Attitudinal variance among patients, next of kin and health care professionals towards the use of containment measures in three psychiatric hospitals in Switzerland

Abstract

Background In psychiatric treatment containment measures are used to de-escalate high-risk situations. These measures can be characterized by their immanent amount of coercion. Previous research could show that the attitudes towards different containment measures vary throughout countries. The aim of this study was to compare the attitudes towards containment measures between three study sites in Switzerland which differ in their clinic traditions and policies and their actual usage of these measures. Methods We used the Attitude to Containment Measures Questionnaire (ACMQ) in three psychiatric hospitals in Switzerland (Zurich, Muensingen and Monthey) in patients, their next of kin (NOK) and health care professionals (HCP). Furthermore, we assessed the cultural specifics and rates of coercive measures for these three hospitals. Results We found substantial differences in the usage of and the attitudes towards some containment measures between the three study sites. The study site accounted for a variance of nearly zero in as needed medication to 15% in seclusion. The differences between study sites were bigger in the HCPs’ attitudes (up to 50% of the variance), compared to NOK and patients. In the latter the study site accounted for up to 6% of the variance. The usage/personal experience of containment measures in general was associated with higher agreement. Conclusions Although being situated in the same country, there are substantial differences in the rates of containment measures between the three study sites. We showed that the HCP’s attitudes are more associated with the clinic traditions and policies compared to patients’ and their NOKs’ attitudes. One can conclude that patients’ preferences depend less on clinic traditions and policies. Therefore, it is important to adapt treatment to the individual patients’ attitudes. Trial registration The study was reviewed and approved by the Cantonal Ethics Commission of Zurich, Switzerland (Ref.-No. EK: 2016–01526, decision on 28.09.2016) and the Cantonal Ethics Commission of Bern, Switzerland (Ref.-Nr. KEK-BE: 2015–00074). This study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The permission for conduction of the study was granted by the medical directors at the three study sites. The authors informed the respondents (patients, NOK, HCP) of their rights in the study in an oral presentation and/or a cover letter. They assured the participants of the confidentiality and anonymity of the data, and the voluntariness of participation. Patients were given an information sheet with the possibility to consent in the conduction of the study. Return of the completed questionnaires from HCP and NOK was constituted as confirmation of their consent. No identifying factors were collected to ensure privacy. This article does not contai...

Patient safety in inpatient mental health settings: a systematic review

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Evaluation of coercive measures in different psychiatric hospitals: the impact of institutional characteristics

“…However, other influencing factors should also be considered here. In particular, the attitudes of the staff members with respect to mechanical restraint and seclusion play a crucial role and can differ among the hospitals [ 51 – 55 ]. Here, the key focus is on the area of conflict between the staff’s risk-taking propensity and their respect for patient autonomy.…”

Influence of mental health professionals’ attitudes and personality traits on decision‐making around coercion: Results from an experimental quantitative survey using case vignettes

“…First insights into the decision-making processes in clinical practice have led to a stronger focus on the subjective aspects involved in the use of coercion. These include not only the subjective experience of people affected by coercive interventions, [20][21][22] but also attitudes, personality traits and personal experiences of the mental health professionals involved. [23][24][25][26][27][28] The latter might be important with regard to the use of coercion for two main reasons: firstly, the subjective experiences of mental health professionals are a key element of interactions with people with mental disorders and might influence the escalation or de-escalation of potential conflictual situations.…”