Same, Same But Different: How the Interplay of Legal Procedures and Structural Factors Can Influence the Use of Coercion

Mahler, Lieselotte; Mielau, Juliane; Heinz, Andreas; Wullschleger, Alexandre

doi:10.3389/fpsyt.2019.00249

Cited by 5 publications

(3 citation statements)

References 29 publications

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“…The frequency of coercive measures varies markedly, both internationally and locally, due to differences in legislation, regulations, and clinical practice among and within countries (4,5). However, patient-centered and supportive treatment settings and an implementation of open-door strategies seem successful in a responsible reduction of coercive measures (6,7).…”

Section: Introductionmentioning

confidence: 99%

Approval of Coercion in Psychiatry in Public Perception and the Role of Stigmatization

et al. 2022

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Background: Coercion is routinely used in psychiatry. Its benefits and drawbacks are controversially debated. In addition, the majority of persons with mental health problems are exposed to stigmatization and are assumed to be dangerous. Stigmatization is associated with negative consequences for individuals with mental illness such as disapproval, social rejection, exclusion, and discrimination. Being subjected to coercive measures can increase the stigmatization of the affected persons, and stigmatization might lead to higher approval for coercion.Aims of the Study: This study aims to examine the approval for coercive measures in psychiatry by the general public, and to explore its relation with person- and situation-specific factors as well as with stigmatization.Method: We conducted a representative survey of the general population (N = 2,207) in the canton of Basel-Stadt, Switzerland. Participants were asked to read a vignette depicting psychopathological symptoms of a fictitious character and indicate whether they would accept coercive measures for the person in the vignette. Desire for social distance and perceived dangerousness were assessed as measures of stigmatization.Findings: The person in the case vignette exhibiting dangerous behavior, showing symptoms of a psychotic disorder, being perceived as dangerous, and treatment being understood as helpful increased approval of coercion in general, while familiarity of the respondents with mental illness decreased approval.Conclusions: The public attitude regarding the approval of coercion in psychiatry is highly differentiated and largely follows the current legal framework and medical treatment guidelines. Higher approval occurred in situations of self-harm or harm to others and when coercive measures were thought to have a beneficial effect for the affected persons. A considerable part of the approval for coercion is predicted by stigmatization. With the increasing severity of coercive measures, the influence of person- and situation-specific factors and of familiarity with mental illness decreased and generalizing and stigmatizing attitudes became stronger predictors for the approval of more severe measures.

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Section: Introductionmentioning

confidence: 99%

Approval of Coercion in Psychiatry in Public Perception and the Role of Stigmatization

et al. 2022

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“…Examples include promoting and protecting the right to free and informed consent; supporting advance planning; the provision of crisis support; the prohibition of involuntary hospitalization and treatment; and eliminating seclusion and restraint ( 3 ). However, each country has its own regulation and legislation regarding collecting data on coercion ( 15 ). Consequently, it is difficult to compare the level and consequences of coercive measures between the countries and regions of Europe.…”

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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“…Most of them only mentioned the Weddinger Modell as an approved concept used in (acute) psychiatric wards to promote recovery and reduce coercion. Several studies [15][16][17][18] explicitly addressed the Weddinger Modell, but did not evaluate it empirically. Overall, eight studies corresponded to the inclusion criteria after full-text screening.…”

Section: Resultsmentioning

confidence: 99%

The Weddinger Modell – A Systematic Review of the Scientific Findings to Date and Experiences from Clinical Practice

Oster

Cole

Mahler³

2021

MRAJ

Self Cite

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Establishing a stable and trusting therapeutic relationship is of particular relevance in the treatment of people with (severe) mental disorders and plays a crucial role in preventing escalations and avoiding coercive measures. However, rigid ward structures and rules leave little room and flexibility for the individual needs and explanatory models of persons in acute crises. Considering this background and based on practical experience, a new recovery-oriented treatment concept, the Weddinger Modell, was developed and implemented in 2010 at the Department of Psychiatry of the Charité at the St. Hedwig Hospital (PUK SHK) in Berlin. After having worked with the Weddinger Modell for over 10 years, the model’s effectiveness for promoting treatment quality and therapeutic relationship and preventing coercion has been proven in numerous scientific studies and in daily clinical practice. This literature review aims at providing a systematic overview of the scientific findings to date on mechanisms and effects of the Weddinger Modell. For this purpose, a literature search was conducted in all relevant bibliographic databases. Overall, eight studies examining the Weddinger Modell, either as a whole model or focusing on specific parts of the model, were included in this study and systematically analyzed with regard to the following variables: aim of the study, sample, evaluated aspect of the Weddinger Modell, measured variable (method used), date of evaluation, and outcome. Three main dimensions of effects (promotion of treatment quality, prevention of coercion, reduction of negative effects after coercion) of the Weddinger Modell were found. The findings of this review are presented with regard to the specific requirements in the treatment of people in acute psychiatric crises and linked with different phases in the course of psychiatric treatment (Fig. 2). Furthermore, the findings are considered in light of their practical relevance and the flexible and resource-efficient implementation of the Weddinger Modell in (acute) psychiatric settings is discussed.

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Same, Same But Different: How the Interplay of Legal Procedures and Structural Factors Can Influence the Use of Coercion

Cited by 5 publications

References 29 publications

Approval of Coercion in Psychiatry in Public Perception and the Role of Stigmatization

Approval of Coercion in Psychiatry in Public Perception and the Role of Stigmatization

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

The Weddinger Modell – A Systematic Review of the Scientific Findings to Date and Experiences from Clinical Practice

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