Evidence synthesis on coercion in mental health: An umbrella review

Aragonés‐Calleja, Miriam; Sánchez‐Martínez, Vanessa

doi:10.1111/inm.13248

Cited by 7 publications

(1 citation statement)

References 86 publications

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“…Coercion encompasses a broad range of practices in the context of mental health care, characterized by the use of force and threats ( 3 ). However, the use of coercion entails challenging ethical situations ( 4 , 5 ), might cause adverse physical and psychological effects and is an emotional stressor for both individuals with psychiatric diagnoses and healthcare workers ( 6 ). The possible association of aggressive behaviour with mental illness might drive negative public perceptions and stigmatisation of people with these mental disorders, and the mandated imposition of treatment to avert further risk of interpersonal violence might even exacerbate stigma ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Expert opinions on improving coercion data collection across Europe: a concept mapping study

Lickiewicz,

Efkemann,

Husum

et al. 2024

Front. Psychiatry

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IntroductionCoercion is frequently used in mental health practice. Since it overrides some patients’ fundamental human rights, adequate use of coercion requires legal and ethical justifications. Having internationally standardised datasets to benchmark and monitor coercion reduction programs is desirable. However, only a few countries have specific, open, publicly accessible registries for this issue.MethodsThis study aims to assemble expert opinions regarding strategies that might be feasible for promoting, developing, and implementing an integrated and differentiated coercion data collection system in Europe at national and international levels. A concept mapping methodology was followed, involving 59 experts from 27 countries in generating, sorting and rating strategies regarding relevance and feasibility. The experts were all researchers and/or practitioner members of an EU-COST-Action focused on coercion reduction Fostering and Strengthening Approaches to Reducing Coercion in European Mental Health Services (FOSTREN).ResultsA hierarchical cluster analysis revealed a conceptual map of 41 strategies organized in seven clusters. These clusters fit into two higher-order domains: “Advancing Global Health Research: Collaboration, Accessibility, and Technological Innovations/Advancing International Research” and “Strategies for Comprehensive Healthcare Data Integration, Standardization, and Collaboration.” Regarding the action with the higher priority, relevance was generally rated higher than feasibility. No differences could be found regarding the two domains regarding the relevance rating or feasibility of the respective strategies in those domains. The following strategies were rated as most relevant: “Collection of reliable data”, “Implementation of nationwide register, including data on coercive measures”, and “Equal understanding of different coercive measures”. In analysing the differences in strategies between countries and their health prosperity, the overall rating did not differ substantially between the groups.ConclusionThe strategy rated as most relevant was the collection of reliable data in the nationwide health register, ensuring that countries share a standard understanding/definition of different coercive measures. Respondents did not consider the feasibility of establishing a shared European database for coercive measures to be high, nor did they envision the unification of mental health legislation in the future. There is some consensus on the most suitable strategies that can be adopted to enable international benchmarking of coercion in mental health settings.

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Section: Introductionmentioning

confidence: 99%

Expert opinions on improving coercion data collection across Europe: a concept mapping study

Lickiewicz,

Efkemann,

Husum

et al. 2024

Front. Psychiatry

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Reacting to Demoralization and Investigating the Experience of Dignity in Psychosis: Reflections from an Acute Psychiatric Ward

Belvederi Murri,

Folesani,

Nanni

et al. 2024

Epistemic Justice in Mental Healthcare

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Psychotic disorders are extremely challenging for individuals and their loved ones. The experience of psychosis, as is found in schizophrenia, may subvert the foundations of the individual’s relationship with the world. Irrespective of the theoretical frame of reference, psychotic episodes are characterized by intrinsic impairment of the individual ability to know, make sense of, and experience the world, thus limiting agency and threatening dignity. In addition, individuals with acute psychosis are generally cared for within institutions that entail some degree of separation from society (e.g. the psychiatric ward) and—in extreme cases—with coercive practices. Coercion is established by the law as a “necessary evil” to avoid risky outcomes and to achieve clinical improvements, i.e. recover a better contact with reality. However, this approach may engender situations that are detrimental for individual dignity, morale, and epistemic justice. During the emergence of acute severe mental illness and its treatment, individuals may in fact encounter stigmatization and marginalization, and experience stress, loss of agency and loss of dignity. After one or more hospital admissions, the experience of severe mental illness and the conditions related to treatment may engender demoralization, which is particularly detrimental in the long term and may increase the risk of suicide. This chapter aims to provide an overview of the available evidence on these topics and broad indications on strategies and therapeutic approaches that might improve the experience of psychiatric inpatient care.

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Lesbian, Gay, Bisexual, Transgender and Queer People's Experiences of Stigma Across the Spectrum of Inpatient Psychiatric Care: A Systematic Review

Clark,

Jewell,

Sherman

et al. 2024

Int J Mental Health Nurs

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Lesbian, gay, bisexual, transgender, queer and other diverse sexual orientations and gender identity groups (LGBTQ+) face high rates of poor mental health. In the most severe and emergent of instances, inpatient psychiatric care may be required. LGBTQ+ people report experiences of mistreatment in healthcare settings broadly, such as denial of healthcare services and harassment from healthcare providers and other patients. However, little is known about the experiences of LGBTQ+ people in inpatient psychiatric care settings, specifically. The purpose of this review was to assess the existing literature for descriptions of LGBTQ+ people's experiences within inpatient psychiatric care. We searched multiple databases (i.e., PubMed, PsychINFO, CINAHL, Web of Science and Google Scholar) for peer‐reviewed articles that described the experiences of LGBTQ+ people within inpatient psychiatric care that were published in English. The included articles (N = 14) were analysed using a conceptual model of stigma and organised within those strata (structural, interpersonal and individual stigma) across the inpatient experience, (admission, inpatient unit, and discharge). Themes identified included: noninclusive intake tools and pervasive misgendering during the admission process; lack of healthcare infrastructure, inadequate training and lack of cultural humility, pervasive discrimination and victimization, silencing of LGBTQ+ patients, and feelings of fear and shame while on inpatient units, and lack of community resources during the discharge process. Clinicians should consider the perspectives and experiences of LGBTQ+ people to enact identity‐affirming care practices that may increase mental healthcare engagement and improve long‐term mental health outcomes.

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Evidence synthesis on coercion in mental health: An umbrella review

Cited by 7 publications

References 86 publications

Expert opinions on improving coercion data collection across Europe: a concept mapping study

Expert opinions on improving coercion data collection across Europe: a concept mapping study

Reacting to Demoralization and Investigating the Experience of Dignity in Psychosis: Reflections from an Acute Psychiatric Ward

Lesbian, Gay, Bisexual, Transgender and Queer People's Experiences of Stigma Across the Spectrum of Inpatient Psychiatric Care: A Systematic Review

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