Models, frameworks and theories in the implementation of programs targeted to reduce formal coercion in mental health settings: a systematic review

Introduction: Implementation models, frameworks and theories (hereafter tools) provide researchers and clinicians with an approach to understand the processes and mechanisms for the successful implementation of healthcare innovations. Previous research in mental health settings has revealed, that the implementation of coercion reduction programs presents a number of challenges. However, there is a lack of systematized knowledge of whether the advantages of implementation science have been utilized in this field of research. This systematic review aims to gain a better understanding of which tools have been used by studies when implementing programs aiming to reduce formal coercion in mental health settings, and what implementation outcomes they have reported. Methods: A systematic search was conducted using PubMed, CINAHL, PsycINFO, Cochrane, Scopus, and Web of Science. A manual search was used to supplement database searches. Quality appraisal of included studies was undertaken using MMAT—Mixed Methods Appraisal Tool. A descriptive and narrative synthesis was formed based on extracted data. Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed in this review. Results: We identified 5,295 references after duplicates were removed. Four additional references were found with a manual search. In total eight studies reported in nine papers were included in the review. Coercion reduction programs that were implemented included those that were holistic, and/or used professional judgement, staff training and sensory modulation interventions. Eight different implementation tools were identified from the included studies. None of them reported all eight implementation outcomes sought from the papers. The most frequently reported outcomes were acceptability (4/8 studies) and adaptation (3/8). With regards to implementation costs, no data were provided by any of the studies. The quality of the studies was assessed to be overall quite low. Discussion: Systematic implementation tools are seldom used when efforts are being made to embed interventions to reduce coercive measures in routine mental health care. More high-quality studies are needed in the research area that also involves perspectives of service users and carers. In addition, based on our review, it is unclear what the costs and resources are needed to implement complex interventions with the guidance of an implementation tool. Systematic review registration: [Prospero], identifier [CRD42021284959]

Som natt og dag?

Notatet peker på at det ofte er store forskjeller i forståelsen og opplevelsen av tvang hos de som gjennomfører tvungent psykisk helsevern, og hos brukere som erfarer tvungent psykisk helsevern som negativt. Disse situasjonene er ofte krevende for begge parter

Som natt og dag?

Notatet peker på at det ofte er store forskjeller i forståelsen og opplevelsen av tvang hos de som gjennomfører tvungent psykisk helsevern, og hos brukere som erfarer tvungent psykisk helsevern som negativt. Disse situasjonene er ofte krevende for begge parter

Som natt og dag?

Notatet peker på at det ofte er store forskjeller i forståelsen og opplevelsen av tvang hos de som gjennomfører tvungent psykisk helsevern, og hos brukere som erfarer tvungent psykisk helsevern som negativt. Disse situasjonene er ofte krevende for begge parter

Four reasons why assisted dying should not be offered for depression

Recently, several authors have argued that assisted dying may be ethically appropriate when requested by a person who suffers from serious depression unresponsive to treatment. We here present four arguments to the contrary. First, the arguments made by proponents of assisted dying rely on notions of “treatment-resistant depression” that are problematic. Second, an individual patient suffering from depression may not be justified in believing that chances of recovery are minimal. Third, the therapeutic significance of hope must be acknowledged; when mental healthcare opens up the door to admitting hopelessness, there is a danger of a self-fulfilling prophecy. Finally, proponents of assisted dying in mental healthcare overlook the dangers posed to mental-health services by the institutionalization of assisted dying. The final version of this research has been published in Journal of Bioethical Inquiry. © 2016 Springer Verla

A cross-sectional prospective study of seclusion, restraint and involuntary medication in acute psychiatric wards: patient, staff and ward characteristics

-Background Previous research on mental health care has shown considerable differences in use of seclusion, restraint and involuntary medication among different wards and geographical areas. This study investigates to what extent use of seclusion, restraint and involuntary medication for involuntary admitted patients in Norwegian acute psychiatric wards was associated with patient, staff and ward characteristics. The study includes data from 32 acute psychiatric wards. Methods Multilevel logistic regression using Stata was applied with data from 1016 involuntary admitted patients that were linked to data about wards. The sample comprised two hierarchical levels (patients and wards) and the dependent variables had two values (0 = no use and 1 = use). Coercive measures were defined as use of seclusion, restraint and involuntary depot medication during hospitalization. Results The total number of involuntary admitted patients was 1214 (35% of total sample). The percentage of patients who were exposed to coercive measures ranged from 0-88% across wards. Of the involuntary admitted patients, 424 (35%) had been secluded, 117 (10%) had been restrained and 113 (9%) had received involuntary depot medication at discharge. Data from 1016 patients could be linked in the multilevel analysis. There was a substantial between-ward variance in the use of coercive measures; however, this was influenced to some extent by compositional differences across wards, especially for the use of restraint. Conclusions The substantial between-ward variance, even when adjusting for patients' individual psychopathology, indicates that ward factors influence the use of seclusion, restraint and involuntary medication and that some wards have the potential for quality improvement. Hence, interventions to reduce the use of seclusion, restraint and involuntary medication should take into account organizational and environmental factors.publishedVersio

“A plea for recognition” Users’ experience of humiliation during mental Health care

Background: Studies reveal that users of mental health care services sometimes experience humiliation during care. These experiences may influence the users' recovery process and treatment satisfaction. Method: Thirteen informants with experience in mental health services were recruited for semi-structured interviews. Informants were recruited through collaboration with users' organisations. Modified text condensation was used for analysis of the qualitative data. Results: Users' experiences with humiliation in mental health care were sorted into three main themes. These are themes related to different perspectives between staff and users; themes related to violence of user autonomy; and experiences related to staff attitudes. Discussion: The service users in this study spoke about many different kinds of experiences with humiliation during care. It was a main finding that the feeling of not being recognized for one's own perception of the situation was experienced as a humiliation. This study is a contribution to a better understanding of the humiliation process between staff and users in mental health care services. The findings may be used to improve interaction between staff and users, improve quality of care and to prevent such experiences

En brytningstid i synet på psykiske vansker og behandling - Etiske utfordringer ved bruk av tvang

Helsetjenestene innehar mulighet til å bruke makt for å hjelpe mennesker i sårbare livssituasjoner. Dette gir også mulighet til maktmisbruk. Det er mange eksempler fra historien som viser at det har fart galt av sted, og understreker hvor viktig det er å kontinuerlig ha etiske vurderinger og kritisk refleksjon i all utføring av helse- og omsorgsarbeid. De siste 20 årene har vi sett et økt fokus på demokratiske prosesser innenfor helsetjenesten, og enkeltindividet har fått sterkere rettigheter og rettsvern. Dette har ført til krav om økt brukermedvirkning, pasientrettigheter og likeverdighet mellom pasient og helsepersonell. De psykiske helsetjenestene har gått inn i en ny tid med økt oppmerksomhet på pasienters egne opplevelser, menneskerettigheter og med mer samarbeidsbaserte arbeidsformer. Hvordan skal ulike legitime interesser avveies hvis de står mot hverandre – for eksempel hjelpeplikten versus pasientens selvbestemmelse, og pasientens ønsker versus andres sikkerhet (for eksempel pårørende eller samfunnet)? Hva kjennetegner gode beslutningsprosesser der pasienten er alvorlig syk? Hvordan bør helsepersonell håndtere usikkerheten knyttet til effekt av bruk av tvang? Hvordan kan man definere tvang på en god måte? Disse spørsmålene representerer sentrale etiske utfordringer ved bruk av tvang