Interventions for involuntary psychiatric inpatients: A systematic review

Giacco, Domenico; Conneely, Maev; Masoud, Tumseela; Burn, Erin; Priebe, Stefan

doi:10.1016/j.eurpsy.2018.07.005

Cited by 29 publications

(31 citation statements)

References 45 publications

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“… 73 Findings are also consistent with evidence from structured care planning interventions centred on patient-centred care and increasing involvement in decision-making, which have shown promise in improving patient outcomes, including readmission. 74 …”

Section: Discussionmentioning

confidence: 99%

Patients' experiences of assessment and detention under mental health legislation: systematic review and qualitative meta-synthesis

et al. 2019

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Background Understanding patient experiences of detention under mental health legislation is crucial to efforts to reform policy and practice. Aims To synthesise qualitative evidence on patients' experiences of assessment and detention under mental health legislation. Method Five bibliographic databases were searched, supplemented by reference list screening and citation tracking. Studies were included if they reported on patient experiences of assessment or detention under mental health legislation; reported on patients aged 18 years or older; collected data using qualitative methods; and were reported in peer-reviewed journals. Findings were analysed and synthesised using thematic synthesis. Results The review included 56 papers. Themes were generally consistent across studies and related to information and involvement in care, the environment and relationships with staff, as well as the impact of detention on feelings of self-worth and emotional state. The emotional impact of detention and views of its appropriateness varied, but a frequent theme was fear and distress during detention, including in relation to the use of force and restraint. Where staff were perceived as striving to form caring and collaborative relationships with patients despite the coercive nature of treatment, and when clear information was delivered, the negative impact of involuntary care seemed to be reduced. Conclusions Findings suggest that involuntary in-patient care is often frightening and distressing, but certain factors were identified that can help reduce negative experiences. Coproduction models may be fruitful in developing new ways of working on in-patient wards that provide more voice to patients and staff, and physical and social environments that are more conducive to recovery. Declaration of interest None.

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Section: Discussionmentioning

confidence: 99%

Patients' experiences of assessment and detention under mental health legislation: systematic review and qualitative meta-synthesis

et al. 2019

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“…First, this is the first known study to explore the feasibility of structured shared decision making practices during the first week of involuntary hospitalisation. It is also part of a very small number of interventions which have been developed and tested on involuntary inpatients, although none of them started so early during admission (35). Additionally, the intervention was developed in collaboration with a specifically formed Lived Experience Advisory Panel, consisting of both patients and carers who had recent experience of receiving, or supporting someone who had received involuntary treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The intervention was developed based on previous research including a systematic review (35) and a focus group study (36) by a multi-disciplinary research team. The team included psychiatrists, psychologists, nurses, a lawyer with expertise of the Mental Health Act (MHA), public health experts, research methodologists, patients and carers who worked in consultation with a specifically constituted Lived Experience Advisory Panel (LEAP), which included three patients and two carers who had experience receiving or supporting someone who had received involuntary treatment in the previous year.…”

Section: Methodsmentioning

confidence: 99%

Giving Patients Choices During Involuntary Admission: A New Intervention

et al. 2019

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Background: People who receive involuntary treatment are some of the most vulnerable in psychiatric services. They are more likely to have poorer social and clinical outcomes and to be disillusioned with and disengaged from care. Research indicates that patients’ experience in the first week of involuntary treatment is a critical period: a better experience of care in the first week predicts better quality of life and reduced readmission 1 year later. Patients have identified involvement in clinical decisions as key to improving their experience of care. The aim of this study was to test the feasibility and acceptability of an intervention to facilitate involvement in decision making for involuntary inpatients called OPeNS (Options, Preferences, Negotiate, and Summarise). Methods: This was a mixed method study. The OPeNS intervention was developed based on previous research carried out by a multidisciplinary team. Clinicians were trained to deliver it to involuntary inpatients. Feasibility indices (rates of participation in the intervention and time required to deliver it) were collected. Patients ( N = 14) and clinicians ( N = 5) provided qualitative data on their experience of the intervention in semi-structured interviews which were analysed using thematic analysis. Results: The OPeNS intervention was found to be acceptable by both patients and clinicians and feasible to conduct within the first week of involuntary treatment. Patients’ and clinicians’ experiences of the intervention fall into two themes: ‘Enabling a different dynamic’ and ‘Clashing with usual practices and priorities’. Conclusion: The OPeNS intervention provides a structure that can be used by clinicians across disciplines to facilitate involving involuntary patients in decision making. Although challenges related to changing usual practices were identified, the intervention was received positively and was feasible to conduct in the first week of involuntary treatment.

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“…Research into interventions to improve the experience of coercive care is sparse but feasible, with randomised controlled trials providing preliminary support for patient-centred care planning. 39 The current study highlights the heterogenous nature of patient satisfaction with care during involuntary admission, and suggests that it may be fruitful to apply a stratified approach to future clinical trials by targeting for intervention those individuals likely to have persistently negative attitudes toward care, and therefore poor engagement with services. Hence, patients displaying low awareness of illness could be identified early in the course of their involuntary admission and targeted for recruitment into clinical trials to test the efficacy of specific interventions on their satisfaction with care and future engagement with community services.…”

Section: Strengths and Limitationsmentioning

confidence: 91%

Predictors of involuntary patients’ satisfaction with care: prospective study

et al. 2018

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BackgroundInvoluntary admission can be traumatic and is associated with negative attitudes that persist after the episode of illness has abated.AimsWe aimed to prospectively assess satisfaction with care at the points of involuntary admission and symptomatic recovery, and identify their sociodemographic, clinical and service experience predictors.MethodLevels of satisfaction with care, and clinical and sociodemographic variables were obtained from a representative cohort of 263 patients at the point of involuntary admission and from 155 of these patients 3 months after termination of the involuntary admission. Data were analysed with multiple linear regression modelling.ResultsHigher baseline awareness of illness (B = 0.19, P < 0.001) and older age (B = 0.05, P = 0.001) were associated with more satisfaction with care at baseline and follow-up. Transition to greater satisfaction with care was associated with improvements in awareness of illness (B = 0.13, P < 0.001) and in symptoms (B = 0.05, P = 0.02), as well as older age (B = 0.04, P = 0.01). Objective coercive experiences were not associated with variation in satisfaction with care.ConclusionsThere is wide variation in satisfaction with coercive care. Greater satisfaction with care is positively associated with clinical variables such as increased awareness of illness.Declaration of interestNone.

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Interventions for involuntary psychiatric inpatients: A systematic review

Cited by 29 publications

References 45 publications

Patients' experiences of assessment and detention under mental health legislation: systematic review and qualitative meta-synthesis

Patients' experiences of assessment and detention under mental health legislation: systematic review and qualitative meta-synthesis

Giving Patients Choices During Involuntary Admission: A New Intervention

Predictors of involuntary patients’ satisfaction with care: prospective study

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