Patients’ experiences with coercive mental health treatment in Flexible Assertive Community Treatment: a qualitative study

Abstract

Background Flexible Assertive Community Treatment (FACT) teams have been implemented in Norwegian health and social services over the last years, partly aiming to reduce coercive mental health treatment. We need knowledge about how service users experience coercion within the FACT context. The aim of this paper is to explore service user experiences of coercive mental health treatment in the context of FACT and other treatment contexts they have experienced. Are experiences of coercion different in FACT than in other treatment contexts? If this is the case, which elements of FACT lead to a different experience? Method Within a participatory approach, 24 qualitative interviews with service users in five different FACT teams were analyzed with thematic analysis. Results Participants described negative experiences with formal and informal coercion. Three patterns of experiences with coercion in FACT were identified: FACT as clearly a change for the better, making the best of FACT, and finding that coercion is just as bad in FACT as it was before. Safety, improved quality of treatment, and increased participation were described as mechanisms that can prevent coercion. Conclusion Results from this study support the argument that coercion is at odds with human rights and therefore should be avoided as far as possible. Results suggest that elements of the FACT model may prevent the use of coercion by promoting safety, improved quality of treatment and increased participation.

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

“…Few studies have explored the possible role of ethics in programs to reduce coercive practices. However, determining when involuntary treatment can be effective-ensuring more consensual mental healthcare that does not compromise human rights-remains an enormous challenge [32][33][34]. Despite research examining the ethics of involuntary psychiatric treatment from various perspectives in recent years, there is still a lack of comprehensive scoping reviews that include this field.…”