Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
2.7
2.8
Journals
Healthcare
Special Issues
Moving Away from Coercion in Mental Health Care
share announcement

Moving Away from Coercion in Mental Health Care

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Nursing".

Deadline for manuscript submissions: closed (31 March 2024) | Viewed by 15986

Special Issue Editors

Dr. Eugenie Georgaca

E-Mail Website1 Website2
Guest Editor
School of Psychology, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
Interests: community clinical psychology; recovery; living with severe mental distress; coping strategies; human rights in mental health care; self-help; coercion in mental health care; recovery-oriented mental health services
Dr. Lene Lauge Berring

E-Mail Website1 Website2
Guest Editor
1. Psychiatric Research Unit, Mental Health Services Region Zealand, 4200 Slagelse, Denmark
2. Institute of Regional Health Research, University of Southern Denmark, 5230 Odense, Denmark
Interests: trauma informed care; safewards; recovery; violence prevention strategies; human rights in mental health care; user-participation, coercion in mental health care; recovery-oriented mental health services

Special Issue Information

Dear Colleagues, 

Coercive measures such as involuntary hospitalization, seclusion, restraint and forced medication seem to be frequently practiced in mental health care. These practices raise important human rights issues, and may have a negative impact on service users, carers and professionals, as they can be experienced as dehumanizing and traumatic. There is a momentum internationally to move away from using coercive measures in mental health services, and to adopt voluntary interventions and professional practices that render imposing restrictions unnecessary, thus preempting, preventing and reducing coercion.

Moving away from coercion in mental health services requires an understanding of the risk factors for coercion at individual, systemic and societal levels, especially through examining clinical practices and legal frameworks across countries. It also necessitates highlighting the impact of coercive practices for all involved as well as the best practices for minimizing that impact and supporting post-incident recovery. We also need to increase knowledge of alternative interventions and to demonstrate their effectiveness in preventing the use of coercion and promoting recovery.

We welcome contributions from researchers and practitioners in all mental-health-related disciplines. We strive for a selection of empirical studies (both quantitative and qualitative) as well as systematic reviews that reflect the perspectives of service users, practitioners, carers and health service managers.

Dr. Eugenie Georgaca
Dr. Lene Lauge Berring
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • involuntary hospitalization
  • seclusion
  • restraint
  • forced medication
  • community treatment order
  • risk factors
  • alternative interventions
  • trauma-informed care
  • human rights
  • recovery from coercion

Published Papers (10 papers)

Download All Papers
Order results
Result details
Show export options expand_more Show export options expand_less
Select all
Export citation of selected articles as:

Editorial

Jump to: Research, Review, Other

4 pages, 207 KiB  
Editorial
A Call for Transformation: Moving Away from Coercive Measures in Mental Health Care
by Lene Lauge Berring and Eugenie Georgaca
Healthcare 2023, 11(16), 2315; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare11162315 - 17 Aug 2023
Viewed by 1092
Abstract
Coercion is common practice in mental health care [...] Full article
(This article belongs to the Special Issue Moving Away from Coercion in Mental Health Care)

Research

Jump to: Editorial, Review, Other

21 pages, 802 KiB  
Article
Something Happened with the Way We Work: Evaluating the Implementation of the Reducing Coercion in Norway (ReCoN) Intervention in Primary Mental Health Care
by Tonje Lossius Husum, Irene Wormdahl, Solveig H. H. Kjus, Trond Hatling and Jorun Rugkåsa
Healthcare 2024, 12(7), 786; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare12070786 - 04 Apr 2024
Viewed by 622
Abstract
Background: Current policies to reduce the use of involuntary admissions are largely oriented towards specialist mental health care and have had limited success. We co-created, with stakeholders in five Norwegian municipalities, the ‘Reducing Coercion in Norway’ (ReCoN) intervention that aims to reduce involuntary [...] Read more.
Background: Current policies to reduce the use of involuntary admissions are largely oriented towards specialist mental health care and have had limited success. We co-created, with stakeholders in five Norwegian municipalities, the ‘Reducing Coercion in Norway’ (ReCoN) intervention that aims to reduce involuntary admissions by improving the way in which primary mental health services work and collaborate. The intervention was implemented in five municipalities and is being tested in a cluster randomized control trial, which is yet to be published. The present study evaluates the implementation process in the five intervention municipalities. To assess how the intervention was executed, we report on how its different elements were implemented, and what helped or hindered implementation. Methods: We assessed the process using qualitative methods. Data included detailed notes from quarterly progress interviews with (i) intervention coordinators and representatives from (ii) user organisations and (iii) carer organisations. Finally, an end-of-intervention evaluation seminar included participants from across the sites. Results: The majority of intervention actions were implemented. We believe this was enabled by the co-creating process, which ensured ownership and a good fit for the local setting. The analysis of facilitators and barriers showed a high degree of interconnectedness between different parts of the intervention so that success (or lack thereof) in one area affected the success in others. Future implementation should pay attention to enhanced planning and training, clarify the role and contribution of service user and carer involvement, and pay close attention to the need for implementation support and whether this should be external or internal to services. Conclusions: It is feasible to implement a complex intervention designed to reduce the use of involuntary admissions in general support services, such as the Norwegian primary mental health services. This could have implications for national and international policy aimed at reducing the use of involuntary care. Full article
(This article belongs to the Special Issue Moving Away from Coercion in Mental Health Care)
►▼ Show Figures

Figure 1

19 pages, 351 KiB  
Article
Zero Tolerance for Coercion? Historical, Cultural and Organisational Contexts for Effective Implementation of Coercion-Free Mental Health Services around the World
by Richard Whittington, Deborah Oyine Aluh and Jose-Miguel Caldas-de-Almeida
Healthcare 2023, 11(21), 2834; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare11212834 - 27 Oct 2023
Cited by 2 | Viewed by 1320
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue Moving Away from Coercion in Mental Health Care)
10 pages, 286 KiB  
Article
Attitudes about Mechanical Restraint Use in Mental Health Hospitalization Services: A Spanish Survey
by Carlos Aguilera-Serrano, Jessica Marian Goodman-Casanova, Antonio Bordallo-Aragón, Juan Antonio García-Sánchez, Fermín Mayoral-Cleries and José Guzmán-Parra
Healthcare 2023, 11(13), 1909; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare11131909 - 01 Jul 2023
Viewed by 1160
Abstract
The aim of this study was to analyze the attitudes of professionals in Mental Health Services throughout Spain who are directly or indirectly involved in the use of mechanical restraint and the barriers perceived to reduce its use. The study involved an online [...] Read more.
The aim of this study was to analyze the attitudes of professionals in Mental Health Services throughout Spain who are directly or indirectly involved in the use of mechanical restraint and the barriers perceived to reduce its use. The study involved an online anonymous survey using Google Forms completed by Spanish mental health professionals working with service users; the survey assessed their involvement in and general attitudes and beliefs towards mechanical restraint. The survey was completed by 225 participants. Only 13.30% of the participants considered that mechanical restraint use was never necessary to guarantee the safety of users/staff in dangerous situations. Poor staff training (38.0%) and a lack of resources/staff (34.7%) were the most frequent barriers identified for the reduction of mechanical restraint. In the multivariate analysis, participation in learning programs to prevent the use of mechanical restraint was associated with lower acceptance of the use of mechanical restraint, but the result was barely significant (p = 0.050). A high percentage of mental health staff still consider mechanical restraint use necessary for safety reasons. According to the results, the participants perceived that more staff and resources and better training could reduce the use of mechanical restraint in Mental Health Hospitalization Services. Full article
(This article belongs to the Special Issue Moving Away from Coercion in Mental Health Care)
18 pages, 632 KiB  
Article
Humane and Comprehensive Management of Challenging Behaviour in Health and Social Care: Cross-Sectional Study Testing Newly Developed Instrument
by Sirpa Tölli, Raija Kontio, Pirjo Partanen, Anja Terkamo-Moisio and Arja Häggman-Laitila
Healthcare 2023, 11(5), 753; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare11050753 - 03 Mar 2023
Cited by 1 | Viewed by 2103
Abstract
Background: Management of challenging behaviour causes victimization and violates the human rights of service users in psychiatric and long-term settings for people having mental health issues and learning disabilities. The purpose of the research was to develop and test an instrument for measuring [...] Read more.
Background: Management of challenging behaviour causes victimization and violates the human rights of service users in psychiatric and long-term settings for people having mental health issues and learning disabilities. The purpose of the research was to develop and test an instrument for measuring humane behaviour management (HCMCB). The research was guided by the following questions: (1) What is the structure and content of the Human and Comprehensive management of Challenging Behaviour (HCMCB) instrument, (2) What are the psychometric properties of the HCMCB instrument, and (3) How do Finnish health and social care professionals evaluate their humane and comprehensive management of challenging behaviour? Methods: A cross-sectional study design and STROBE checklist were applied. A convenience sample of health and social care professionals (n = 233) studying at the University of Applied Sciences (n = 13) was recruited. Results: The EFA revealed a 14-factor structure and included a total of 63 items. The Cronbach’s alpha values for factors varied from 0.535 to 0.939. The participants rated their individual competence higher than leadership and organizational culture. Conclusions: HCMCB is a useful tool for evaluating competencies, leadership, and organizational practices in the context of challenging behaviour. HCMCB should be further tested in various international contexts involving challenging behaviour with large samples and longitudinal design. Full article
(This article belongs to the Special Issue Moving Away from Coercion in Mental Health Care)
►▼ Show Figures

Figure 1

Review

Jump to: Editorial, Research, Other

15 pages, 320 KiB  
Review
Involuntary Treatment for Child and Adolescent Anorexia Nervosa—A Narrative Review and Possible Advances to Move Away from Coercion
by Ingar M. Zielinski-Gussen, Beate Herpertz-Dahlmann and Brigitte Dahmen
Healthcare 2023, 11(24), 3149; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare11243149 - 12 Dec 2023
Viewed by 941
Abstract
Background: Children and adolescents with psychiatric disorders frequently experience hospital treatment as coercive. In particular, for patients with severe anorexia nervosa (AN), clinical and ethical challenges often arise if they do not voluntarily agree to hospital admission, often due to the ego-syntonic nature [...] Read more.
Background: Children and adolescents with psychiatric disorders frequently experience hospital treatment as coercive. In particular, for patients with severe anorexia nervosa (AN), clinical and ethical challenges often arise if they do not voluntarily agree to hospital admission, often due to the ego-syntonic nature of the disorder. In these cases, involuntary treatment (IVT) might be life-saving. However, coercion can cause patients to experience excruciating feelings of pressure and guilt and might have long-term consequences. Methods: This narrative review aimed to summarize the current empirical findings regarding IVT for child and adolescent AN. Furthermore, it aimed to present alternative treatment programs to find a collaborative method of treatment for young AN patients and their families. Results: Empirical data on IVT show that even though no inferiority of IVT has been reported regarding treatment outcomes, involuntary hospital treatment takes longer, and IVT patients seem to struggle significantly more with weight restoration. We argue that more patient- and family-oriented treatment options, such as home treatment, might offer a promising approach to shorten or even avoid involuntary hospital admissions and further IVT. Different home treatment approaches, either aiming at preventing hospitalization or at shortening hospital stays, and the results of pilot studies are summarized in this article. Full article
(This article belongs to the Special Issue Moving Away from Coercion in Mental Health Care)
23 pages, 1489 KiB  
Review
Beyond Patient Characteristics: A Narrative Review of Contextual Factors Influencing Involuntary Admissions in Mental Health Care
by Deborah Oyine Aluh, Osaro Aigbogun, Blessing Onyinye Ukoha-Kalu, Manuela Silva, Ugnė Grigaitė, Barbara Pedrosa, Margarida Santos-Dias, Graça Cardoso and José Miguel Caldas-de-Almeida
Healthcare 2023, 11(14), 1986; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare11141986 - 09 Jul 2023
Cited by 2 | Viewed by 2192
Abstract
Variations in the rates of involuntary admission (IA) reflect the influence of unexplained contextual variables that are typically too heterogeneous to be included in systematic reviews. This paper attempts to gather and analyze factors unrelated to the patients that have been linked to [...] Read more.
Variations in the rates of involuntary admission (IA) reflect the influence of unexplained contextual variables that are typically too heterogeneous to be included in systematic reviews. This paper attempts to gather and analyze factors unrelated to the patients that have been linked to IA. The articles included in this review were selected by iteratively searching four electronic databases (PubMed, PsychINFO, EMBASE, and Web of Science). A total of 54 studies from 19 different countries and regions, including 14 European countries, the United States, Canada, China, Vietnam, and Taiwan, were selected. The factors were categorized as service-related factors, impactful events, seasonal and temporal factors, mental health legislation, staff factors, and public attitudes. The factors rarely act in isolation but rather interact and reinforce each other, causing a greater influence on IA. This paper explains how these factors present opportunities for robust and sustainable interventions to reduce IAs. The paper also identifies future directions for research, such as examining the effects of economic recessions. Enhancing global reporting standards is essential to validate future research and support further in-depth studies. The complexity of the factors influencing IA and the implicit role of society suggest that resolving it will require social change. Full article
(This article belongs to the Special Issue Moving Away from Coercion in Mental Health Care)
►▼ Show Figures

Figure 1

Other

25 pages, 3295 KiB  
Systematic Review
Factors and Processes Facilitating Recovery from Coercion in Mental Health Services—A Meta-Ethnography
by Lene Lauge Berring, Eugenie Georgaca, Sophie Hirsch, Hülya Bilgin, Burcu Kömürcü Akik, Merve Aydin, Evi Verbeke, Gian Maria Galeazzi, Stijn Vanheule and Davide Bertani
Healthcare 2024, 12(6), 628; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare12060628 - 11 Mar 2024
Viewed by 1362
Abstract
Background: Being subjected to or witnessing coercive measures in mental health services can have a negative impact on service users, carers and professionals, as they most often are experienced as dehumanising and traumatic. Coercion should be avoided, but when it does happen, it [...] Read more.
Background: Being subjected to or witnessing coercive measures in mental health services can have a negative impact on service users, carers and professionals, as they most often are experienced as dehumanising and traumatic. Coercion should be avoided, but when it does happen, it is important to understand how the experience can be processed so that its consequences are managed. Method: A systematic review and meta-ethnography was used to synthesise findings from qualitative studies that examined service users’, staff’s and relatives’ experiences of recovery from being exposed to coercive measures in mental health care settings. We identified, extracted and synthesised, across 23 studies, the processes and factors that were interpreted as significant to process the experience. Results: Recovery from coercion is dependent on a complex set of conditions that support a sense of dignity and respect, a feeling of safety and empowerment. Being in a facilitating environment, receiving appropriate information and having consistent reciprocal communication with staff are the means through which these conditions can be achieved. People employ strategies to achieve recovery, both during and after coercion, to minimise its impact and process the experience. Conclusions: The findings point to the importance of mental health care settings offering recovery-oriented environments and mental health professionals employing recovery-oriented practices, that would empower service users to develop strategies for managing their mental distress as well as their experiences in mental health care in a way that minimises traumatisation and fosters recovery. Full article
(This article belongs to the Special Issue Moving Away from Coercion in Mental Health Care)
►▼ Show Figures

Figure 1

22 pages, 670 KiB  
Systematic Review
Ethical Issues in Clinical Decision-Making about Involuntary Psychiatric Treatment: A Scoping Review
by Cláudio Domingos Laureano, Carlos Laranjeira, Ana Querido, Maria Anjos Dixe and Francisca Rego
Healthcare 2024, 12(4), 445; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare12040445 - 09 Feb 2024
Viewed by 1901
Abstract
In mental health and psychiatric care, the use of involuntary psychiatric treatment for people with mental disorders is still a central and contentious issue. The main objective of this scoping review was to map and systematize the literature on ethical issues in clinical [...] Read more.
In mental health and psychiatric care, the use of involuntary psychiatric treatment for people with mental disorders is still a central and contentious issue. The main objective of this scoping review was to map and systematize the literature on ethical issues in clinical decision-making about involuntary psychiatric treatment. Five databases (Embase, PsycINFO, CINAHL, Medline, and Scopus) were searched for articles on this topic. Out of a total of 342 articles found, 35 studies from 14 countries were included based on the selection criteria. The articles were analyzed using the inductive content analysis approach. The following main categories were identified: (1) ethical foundations that guide clinical decision-making; (2) criteria for involuntary psychiatric treatment; (3) gaps, barriers, and risks associated with involuntary psychiatric treatment; (4) strategies used to reduce, replace, and improve the negative impact of involuntary treatment; and (5) evidence-based recommendations. Most of the selected articles discuss the logic underlying involuntary treatment of the mentally ill, exploring ethical principles such as autonomy, beneficence, non-maleficence, or justice, as well as how these should be properly balanced. During the process of involuntary psychiatric admission, there was a notable absence of effective communication and a significant power imbalance that disenfranchised those seeking services. This disparity was further intensified by professionals who often use coercive measures without a clear decision-making rationale and by family members who strongly depend on hospital admission. Due to the pluralistic and polarized nature of opinions regarding legal capacity and the complexity and nuance of involuntary admission, further studies should be context-specific and based on co-production and participatory research. Full article
(This article belongs to the Special Issue Moving Away from Coercion in Mental Health Care)
►▼ Show Figures

Figure 1

21 pages, 695 KiB  
Systematic Review
A Systematic Review on the Impact of Seasonality on Severe Mental Illness Admissions: Does Seasonal Variation Affect Coercion?
by Ioannis Rizavas, Rossetos Gournellis, Phoebe Douzenis, Vasiliki Efstathiou, Panagiota Bali, Kostas Lagouvardos and Athanasios Douzenis
Healthcare 2023, 11(15), 2155; https://0-doi-org.brum.beds.ac.uk/10.3390/healthcare11152155 - 28 Jul 2023
Cited by 3 | Viewed by 1172
Abstract
Coercion in psychiatry is associated mainly with involuntary admissions. The purpose of this study was to investigate the associations between hospital admissions of patients suffering from affective and schizophrenic disorders and seasonality. A systematic literature search using PubMed, Scopus and Google Scholar was [...] Read more.
Coercion in psychiatry is associated mainly with involuntary admissions. The purpose of this study was to investigate the associations between hospital admissions of patients suffering from affective and schizophrenic disorders and seasonality. A systematic literature search using PubMed, Scopus and Google Scholar was conducted, including studies with affective and schizophrenia disorder admissions, published from October 1992 to August 2020. A total of 31 studies were included in the review. Four broad severe mental illness admission categories were identified regarding seasonality: affective disorders, schizophrenia disorders, involuntary admission affective disorders and involuntary admission schizophrenia disorders. There was clear and strong evidence for spring and summer peaks for severe mental illness admissions; data provided for age, gender and involuntary admissions was limited. Seasonality may have a significant effect on the onset and exacerbation of psychopathology of severe mental illness and should be considered as a risk factor in psychiatric admissions, violence and the risk of mental health coercion. A better understanding of the impact of seasonality on severe mental illness will help professionals to provide the best practices in mental health services in order to reduce and prevent psychiatric hospitalizations (especially involuntary admissions) resulting in further coercive measures. Full article
(This article belongs to the Special Issue Moving Away from Coercion in Mental Health Care)
►▼ Show Figures

Figure 1

Show export options expand_more Show export options expand_less
Select all
Export citation of selected articles as:
 
Displaying articles 1-10
Back to TopTop