Between No Help and Coercion: Toward Referral to Involuntary Psychiatric Admission. A Qualitative Interview Study of Stakeholders' Perspectives

Wormdahl, Irene; Husum, Tonje Lossius; Kjus, Solveig Helene Høymork; Rugkåsa, Jorun; Hatling, Trond; Rise, Marit By

doi:10.3389/fpsyt.2021.708175

Cited by 14 publications

(26 citation statements)

References 22 publications

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“…This is in line with studies that show that lack of resources and flexibility in healthcare can increase the risk of involuntary hospital admission 33 and that there is a need for easy access to healthcare in the early stages of deterioration. 34 In the present study, both groups underlined the importance of maintaining significant relationships and called for frameworks that allow for continued contact with patients even when they need treatment and care from other health service providers for shorter or longer periods.…”

Section: Discussionmentioning

confidence: 86%

Health professionals’ experience of treatment of patients whose community treatment order was revoked under new capacity-based mental health legislation in Norway: qualitative study

et al. 2022

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Background Norway introduced capacity-based legislation in mental healthcare on 1 September 2017 with the aim of increasing patient autonomy and legal protection and reducing the use of coercion. The new legislation was expected to be particularly important for patients under community treatment orders (CTOs). Aims To explore health professionals’ experiences of how capacity-based legislation affects healthcare services for patients whose compulsory treatment order was revoked as a result of being assessed as having capacity to consent. Method Nine health professionals responsible for treatment and care of patients whose CTO was revoked owing to the new legislation were interviewed in depth from September 2019 to March 2020. We used a hermeneutic approach to the interviews and analysis of the transcripts. Results The participants found that capacity-based legislation raised their awareness of their responsibility for patient autonomy and involvement in treatment and care. They also felt a need for more frequent assessments of patients’ condition and capacity to consent and more flexibility between levels of care. Conclusions The study shows that health professionals found that capacity-based legislation raised their awareness of their responsibility for patient autonomy and involvement in treatment and care. They sought closer dialogue with patients, providing information and advice, and more frequently assessing patients’ condition to adjust treatment and care to enable them to retain their capacity to consent. This could be challenging and required competence, continuity and close collaboration between personnel in different healthcare services at primary and specialist level.

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Section: Discussionmentioning

confidence: 86%

Health professionals’ experience of treatment of patients whose community treatment order was revoked under new capacity-based mental health legislation in Norway: qualitative study

et al. 2022

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“…As many studies revealed [ 20 , 52 , 53 ], perceived violence (risk of dangerousness to self or others) is a central factor in psychiatrists’ judgments regarding IA, and this is true especially under the risk criteria provisions on IA in China. Psychiatrists’ assessment would reflect their evaluation of patients as well as their attitude and understanding of risk criteria on IA [ 54 , 55 ]. In other words, the three factors above might be the most important for clinicians on IA decision making.…”

Section: Discussionmentioning

confidence: 99%

Status and clinical influencing factors of involuntary admission in chinese patients with schizophrenia

Zheng

Shao

et al. 2022

BMC Psychiatry

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Background Though controversial for its various disadvantages, involuntary admission (IA) is necessary in providing mental health care for patients suffering from schizophrenia in China. This article examines the IA rate in a representative sample, and under which circumstances are these patients more likely to be admitted involuntarily. Methods Adult patients consecutively admitted to two typical hospitals in Shanghai between 2013 and 2014 with a diagnosis of ICD-10 schizophrenia were included. 2167 patients were included in this study. Sociodemographic and clinical data, as well as personal information of psychiatrists who made risk assessment, were collected. The whole sample was divided into voluntary and involuntary admission groups. Group comparisons were performed with SPSS 17.0, using one-way ANOVA, Wilcoxon rank sum test, Chi-squares and Logistic regression. Results Among 2167 inpatients, the majority (2003, 92.4%) were involuntarily admitted. Clinical features, including age of patients (p < 0.001, OR = 1.037), lacking of insight (p < 0.001, OR = 3.691), were statistically significant for IA. Psychiatrist’s age (p < 0.001, OR = 1.042) was independently associated with IA. However, risk behaviors had dramatically affected patients’ admission status, of which the strongest predictor of IA was noncompliance with treatment (p < 0.001, OR = 3.597). The areas under the curve of the ROC and accuracy for the regression model were 0.815 and 0.927, respectively. Conclusion IA patients account for a major proportion of all those hospitalized with schizophrenia in China. Insights and risk behaviors contributed the most reasons for admission status of patients. This research shed light on necessity of further qualitative studies learning detailed evaluation processes of IA and high-quality interventional studies aiming to limit the performance of IA among patients with schizophrenia.

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“…The present study was conducted in the five Norwegian municipalities constituting the intervention arm in the cluster RCT. To prepare for the co-creation of the intervention, qualitative interviews and focus groups were performed to explore individuals' paths towards referral to involuntary admissions [31] and current practice in the municipalities [32]. The ReCoN trial did not provide finances to the participating municipalities.…”

Section: Study Settingmentioning

confidence: 99%

“…The fourth and fifth strategy areas relate to collaboration between services both across care levels (Collaboration Across Primary and Specialist Care Levels) and within the primary care level (Collaboration within the Primary Care Level). Processes leading to involuntary admissions typically unfold in the community and involve multiple services from both primary and specialist care [31]. Poor collaboration and fragmented service provision are factors found both in Norway [41,42] and other countries [43] that can affect the quality and coherence of service provision to people with SMIs in need of multiple services.…”

Section: Potential To Facilitate Comprehensive and Complementary Serv...mentioning

confidence: 99%

The ReCoN intervention: a co-created comprehensive intervention for primary mental health care aiming to prevent involuntary admissions

Wormdahl

Hatling

Husum

et al. 2022

BMC Health Serv Res

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Background Reducing involuntary psychiatric admissions is a global concern. In Norway, the rate of involuntary admissions was 199 per 100,000 people 16 years and older in 2020. Individuals’ paths towards involuntary psychiatric admissions usually unfold when they live in the community and referrals to such admissions are often initiated by primary health care professionals. Interventions at the primary health care level can therefore have the potential to prevent such admissions. Interventions developed specifically for this care level are, however, lacking. To enhance the quality and development of services in a way that meets stakeholders’ needs and facilitates implementation to practice, involving both persons with lived experience and service providers in developing such interventions is requested. Aim To develop a comprehensive intervention for primary mental health care aiming to prevent involuntary admissions of adults. Methods This study had an action research approach with a participatory research design. Dialogue conferences with multiple stakeholders in five Norwegian municipalities, inductive thematic analysis of data material from the conferences, and a series of feedback meetings were conducted. Results The co-creation process resulted in the development of the ReCoN (Reducing Coercion in Norway) intervention. This is a comprehensive intervention that includes six strategy areas: [1] Management, [2] Involving Persons with Lived Experience and Family Carers, [3] Competence Development, [4] Collaboration across Primary and Specialist Care Levels, [5] Collaboration within the Primary Care Level, and [6] Tailoring Individual Services. Each strategy area has two to four action areas with specified measures that constitute the practical actions or tasks that are believed to collectively impact the need for involuntary admissions. Conclusions The ReCoN intervention has the potential for application to both national and international mental health services. The co-creation process with the full range of stakeholders ensures face validity, acceptability, and relevance. The effectiveness of the ReCoN intervention is currently being tested in a cluster randomised controlled trial. Given positive effects, the ReCoN intervention may impact individuals with a severe mental illness at risk of involuntary admissions, as more people may experience empowerment and autonomy instead of coercion in their recovery process.

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Between No Help and Coercion: Toward Referral to Involuntary Psychiatric Admission. A Qualitative Interview Study of Stakeholders' Perspectives

Cited by 14 publications

References 22 publications

Health professionals’ experience of treatment of patients whose community treatment order was revoked under new capacity-based mental health legislation in Norway: qualitative study

Health professionals’ experience of treatment of patients whose community treatment order was revoked under new capacity-based mental health legislation in Norway: qualitative study

Status and clinical influencing factors of involuntary admission in chinese patients with schizophrenia

The ReCoN intervention: a co-created comprehensive intervention for primary mental health care aiming to prevent involuntary admissions

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