Coercion or collaboration: service-user experiences of risk management in hospital and a trauma-informed crisis house

Prytherch, Hannah; Cooke, Anne; Marsh, Ian

doi:10.1080/17522439.2020.1830155

Cited by 10 publications

(16 citation statements)

References 16 publications

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“…Positive reports regarding service user experiences, therapeutic relationships, and the availability of non‐standard therapeutic models are prominent in the literature on crisis houses 121‐124 . This, together with evidence of satisfactory outcomes and similar or lower costs compared to inpatient care, provides a justification for including community residential alternatives to inpatient acute care as a standard part of the range of services in any mental health system where choice, flexibility and cost‐effectiveness are prioritized.…”

Section: Intensive Treatment Following Crisismentioning

confidence: 99%

Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

et al. 2022

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Acute services for mental health crises are very important to service users and their supporters, and consume a substantial share of mental health resources in many countries. However, acute care is often unpopular and sometimes coercive, and the evidence on which models are best for patient experience and outcomes remains surprisingly limited, in part reflecting challenges in conducting studies with people in crisis. Evidence on best approaches to initial assessment and immediate management is particularly lacking, but some innovative models involving extended assessment, brief interventions, and diversifying settings and strategies for providing support are potentially helpful. Acute wards continue to be central in the intensive treatment phase following a crisis, but new approaches need to be developed, evaluated and implemented to reducing coercion, addressing trauma, diversifying treatments and the inpatient workforce, and making decision‐making and care collaborative. Intensive home treatment services, acute day units, and community crisis services have supporting evidence in diverting some service users from hospital admission: a greater understanding of how best to implement them in a wide range of contexts and what works best for which service users would be valuable. Approaches to crisis management in the voluntary sector are more flexible and informal: such services have potential to complement and provide valuable learning for statutory sector services, especially for groups who tend to be underserved or disengaged. Such approaches often involve staff with personal experience of mental health crises, who have important potential roles in improving quality of acute care across sectors. Large gaps exist in many low‐ and middle‐income countries, fuelled by poor access to quality mental health care. Responses need to build on a foundation of existing community responses and contextually relevant evidence. The necessity of moving outside formal systems in low‐resource settings may lead to wider learning from locally embedded strategies.

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Section: Intensive Treatment Following Crisismentioning

confidence: 99%

Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

et al. 2022

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“…Furthermore, participants described how coercive practice could be retraumatizing, exacerbating distress, reminiscent of prior abuse and sometimes contributing to increased suicidality. In contrast, the trauma‐informed crisis house was said to be based on the formation of trusting relationships that empowered the individual to develop ways to keep themselves safe (Prytherch et al, 2020). A trauma‐informed approach with an acknowledgement of the central role power, control and trust provides an alternative way of conceptualizing the behaviours that often lead to the use of CP and the impact of these practices themselves (Sweeney et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

“…Trauma-informed care is one approach gaining interest in mental health care that recognizes how a person's prior experiences, including reports of trauma, influence their responses in the present and may prove a useful model for understanding the dynamic nature of coercion with clinical utility (Muskett, 2014). For example, Prytherch et al (2020) explored service-user experiences of risk management in a hospital setting compared to a trauma-informed crisis house. Participants described coercive practices, which were only experienced in hospital services, as harmful, undermining of the therapeutic relationship and therefore ineffective at managing risk in the long term.…”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with use of coercive practices in adult mental health inpatients: A systematic review

Beames

Onwumere

2021

Psychiatric Ment Health Nurs

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What is known on the subject?• Coercive practices such as restraint (physically holding a person) or seclusion (containing a person in locked room) are frequently used in mental health care.• How often and which specific practices are used is not consistent across different healthcare systems, hospitals or wards.• Internationally, there is agreement on the need to monitor and reduce the use of coercive practices. What this paper adds to existing knowledge?• The reviewed evidence suggests a number of different factors affect a person's risk of experiencing coercive practices, while admitted to a mental health ward.• However, there is currently not enough high-quality research evidence to say which factors are most important or how they work to influence the likelihood of a person experiencing coercive practice. What are the implications for practice?• When carrying out risk assessments, mental health professionals must take into account that a number of different factors are important and explore these with the patient.• Care plans aimed at minimizing the use of coercive practices, such as restraint, must be personalized and developed with the individual.

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“…Despite a widespread acceptance of the perceived need for involuntary treatment, research into the experiences of compulsory mental health treatment has challenged the assumption that such responses are always enacted in the best interests of people experiencing distress, or the community more broadly. The extant literature demonstrates the dominance of a medical-custodial approach within hospital settings, which frequently exacerbates rather than alleviates distress, for example, through the trauma and humiliation of having belongings confiscated and being strip-searched (Prytherch et al, 2021). Whitaker et al (2021) note that it is common for people with psychiatric diagnoses to be subjected to an ongoing cycle of involuntary admissions, which can be spirit-breaking.…”

Section: Literature Reviewmentioning

confidence: 99%

“…Importantly, the trauma of compulsory mental health service provision is often compounded by women's previous exposure to sexual violence (Soros, 2021), which is particularly pertinent given the higher rates of sexual violence experienced by women with a psychiatric diagnosis in comparison to non-psychiatrised women. Women who have experienced gendered violence have described psychiatric coercion, including detention, and forced treatment, as re-traumatising due to their powerlessness and humiliation within such contexts, thus highlighting the relevance of a gender lens in understanding the impacts of involuntary treatment (Prytherch et al, 2021). Alarmingly, women detained within psychiatric units are also at high risk of experiencing sexual violence within these settings by male patients, male staff or partners/ex-partners (McGarry, 2019).…”

Section: The Relevance Of a Gender Lens In Understanding Involuntary ...mentioning

confidence: 99%

“My Voice Was Discounted the Whole Way Through”: A Gendered Analysis of Women’s Experiences of Involuntary Mental Health Treatment

Tseris

Hart

Franks

2022

Affilia

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Although it is well established that women experience significant gendered oppressions when accessing mental health services, research exploring the impacts of involuntary mental health services is frequently conducted without attending specifically to gender. This article reports on a qualitative study that explored women's experiences of compulsory mental health treatment in Australia. In-depth interviews revealed substantial gendered harms experienced by women within involuntary mental health treatment settings. Themes identified were: involuntary treatment replicates the dynamics and tactics of gendered violence; treatment involves profound deprivation and losses, with potential implications across the lifecourse; mental health services disrupt and undermine mothering; and recovery is found outside of coercive mental health systems. The study reveals the heightened harms experienced by women within involuntary mental health contexts, as well as women's strategic resistances to psychiatric oppression. It demonstrates the relevance of a conceptual lens that is attuned to gender, in order to develop a deeper understanding of women's experiences of intersecting oppressions within involuntary mental health settings. Implications include the need for alliance-building across feminist and critical mental health movements, and the need for a much more robust engagement by the social work profession in challenging the widespread acceptance of involuntary mental health treatment.

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Coercion or collaboration: service-user experiences of risk management in hospital and a trauma-informed crisis house

Cited by 10 publications

References 16 publications

Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

Risk factors associated with use of coercive practices in adult mental health inpatients: A systematic review

“My Voice Was Discounted the Whole Way Through”: A Gendered Analysis of Women’s Experiences of Involuntary Mental Health Treatment

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