Geographical variation in compulsory hospitalisation – ethical challenges

Hofstad, Tore; Husum, Tonje Lossius; Rugkåsa, Jorun; Hofmann, Bjørn

doi:10.1186/s12913-022-08798-2

Cited by 5 publications

(5 citation statements)

References 102 publications

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“…When meaningful comparisons are possible, research has also shown considerable variation in use in and between different countries and geographical areas ( 16 , 17 ). Geographical variation in the use of coercive interventions represents an ethical challenge in health services ( 18 ). Further, considerable conceptual and practical difficulties exist in understanding and researching compulsion and coercion.…”

Section: Introductionmentioning

confidence: 99%

Expert opinions on improving coercion data collection across Europe: a concept mapping study

Lickiewicz,

Efkemann,

Husum

et al. 2024

Front. Psychiatry

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IntroductionCoercion is frequently used in mental health practice. Since it overrides some patients’ fundamental human rights, adequate use of coercion requires legal and ethical justifications. Having internationally standardised datasets to benchmark and monitor coercion reduction programs is desirable. However, only a few countries have specific, open, publicly accessible registries for this issue.MethodsThis study aims to assemble expert opinions regarding strategies that might be feasible for promoting, developing, and implementing an integrated and differentiated coercion data collection system in Europe at national and international levels. A concept mapping methodology was followed, involving 59 experts from 27 countries in generating, sorting and rating strategies regarding relevance and feasibility. The experts were all researchers and/or practitioner members of an EU-COST-Action focused on coercion reduction Fostering and Strengthening Approaches to Reducing Coercion in European Mental Health Services (FOSTREN).ResultsA hierarchical cluster analysis revealed a conceptual map of 41 strategies organized in seven clusters. These clusters fit into two higher-order domains: “Advancing Global Health Research: Collaboration, Accessibility, and Technological Innovations/Advancing International Research” and “Strategies for Comprehensive Healthcare Data Integration, Standardization, and Collaboration.” Regarding the action with the higher priority, relevance was generally rated higher than feasibility. No differences could be found regarding the two domains regarding the relevance rating or feasibility of the respective strategies in those domains. The following strategies were rated as most relevant: “Collection of reliable data”, “Implementation of nationwide register, including data on coercive measures”, and “Equal understanding of different coercive measures”. In analysing the differences in strategies between countries and their health prosperity, the overall rating did not differ substantially between the groups.ConclusionThe strategy rated as most relevant was the collection of reliable data in the nationwide health register, ensuring that countries share a standard understanding/definition of different coercive measures. Respondents did not consider the feasibility of establishing a shared European database for coercive measures to be high, nor did they envision the unification of mental health legislation in the future. There is some consensus on the most suitable strategies that can be adopted to enable international benchmarking of coercion in mental health settings.

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Section: Introductionmentioning

confidence: 99%

Expert opinions on improving coercion data collection across Europe: a concept mapping study

Lickiewicz,

Efkemann,

Husum

et al. 2024

Front. Psychiatry

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“…He argued that self-protection and the need to prevent harm to others are the only legitimate reasons to interfere with another person's freedom of action. In line with the principles of beneficence and non-maleficence developed by Beauchamp and Childress, several authors [44,77] suggest that the arguments for and against must be weighed, such that the use of coercive measures is only morally acceptable when the 'benefits' of protection or treatment outweigh the 'negative effects' on autonomy and the integrity of patients. Assessing the balance between promoting good (beneficence) and inflicting harm (maleficence) is, therefore, a primary ethical challenge.…”

Section: Discussionmentioning

confidence: 99%

Ethical Issues in Clinical Decision-Making about Involuntary Psychiatric Treatment: A Scoping Review

Laureano,

Laranjeira,

Querido

et al. 2024

Healthcare

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In mental health and psychiatric care, the use of involuntary psychiatric treatment for people with mental disorders is still a central and contentious issue. The main objective of this scoping review was to map and systematize the literature on ethical issues in clinical decision-making about involuntary psychiatric treatment. Five databases (Embase, PsycINFO, CINAHL, Medline, and Scopus) were searched for articles on this topic. Out of a total of 342 articles found, 35 studies from 14 countries were included based on the selection criteria. The articles were analyzed using the inductive content analysis approach. The following main categories were identified: (1) ethical foundations that guide clinical decision-making; (2) criteria for involuntary psychiatric treatment; (3) gaps, barriers, and risks associated with involuntary psychiatric treatment; (4) strategies used to reduce, replace, and improve the negative impact of involuntary treatment; and (5) evidence-based recommendations. Most of the selected articles discuss the logic underlying involuntary treatment of the mentally ill, exploring ethical principles such as autonomy, beneficence, non-maleficence, or justice, as well as how these should be properly balanced. During the process of involuntary psychiatric admission, there was a notable absence of effective communication and a significant power imbalance that disenfranchised those seeking services. This disparity was further intensified by professionals who often use coercive measures without a clear decision-making rationale and by family members who strongly depend on hospital admission. Due to the pluralistic and polarized nature of opinions regarding legal capacity and the complexity and nuance of involuntary admission, further studies should be context-specific and based on co-production and participatory research.

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“…We know that previously committed patients have greater likelihood of later involuntary care, which may maintain the patterns of involuntary care without fully taking into account the patient’s symptoms or risks ([ 58 ] see Lived experience commentary by Olive & Nyikavaranda). Given the concerns voiced by user organizations [ 59 ], the ethical concern surrounding the provision of treatment without a person’s consent [ 60 , 61 ], and over geographical variations in such treatment [ 62 ] there is an urgent need for additional studies that test core assumptions of mental health acts.…”

Section: Discussionmentioning

confidence: 99%

The relationship between area levels of involuntary psychiatric care and patient outcomes: a longitudinal national register study from Norway

et al. 2023

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Background Mental health legislation permits involuntary care of patients with severe mental disorders who meet set legal criteria. The Norwegian Mental Health Act assumes this will improve health and reduce risk of deterioration and death. Professionals have warned against potentially adverse effects of recent initiatives to heighten involuntary care thresholds, but no studies have investigated whether high thresholds have adverse effects. Aim To test the hypothesis that areas with lower levels of involuntary care show higher levels of morbidity and mortality in their severe mental disorder populations over time compared to areas with higher levels. Data availability precluded analyses of the effect on health and safety of others. Methods Using national data, we calculated standardized (by age, sex, and urbanicity) involuntary care ratios across Community Mental Health Center areas in Norway. For patients diagnosed with severe mental disorders (ICD10 F20-31), we tested whether lower area ratios in 2015 was associated with 1) case fatality over four years, 2) an increase in inpatient days, and 3) time to first episode of involuntary care over the following two years. We also assessed 4) whether area ratios in 2015 predicted an increase in the number of patients diagnosed with F20-31 in the subsequent two years and whether 5) standardized involuntary care area ratios in 2014–2017 predicted an increase in the standardized suicide ratios in 2014–2018. Analyses were prespecified (ClinicalTrials.gov NCT04655287). Results We found no adverse effects on patients’ health in areas with lower standardized involuntary care ratios. The standardization variables age, sex, and urbanicity explained 70.5% of the variance in raw rates of involuntary care. Conclusions Lower standardized involuntary care ratios are not associated with adverse effects for patients with severe mental disorders in Norway. This finding merits further research of the way involuntary care works.

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Geographical variation in compulsory hospitalisation – ethical challenges

Cited by 5 publications

References 102 publications

Expert opinions on improving coercion data collection across Europe: a concept mapping study

Expert opinions on improving coercion data collection across Europe: a concept mapping study

Ethical Issues in Clinical Decision-Making about Involuntary Psychiatric Treatment: A Scoping Review

The relationship between area levels of involuntary psychiatric care and patient outcomes: a longitudinal national register study from Norway

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