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

Abstract

Background Carers are key providers of care and support to mental health patients and mental health policies consistently mandate carer involvement. Understanding carers' experiences of and views about assessment for involuntary admission and subsequent detention is crucial to efforts to improve policy and practice. Aims We aimed to synthesise qualitative evidence of carers' experiences of the assessment and detention of their family and friends under mental health legislation. Method We searched five bibliographic databases, reference lists and citations. Studies were included if they collected data using qualitative methods and the patients were aged 18 or older; reported on carer experiences of assessment or detention under mental health legislation anywhere in the world; and were published in peer-reviewed journals. We used meta-synthesis. Results The review included 23 papers. Themes were consistent across time and setting and related to the emotional impact of detention; the availability of support for carers; the extent to which carers felt involved in decision-making; relationships with patients and staff during detention; and the quality of care provided to patients. Carers often described conflicting feelings of relief coupled with distress and anxiety about how the patient might cope and respond. Carers also spoke about the need for timely and accessible information, supportive and trusting relationships with mental health professionals, and of involvement as partners in care. Conclusions Research is needed to explore whether and how health service and other interventions can improve the involvement and support of carers prior to, during and after the detention of family members and friends.

Feasibility of a Web-Based Psychoeducation Course and Experiences of Caregivers Living With a Person With Schizophrenia Spectrum Disorder: Mixed Methods Study

“…Indeed, cooperation with professionals was seen as challenging, especially if they had different views of the patient’s needs in inpatient care. As found in earlier studies [ 66 , 67 ], caregivers had contradictory feelings when a person with SSD was admitted to a hospital. They were relieved that the person was getting help; however, they also felt that they did not receive information and that they were ignored as a resource in care.…”

Implementing organicity investigations in early psychosis: Spreading expertise

“…In contrast, convincing the patient sometimes proved difficult, and psychiatrists tried to provide guidance and balanced information during these trying times [ 20 ]. Their goal was to avoid the entanglement of care and coercion which affects caregivers, the patients and their families [ 21 , 22 ]. Their feeling of exigency to implement organicity investigations may also originate from the relatively high frequency of psychoses of organic origin in the expert centers they trained at.…”

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

“…Involuntary psychiatric admissions go against the fundamental health care principle of patient autonomy (1,2). Many individuals exposed to such admissions, along with their carers, report experiences of fear and distress (3,4). Moreover, evidence that coercive practices lead to better outcomes is limited (5)(6)(7).…”

“…Although services at the primary health care level play a key role in providing services to people with severe mental illness (SMI), the role of these services in such paths remains largely undocumented (13,14). Persons with lived experience of involuntary admission have reported lack of information and involvement in treatment decisions (3); carers experience difficulties getting preventive help prior to an individual's acute crisis and report lack of adequate support for themselves in such situations (4). A systematic review and meta-synthesis of multiple stakeholders' experiences with involuntary psychiatric admission decision-making found that collaboration between the services involved was lacking, that medical views dominated assessments, and that the admission process could be experienced as heavy-handed (especially given that it often involves police) (15).…”