Supported Decision Making in the Prevention of Compulsory Interventions in Mental Health Care

Zinkler, Martin

doi:10.3389/fpsyt.2019.00137

Cited by 8 publications

(5 citation statements)

References 15 publications

(18 reference statements)

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“…The majority of patients and psychiatrists approved drug control by nurses in the psychiatric ward, with psychiatrists being 3.1 times more likely to be positively assessed for control. Our results differ from other reports [25], which is due to the paternalistic model dominating Russian psychiatry. Naturally, patients were 3.2 times more likely than psychiatrists to talk about the inappropriateness of medication control, which is associated with a high prevalence of anosognosia among them.…”

Section: Discussioncontrasting

confidence: 99%

Restriction of the Rights and Coercion of Patients in a Psychiatric Hospital: The Opinion of People With Mental Disorders and Psychiatrists

Rzhevskaya

2023

IRJ

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Objectives: Restriction of the rights of patients in a psychiatric hospital, isolation and fixation, compulsory treatment, and round-the-clock monitoring are negatively perceived by them, contribute to the stigma of a psychiatric hospital, and prevent timely access to psychiatric help We assessed the opinions of patients in psychiatric hospitals and psychiatrists about coercion and violence in the provision of psychiatric care for recommendations on their prevention. Methods: An anonymous survey of psychiatrists and patients was conducted in psychiatric hospitals in three regions. Data were analyzed using descriptive and non-parametric statistical methods. Results: Psychiatrists and patients were positive about the coercive measures in the psychiatric hospital. Physical restraint was considered the prerogative of orderlies by 64.5% of psychiatrists and 35.4% of patients. According to 19.6% of doctors and 28.4% of patients, a psychiatrist can independently apply physical restraint to aggressive patients. Injections of sedative drugs by a psychiatrist personally were considered justified by 81.3% of physicians and 64.6% of patients. Most patients and physicians noted that the psychiatrist needed to be involved in the application of physical restraint to an aggressive patient. Discussion: Psychiatry is currently dominated by an archaic paternalistic model of doctor-patient relations and the delegation of additional functions of social control to psychiatrists. The introduction of a contractual model is required for more effective interaction between the psychiatrist and the patient.

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Section: Discussioncontrasting

confidence: 99%

Restriction of the Rights and Coercion of Patients in a Psychiatric Hospital: The Opinion of People With Mental Disorders and Psychiatrists

Rzhevskaya

2023

IRJ

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“…Nevertheless, patients who had been receiving treatment for a longer period did acknowledge improvements in the care provided and the decreased use of coercive measures. To achieve the latter result, previous studies have recommended greater involvement by patients, shared decision making [54,55] and wide-ranging strategies to re-direct inpatient psychiatric services towards patient-centred care [56]. Moreover, in the case of psychotic disorders and perhaps all serious mental disorders that tend to have a chronic course, SDM can be understood as an iterative model, wherein upon discharge patients are asked to reflect on the admission and provide feedback on how they viewed the decision-making process, particularly if the patient was coerced into receiving a pharmaceutical intervention.…”

Section: Discussionmentioning

confidence: 99%

“It’s That They Treated Me Like an Object”: A Qualitative Study on the Participation of People Diagnosed with Psychotic Disorders in Their Health Care

Villena

Morales-Asencio

Quemada

et al. 2023

IJERPH

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The mental health recovery model is based on shared decision making, in which patients’ preferences and perceptions of the care received are taken into account. However, persons with psychosis usually have very few opportunities to participate in this process. The present study explores the experiences and perceptions of a group of patients with psychosis—in some cases longstanding, in others more recently diagnosed—concerning their participation in the decisions taken about the approach to their condition and about the attention received from healthcare professionals and services. For this purpose, we performed a qualitative analysis of the outcomes derived from five focus groups and six in-depth interviews (36 participants). Two major themes, with five sub-themes, were identified: shared decision-making (drug-centred approach, negotiation process, and lack of information) and the care environment and styles of clinical practice as determinants (aggressive versus person-centred environments, and styles of professional practice). The main conclusions drawn are that users want to participate more in decision making, they want to be offered a range of psychosocial options from the outset and that their treatment should be based on accessibility, humanity and respect. These findings are in line with the guidelines for clinical practice and should be taken into account in the design of care programmes and the organisation of services for persons with psychosis.

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“…O índice médio de internação compulsória no serviço é de 1,7% -menos de um quinto daquele observado na Alemanha nacionalmente (10,7%) (121). As internações compulsórias são evitadas mediante tomada de decisão apoiada, com base na vontade e preferência, particularmente quando há risco de lesões (122)(123)(124). A opção de receber tratamento domiciliar também contribuiu para as baixas taxas de internações compulsórias.…”

Section: Respeito à Capacidade Jurídicaunclassified

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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Supported Decision Making in the Prevention of Compulsory Interventions in Mental Health Care

Cited by 8 publications

References 15 publications

Restriction of the Rights and Coercion of Patients in a Psychiatric Hospital: The Opinion of People With Mental Disorders and Psychiatrists

Restriction of the Rights and Coercion of Patients in a Psychiatric Hospital: The Opinion of People With Mental Disorders and Psychiatrists

“It’s That They Treated Me Like an Object”: A Qualitative Study on the Participation of People Diagnosed with Psychotic Disorders in Their Health Care

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

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