Professionals’ perspectives on factors within primary mental health services that can affect pathways to involuntary psychiatric admissions

Abstract

Background Reducing involuntary psychiatric admissions has been on the international human rights and health policy agenda for years. Despite the last decades’ shift towards more services for adults with severe mental illness being provided in the community, most research on how to reduce involuntary admissions has been conducted at secondary health care level. Research from the primary health care level is largely lacking. The aim of this study was to explore mental health professionals’ experiences with factors within primary mental health services that might increase the risk of involuntary psychiatric admissions of adults, and their views on how such admissions might be avoided. Methods Qualitative semi-structured interviews with thirty-two mental health professionals from five Norwegian municipalities. Data were analysed according to the Systematic Text Condensation method. Results Within primary mental health care professionals experienced that a number of factors could increase the risk of involuntary psychiatric admissions. Insufficient time and flexibility in long-term follow-up, limited resources, none or arbitrary use of crisis plans, lack of tailored housing, few employment opportunities, little diversity in activities offered, limited opportunities for voluntary admissions, inadequate collaboration between services and lack of competence were some of the factors mentioned to increase the risk of involuntary psychiatric admissions. Several suggestions on how involuntary psychiatric admissions might be avoided were put forward. Conclusions Mental health professionals within primary mental health care experienced that their services might play an active part in preventing the use of involuntary psychiatric admissions, suggesting potential to facilitate a reduction by intervening at this service level. Health authorities’ incentives to reduce involuntary psychiatric admissions should to a greater extent incorporate the primary health care level. Further research is needed on effective interventions and comprehensive models adapted for this care level.

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

“…If a medical perspective dominates, assessment of the individual's overall situation might be limited, and thus access to services that focus more on personal and social recovery in an early phase of deterioration will not be provided. Furthermore, factors that can hamper individual service adaptation include limited resources within services, budget cuts, rigid allocation systems, heavy caseloads, no or arbitrary use of crisis plans, and limited opportunities for voluntary admissions prior to the situation becoming acute (17,20). Lack of alternatives due to a narrow range of housing, activity, and employment opportunities for people with SMI can negatively affect personal recovery and services' ability to reverse individuals' paths toward referral to involuntary admission (12,17,21).…”

“…To prepare for this, comprehensive mapping of current practices was conducted using qualitative methods, and the analysis presented here is based on these data. In the following, involuntary psychiatric admissions are those sanctioned by the Norwegian Mental Health Care Act § 3-2 (involuntary observation) and § 3-3 (involuntary admission) (17).…”

“…Norwegian mental health legislation sets out stringent criteria for involuntary admissions, requiring that options for voluntary engagement have been exhausted (17). It is also required that the need for involuntary admission is assessed by a medical practitioner outside of the secondary inpatient unit (unless the individual is under a community treatment order).…”

“…All interviewees were also asked if they were aware of the rate of involuntary admissions in their municipality. Other themes in the semistructured interview guide, such as factors in current practice that can affect pathways to involuntary admissions, and suggested measures to prevent such admissions, are and will be published elsewhere (17).…”

Flexible assertive community treatment teams can change complex and fragmented service systems: experiences of service providers

“…The service systems in which FACT teams are implemented are described as complex [44][45][46][47] and fragmented [11,44,45,[47][48][49][50][51][52][53][54], with challenges in collaboration [50,54]. Complexity, fragmentation [55][56][57][58][59][60] and challenges in collaboration [58][59][60][61] are also found in the Norwegian system. The Norwegian formal public service system consists of two levels of administration: the municipal level, which is responsible for primary care, and the state level, which is responsible for specialized care.…”