Experiences of involuntary psychiatric admission decision-making: a systematic review and meta-synthesis of the perspectives of service users, informal carers, and professionals

Sugiura, Kanna; Pertega, Elvira; Holmberg, Christopher

doi:10.1016/j.ijlp.2020.101645

Cited by 32 publications

(26 citation statements)

References 61 publications

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“…In Norway, the health government's directives to reduce involuntary admissions have formally addressed the secondary health care level (28). Without this being on the agenda at all care levels, professionals at the primary care level might simply continue their former ways of doing things (15), leaving involuntary admissions unquestioned with regard to the organization and provision of services between care levels. A lack of systematic focus in primary mental health services on reducing involuntary admissions (17) might indicate that professionals' attitudes toward involuntary admissions have not been particularly challenged at this care level.…”

Section: Discussionmentioning

confidence: 99%

“…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). Previous studies have largely been limited to experiences during detention, of the admission process, and of the admission Abbreviations: SMI, severe mental illness; GP, general practitioner; PTSD, posttraumatic stress disorder.…”

Section: Introductionmentioning

confidence: 99%

“…decision-making process (3,4,15). In the Norwegian context, studies focusing on the involuntary admission process have primarily been quantitative (16).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…Em muitos casos, as práticas coercitivas são justificadas, por aqueles que as utilizam, com base no "risco" ou "periculosidade" (64), o que causa preocupação, considerando o potencial de viés e subjetividade (65). Outras razões importantes incluem a falta de compreensão sobre as consequências negativas e prejudiciais dessas práticas para a saúde, bem-estar, senso de si e valor próprio das pessoas e na relação terapêutica (51), a falta de opções de cuidados e apoio alternativas, a falta de recursos, conhecimentos e habilidades para lidar com situações desafiadoras (inclusive crises) de forma não confrontativa, bem como culturas de serviço negativas em que valores, crenças, atitudes, regras e práticas compartilhadas pelos diferentes membros de um serviço são aceitos sem reflexão e são considerados "o jeito como se faz por aqui".…”

Section: Práticas Não Coercitivasunclassified

“…No entanto, as pessoas têm maior risco de terem seus direitos desrespeitados nesses serviços, com internação e tratamento forçados e práticas coercitivas como isolamento e contenção mecânica, química e física. Tais práticas são conhecidas por seus efeitos prejudiciais à saúde mental, emocional e física das pessoas e, por vezes, resultam em morte (49,50,64).…”

Section: Serviços De Saúde Mental Para Atenção à Criseunclassified

Orientações sobre Serviços Comunitários de Saúde Mental: Promoção de Abordagens Centradas na Pessoa e Baseadas em Direitos

2022

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Ao destacar serviços de saúde mental ao redor do mundo que adotaram boas práticas, o guia Orientações sobre serviços comunitários de saúde mental: promoção de abordagens centradas na pessoa e baseadas em direitos e a série de sete pacotes técnicos pretendem lançar luz e apoiar os países no desenvolvimento e na reforma de serviços e respostas de base comunitária sob a ótica dos direitos humanos, promovendo direitos fundamentais como igualdade, não discriminação, capacidade jurídica, consentimento livre e esclarecido e inclusão social. O guia oferece um roteiro para pôr fim à institucionalização, à hospitalização e ao tratamento involuntários, e descreve etapas específicas para a construção de serviços de saúde mental que respeitem a dignidade inerente a todo ser humano sobre a importância de essa questão urgente e incentivar os formuladores de políticas em todo o mundo a investir em serviços de saúde mental de base comunitária que estejam alinhados com os estândares internacionais dos direitos humanos. Apresenta, ainda, uma visão sobre a atenção à saúde mental dentro dos mais elevados padrões de respeito aos direitos humanos e dá esperança de uma vida melhor a milhões de pessoas com condições de saúde mental e deficiências psicossociais, e a suas famílias, em todo o mundo.

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Clinical determinants of involuntary psychiatric hospitalization: A clinical profile approach

et al. 2023

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Objectives The study examines the clinical determinants of involuntary psychiatric hospitalization. Specifically, it investigates whether distinct clinical profiles of hospitalized patients can be discerned, what other characteristics they are linked with, and which profiles predict involuntary admission. Methods In this cross‐sectional multicentre population study, data were collected for 1067 consecutive admissions in all public psychiatric clinics of Thessaloniki, Greece, during 12 months. Through Latent Class Analysis distinct patient clinical profiles were established based on Health of the Nation Outcome Scales ratings. The profiles were then correlated with sociodemographic, other clinical, and treatment‐related factors as covariates and admission status as a distal outcome. Results Three profiles emerged. The “Disorganized Psychotic Symptoms” profile, combining positive psychotic symptomatology and disorganization, included mainly men, with previous involuntary hospitalizations and poor contact with mental health services and adherence to medication, indicating a deteriorating condition and chronic course. Τhe “Active Psychotic Symptoms” profile included younger persons with positive psychotic symptomatology in the context of normal functioning. The “Depressive Symptoms” profile, characterized by depressed mood coupled with nonaccidental self‐injury, included mainly older women in regular contact with mental health professionals and treatment. The first two profiles were associated with involuntary admission and the third with voluntary admission. Conclusions Identifying patient profiles allows the examination of the combined effect of clinical, sociodemographic, and treatment‐related characteristics as risk factors for involuntary hospitalization, moving beyond the variable‐centered approach mainly adopted to date. The identification of two profiles associated with involuntary admission necessitates the development of interventions tailored to chronic patients and younger persons suffering from psychosis respectively.

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Experiences of involuntary psychiatric admission decision-making: a systematic review and meta-synthesis of the perspectives of service users, informal carers, and professionals

Cited by 32 publications

References 61 publications

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

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

Orientações sobre Serviços Comunitários de Saúde Mental: Promoção de Abordagens Centradas na Pessoa e Baseadas em Direitos

Clinical determinants of involuntary psychiatric hospitalization: A clinical profile approach

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