in their situation and the staff in their work. CONCLUSION We conclude that dignity design concepts are highly applicable also in an acute psychiatric setting and improve the situation of secluded mental health patients, which is much needed. Findings align with other environmental changes in psychiatric wards that improve the patients' well-being and reduce aggression.
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Affiliation(s)
- Ann Faerden
- Department of Acute Psychiatry, Oslo University Hospital, Norway
| | - Christine Rosenqvist
- User Representative Advisory Board, Department of Acute Psychiatry, Oslo University Hospital, Norway
| | | | | | | | | | - Trude Røssæg
- Department of Acute Psychiatry, Oslo University Hospital, Norway
| | - Nils Davik
- Department of Acute Psychiatry, Oslo University Hospital, Norway
| | - Elfrida Kvarstein
- Section for Personality Psychiatry and Specialized Treatment, Oslo University Hospital, Norway
| | - Geir Pedersen
- Section for Personality Psychiatry and Specialized Treatment, Oslo University Hospital, Norway
| | - Ingrid Dieset
- Department of Acute Psychiatry, Oslo University Hospital, Norway
| | | | - Harald Weedon-Fekjær
- Oslo Center for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Norway
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Bramesfeld A, Röding D. Der Einfluss des Behandlungsvolumens psychiatrischer Kliniken auf das
Risiko der Anwendung besonderer Sicherungsmaßnahmen. PSYCHIATRISCHE PRAXIS 2022; 50:122-127. [PMID: 36126935 DOI: 10.1055/a-1914-8459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Zusammenfassung
Ziel Bestimmen des Einflusses des Behandlungsvolumens auf die
Häufigkeit und Dauer der Anwendung von Besonderen
Sicherungsmaßnahmen (bSm) wie Fixierung und Isolierung.
Methode Datenbasis sind krankenhausbezogene Registerdaten aus
Niedersachsen der Halbjahre 2/2019 bis 1/2021 zu Fällen,
die nach dem Niedersächsischen Gesetz für Psychisch Kranke
(NPsychKG) untergebracht sind, zum Anteil der Fälle, die eine bSm
erhielten sowie zur Anzahl und kumulativen Dauer von bSm/Fall. Es wurden
einfache lineare Regressionsmodelle gerechnet.
Ergebnis und Diskussion Mit Zunahme des Behandlungsvolumens von nach
NPsychKG untergebrachten Fällen sinkt der Anteil der Fälle, die
bSm erhalten. Dieses Ergebnis bleibt bestehen auch wenn statistische
Ausreißer aus den Berechnungen herausgelassen werden.
Schlussfolgerung Angesichts von Hinweisen, dass auch in der
psychiatrischen Versorgung das Behandlungsvolumen mit dem gewünschten
Behandlungsziel assoziiert ist, sollte das Spannungsfeld wohnortnahe
vollstationäre Versorgung in kleinen Kliniken versus Konzentration von
Expertise in Zentren diskutiert werden.
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Affiliation(s)
- Anke Bramesfeld
- Institut für Epidemiologie, Sozialmedizin und
Gesundheitssystemforschung, Medizinische Hochschule Hannover, Hannover,
Germany
| | - Dominik Röding
- Institut für Epidemiologie, Sozialmedizin und
Gesundheitssystemforschung, Medizinische Hochschule Hannover, Hannover,
Germany
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Dror C, Hertz-Palmor N, Barzilai Y, Gila S, Tali BZ, Alex G, Tal L, Maya KL, Talia S, Doron G, Bloch Y. Youth Psychiatric Hospitalization in Israel during COVID-19: A Multi-Center Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9870. [PMID: 36011509 PMCID: PMC9407708 DOI: 10.3390/ijerph19169870] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
During the COVID-19 pandemic there have been numerous reports of increases in psychiatric morbidity and a deterioration of status among existing patients. There is little information about how this increase has affected youth and rates of adolescent psychiatric hospitalization. Our study was aimed at examining trends in youth psychiatric hospitalization during the first year of the COVID-19 pandemic. Method: We used medical records to compare trends in hospitalization rates from 2019 to 2020, among psychiatric youth wards from five different centers in Israel. Results: The number of patients that were hospitalized in youth psychiatric wards decreased significantly from 2019 (Mean ± SD=52.2 ± 28.6 per month) to 2020 (M ± SD = 40.8 ± 22.0; unstandardized B = −11.4, 95% CI = −14.4 to −8.3, p < 0.0001). There was a significant decrease in the number of patients that were hospitalized due to internalizing disorders from 2019 (M ± SD = 22.3 ± 9.3 per month) to 2020 (M ± SD = 16.8 ± 7.7; B = −5.5, 95% CI = −8.0 to −3.0, p = 0.0002) and a marginally significant increase in the number of restraints per month (2019: M ± SD = 2.8 ± 6.8, 2020: M ± SD = 9.0 ± 14.5; Z = −1.96, Rosenthal’s r = 0.36, p = 0.07). Conclusions: There was a significant decline in psychiatric hospitalizations during the pandemic, specifically among patients suffering from internalizing disorders. The reasons for this decline, and the future impact these changes had on hospitalizations during the pandemic demand further research. Study limitations: This is a retrospective multicenter study from five medical centers in Israel, therefore generalizability of our findings is limited.
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Affiliation(s)
- Chen Dror
- The Emotion-Cognition Research Center, Shalvata Mental Health Center, Hod Hasharon 45100, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Nimrod Hertz-Palmor
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
- Sheba Medical Center, Ramat Gan 52621, Israel
| | - Yael Barzilai
- The Emotion-Cognition Research Center, Shalvata Mental Health Center, Hod Hasharon 45100, Israel
| | - Schoen Gila
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
- Geha Mental Health Center, Petah Tikva 49100, Israel
| | - Bretler-Zager Tali
- Ziv Medical Center (Safed), Safed 13100, Israel
- The Azrieli Faculty of Medicine, Bar-Ilan University, Poriya 15208, Israel
| | - Gizunterman Alex
- Eitanim Mental Health Center, Harav Rafael Katzalbogen, Jerusalem 9097200, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112102, Israel
| | - Lahav Tal
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
- Nes-ziona Mental Health Center, Beer Yaakov 70350, Israel
| | - Kritchmann-Lupo Maya
- The Emotion-Cognition Research Center, Shalvata Mental Health Center, Hod Hasharon 45100, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Saker Talia
- The Emotion-Cognition Research Center, Shalvata Mental Health Center, Hod Hasharon 45100, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
| | - Gothelf Doron
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
- Sheba Medical Center, Ramat Gan 52621, Israel
| | - Yuval Bloch
- The Emotion-Cognition Research Center, Shalvata Mental Health Center, Hod Hasharon 45100, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, Israel
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Fukasawa M, Miyake M, Kikkawa T, Sueyasu T. Development of the Japanese version of Staff Attitude to Coercion Scale. Front Psychiatry 2022; 13:1026676. [PMID: 36325534 PMCID: PMC9618617 DOI: 10.3389/fpsyt.2022.1026676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/30/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND An important factor in proceeding the efforts to reduce coercion in psychiatry is the attitudes of clinical staff toward its use. We aimed to develop the Japanese version of the Staff Attitude to Coercion Scale (SACS) and clarify its psychometric properties. METHODS After the translation and back-translation of the SACS, which includes 15 items consisting of three subscales, we conducted an anonymous self-administered questionnaire survey of clinical staffs working in 17 wards in two psychiatric hospitals. We administered the second survey to some of the participants to confirm the test-retest reliability. Additionally, we obtained information regarding the 17 wards from the institutions. Internal consistency was assessed using Cronbach's alpha coefficients. Test-retest reliability was assessed using intraclass correlation coefficients (ICC). Structural validity was examined using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). For construct validity, the correlation of the SACS score within wards and its association with the actual use of seclusion/restraints were explored using multilevel multivariate linear regression analyses. RESULTS We used 261 (67.1%) responses, 35 responses of which were also used to examine test-retest reliability. Cronbach's alpha coefficients (0.761) and ICC (0.738) indicated good reliability. The results of CFA based on the original three-dimensional structure did not indicate a good fit (CFA = 0.830, RMSEA = 0.088). EFA suggested a four-factor structure, two of which were almost consistent with the original two subscales. The correlation of the SACS score within wards was confirmed while a positive association with the actual use of seclusion/restraints was not identified. CONCLUSION While the original three-dimensional structure was not replicated, construct validity was partially confirmed. Reliability of the total scale was good. In Japan, although using the subscales was not recommended, using the total scale of SACS seemed acceptable.
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Affiliation(s)
- Maiko Fukasawa
- Health Promotion Center, Fukushima Medical University, Fukushima, Japan
| | - Michi Miyake
- Department of Public Mental Health Research, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Takahiro Kikkawa
- Faculty of Nursing, Undergraduate School of Medicine, Tokai University, Isehara, Japan
| | - Tamio Sueyasu
- Department of Nursing, School of Health Sciences, Bukkyo University, Kyoto, Japan
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Ross T, Bulla J, Fontao MI. Space and Well-Being in High Security Environments. Front Psychiatry 2022; 13:894520. [PMID: 35711591 PMCID: PMC9195501 DOI: 10.3389/fpsyt.2022.894520] [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] [Received: 03/11/2022] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
Research into the spatial dimensions of deprivation of liberty and psychiatric hospitalization has a long and complex tradition. In this context, the increasing numbers of prisoners and patients in forensic hospitals have impressively shown how difficult it is to ensure security, therapy and rehabilitation when space is scarce or not well-suited. In this narrative review, we present the main findings of recent lines of research on spaces in prisons and forensic psychiatric wards, with particular attention to the links between overcrowding in prisons and secure forensic psychiatric hospitals and violence, the foundations of prison and hospital architecture, and on how the design of spaces in prisons and hospitals can influence well-being. We assess and discuss these findings in the context of the current debate on how well-being in secure spaces can support the achievement of rehabilitation goals even in overcrowded institutions.
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Affiliation(s)
- Thomas Ross
- Forensic Psychiatry and Psychotherapy, Reichenau Psychiatric Center, Reichenau, Germany
| | - Jan Bulla
- Forensic Psychiatry and Psychotherapy, Reichenau Psychiatric Center, Reichenau, Germany
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Ruud T, Haugom EW, Pincus HA, Hynnekleiv T. Measuring Seclusion in Psychiatric Intensive Care: Development and Measurement Properties of the Clinical Seclusion Checklist. Front Psychiatry 2021; 12:768500. [PMID: 35002798 PMCID: PMC8733687 DOI: 10.3389/fpsyt.2021.768500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Acute psychiatric units in general hospitals must ensure that acutely disturbed patients do not harm themselves or others, and simultaneously provide care and treatment and help patients regain control of their behavior. This led to the development of strategies for the seclusion of a patient in this state within a particular area separated from other patients in the ward. While versions of this practice have been used in different countries and settings, a systematic framework for describing the various parameters and types of seclusion interventions has not been available. The aims of the project were to develop and test a valid and reliable checklist for characterizing seclusion in inpatient psychiatric care. Methods: Development and testing of the checklist were accomplished in five stages. Staff in psychiatric units completed detailed descriptions of seclusion episodes. Elements of seclusion were identified by thematic analysis of this material, and consensus regarding these elements was achieved through a Delphi process comprising two rounds. Good content validity was ensured through the sample of seclusion episodes and the representative participants in the Delphi process. The first draft of the checklist was revised based on testing by clinicians assessing seclusion episodes. The revised checklist with six reasons for and 10 elements of seclusion was tested with different response scales, and acceptable interrater reliability was achieved. Results: The Clinical Seclusion Checklist is a brief and feasible tool measuring six reasons for seclusion, 10 elements of seclusion, and four contextual factors. It was developed through a transparent process and exhibited good content validity and acceptable interrater reliability. Conclusion: The checklist is a step toward achieving valid and clinically relevant measurements of seclusion. Its use in psychiatric units may contribute to quality assurance, more reliable statistics and comparisons across sites and periods, improved research on patients' experiences of seclusion and its effects, reduction of negative consequences of seclusion, and improvement of psychiatric intensive care.
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Affiliation(s)
- Torleif Ruud
- Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Espen Woldsengen Haugom
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Acute Psychiatry and Psychosis Treatment, Sanderud, Division of Mental Health, Innlandet Hospital Trust, Ottestad, Norway
| | - Harold Alan Pincus
- Department of Psychiatry and Irving Institute for Clinical and Translational Research, Columbia University, New York City, NY, United States
- New York State Psychiatric Institute, New York City, NY, United States
| | - Torfinn Hynnekleiv
- Department of Acute Psychiatry and Psychosis Treatment, Division of Mental Health, Innlandet Hospital Trust, Reinsvoll, Norway
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van Melle AL, van der Ham AJ, Widdershoven GAM, Voskes Y. Implementation of High and Intensive Care (HIC) in the Netherlands: a Process Evaluation. Psychiatr Q 2021; 92:1327-1339. [PMID: 33772426 PMCID: PMC8531100 DOI: 10.1007/s11126-021-09906-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2021] [Indexed: 11/25/2022]
Abstract
The High and Intensive Care model (HIC) was developed to reduce coercion and improve the quality of acute mental health care in the Netherlands. This study aimed to identify drivers of change which motivate professionals and management to implement HIC, and to identify facilitators and barriers to the implementation process. 41 interviews were conducted with multiple disciplines on 29 closed acute admission wards for adult psychiatric patients of 21 mental healthcare institutions in the Netherlands. The interviews were analysed by means of thematic analysis, consisting of the steps of open coding, axial coding and selective coding. Findings reveal three major drivers of change: the combination of existing interventions in one overall approach to reduce coercion, the focus on contact and cooperation and the alignment with recovery oriented care. Facilitators to implementation of HIC were leadership, involving staff, making choices about what to implement first, using positive feedback and celebrating successes, training and reflection, and providing operationalizable goals. Barriers included the lack of formal organizational support, resistance to change, shortage of staff and use of flex workers, time restraints and costs, lack of knowledge, lack of facilities, and envisaged shortcomings of the HIC standards. Drivers of change motivate staff to implement HIC. In the process of implementation, attention to facilitators and barriers on the level of culture, structure and practice is needed.
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Affiliation(s)
- A Laura van Melle
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, Netherlands. .,GGZ inGeest, Amsterdam, The Netherlands.
| | - Alida J van der Ham
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, Netherlands
| | | | - Yolande Voskes
- Department of Ethics, Law and Humanities, Amsterdam UMC, Amsterdam, Netherlands.,Mental Healthcare Centre GGZ Breburg, Tilburg, The Netherlands.,Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands
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15
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Seclusion in an enriched environment versus seclusion as usual: A quasi-experimental study using mixed methods. PLoS One 2021; 16:e0259620. [PMID: 34762714 PMCID: PMC8584674 DOI: 10.1371/journal.pone.0259620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/25/2021] [Indexed: 11/27/2022] Open
Abstract
Background For patients, seclusion during psychiatric treatment is often a traumatic experience. To prevent such experiences, adjustments in the design of seclusion rooms have been recommended. Methods As there have been no empirical studies on the matter, we used a quasi-experimental design to compare the experiences in seclusion of two groups of patients: 26 who had been secluded in a room designed according to the principles of healing environment, a so called ‘Enriched Environment Seclusion room’ (EES), and 27 who had been secluded in a regular seclusion (RS) room. The enrichment included audio-visual facilities, a fixed toilet, a couch and a self-service system to adjust light, colour, blinds and temperature according to the patient’s preferences. Insight into their experiences was obtained using the Patient View-of-Seclusion Questionnaire, which comprises nine statements on seclusion, supplemented with open-ended questions. Results The responses regarding seclusion experiences between the two groups did not differ significantly (U = 280.00, p = .21, r = -.17). Although those who had been secluded in the specially designed room had greatly appreciated the opportunities for distraction, and those who had been secluded in a regular seclusion room expressed the need for more distracting activities during seclusion, both groups described seclusion as a dreadful experience. If seclusion cannot be avoided, patients recommend facilities for distraction (such as those provided in an enriched environment seclusion room) to be available. Conclusion Whatever the physical environment and facilities of a seclusion room, we may thus conclude that seclusion is a burdensome experience.
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Mann K, Gröschel S, Singer S, Breitmaier J, Claus S, Fani M, Rambach S, Salize HJ, Lieb K. Evaluation of coercive measures in different psychiatric hospitals: the impact of institutional characteristics. BMC Psychiatry 2021; 21:419. [PMID: 34419009 PMCID: PMC8380405 DOI: 10.1186/s12888-021-03410-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/05/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Epidemiological studies have demonstrated considerable differences in the use of coercive measures among psychiatric hospitals; however, the underlying reasons for these differences are largely unclear. We investigated to what extent these differences could be explained by institutional factors. METHODS Four psychiatric hospitals with identical responsibilities within the mental health care system, but with different inpatient care organizations, participated in this prospective observational study. We included all patients admitted over a period of 24 months who were affected by mechanical restraint, seclusion, or compulsory medication. In addition to the patterns of coercive measures, we investigated the effect of each hospital on the frequency of compulsory medication and the cumulative duration of mechanical restraint and seclusion, using multivariate binary logistic regression. To compare the two outcomes between hospitals, odds ratios (OR) with corresponding 95% confidence intervals (CI) were calculated. RESULTS Altogether, coercive measures were applied in 1542 cases, corresponding to an overall prevalence of 8%. The frequency and patterns of the modalities of coercive measures were different between hospitals, and the differences could be at least partially related to institutional characteristics. For the two hospitals that had no permanently locked wards, certain findings were particularly noticeable. In one of these hospitals, the probability of receiving compulsory medication was significantly higher compared with the other institutions (OR 1.9, CI 1.1-3.0 for patients < 65 years; OR 8.0, CI 3.1-20.7 for patients ≥65 years); in the other hospital, in patients younger than 65 years, the cumulative duration of restraint and seclusion was significantly longer compared with the other institutions (OR 2.6, CI 1.7-3.9). CONCLUSIONS The findings are compatible with the hypothesis that more open settings are associated with a more extensive use of coercion. However, due to numerous influencing factors, these results should be interpreted with caution. In view of the relevance of this issue, further research is needed for a deeper understanding of the reasons underlying the differences among hospitals.
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Affiliation(s)
- Klaus Mann
- Department of Psychiatry and Psychotherapy, University Medical Center, Untere Zahlbacher Str. 8, 55131, Mainz, Germany.
| | - Sonja Gröschel
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center, Untere Zahlbacher Str. 8, 55131 Mainz, Germany ,grid.410607.4Department of Neurology, University Medical Center, Mainz, Germany
| | - Susanne Singer
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center, Untere Zahlbacher Str. 8, 55131 Mainz, Germany ,grid.410607.4Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Center, Mainz, Germany
| | - Jörg Breitmaier
- Department of Psychiatry and Psychotherapy, Krankenhaus Zum Guten Hirten, Ludwigshafen, Germany
| | - Sylvia Claus
- Department of Psychiatry, Psychosomatics und Psychotherapy, Pfalzklinikum, Klingenmünster, Germany
| | - Markus Fani
- Department of Geriatric Psychiatry, Psychosomatics und Psychotherapy, Pfalzklinikum, Klingenmünster, Germany
| | - Stephan Rambach
- Clinic for Psychiatry and Psychotherapy, Municipal Hospital, Pirmasens, Germany
| | - Hans-Joachim Salize
- grid.413757.30000 0004 0477 2235Central Institute of Mental Health, Medical Faculty Mannheim / Heidelberg University, Mannheim, Germany
| | - Klaus Lieb
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center, Untere Zahlbacher Str. 8, 55131 Mainz, Germany
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Bell D, Hallett N. Role of occupational therapy in reducing and managing violence among mental health inpatients: a scoping review protocol. BMJ Open 2021; 11:e046260. [PMID: 34321294 PMCID: PMC8319987 DOI: 10.1136/bmjopen-2020-046260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 07/14/2021] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Violence is pervasive among psychiatric inpatients and has profound consequences for its victims, its perpetrators and mental health services. Currently, the unique contribution of occupational therapists to reducing and managing violence among this patient group has not been systematically explored. However, an a priori model which provides an initial understanding of its role in this respect can be identified from the wider scholarly literature. This scoping review aims to apply and refine this model, thereby producing an amended version that will form the basis for further research. METHODS AND ANALYSIS This scoping review is based upon guidance from the Joanna Briggs Institute, Levac, Colquhoun and O'Brien's scoping review framework, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review checklist. Electronic databases (Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, PsycINFO, Medline, PsycARTICLES, ProQuest Health and Medicine, Allied and Complementary Medicine Database (AMED) and Google Scholar) and grey literature will be searched to identify relevant papers. Included articles will apply occupational therapy theory or occupational science to the reduction or management of violence among psychiatric inpatients and will be critically appraised by two independent reviewers. Study characteristics will be presented using frequency counts, and qualitative data will be analysed using 'best-fit' framework synthesis and secondary thematic analysis to produce an overall model of occupational therapy's contribution to violence management and reduction. ETHICS AND DISSEMINATION Results will be disseminated through a peer-reviewed academic journal and via professional conferences. The review will collect secondary data and therefore will not require ethical approval.
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Affiliation(s)
- David Bell
- School of Nursing, University of Birmingham, Birmingham, UK
- Occupational Therapy Department, St Andrew's Healthcare, Birmingham, UK
| | - Nutmeg Hallett
- School of Nursing, University of Birmingham, Birmingham, UK
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18
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Oostermeijer S, Brasier C, Harvey C, Hamilton B, Roper C, Martel A, Fletcher J, Brophy L. Design features that reduce the use of seclusion and restraint in mental health facilities: a rapid systematic review. BMJ Open 2021; 11:e046647. [PMID: 34233981 PMCID: PMC8264870 DOI: 10.1136/bmjopen-2020-046647] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
UNLABELLED Increasing efforts are being made to prevent and/or eliminate the use of seclusion and restraint in mental health facilities. Recent literature recognises the importance of the physical environment in supporting better outcomes in mental health services. This rapid review scoped the existing literature studying what physical design features of mental health facilities can reduce the use of seclusion and physical restraint. DESIGN A rapid review of peer-reviewed literature. METHODS Peer-reviewed literature was searched for studies on architectural design and the use of restraint and seclusion in mental health facilities. The following academic databases were searched: Cochrane Library, Medline, PsycINFO, Scopus and Avery for English language literature published between January 2010 and August 2019. The Joanna Briggs Institute's critical appraisal tool was used to assess the quality of included studies. RESULTS We identified 35 peer-reviewed studies. The findings revealed several overarching themes in design efforts to reduce the use of seclusion and restraint: a beneficial physical environment (eg, access to gardens or recreational facilities); sensory or comfort rooms; and private, uncrowded and calm spaces. The critical appraisal indicated that the overall quality of studies was low, as such the findings should be interpreted with caution. CONCLUSION This study found preliminary evidence that the physical environment has a role in supporting the reduction in the use of seclusion and restraint. This is likely to be achieved through a multilayered approach, founded on good design features and building towards specific design features which may reduce occurrences of seclusion and restraint. Future designs should include consumers in a codesign process to maximise the potential for change and innovation that is genuinely guided by the insights of lived experience expertise.
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Affiliation(s)
- Sanne Oostermeijer
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Catherine Brasier
- Social Work and Social Policy, La Trobe University, Melbourne, Victoria, Australia
| | - Carol Harvey
- Psychiatry, The University of Melbourne, Melbourne, Victoria, Australia
| | - Bridget Hamilton
- Centre for Psychiatric Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| | - Cath Roper
- Centre for Psychiatric Nursing, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Martel
- Melbourne School of Design, The University of Melbourne, Melbourne, Victoria, Australia
| | - Justine Fletcher
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lisa Brophy
- Social Work and Social Policy, La Trobe University, Melbourne, Victoria, Australia
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19
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Ma D, Su J, Wang H, Zhao Y, Li H, Li Y, Zhang X, Qi Y, Sun J. Sensory-based approaches in psychiatric care: A systematic mixed-methods review. J Adv Nurs 2021; 77:3991-4004. [PMID: 33951221 DOI: 10.1111/jan.14884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 02/18/2021] [Accepted: 04/18/2021] [Indexed: 11/28/2022]
Abstract
AIMS Sensory-based approaches, including sensory room, sensory cart and specific sensory integration programs, feature various sensory stimulations to focus on a particular space or program. This systematic mixed-methods review describes the impact of sensory-based approaches in psychiatric care and summarizes the important components of sensory interventions. DESIGN Systematic mixed-methods review was based on the guidelines by Pluye and Hong for comprehensively searching, appraising and synthesizing research evidence. DATA SOURCES Data were collected from five databases: CINAHL, Embase, Pubmed, Web of Science and Cochrane before March 9, 2020. REVIEW METHODS Qualitative, quantitative, mixed-methods and original studies published in English on sensory-based approaches in psychiatric care were included. The studies were selected by screening titles, abstracts and full texts, and the quality of each study was assessed by two researchers independently. The data were analysed using thematic analysis. RESULTS Sixteen studies were chosen for review. Through data integration, four subthemes with positive effects were formed: (1) calming of the patient's mood; (2) calming of the patient's body; (3) improvement of self-care ability; and (4) improvement of the nurse-patient relationship. The sensory-based approach may also lead to negative effects. CONCLUSIONS Several important components play important roles in the sensory-based approaches: (1) rich, culture-based, personalized sensory stimulation; (2) a quiet, safe, home-based physical environment; (3) a good one-to-one nurse-patient relationship; (4) and the cultivation of patient autonomy and self-management. Sensory-based approaches in a multicultural environment and home environment will be important topics of psychiatric care in the future. IMPACT There is a lack of synthesis of studies on results of sensory-based approaches in psychiatric care. Four components are important to sensory interventions. It is necessary for mental health service centres and home care for the patients with psychotic disorders to use sensory-based approaches for reference.
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Affiliation(s)
- Dongfei Ma
- School of Nursing, Jilin University, Jilin, People's Republic of China
| | - Jianping Su
- School of Nursing, Jilin University, Jilin, People's Republic of China.,School of Nursing, Xinjiang Medical University, Urumqi, People's Republic of China
| | - Hong Wang
- The First Bethune Hospital of Jilin University, Jilin, People's Republic of China
| | - Yingnan Zhao
- School of Nursing, Jilin University, Jilin, People's Republic of China
| | - Huanhuan Li
- School of Nursing, Jilin University, Jilin, People's Republic of China
| | - Yijing Li
- School of Nursing, Jilin University, Jilin, People's Republic of China
| | - Xu Zhang
- School of Nursing, Jilin University, Jilin, People's Republic of China
| | - Yicheng Qi
- School of Nursing, Jilin University, Jilin, People's Republic of China
| | - Jiao Sun
- School of Nursing, Jilin University, Jilin, People's Republic of China
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Reinwald JR, Horten B, Dreßing H, Salize HJ. [Structural Features and Use of Coercive Measures in Forensic Psychiatry Throughout Germany]. PSYCHIATRISCHE PRAXIS 2021; 49:22-28. [PMID: 33773502 DOI: 10.1055/a-1391-0192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Nationwide assessment of structural data and the frequency of use of coercive measures in forensic psychiatric hospitals in Germany. METHODS Quantitative survey using a postal questionnaire on structural data and on the use of coercive measures in forensic psychiatric hospitals as part of the "ZIPHER" study. RESULTS About one fourth of all forensic patients are affected by coercive measures, with seclusion (21.2 %) being way more often than mechanical restraint (3.2 %). This ratio contrasts with general psychiatric hospitals, where restraints are more common than seclusions. CONCLUSION The results of the study reveal nationwide peculiarities in the use of coercive measures in forensic psychiatric hospitals. At the same time, it demonstrated the lack of general structural and process data of forensic hospitals in Germany.
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Affiliation(s)
- Jonathan Rochus Reinwald
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim
| | - Barbara Horten
- Institut für Kriminologie, Ruprecht-Karls-Universität Heidelberg
| | - Harald Dreßing
- Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim
| | - Hans-Joachim Salize
- Arbeitsgruppe Versorgungsforschung, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim der Universität Heidelberg, Mannheim
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21
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Baker J, Berzins K, Canvin K, Benson I, Kellar I, Wright J, Lopez RR, Duxbury J, Kendall T, Stewart D. Non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings: the COMPARE systematic mapping review. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
ObjectivesThe study aimed to provide a mapping review of non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings; classify intervention components using the behaviour change technique taxonomy; explore evidence of behaviour change techniques and interventions; and identify the behaviour change techniques that show most effectiveness and those that require further testing.BackgroundIncidents involving violence and aggression occur frequently in adult mental health inpatient settings. They often result in restrictive practices such as restraint and seclusion. These practices carry significant risks, including physical and psychological harm to service users and staff, and costs to the NHS. A number of interventions aim to reduce the use of restrictive practices by using behaviour change techniques to modify practice. Some interventions have been evaluated, but effectiveness research is hampered by limited attention to the specific components. The behaviour change technique taxonomy provides a common language with which to specify intervention content.DesignSystematic mapping study and analysis.Data sourcesEnglish-language health and social care research databases, and grey literature, including social media. The databases searched included British Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CCRCT), Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE), EMBASE, Health Technology Assessment (HTA) Database, HTA Canadian and International, Ovid MEDLINE®, NHS Economic Evaluation Database (NHS EED), PsycInfo®and PubMed. Databases were searched from 1999 to 2019.Review methodsBroad literature search; identification, description and classification of interventions using the behaviour change technique taxonomy; and quality appraisal of reports. Records of interventions to reduce any form of restrictive practice used with adults in mental health services were retrieved and subject to scrutiny of content, to identify interventions; quality appraisal, using the Mixed Methods Appraisal Tool; and data extraction, regarding whether participants were staff or service users, number of participants, study setting, intervention type, procedures and fidelity. The resulting data set for extraction was guided by the Workgroup for Intervention Development and Evaluation Research, Cochrane and theory coding scheme recommendations. The behaviour change technique taxonomy was applied systematically to each identified intervention. Intervention data were examined for overarching patterns, range and frequency. Overall percentages of behaviour change techniques by behaviour change technique cluster were reported. Procedures used within interventions, for example staff training, were described using the behaviour change technique taxonomy.ResultsThe final data set comprised 221 records reporting 150 interventions, 109 of which had been evaluated. The most common evaluation approach was a non-randomised design. There were six randomised controlled trials. Behaviour change techniques from 14 out of a possible 16 clusters were detected. Behaviour change techniques found in the interventions were most likely to be those that demonstrated statistically significant effects. The most common intervention target was seclusion and restraint reduction. The most common strategy was staff training. Over two-thirds of the behaviour change techniques mapped onto four clusters, that is ‘goals and planning’, ‘antecedents’, ‘shaping knowledge’ and ‘feedback and monitoring’. The number of behaviour change techniques identified per intervention ranged from 1 to 33 (mean 8 techniques).LimitationsMany interventions were poorly described and might have contained additional behaviour change techniques that were not detected. The finding that the evidence was weak restricted the study’s scope for examining behaviour change technique effectiveness. The literature search was restricted to English-language records.ConclusionsStudies on interventions to reduce restrictive practices appear to be diverse and poor. Interventions tend to contain multiple procedures delivered in multiple ways.Future workPrior to future commissioning decisions, further research to enhance the evidence base could help address the urgent need for effective strategies. Testing individual procedures, for example, audit and feedback, could ascertain which are the most effective intervention components. Separate testing of individual components could improve understanding of content and delivery.Study registrationThe study is registered as PROSPERO CRD42018086985.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 9, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- John Baker
- School of Healthcare, University of Leeds, Leeds, UK
| | | | - Krysia Canvin
- School of Healthcare, University of Leeds, Leeds, UK
| | - Iris Benson
- Mersey Care NHS Foundation Trust, Prescot, UK
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, UK
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Joy Duxbury
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | | | - Duncan Stewart
- Department of Health Sciences, University of York, York, UK
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22
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Digby R, Bushell H, Bucknall TK. Implementing a Psychiatric Behaviours of Concern emergency team in an acute inpatient psychiatry unit: Staff perspectives. Int J Ment Health Nurs 2020; 29:888-898. [PMID: 32243059 DOI: 10.1111/inm.12723] [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: 01/24/2020] [Revised: 03/02/2020] [Accepted: 03/04/2020] [Indexed: 11/29/2022]
Abstract
Behaviours of concern including aggression are widespread in mental health inpatient settings. Restrictive interventions such as restraint and seclusion can cause additional trauma to already traumatized patients. To decrease use of these interventions in an acute psychiatric unit in Melbourne, Australia, a Psychiatric Behaviours of Concern (Psy-BOC) response team was introduced. In a Psy-BOC call, senior medical, nursing, and allied health staff respond to escalating behavioural situations to work with the primary treating team to implement clinical interventions of least restrictive practice. Here, we present qualitative findings reporting staff response to Psy-BOC. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ). Twenty-four staff participated in five focus groups. Four themes were identified: Identifying behavioural deterioration, responding to behaviours of concern, staff reactions, and barriers. Although staff were skilled in recognizing and de-escalating behaviours of concern, patients were secluded when heightened risk was perceived. The adoption of Psy-BOC was met with some resistance to the cultural change required to adopt this new model. Increased awareness, early identification of behaviours of concern, and pressure from management resulted in reductions in restrictive interventions. Management of patients with drug-induced psychosis without restraint presented specific difficulties. The ward setting was challenging, offering no break-out spaces for patients, and few comfortable areas. Some staff appreciated the advice and expertise of the Psy-Boc team, others felt disempowered and undermined. Improving leadership, staff education, support and collaboration, and including frontline staff in refining the process could enhance the Psy-BOC response and increase safety for all.
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Affiliation(s)
- Robin Digby
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research Alfred Health Partnership, Alfred Health, Melbourne, Victoria, Australia
| | - Hannah Bushell
- Alfred Mental and Addictions Health, Prahran, Victoria, Australia
| | - Tracey K Bucknall
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research Alfred Health Partnership, Alfred Health, Melbourne, Victoria, Australia
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Does high and intensive care reduce coercion? Association of HIC model fidelity to seclusion use in the Netherlands. BMC Psychiatry 2020; 20:469. [PMID: 32993572 PMCID: PMC7523051 DOI: 10.1186/s12888-020-02855-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/03/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND A new inpatient care model has been developed in the Netherlands: High and Intensive Care (HIC). The purpose of HIC is to improve quality of inpatient mental healthcare and to reduce coercion. METHODS In 2014, audits were held at 32 closed acute admission wards for adult patients throughout the Netherlands. The audits were done by trained auditors, who were professionals of the participating institutes, using the HIC monitor, a model fidelity scale to assess implementation of the HIC model. The HIC model fidelity scale (67 items) encompasses 11 domains including for example team structure, team processes, diagnostics and treatment, and building environment. Data on seclusion and forced medication was collected using the Argus rating scale. The association between HIC monitor scores and the use of seclusion and forced medication was analyzed, corrected for patient characteristics. RESULTS Results showed that wards having a relatively high HIC monitor total score, indicating a high level of implementation of the model as compared to wards scoring lower on the monitor, had lower seclusion hours per admission hours (2.58 versus 4.20) and less forced medication events per admission days (0.0162 versus 0.0207). The HIC model fidelity scores explained 27% of the variance in seclusion rates (p < 0.001). Adding patient characteristics to HIC items in the regression model showed an increase of the explained variance to 40%. CONCLUSIONS This study showed that higher HIC model fidelity was associated with less seclusion and less forced medication at acute closed psychiatric wards in the Netherlands.
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Abstract
From 2004 onwards, above 50 seclusion reduction programs (SRP) were developed, implemented and evaluated in the Netherlands. However, little is known about their sustainability, as to which extent obtained reduction could be maintained. This study monitored three programs over ten years seeking to identify important factors contributing to this. We reviewed documents of three SRPs that received governmental funding to reduce seclusion. Next, we interviewed key figures from each institute, to investigate the SRP documents and their implementation in practice. We monitored the number of seclusion events and the number of seclusion days with the Argus rating scale over ten years in three separate phases: 2008-2010, 2011-2014 and 2015-2017. As we were interested in sustainability after the governmental funding ended in 2012, our focus was on the last phase. Although in different rate, all mental health institutes showed some decline in seclusion events during and immediately after the SRP. After end of funding one institute showed numbers going up and down. The second showed an increase in number of seclusion days. The third institute displayed a sustained and continuous reduction in use of seclusion, even several years after the received funding. This institute was the only one with an ongoing institutional SRP after the governmental funding. To sustain accomplished seclusion reduction, a continuous effort is needed for institutional awareness of the use of seclusion, even after successful implementation of SRPs. If not, successful SRPs implemented in psychiatry will easily relapse in traditional use of seclusion.
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Abstract
The appropriate treatment of mentally unwell, aggressive patients has challenged psychiatry for centuries. Seclusion is practiced worldwide, but concerns remain regarding its appropriateness and lack of alternatives. Patients generally report seclusion as a negative experience, though there is a paucity of literature exploring this in detail. This investigation was a service evaluation appraising inpatients' perspective of processes occurring before (information, communication), during (review, care), and after (debrief, reflection) seclusion in a psychiatric intensive care unit (PICU). In this phenomenological study, qualitative data were gathered using a questionnaire in a structured interview. All patients had been nursed in seclusion during admission to a male PICU at South London and the Maudsley NHS Foundation Trust. Ten patients were interviewed over 4 months. The central theme was perceived lack of communication in the patient-professional relationship, which manifested itself as (i) violence against patients, (ii) lack of psychological support, and (iii) the need for alternatives. Such feedback from patients queries whether national guidelines are appropriate and/or being adhered to. Healthcare practitioners have a responsibility to challenge accepted practice to continually improve the standard of patient-centred care. Utilising patient perspectives can be a powerful driver of change towards more humane treatment of vulnerable patients.
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Affiliation(s)
- Silvia Allikmets
- Department of Life Sciences & Medicine, GKT School of Medical Education, King's College London, London, United Kingdom
| | - Caryl Marshall
- Southwark High Support Rehabilitation, South London and the Maudsley NHS Foundation Trust, London, United Kingdom.,Community Forensic LD/ASD, Oxleas NHS Foundation Trust, South London Partnership, London, United Kingdom
| | - Omar Murad
- Psychiatric Intensive Care, South London and the Maudsley NHS Foundation Trust, London, United Kingdom
| | - Kamal Gupta
- South London and the Maudsley NHS Foundation Trust, London, United Kingdom
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Efkemann SA, Ueberberg B, Haußleiter IS, Hoffmann K, Juckel G. Socio-economic impact on involuntary admissions and coercive measures in psychiatric hospitals in Germany. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2020; 71:101597. [PMID: 32768099 DOI: 10.1016/j.ijlp.2020.101597] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE The present study aimed to characterize involuntary psychiatric admissions and coercive measures within psychiatric hospitals regarding their temporal development and processual aspects. Moreover, the influence of socio-economic factors on involuntary admissions and coercive measures was investigated. METHODS Different data sets from the federal state of North-Rhine Westphalia (NRW) were used in this study. In addition to a survey in which n = 33 hospitals responded (40.7%), official data from the Federal Health Ministry were analysed over a decade regarding involuntary admissions and coercive measures. These data were available for all n = 54 districts, respectively, all n = 81 psychiatric hospitals in NRW. Datasets were mainly analysed comparing different socio-economic clusters. RESULTS The hospital admission rate increased significantly over time (from 1.12 to 1.34 per 1000 inhabitants) within ten years. However, whereas the admission rates differed significantly between socio-economic clusters, the amount of coercive measures used in the hospitals did not. Compared to general psychiatry and addiction medicine, geriatric psychiatry had the highest amount of involuntary admissions (12.2% under public law, 14.1% under civil law). Furthermore, most coercive measures lasted at least an hour. CONCLUSION It seems that, despite intense discussions and enhanced efforts to reduce coercion, there are still some neglected aspects, such as the need for coercive measures and their duration, particularly in the geriatric psychiatric setting. In addition, the results show that further approaches to prevent involuntary admissions are needed to address other stakeholders beyond the hospitals and further aspects of the socio-economic environment.
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Affiliation(s)
- S A Efkemann
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Germany.
| | - B Ueberberg
- LWL-Institute of Mental Health, LWL University Hospital, Ruhr University Bochum, Germany
| | - I S Haußleiter
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Germany; LWL-Institute of Mental Health, LWL University Hospital, Ruhr University Bochum, Germany
| | - K Hoffmann
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Germany; LWL-Institute of Mental Health, LWL University Hospital, Ruhr University Bochum, Germany
| | - G Juckel
- Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Germany; LWL-Institute of Mental Health, LWL University Hospital, Ruhr University Bochum, Germany
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Gooding P, McSherry B, Roper C. Preventing and reducing 'coercion' in mental health services: an international scoping review of English-language studies. Acta Psychiatr Scand 2020; 142:27-39. [PMID: 31953847 PMCID: PMC7496148 DOI: 10.1111/acps.13152] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2020] [Indexed: 11/30/2022]
Abstract
This article discusses initiatives aimed at preventing and reducing 'coercive practices' in mental health and community settings worldwide, including in hospitals in high-income countries, and in family homes and rural communities in low- and middle-income countries. The article provides a scoping review of the current state of English-language empirical research. It identifies several promising opportunities for improving responses that promote support based on individuals' rights, will and preferences. It also points out several gaps in research and practice (including, importantly, a gap in reviews of non-English-language studies). Overall, many studies suggest that efforts to prevent and reduce coercion appear to be effective. However, no jurisdiction appears to have combined the full suite of laws, policies and practices which are available, and which taken together might further the goal of eliminating coercion.
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Affiliation(s)
- P. Gooding
- University of MelbourneParkvilleVicAustralia
| | - B. McSherry
- University of MelbourneParkvilleVicAustralia
| | - C. Roper
- University of MelbourneParkvilleVicAustralia
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Greenway KT, Garel N, Jerome L, Feduccia AA. Integrating psychotherapy and psychopharmacology: psychedelic-assisted psychotherapy and other combined treatments. Expert Rev Clin Pharmacol 2020; 13:655-670. [DOI: 10.1080/17512433.2020.1772054] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Kyle T. Greenway
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Nicolas Garel
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Lisa Jerome
- Data Services, MAPS Public Benefit Corporation
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Veereschild HM, Noorthoorn EO, Nijman HLI, Mulder CL, Dankers M, Van der Veen JA, Loonen AJM, Hutschemaekers GJM. Diagnose, indicate, and treat severe mental illness (DITSMI) as appropriate care: A three-year follow-up study in long-term residential psychiatric patients on the effects of re-diagnosis on medication prescription, patient functioning, and hospital bed utilization. Eur Psychiatry 2020; 63:e47. [PMID: 32381136 PMCID: PMC7358634 DOI: 10.1192/j.eurpsy.2020.46] [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] [Indexed: 12/04/2022] Open
Abstract
Background. While polypharmacy is common in long-term residential psychiatric patients, prescription combinations may, from an evidence-based perspective, be irrational. Potentially, many psychiatric patients are treated on the basis of a poor diagnosis. We therefore evaluated the DITSMI model (i.e., Diagnose, Indicate, and Treat Severe Mental Illness), an intervention that involves diagnosis (or re-diagnosis) and appropriate treatment for severely mentally ill long-term residential psychiatric patients. Our main objective was to determine whether DITSMI affected changes over time regarding diagnoses, pharmacological treatment, psychosocial functioning, and bed utilization. Methods. DITSMI was implemented in a consecutive patient sample of 94 long-term residential psychiatric patients during a longitudinal cohort study without a control group. The cohort was followed for three calendar years. Data were extracted from electronic medical charts. As well as diagnoses, medication use and current mental status, we assessed psychosocial functioning using the Health of the Nations Outcome Scale (HoNOS). Bed utilization was assessed according to length of stay (LOS). Change was analyzed by comparing proportions of these data and testing them with chi-square calculations. We compared the numbers of diagnoses and medication changes, the proportions of HoNOS scores below cut-off, and the proportions of LOS before and after provision of the protocol. Results. Implementation of the DITSMI model was followed by different diagnoses in 49% of patients, different medication in 67%, some improvement in psychosocial functioning, and a 40% decrease in bed utilization. Conclusions. Our results suggest that DITSMI can be recommended as an appropriate care for all long-term residential psychiatric patients.
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Affiliation(s)
- H M Veereschild
- GGNet Community Mental Health Center, Warnsveld, The Netherlands
| | - E O Noorthoorn
- GGNet Community Mental Health Center, Warnsveld, The Netherlands
| | - H L I Nijman
- Fivoor, Forensic Psychiatric Institute, Rotterdam, The Netherlands.,Department of Social Sciences, Clinical Psychology at the Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - C L Mulder
- Public Mental Health Care, Parnassia Psychiatric Institute, Rotterdam, The Netherlands.,Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - M Dankers
- Dutch Institute for Rational Use of Medicine, Utrecht, The Netherlands
| | - J A Van der Veen
- GGNet Community Mental Health Center, Warnsveld, The Netherlands
| | - A J M Loonen
- Pharamacology Department of Pharmacotherapy, Epidemiology & Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - G J M Hutschemaekers
- Department of Social Sciences, Clinical Psychology at the Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.,Pro Persona Mental Health Care, Nijmegen, The Netherlands
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Thibaut B, Dewa LH, Ramtale SC, D'Lima D, Adam S, Ashrafian H, Darzi A, Archer S. Patient safety in inpatient mental health settings: a systematic review. BMJ Open 2019; 9:e030230. [PMID: 31874869 PMCID: PMC7008434 DOI: 10.1136/bmjopen-2019-030230] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology. DESIGN Systematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to 'mental health', 'patient safety', 'inpatient setting' and 'research'. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model. RESULTS Of the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control. CONCLUSIONS Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice. PROSPERO REGISTRATION NUMBER CRD42016034057.
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Affiliation(s)
- Bethan Thibaut
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lindsay Helen Dewa
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sonny Christian Ramtale
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Danielle D'Lima
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sheila Adam
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hutan Ashrafian
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ara Darzi
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephanie Archer
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
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Fernández VI, Karavokyros S, Lagier F, Bauer L, Védie C. Soigner sans contention physique, quels enjeux psychiques ? De la contention à la contenance. EVOLUTION PSYCHIATRIQUE 2019. [DOI: 10.1016/j.evopsy.2019.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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[Influence of staffing levels on conflicts in inpatient psychiatric care]. DER NERVENARZT 2019; 89:821-827. [PMID: 29666880 DOI: 10.1007/s00115-018-0521-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Acute psychiatric wards are an important element in the mental healthcare of people at risk for acute harm to others or self-harm. Unfortunately, aggression, violence (conflict) and the use of coercion (containment) are still part of psychiatric care. The decisive factor for the correct handling of these situations is the quantity as well as the quality of the employees. Therefore, the present study dealt with the care situation on acute psychiatric wards. The hypothesis is that both the number of beds on the acute psychiatric ward and the number of caregivers have an impact on the occurrence of conflict and containment. For this purpose, data were collected in 6 clinics on a total of 12 acute psychiatric wards. The Patient Staff Conflict Checklist - Shift Report (PCC-SR) was used as the data entry tool. A total of 2026 shifts (early, late and night shifts) were recorded and evaluated. The staffing of the wards with nursing personnel varied considerably. The results show that both the size of the ward and also the number of caregivers on acute psychiatric wards have a significant impact on the occurrence of conflicts. The results also show that the incidence of conflicting behavior of patients differs both in terms of the wards of the hospitals involved and in the type of service considered. In addition, it can be seen that the extent of closure of an acute ward (i. e. the closed ward or entrance door) and the size of a ward (i. e. the number of beds) have a negative impact on the incidence of inpatient acute psychiatric contexts. The occurrence of conflict behavior can lead to alien or self-endangerment and to a variety of de-escalating and containment measures. This requires appropriate human resources.
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Rimondini M, Busch IM, Mazzi MA, Donisi V, Poli A, Bovolenta E, Moretti F. Patient empowerment in risk management: a mixed-method study to explore mental health professionals' perspective. BMC Health Serv Res 2019; 19:382. [PMID: 31196085 PMCID: PMC6567542 DOI: 10.1186/s12913-019-4215-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 06/04/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In the last years, patients' empowerment has been increasingly recognized as a crucial dimension of patient-centered healthcare and patient safety. Nevertheless, little work has been done so far in the field of patient safety to investigate strategies for empowering psychiatric patients. Therefore, the aim of this study was to identify, by using focus groups, whether and how psychiatric patients' empowerment can improve risk management according to the perspective of healthcare providers (HPs). METHODS A mixed-method approach composed of a qualitative data collection method (i.e., focus groups) and a quantitative analysis technique (i.e., inductive content analysis) was applied. HPs working in mental health settings shared their perspectives on psychiatric patients' empowerment in risk management. After the transcription of the audio-taped discussions and the subsequent development of a hierarchical four-level coding system (strategy versus critical issue, thematic area, category, subcategory), two independent raters codified the transcripts and synthesized the content. Absolute frequencies are reported for quantitative data. RESULTS Twelve focus groups consisting of six to ten participants, each with an overall sample size of 95 participants (65 women; average age ± SD 47 ± 9 yrs), were enrolled. A total of 1252 participants' verbal contributions (i.e., units of analysis) were assessed. Strategies and critical issues (Level 1) were mentioned almost equally (52 and 48%, respectively) by the HPs. Most of the contributions at Level 2 referred to the thematic areas Treatment and Cure (69%) and Emergency Management (21%). In the area Treatment and Cure, the category Therapeutic Compliance (Level 3) was discussed in one third of all contributions. CONCLUSIONS Our results suggest that HPs consider patients as crucial partners in risk management and expect them to play a key role in actively enhancing safety. Policy makers should be aware that risk management in mental health settings particularly relies on the therapeutic relationship between HPs and patients. Therefore, allocating sufficient human and financial resources to mental health care aiming to further support the relationship between patients and HPs is of utmost importance.
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Affiliation(s)
- M. Rimondini
- Section of Clinical Psychology, Department of Biomedicine, Neuroscience and Movement, University of Verona, Verona, Italy
| | - I. M. Busch
- Section of Clinical Psychology, Department of Biomedicine, Neuroscience and Movement, University of Verona, Verona, Italy
| | - M. A. Mazzi
- Section of Clinical Psychology, Department of Biomedicine, Neuroscience and Movement, University of Verona, Verona, Italy
| | - V. Donisi
- Section of Clinical Psychology, Department of Biomedicine, Neuroscience and Movement, University of Verona, Verona, Italy
| | - A. Poli
- Section of Hygiene and Preventive Medicine, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - E. Bovolenta
- Section of Hygiene and Preventive Medicine, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - F. Moretti
- Section of Hygiene and Preventive Medicine, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
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Chuttoo L, Chuttoo V. Supporting patients with serious mental illness during physical health treatment. Nurs Stand 2019; 34:e11331. [PMID: 31468899 DOI: 10.7748/ns.2019.e11331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2019] [Indexed: 12/22/2022]
Abstract
People with serious mental illness (SMI) are more likely to experience severe health conditions, such as cardiovascular disease, respiratory disease and stroke, and are likely to die earlier, than the general population. This article explores the reasons for such disparities, using a case study approach to outline the ways that general nurses can support people with SMI when they access general healthcare services. It identifies five areas of learning from the case study: diagnostic overshadowing and stigma; developing the therapeutic relationship; the ward environment; inclusion of family members and carers; and integration of physical and mental health services.
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Affiliation(s)
- Lauren Chuttoo
- South London and Maudsley NHS Foundation Trust, London, England
| | - Vijay Chuttoo
- Springfield University Hospital, South West London and St George's Mental Health NHS Trust, London, England
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Wijk H, Deglʼ Innocenti A, Kullgren A, Alexiou E. Evidence-Based Design Has a Sustainable Positive Effect on Patients' Perceptions of Quality of Care in Forensic Psychiatry: A 3-Year Follow-Up Study. JOURNAL OF FORENSIC NURSING 2019; 15:60-68. [PMID: 30653189 DOI: 10.1097/jfn.0000000000000226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This prospective longitudinal study aimed to assess the sustainable effect on patients' assessment of ward atmosphere and quality of care at three forensic psychiatric clinics relocated to new facilities built with the latest evidence-based healthcare environment design to support recovery. Baseline data were collected in the old facilities and during three follow-ups after relocation, between 2010 and 2016. Of 74 patients who gave informed consent to participate, 58 patients (100%) answered the questionnaires at baseline, with 25 patients (43%) completing them at Follow-up 1, 11 patients (19%) at Follow-up 2, and seven patients (12%) at Follow-up 3. This study provides evidence that the mean values of patients' perceptions of care quality in these forensic psychiatric facilities increased when moving to new buildings and were stable up to 3 years after relocation, which was statistically significant in the domain of secluded environment (p < 0.05). The sample size at Follow-up 3 was small, and thus the results are limited, which indicates that further research is needed to confirm the findings.
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Affiliation(s)
- Helle Wijk
- Department Quality Assurance, Sahlgrenska University Hospital
| | - Alessio Deglʼ Innocenti
- Center for Ethics, Law, and Mental Health, Sahlgrenska Academy, University of Gothenburg
- Gothia Forum for Clinical Trials, Sahlgrenska University Hospital
| | | | - Eirini Alexiou
- Center for Ethics, Law, and Mental Health, Sahlgrenska Academy, University of Gothenburg
- Forensic Psychiatric Clinic, Sahlgrenska University Hospital
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Wöckel L, Rung D, Bachmann S, Dietschi H, Wild D. Burg Lino – Ein innenarchitektonisches Konzept zur Verbesserung der stationären Behandlung in der Kinder- und Jugendpsychiatrie. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2019; 47:19-26. [DOI: 10.1024/1422-4917/a000641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Es gibt nur wenige Daten über Krankenhausarchitektur in psychiatrischen Kliniken. Die bisherigen Daten weisen darauf hin, dass architektonische Verbesserungen die Anwendung von Zwangsmaßnahmen verringern und zu einer Verminderung von aggressivem Verhalten, Selbst- und Fremdgefährdung und einer Veränderung in der Art und Häufigkeit einer Medikation führen. Mit dem Ziel, die Krankenhausumgebung der stationären Behandlung zu verbessern, hat das Zentrum für Kinder- und Jugendpsychiatrie und -psychotherapie der Clienia Littenheid AG das Raum- und Kommunikationskonzept „Burg Lino“ entwickelt. Gemeinsam mit den Patientinnen und Patienten, ihren Eltern und den Mitarbeitenden des multidisziplinären Teams entstand ein Konzept, das den Genesungsprozess von Kindern und Jugendlichen unterstützen und ihnen den stationären Aufenthalt erleichtern soll. Das architektonische Raumkonzept leitet sich aus der Geschichte von „Burg Lino“ ab und vereinigt Farben, Formen, Materialien, Grafiken und Möbel, um einen Genesungsprozess anzustoßen und eine angstreduzierende Umgebung zu schaffen. Mit Umsetzung von „Burg Lino“ stellten wir eine signifikante Zunahme stationärer Aufnahmen und der Belegung fest. Die Verweildauern und der Anteil der Behandlungstage unfreiwilliger Aufnahmen im fakultativ geschlossenen Bereich nahmen hingegen ab. Wir vermuten, dass diese Veränderungen Folge eines höheren Commitments, einer höheren Akzeptanz und geringeren Aggressivität bei den Patienten sowie einer höheren Motivation und Zufriedenheit bei den Mitarbeitenden ist.
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Affiliation(s)
- Lars Wöckel
- Clienia Littenheid AG, Privatklinik für Psychiatrie und Psychotherapie, Littenheid, Schweiz
- Universitäre Psychiatrische Kliniken Basel, Klinik für Kinder- und Jugendpsychiatrie, Basel, Schweiz
| | - Dieter Rung
- Clienia Littenheid AG, Privatklinik für Psychiatrie und Psychotherapie, Littenheid, Schweiz
| | - Silke Bachmann
- Clienia Littenheid AG, Privatklinik für Psychiatrie und Psychotherapie, Littenheid, Schweiz
| | - Hubert Dietschi
- Clienia Littenheid AG, Privatklinik für Psychiatrie und Psychotherapie, Littenheid, Schweiz
| | - Daniel Wild
- Clienia Littenheid AG, Privatklinik für Psychiatrie und Psychotherapie, Littenheid, Schweiz
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Kalagi J, Otte I, Vollmann J, Juckel G, Gather J. Requirements for the implementation of open door policies in acute psychiatry from a mental health professionals' and patients' view: a qualitative interview study. BMC Psychiatry 2018; 18:304. [PMID: 30231893 PMCID: PMC6147044 DOI: 10.1186/s12888-018-1866-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 08/28/2018] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Treating legally committed patients on open, instead of locked wards is controversially discussed and the affected stakeholders (patients, mental health professionals) have ambiguous views on the benefits and disadvantages. The study aims to assess the opinions and values of relevant stakeholders with regard to the requirements for implementing open wards in psychiatric hospitals. METHODS Semi-structured interviews were conducted with 15 psychiatrists, 15 psychiatric nurses and 15 patients, and were analyzed using qualitative content analysis. RESULTS The interviewees identified conceptual, personnel and spatial requirements necessary for an open door policy. Observation and door watch concepts are judged to be essential for open wards, and patients appreciate the therapeutic value they hold. However, nurses find the door watch problematic. All groups suggest seclusion or small locked divisions as a possible way of handling agitated patients. All stakeholders agree that such concepts can only succeed if sufficient, qualified staff is available. They also agree that freedom of movement is a key element in the management of acutely ill patients, which can be achieved with an open door policy. Finally, the interviewees suggested removing the door from direct view to prevent absconding. CONCLUSIONS For psychiatric institutions seeking to implement (partially) open wards, the present results may have high practical relevance. The stakeholders' suggestions also illustrate that fundamental clinical changes depend on resource investments which - at least at a certain point - might not be feasible for individual psychiatric institutions but presumably require initiatives on the level of mental health care providers or policy makers.
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Affiliation(s)
- J. Kalagi
- 0000 0004 0490 981Xgrid.5570.7Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Alexandrinenstr. 1-3, 44791 Bochum, Germany
| | - I. Otte
- 0000 0004 0490 981Xgrid.5570.7Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstr. 258a, 44799 Bochum, Germany
| | - J. Vollmann
- 0000 0004 0490 981Xgrid.5570.7Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstr. 258a, 44799 Bochum, Germany
| | - G. Juckel
- 0000 0004 0490 981Xgrid.5570.7Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Alexandrinenstr. 1-3, 44791 Bochum, Germany
| | - J. Gather
- 0000 0004 0490 981Xgrid.5570.7Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Alexandrinenstr. 1-3, 44791 Bochum, Germany ,0000 0004 0490 981Xgrid.5570.7Institute for Medical Ethics and History of Medicine, Ruhr University Bochum, Markstr. 258a, 44799 Bochum, Germany
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Fukasawa M, Miyake M, Suzuki Y, Fukuda Y, Yamanouchi Y. Relationship between the use of seclusion and mechanical restraint and the nurse-bed ratio in psychiatric wards in Japan. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2018; 60:57-63. [PMID: 30217332 DOI: 10.1016/j.ijlp.2018.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 07/18/2018] [Accepted: 08/06/2018] [Indexed: 06/08/2023]
Abstract
The relationship between the number of nurses in psychiatric wards and frequency of use of seclusion and restraint has been unclear. We aimed to clarify this relationship in Japanese general psychiatric wards while controlling for patient and ward-level characteristics. We hypothesized that seclusion and mechanical restraint are less likely to be used in a ward with more nurses. We used data for individual admissions from April 2015 to March 2017 in hospitals participating in the Psychiatric Electronic Clinical Observation (PECO) system, which extracted data from each hospital's electronic health record system. We analyzed the data of 10,013 admissions in 113 wards of 23 hospitals. We examined the relationships between the number of nurses per 10 beds in each ward and the use of seclusion and mechanical restraint, controlling for the patients' age, sex, diagnosis, voluntary versus involuntary admission, prescribed dose of antipsychotics, severity of symptoms, and length of stay, in addition to ward-level characteristics including ward size, location (urban or rural), and type of ward (acute ward or not), using multilevel multivariate logistic regression analyses. The fraction of admissions exposed to at least one episode of seclusion or mechanical restraint was 36.7% and 14.9%, respectively. The odds ratios of the number of nurses per 10 beds for the use of seclusion and mechanical restraint were 2.36 and 1.74, respectively, indicating that both seclusion and mechanical restraint were actually used more frequently in wards with more nurses. A possible explanation is that patients anticipated to need coercive measures are more likely to be admitted to wards with many nurses. Increasing the number of nurses in a ward may not contribute to reducing the use of seclusion and restraint.
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Affiliation(s)
- Maiko Fukasawa
- Department of Mental Health Policy, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-higashi, Kodaira, Tokyo 187-8553, Japan.
| | - Michi Miyake
- Department of Mental Health Policy, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-higashi, Kodaira, Tokyo 187-8553, Japan
| | - Yuriko Suzuki
- Department of Mental Health Policy, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-higashi, Kodaira, Tokyo 187-8553, Japan
| | - Yusuke Fukuda
- Health Service Bureau, Ministry of Health, Labour and Welfare, 1-2-2 Kasumigaseki, Chiyoda-ku, Tokyo 100-8916, Japan
| | - Yoshio Yamanouchi
- Department of Mental Health Policy, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-higashi, Kodaira, Tokyo 187-8553, Japan
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Mann-Poll PS, Smit A, Noorthoorn EO, Janssen WA, Koekkoek B, Hutschemaekers GJM. Long-Term Impact of a Tailored Seclusion Reduction Program: Evidence for Change? Psychiatr Q 2018. [PMID: 29527618 DOI: 10.1007/s11126-018-9571-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
International comparative studies show that Dutch seclusion rates are relatively high. Therefore, several programs to change this practice were developed and implemented. The purpose of this study was to examine the impact of a seclusion reduction program over a long time frame, from 2004 until 2013. Three phases could be identified; the phase of development and implementation of the program (2004-2007), the project phase (2008-2010) and the consolidation phase (2011-2013). Five inpatient wards of a mental health institute were monitored. Each ward had one or more seclusion rooms. Primary outcome were the number and the duration of seclusion incidents. Involuntary medication was monitored as well to rule out substitution of one coercive measure by another. Case mix correction for patient characteristics was done by a multi-level logistic regression analysis with patient characteristics as predictors and hours seclusion per admission hours as outcome. Seclusion use reduced significantly during the project phase, both in number (-73%) and duration (-80%) and was not substituted by the use of enforced medication. Patient compilation as analyzed by the multi- level regression seemed not to confound the findings. Findings show a slight increase in number and seclusion days over the last year of monitoring. Whether this should be interpreted as a continuous or temporary trend remains unclear and is subject for further investigation.
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Affiliation(s)
| | - Annet Smit
- Pro Persona Mental Health Care, Wolfheze, the Netherlands
| | - Eric O Noorthoorn
- GGNet Mental Health Centre, 7231 PA, Warnsveld, Netherlands. .,Stichting Benchmark GGz, Rembrantlaan 46, 3723 BK, Bilthoven, the Netherlands.
| | - Wim A Janssen
- The Hague University of Applied Science, Hague, the Netherlands
| | - Bauke Koekkoek
- Pro Persona Mental Health Care, Wolfheze, the Netherlands.,University of Applied Sciences, Nijmegen, the Netherlands
| | - Giel J M Hutschemaekers
- Pro Persona Mental Health Care, Nijmegen, the Netherlands.,Clinical Psychology, Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, the Netherlands
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40
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Morisset J. [Reclusion and physical restraint in psychiatry: Influencing factors and alternatives.]. Rech Soins Infirm 2018:78-90. [PMID: 29771102 DOI: 10.3917/rsi.132.0078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Introduction and context: The use of reclusion and restraint is neither a recent practice nor a rare practice in psychiatric services. In France, the Controller General of Places of Deprivation of Liberty reported certain drifts in 2015. Since then, the public authorities have sought to frame this practice with the aim of limiting its use. OBJECTIVE AND METHOD The purpose of this study is to examine how, through a literature review, the topic of limitation of constraint measures and the definition of a future direction of research is discussed. RESULTS It appears that health professionals seek to identify the cultural, social, and environmental characteristics of patients undergoing these restraint measures. However, they also question their approaches, both ethically, environmentally, organizationally, or through caregiving. CONCLUSION Co-ordination within the multidisciplinary team is mentioned but little discussed in this literature review. The place given to the role of nursing seems to be questionable, in terms of its specific approach, its expertise, and its field of action, and must be the subject of a new study.
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41
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Mauras T, Perony A, Yadak J, Velasco A, Goudal P, Marcel JL. [Seclusion and restraint: From prescription to decision]. Encephale 2018; 45:95-97. [PMID: 29402385 DOI: 10.1016/j.encep.2017.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/07/2017] [Accepted: 11/14/2017] [Indexed: 10/17/2022]
Abstract
Psychiatric care has always included patients in crisis who are potentially dangerous or agitated. Faced with the many issues they may encounter, the therapeutic relationship has always been prioritized over all other considerations. However, the practice of seclusion and restraint has been steadily increasing in the past few decades. Their use is becoming customary rather than exceptional and consequently fosters less thought by the care teams. In the Healthcare System Modernization Act of January 26th, 2016, the lawmakers sought to underline the freedom-destroying nature of these practices and the necessity of their regulation. This law represents a fundamental change in the nature of seclusion and restraint. What was but a simple prescription becomes a conscious decision of depriving someone of her or his freedom and must only be considered as a last resort. The changes in the Law and the recent changes in the recommendations for clinical practice by the French National Institute of Health invite reflection. Many questions remain about the origins of violence, the reasons for the increasing use of seclusion and restraint measures, and the alternatives that have been developed. Many theories suggest that the less stressful and constrained an environment is, the more empowered the patient will be. He is an actor in his own care and is considered a full active participant. The Law is reconciled with caregivers initiating a reflection on the benefits of these measures regarding the violation of fundamental freedoms. Reflection on psychiatric care and the quality of its management must be the focus when caring for patients in crisis.
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Affiliation(s)
- T Mauras
- Centre hospitalier Sainte-Anne (secteur 3, Dr-J.-L.-Marcel), 1, rue Cabanis, 75014 Paris, France.
| | - A Perony
- Centre hospitalier Sainte-Anne (secteur 3, Dr-J.-L.-Marcel), 1, rue Cabanis, 75014 Paris, France
| | - J Yadak
- Cochin Psychiatry Department, AP-HP, Cochin Hospital, Paris, France
| | - A Velasco
- Centre hospitalier Sainte-Anne (secteur 3, Dr-J.-L.-Marcel), 1, rue Cabanis, 75014 Paris, France
| | - P Goudal
- Centre hospitalier Sainte-Anne (secteur 3, Dr-J.-L.-Marcel), 1, rue Cabanis, 75014 Paris, France
| | - J-L Marcel
- Centre hospitalier Sainte-Anne (secteur 3, Dr-J.-L.-Marcel), 1, rue Cabanis, 75014 Paris, France
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Aguilera-Serrano C, Guzman-Parra J, Garcia-Sanchez JA, Moreno-Küstner B, Mayoral-Cleries F. Variables Associated With the Subjective Experience of Coercive Measures in Psychiatric Inpatients: A Systematic Review. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2018; 63:129-144. [PMID: 29069981 PMCID: PMC5788134 DOI: 10.1177/0706743717738491] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This systematic review presents evidence regarding factors that may influence the patient's subjective experience of an episode of mechanical restraint, seclusion, or forced administration of medication. METHOD Two authors searched CINAHL, PubMed, SCOPUS, Web of Science, and Psych-Info, considering published studies between 1 January 1992 and 1 February 2016. Based on the inclusion criteria and methodological quality, 34 studies were selected, reporting a total sample of 1,869 participants. RESULTS The results showed that the provision of information, contact and interaction with staff, and adequate communication with professionals are factors that influence the subjective experience of these measures. Humane treatment, respect, and staff support are also associated with a better experience, and debriefing is an important procedure/technique to reduce the emotional impact of these measures. Likewise, the quality of the working and physical environment and some individual and treatment variables were related to the experience of these measures. There are different results in relation to the most frequently associated experiences and, despite some data that indicate positive experiences, the evidence shows such experiences to be predominantly negative and frequently with adverse consequences. It seems that patients find forced medication and seclusion to be more tolerable than mechanical restraint and combined measures. CONCLUSIONS It appears that the role of the staff and the environmental conditions, which are potentially modifiable, affect the subjective experience of these measures. There was considerable heterogeneity among studies in terms of coercive measures experienced by participants and study designs.
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Affiliation(s)
- Carlos Aguilera-Serrano
- 1 Department of Mental Health, University General Hospital of Malaga, Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain.,2 University of Málaga, Andalucía Tech, Faculty of Psychology, Málaga, Spain
| | - Jose Guzman-Parra
- 1 Department of Mental Health, University General Hospital of Malaga, Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain.,3 Departamento Personalidad, Evaluación y Tratamiento Psicológico, Grupo GAP, Facultad de Psicología, Universidad de Málaga, Spain
| | - Juan A Garcia-Sanchez
- 1 Department of Mental Health, University General Hospital of Malaga, Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
| | | | - Fermin Mayoral-Cleries
- 1 Department of Mental Health, University General Hospital of Malaga, Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
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Roos E, Bjerkeset O, Svavarsdóttir MH, Steinsbekk A. Like a hotel, but boring: users' experience with short-time community-based residential aftercare. BMC Health Serv Res 2017; 17:832. [PMID: 29246222 PMCID: PMC5732432 DOI: 10.1186/s12913-017-2777-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 12/05/2017] [Indexed: 11/26/2022] Open
Abstract
Background The discharge process from hospital to home for patients with severe mental illness (SMI) is often complex, and most are in need of tailored and coordinated community services at home. One solution is to discharge patients to inpatient short-stay community residential aftercare (CRA). The aim of this study was to explore how patients with SMI experience a stay in CRA established in a City in Central Norway. Methods A descriptive qualitative study with individual interviews and a group interview with 13 persons. The CRA aims to improve the discharge process from hospital to independent supported living by facilitating the establishment of health and social services and preparing the patients. The philosophy is to help patients use community resources by e.g. not offering any organized in-house activities. The main question in the interviews was “How have you experienced the stay at the CRA?” The interviews were analyzed with a thematic approach using systematic text condensation. Results The participants experienced the stay at the CRA “Like a hotel” but also boring, due to the lack of organized in-house activities. The patients generally said they were not informed about the philosophy of the CRA before the stay. The participants had to come up with activities outside the CRA and said they got active help from the staff to do so; some experienced this as positive, whereas others wanted more organized in-house activities like they were used to from mental health hospital stays. Participants described the staff in the CRA to be helpful and forthcoming, but they did not notice the staff being active in organizing the aftercare. Conclusions The stay at the CRA was experienced as different from other services, with more freedom and focus on self-care, and lack of in-house activities. This led to increased self-activity among the patients, but some wanted more in-house activities. To prepare the patients better for the stay at the CRA, more information about the philosophy is needed in the pre-admission process. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2777-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eirik Roos
- Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, 7491, Trondheim, Norway. .,, Municipality of Trondheim, Norway.
| | - Ottar Bjerkeset
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Margrét Hrönn Svavarsdóttir
- Department of Health Sciences, Norwegian University of Sciences and Technology, Gjøvik, Norway.,School of Health Sciences, University of Akureyri, Akureyri, Iceland
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, 7491, Trondheim, Norway
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Sato M, Noda T, Sugiyama N, Yoshihama F, Miyake M, Ito H. Characteristics of aggression among psychiatric inpatients by ward type in Japan: Using the Staff Observation Aggression Scale - Revised (SOAS-R). Int J Ment Health Nurs 2017; 26:602-611. [PMID: 27445160 DOI: 10.1111/inm.12228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 02/14/2016] [Accepted: 03/16/2016] [Indexed: 12/01/2022]
Abstract
Aggressive behaviour by psychiatric patients is a serious issue in clinical practice, and adequate management of such behaviour is required, with careful evaluation of the factors causing the aggression. To examine the characteristics of aggressive incidents by ward type, a cross-sectional descriptive study was conducted for 6 months between April 2012 and June 2013 using the Staff Observation Aggression Scale - Revised, Japanese version (SOAS-R) in 30 wards across 20 Japanese psychiatric hospitals. Participating wards were categorized into three types based on the Japanese medical reimbursement system: emergency psychiatric, acute psychiatric, and standard wards (common in Japan, mostly treating non-acute patients). On analyzing the 443 incidents reported, results showed significant differences in SOAS-R responses by ward type. In acute and emergency psychiatric wards, staff members were the most common target of aggression. In acute psychiatric wards, staff requiring patients to take medication was the most common provocation, and verbal aggression was the most commonly used means. In emergency psychiatric wards, victims felt threatened. In contrast, in standard wards, both the target and provocation of aggression were most commonly other patients, hands were used, victims reported experiencing physical pain, and seclusion was applied to stop their behaviour. These findings suggest that ward environment was an important factor influencing aggressive behaviour. Ensuring the quality and safety of psychiatric care requires understanding the characteristics of incidents that staff are likely to encounter in each ward type, as well as implementing efforts to deal with the incidents adequately and improve the treatment environment.
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Affiliation(s)
- Makiko Sato
- Department of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Toshie Noda
- Department of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan.,Fukkokai Foundation, Numazu Chuo Hospital, Numazu, Japan
| | - Naoya Sugiyama
- Department of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan.,Fukkokai Foundation, Numazu Chuo Hospital, Numazu, Japan
| | | | - Michi Miyake
- Department of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan.,Japanese Psychiatric Nurses Association, Tokyo, Japan
| | - Hiroto Ito
- Department of Social Psychiatry, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Japan
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Loi F, Marlowe K. East London Modified-Broset as Decision-Making Tool to Predict Seclusion in Psychiatric Intensive Care Units. Front Psychiatry 2017; 8:194. [PMID: 29046647 PMCID: PMC5632740 DOI: 10.3389/fpsyt.2017.00194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/19/2017] [Indexed: 11/16/2022] Open
Abstract
Seclusion is a last resort intervention for management of aggressive behavior in psychiatric settings. There is no current objective and practical decision-making instrument for seclusion use on psychiatric wards. Our aim was to test the predictive and discriminatory characteristics of the East London Modified-Broset (ELMB), to delineate its decision-making profile for seclusion of adult psychiatric patients, and second to benchmark it against the psychometric properties of the Broset Violence Checklist (BVC). ELMB, an 8-item modified version of the 6-item BVC, was retrospectively employed to evaluate the seclusion decision-making process on two Psychiatric Intensive Care Units (patients n = 201; incidents n = 2,187). Data analyses were carried out using multivariate regression and Receiver Operating Characteristic (ROC) curves. Predictors of seclusion were: physical violence toward staff/patients OR = 24.2; non-compliance with PRN (pro re nata) medications OR = 9.8; and damage to hospital property OR = 2.9. ROC analyses indicated that ELMB was significantly more accurate that BVC, with higher sensitivity, specificity, and positive likelihood ratio. Results were similar across gender. The ELMB is a sensitive and specific instrument that can be used to guide the decision-making process when implementing seclusion.
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Affiliation(s)
- Felice Loi
- Juniper Court Churchill Hospital CAS Behavioural Health, London, United Kingdom
| | - Karl Marlowe
- Millharbour PICU Mile End Hospital East London NHS Foundation Trust, London, United Kingdom
- Centre for Psychiatry Queen Mary University of London, London, United Kingdom
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46
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Kuivalainen S, Vehviläinen-Julkunen K, Louheranta O, Putkonen A, Repo-Tiihonen E, Tiihonen J. De-escalation techniques used, and reasons for seclusion and restraint, in a forensic psychiatric hospital. Int J Ment Health Nurs 2017; 26:513-524. [PMID: 28960738 DOI: 10.1111/inm.12389] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/10/2017] [Indexed: 11/28/2022]
Abstract
In Finland, the Mental Health Act determines the legal basis for seclusion and restraint. Restrictive measures are implemented to manage challenging situations and should be used as a last resort in psychiatric inpatient care. In the present study, we examined the reasons for seclusion and restraint, as well as whether any de-escalation techniques were used to help patients calm down. Seclusion and restraint files from a 4-year period (1 June 2009-31 May 2013) were retrospectively investigated and analysed by content analysis. Descriptive statistics were calculated. A total of 144 episodes of seclusion and restraint were included to analyse the reasons for seclusion and restraint, and 113 episodes were analysed to examine unsuccessful de-escalation techniques. The most commonly-used techniques were one-to-one interaction with a patient (n = 74, 65.5% of n = 113) and administration of extra medication (n = 37, 32.7% of n = 113). The reasons for seclusion and restraint were threatening harmful behaviour (n = 51, 35.4% of n = 144), direct harmful behaviour (n = 43, 29.9%), indirect harmful behaviour (n = 42, 29.1%), and other behaviours (n = 8, 5.6%). In general, the same de-escalation techniques were used with most patients. Most episodes of seclusion or restraint were due to threats of violence or direct violence. Individual means of self-regulation and patient guidance on these techniques are needed. Additionally, staff should be educated on a diverse range of de-escalation techniques. Future studies should focus on examining de-escalation techniques for the prevention of seclusion.
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Affiliation(s)
- Satu Kuivalainen
- Department of Forensic Psychiatry, University of Eastern Finland, Kuopio, Finland
| | | | - Olavi Louheranta
- Department of Forensic Psychiatry, University of Eastern Finland, Kuopio, Finland
| | - Anu Putkonen
- Department of Forensic Psychiatry, University of Eastern Finland, Kuopio, Finland
| | - Eila Repo-Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Kuopio, Finland.,National Institute for Health and Welfare, Helsinki, Finland.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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van de Sande R, Noorthoorn E, Nijman H, Wierdsma A, van de Staak C, Hellendoorn E, Mulder N. Associations between psychiatric symptoms and seclusion use: Clinical implications for care planning. Int J Ment Health Nurs 2017; 26:423-436. [PMID: 28960735 DOI: 10.1111/inm.12381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2017] [Indexed: 11/30/2022]
Abstract
Findings from an increasing number of studies suggest that incorporating systematic short-term risk assessments in treatment planning could lead to safer practice on psychiatric admissions wards. The aim of the present study was to investigate the associations between the scores of three structured observation tools - the Kennedy Axis V (K-Axis-V), the Brief Psychiatric Rating Scale (BPRS), and the Social Dysfunction and Aggression Scale (SDAS) - and seclusion. In total, 1840 weekly risk assessments with these observation scales were collected over 2342 admission weeks. These assessment scores related to 370 acutely-admitted psychiatric patients and were subjected to a multilevel analysis. It was found that several dynamic and static factors were related to seclusion. Dynamic factors included violent behaviour, current substance abuse, suspiciousness, and negativism. Static factors included ethnicity and having been diagnosed with a substance abuse disorder. The findings suggest that the incorporation of the Kennedy-Axis V, the BPRS, and the SDAS into standard practice might be helpful in identifying patients at high risk of seclusion, and could be supportive to treatment planning and clinical decision-making in the prevention of seclusion use in acute psychiatric settings.
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Affiliation(s)
- Roland van de Sande
- Department of Health, Utrecht University of Applied Science, Utrecht, The Netherlands
| | - Eric Noorthoorn
- GGnet Mental Health Centre, GGnet, Warnsveld, The Netherlands
| | - Henk Nijman
- Roosenburg, Altrecht Aventurijn, Den Dolder, The Netherlands
| | - Andre Wierdsma
- Department of Psychiatry, Research Centre O3, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Cees van de Staak
- Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Edwin Hellendoorn
- Acute Psychiatric Care, Parnassia Groep Bavo Europoort, Rotterdam, The Netherlands
| | - Niels Mulder
- Department of Psychiatry, Research Centre O3, ParnassiaBavoGroep, Erasmus Medical Centre, Rotterdam, The Netherlands
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Haines A, Brown A, McCabe R, Rogerson M, Whittington R. Factors impacting perceived safety among staff working on mental health wards. BJPsych Open 2017; 3:204-211. [PMID: 28904814 PMCID: PMC5584653 DOI: 10.1192/bjpo.bp.117.005280] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 06/06/2017] [Accepted: 07/21/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Safety at work is a core issue for mental health staff working on in-patient units. At present, there is a limited theoretical base regarding which factors may affect staff perceptions of safety. AIMS This study attempted to identify which factors affect perceived staff safety working on in-patient mental health wards. METHOD A cross-sectional design was employed across 101 forensic and non-forensic mental health wards, over seven National Health Service trusts nationally. Measures included an online staff survey, Ward Features Checklist and recorded incident data. Data were analysed using categorical principal components analysis and ordinal regression. RESULTS Perceptions of staff safety were increased by ward brightness, higher number of patient beds, lower staff to patient ratios, less dayroom space and more urban views. CONCLUSIONS The findings from this study do not represent common-sense assumptions. Results are discussed in the context of the literature and may have implications for current initiatives aimed at managing in-patient violence and aggression. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY) license.
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Affiliation(s)
- Alina Haines
- , PhD, Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Andrew Brown
- , MSc, Forensic Personality and Autism Spectrum Disorder Assessment and Liaison Team, Mersey Care NHS Foundation Trust, Rainhill, UK
| | - Rhiannah McCabe
- , MSc, Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Michelle Rogerson
- , PhD, Applied Criminology Centre, University of Huddersfield, Huddersfield, UK
| | - Richard Whittington
- , PhD, Department of Health Services Research, University of Liverpool, Liverpool, UK
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49
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[Architectural modernization of psychiatric hospitals influences the use of coercive measures]. DER NERVENARZT 2017; 88:70-77. [PMID: 26820456 DOI: 10.1007/s00115-015-0054-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Coercive measures are widely applied in psychiatric hospitals as a last resort to prevent patients seriously harming themselves or others, with negative psychological and somatic consequences for those affected. OBJECTIVE In a naturalistic observational study it was investigated whether relocation of the structural milieu of a psychiatric hospital to an architectonically improved new building influenced the application of coercive measures. MATERIAL AND METHODS The frequency and duration of coercive measures (e.g. fixation, coercive medication and preventive restraints) were routinely documented and compared in the periods before and after the relocation. RESULTS After the relocation the utilization of coercive measures was significantly reduced by 48-84 %. CONCLUSION Despite the limitations of the study design the results suggest that the architectural improvements reduced the application of coercive measures. It is speculated that the positive structural milieu enhanced the well-being of patients and staff and their social relations, which in turn prevented coercive measures.
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50
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Nugteren W, van der Zalm Y, Hafsteinsdóttir TB, van der Venne C, Kool N, van Meijel B. Experiences of Patients in Acute and Closed Psychiatric Wards: A Systematic Review. Perspect Psychiatr Care 2016; 52:292-300. [PMID: 26033512 DOI: 10.1111/ppc.12125] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 04/23/2015] [Accepted: 04/23/2015] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To obtain insight into the patients' experiences during treatment in an acute, closed psychiatric ward. DESIGN AND METHODS A systematic literature search was conducted in the databases Medline, Embase, CINAHL, and Cochrane. FINDINGS Ten articles were selected. Four main themes emerged from the literature: (a) the inappropriate use of the ward rules, (b) nurses' lack of time for interacting with patients, (c) the feeling of humiliation, and (d) the involvement of significant others. PRACTICE IMPLICATIONS Nurses can use the findings of this systematic review to improve quality of care in acute psychiatric units.
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Affiliation(s)
- Willem Nugteren
- Faculty of Clinical Health Sciences, Utrecht University, Utrecht, the Netherlands. .,Parnassia Psychiatric Institute, The Hague & Research Group Mental Health Nursing, Inholland University of Applied Sciences, Amsterdam, the Netherlands.
| | - Yvonne van der Zalm
- Faculty of Clinical Health Sciences, Utrecht University, Utrecht, the Netherlands.,Rivierduinen, Oegstgeest, the Netherlands.,Research Group Mental Health Nursing, Inholland University of Applied Sciences, Amsterdam, the Netherlands
| | - Thóra B Hafsteinsdóttir
- Department of Rehabilitation, Nursing Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands.,Faculty of Health Care, University of Applied Sciences Utrecht, Utrecht, the Netherlands.,Nursing Science Program, Faculty of Clinical Health Sciences, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Cokky van der Venne
- Research Group Mental Health Nursing, Inholland University of Applied Sciences, Amsterdam, the Netherlands.,Parnassia Psychiatric Institute, Parnassia Academy, The Hague, the Netherlands
| | - Nienke Kool
- Palier/Parnassia Psychiatric Institute & Research Group Mental Health Nursing, Inholland University of Applied Sciences, Amsterdam, the Netherlands
| | - Berno van Meijel
- Parnassia Psychiatric Institute, Parnassia Academy, The Hague, the Netherlands.,Department of Health, Sports and Welfare/Cluster Nursing, Mental Health Nursing, Research Group Mental Health Nursing, Inholland University of Applied Sciences, Amsterdam, the Netherlands.,Department of Psychiatry, Amsterdam & VU Medical Center, Amsterdam, the Netherlands
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