Databases on the use of seclusion and restraint should be established using comparable key indicators. Comparisons between countries and different practices can help to overcome prejudice and improve clinical practice.

BackgroundSeveral countries have established or are planning acute psychiatric in-patient services that accept around-the-clock emergency admission of adolescents. Our aim was to investigate the characteristics and clinical outcomes of a cohort of patients at four Norwegian units.MethodsWe used a prospective pre-post observational design. Four units implemented a clinician-rated outcome measure, the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA), which measures mental health problems and their severity. We collected also data about the diagnoses, suicidal problems, family situations, and the involvement of the Child Protection Service. Predictions of outcome (change in HoNOSCA total score) were analysed with a regression model.ResultsThe sample comprised 192 adolescents admitted during one year (response rate 87%). Mean age was 15.7 years (range 10-18) and 70% were girls. Fifty-eight per cent had suicidal problems at intake and the mean intake HoNOSCA total score was 18.5 (SD 6.4). The largest groups of main diagnostic conditions were affective (28%) and externalizing (26%) disorders. Diagnoses and other patient characteristics at intake did not differ between units. Clinical psychiatric disorders and developmental disorders were associated with severity (on HoNOSCA) at intake but not with outcome. Of adolescents ≥ 16 years, 33% were compulsorily admitted. Median length of stay was 8.5 days and 75% of patients stayed less than a month. Compulsory admissions and length of stay varied between units. Mean change (improvement) in the HoNOSCA total score was 5.1 (SD 6.2), with considerable variation between units. Mean discharge score was close to the often-reported outpatient level, and self-injury and emotional symptoms were the most reduced symptoms during the stay. In a regression model, unit, high HoNOSCA total score at intake, or involvement of the Child Protection Service predicted improvement during admission.ConclusionsAcute psychiatric in-patient units for adolescents effectively meet important needs for young people with suicidal risks or other severe mental health problems. These units may act in suicide prevention, stabilizing symptom severity at a lower level within a short stay. It is important to explore the differences in outcome, compulsory admissions, and length of stay between units.

The objective of the study was to investigate the experiences of humiliations by patients in the admission process to acute psychiatric wards. One-hundred-and-two patients were interviewed within 48 h after hospitalization about their experiences of the admission process. The structured Admission Experience Survey questionnaire was used to identify negative events of the admission process. Perceived humiliation was defined by a cut-off on the self-reported Cantrill's Ladder Scale. Six qualitative depth interviews of patients with high and low humiliation scores were performed in order to relate interview information on humiliation experiences to the self-report. Negative events during the admission process were significantly more common among patients with involuntary admission, but were also observed among those voluntary admitted. Humiliation in connection with negative events during the admission process was reported by 48 patients, 24 involuntary and 24 voluntary admitted. In univariate analyses, humiliation was significantly associated with events where the patients were exposed to verbal or physical force, as well as with the conviction that "the admission was not right". In multivariate analyses, the latter conviction was the only significant one, although "use of physical force" also showed a trend (P=0.06). Negative events are common among the routines, procedures, and situations of the admission process to acute psychiatric wards. Some of them can hopefully be modified such as the use of verbal and physical force. In contrast, the conviction that "the admission was not right", which showed the strongest association with humiliation, seems less modifiable in the admission process.

The purpose of this study was to examine the extent to which patient views influence treatment planning by measuring the level of agreement between patients and health workers regarding patient needs as well as the impact of patient wishes on decision making when viewpoints conflict. Data on patient characteristics and needs were collected for a sample of 1080 patients within Norwegian mental health care using patient interviews and health worker ratings. Results of the assessment were then reviewed by multidisciplinary treatment teams responsible for making decisions regarding patient needs for services. On average, patients, health workers, and teams identified 4.3 (SD = 4.2), 9.3 (SD = 5.5), and 10.3 (SD = 5.7), respectively, of 40 possible needs per patient. In cases where patient and health workers disagreed on the presence of a need, the teams tended to concur with the health worker. Interestingly, health care workers and teams were far more inclined than their patients to identify needs related to professional monitoring and follow-up. Results may indicate that contemporary tenets in mental health care regarding user involvement and autonomy are not sufficiently emphasized in practice.

Objective: Paths toward referral to involuntary psychiatric admission mainly unfold in the contexts where people live their everyday lives. Modern health services are organized such that primary health care services are often those who provide long-term follow-up for people with severe mental illness and who serve as gatekeepers to involuntary admissions at the secondary care level. However, most efforts to reduce involuntary admissions have been directed toward the secondary health care level; interventions at the primary care level are sparse. To adapt effective measures for this care level, a better understanding is needed of the contextual characteristics surrounding individuals' paths ending in referrals for involuntary admission. This study aims to explore what characterizes such paths, based on the personal experiences of multiple stakeholders.Method: One hundred and three participants from five Norwegian municipalities participated in individual interviews or focus groups. They included professionals from the primary and secondary care levels and people with lived experience of severe mental illness and/or involuntary admission and carers. Data was subject to constant comparison in inductive analysis inspired by grounded theory.Results: Four main categories emerged from the analysis: deterioration and deprivation, difficult to get help, insufficient adaptation of services provided, and when things get acute. Combined, these illustrate typical characteristics of paths toward referral for involuntary psychiatric admission.Conclusion: The results demonstrate the complexity of individuals' paths toward referral to involuntary psychiatric admission and underline the importance of comprehensive and individualized approaches to reduce involuntary admissions. Furthermore, the findings indicate a gap in current practice between the policies to reduce involuntary admissions and the provision of, access to, and adaptation of less restrictive services for adults with severe mental illness at risk of involuntary admissions. To address this gap, further research is needed on effective measures and interventions at the primary care level.