Background and purpose of the study
Involuntary admission (IA) is a frequent and growing phenomenon, both in Belgium and in other countries. Many persons and actors are involved in an involuntary admission. Remarkably, both in Belgium and internationally, research from an interdisciplinary perspective is scarce.
The research had two purposes:
- Mapping the experiences of different stakeholders involved in an IA.
- Formulating recommendations based on scientific, experiential and practice-based knowledge to optimize the application of IA.
To achieve the objectives of the study, an international literature study was conducted, and focus groups were organized with experts by experience, relatives, general practitioners, psychiatrists, staff of a psychiatric hospital, lawyers, judges and public prosecutors and police officers. A total of 50 people participated in the focus groups. In this study, focus groups were conducted with both professional actors and (family) experience experts as well. The experiential knowledge of the (family) experience experts is an added value for this and any future research on mental health care. Especially when the rights of individuals are potentially at stake, research with people with experience is a necessity.
Results
Social context matters
A recurring experience among all actors is that the evolution to community-based care, the reduction of beds and budget cuts lead to a high case load and a put a strain on residential and outpatient care. They also point to a lack of tolerance in society. These evolutions are associated with an increase in the number of IH’s. The increasing number of IA’s puts further pressure on (voluntary) care.
Law in practice is key
In the application of the IA, important differences are noted between general practitioners, public prosecutors, judges, lawyers, psychiatrists, and hospital (departments). Bottlenecks in IA do not find their origin in the legislation, but in the application of the legislation. All actors recognize the impact of an IA on the person. The professionals mainly focus on the impact at the start of an IA, while people with experience and their care givers go more into the negative impact of an IA during and after an IA. All actors acknowledge the necessity of an IA. Still, negative experiences are predominant among people with experience and their care givers. For people with experience and their care givers an IA can be a traumatic experience, even long after their discharge.
Different actors: role and positioning
The central actor in the IA is the psychiatrist. The medical perspective is central. Others care providers receive little attention and are given limited weight. However, the mental health care sector is seen is highly important. Public prosecutors are a radar in the network of an IA, although their role and position is not clearly visible to all actors. General practitioners do not hold a central position in an IA, they are mainly a source of information at the start of an IA. Family members do not occupy a central position in an IA either. They are mainly a source of information at the start of an IA. Lawyers even seem to be situated outside ‘the circle’ of an IA and they are criticized for their position ‘on the edge’. A feeling of powerlessness and loss of control prevails among the experts per experience, throughout the entire course of an IA and especially during the stay in hospital. The similarities between the experiences of family members and experts by experience are striking there is a shared sense of powerlessness.
No patient rights-reflex yet
Experience experts indicate that they receive insufficient – clear – information, especially concerning medication and their patient files. Experts by experience are left with unanswered questions: What is written in the medical report? Why is an IA procedure initiated? What steps are taken in an IA procedure? What opportunities does the person have to have his/her voice heard? What steps can a person take to terminate an IA procedure, …?
Intersectoral cooperation: mixed report
What is going well? Overall, the cooperation between professional actors in an emergency procedure seems to run well because of clear agreements, on paper, with an explicit commitment from the actors involved. Each actor knows who has what task, role, and responsibility.
What could be better? There is frustration among general practitioners and police at the start of an IA because of the time lost on waiting, before the next step can be taken; because they feel they are responsible for ensuring the person’s safety; and because, if the IA does not go ahead, they have to provide further care.
A lack of training and education
A recurring experience among all professionals is that they often learn by doing, in practice, and they problematize the lack of training and education.
Ten recommendations
The ten central recommendations are based on four starting points: 1) to maximize voluntary treatment and alternatives to involuntary interventions and to involuntary admissions; 2) to strengthen the position (in decision making) of people with experience and their families; 3. to stimulate recovery; 4. To improve interdisciplinary cooperation.
The recommendations are:
- Make use of advance statements, to improve the experiences of people and to prevent involuntary admissions.
- Plan aftercare already during the inpatient stay.
- Treat the person as a partner throughout the decision-making processes.
- Treat caregivers as a partner by recognizing their unique experience.
- Actively inform people with experience, on their (patient) rights.
- Limit the experience of coercion and safeguard autonomy as much as possible.
- Actively involve people with experience at the level of patient care and of service (provision) and at policy level.
- Develop a protocol for inter-agency collaboration and give greater attention to assessing (perceived) power differences in inter-agency collaboration.
- Invest in interdisciplinary training and include people with lived experience in training.
- Register and disseminate good practices regarding the previous recommendations.
Want to know more about this book?
Freya Vander Laenen (2021), Gedwongen opname, Ervaringen van professionals en ervaringsdeskundigen, Gompel&Svacina Uitgevers, Antwerpen/ ‘s-Hertogenbosch www.gompel-svacina.eu
