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

Abstract

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.

Carers' experiences of involuntary admission under mental health legislation: systematic review and qualitative meta-synthesis

“…Patient experiences have therefore been reported separately. 23 This paper reports the experiences of carers only.…”

Reducing coercion in mental healthcare

“…While a significant proportion of those subjected involuntary treatment retrospectively acknowledge that such treatment was necessary many have strong negative perceptions about the use of forcible treatment as they wish to be treated with respect rather than being subjected to the professionals' control (Tingleff et al ., 2017; Turnpenny et al ., 2018). Many of those subjected to involuntary admission do not feel it is justified or beneficial (Katsakou and Priebe, 2006; Priebe et al ., 2008) and tend to recall their experience as highly distressing and even traumatic (Paksarian et al, 2014; Rose et al ., 2017; Turnpenny et al ., 2018; Akhter et al ., 2019). Coercive interventions can weaken or damage therapeutic relationships and dissuade people from seeking further treatment thus increasing the risk of non-adherence and involuntary treatment, particularly those with long-term mental health problems (Swartz et al ., 2003; Jaeger et al ., 2013; Rose et al ., 2017).…”

Perspectives on Involuntary Treatment of Anorexia Nervosa

“…Some patients argue for the use of involuntary treatment earlier in the illness course, whereas other argue for the right to choose to die from anorexia nervosa (40). Reports of this typically negative perception of involuntary treatment are well-known from general psychiatric patients also (38,39,42). The impact of different involuntary measures on these patients seems to vary by measures, with seclusion and restraint having an especially negative impact (6,39,42).…”

“…Reports of this typically negative perception of involuntary treatment are well-known from general psychiatric patients also (38,39,42). The impact of different involuntary measures on these patients seems to vary by measures, with seclusion and restraint having an especially negative impact (6,39,42). The subjective implications of nasogastric feeding specifically have in a small qualitative study been reported to increase rebellious behavior as well as involuntary measures such as restraint and forced medication (23).…”