Caffeine is a legally available, widely consumed psychoactive substance with mild central nervous system stimulant properties. There is sufficient caffeine in a cup of coffee to have a stimulant ...effect. Caffeine can adversely affect some mental health symptoms, notably sleep and anxiety.
Effects would be worse if consumed excessively. This survey aimed to describe the pattern of provision of caffeinated coffee to patients admitted to UK adult psychiatric intensive care units (PICUs) in order to inform local practice. All NHS adult PICUs across the UK were contacted to establish
what type of coffee they routinely provided to their patients. Two thirds of PICUs provided only decaffeinated instant coffee to their patients. However, a minority provided caffeinated coffee in an unregulated manner, including three units which did not routinely offer decaffeinated coffee.
National guidance to inform and direct the practice of providing or restricting the consumption of drinks containing psychoactive substances on a PICU may be beneficial.
Objective : To explore experiences of restrictive practices from the perspectives of acute care inpatients and staff.Method : Qualitative semi-structured interviews were undertaken exploring ...participants' experiences deemed to involve restrictive practices. Additionally,
a period of observational fieldwork was undertaken. Nine inpatient participants and eight staff member participants were recruited across two adult psychiatric wards. Data were analysed using thematic analysis.Results : Analysis of data from the inpatient participants identified three
superordinate themes including 'Overpowered by staff', 'Making sense of restrictive practices' and 'Surviving restrictive practices'. Analysis of data from staff member participants identified three superordinate themes including 'Legitimate practices', 'Impact' and 'Strategies to avoid restrictive
practices'. Our analysis found a key discrepancy in how alternatives to restrictive practices were experienced by patients, where staff felt they were able to use 'negotiation' with patients, whereas patients experienced these approaches as coercive.Conclusion : Whilst some positive
experiences are noted by patients and staff, restrictive practices continue to be experienced negatively by both patients and staff, supporting the current focus on reducing the use of restrictive practices in the acute care setting. The use of de-escalation and other alternative interventions
to restrictive practices are experienced differently by patients and staff and further research is required to examine the use of these alternative strategies.
Even if coercive measures are widely applied in psychiatry and have numerous well-known drawbacks, there is limited known on the agreement among mental healthcare professionals' opinions on their ...use. In a questionnaire study using standardized scenarios, we investigated variation in staff opinions on coercion.
In a web-based survey distributed to staff at three psychiatry hospitals, respondents were asked to consider if and what coercion to use by introducing two hypothetical scenarios involving involuntary psychiatric admission and in-hospital coercion.
One hundred thirty-two out of 601 invited staff members responded to the survey (Response Rate = 22%). There was large variation in participating staff members' opinions on how to best manage critical situations and what coercive measures were warranted. In the first scenario, 57% of respondents (
= 76) believed that the patient should be involuntarily admitted to hospital while the remaining respondents believed that the situation should be managed otherwise. Regarding the second scenario, 62% of respondents responded that some in-hospital coercion should be used. The majority of respondents believed that colleagues would behave similarly (60%) or with a tendency towards more coercion use (34%). Male gender, being nursing staff and having less coercion experience predicted being less inclined to choose involuntary hospital admission.
There is a high degree of variation in coercion use. This study suggests that this variation persists despite staff members being confronted with the same standardized situations. There is a need for evidence-based further guidance to minimize coercion in critical mental healthcare situations.
Elimination of restrictive practices (physical/mechanical restraint and seclusion) from adult acute mental health care services has been demanded internationally for many decades. This study aimed ...to: (1) Identify priority issues in the elimination of and use of alternative approaches to restrictive practices (seclusion and physical/mechanical restraint) in rural/regional acute adult mental healthcare services, as told by mental healthcare service users and practitioners, (2) identify the community-based, system-level feedback loops that enhance or reduce the use of restrictive practices and viable alternatives and, (3) identify potential action areas to improve system structures to increase regional mental healthcare services' ability to eliminate restrictive practices and use alternative approaches. Group model building (GMB) workshops were held with a small group (n = 9) of mental healthcare practitioners and service users with lived experience of restrictive practice use. This participatory approach enables exploration and visual mapping of local structures causing behaviour patterns of practitioner and service user concern over time - in this case, the barriers, and enablers to alternative approaches to restrictive practices in adult acute mental healthcare services within the Geelong-Barwon region. This is the first study that specifically applies GMB in the discussion of the elimination of restrictive practices in mental health in the non-metropolitan regional/rural context. Participants identified four key priorities in relation to eliminating restrictive practices: (1) self-advocacy, (2) continuity of care, (3) early intervention, and (4) safety for all. The study findings were distilled into a novel preliminary set of mental healthcare practitioner and service user action ideas.
Objectives:
Forensic mental health services (FMHS) have higher rates, duration and frequency of restrictive practices (seclusion, physical restraint and mechanical restraint). Data generated by ...services can be used to set targets (benchmarks) with like services to reduce or eliminate restrictive practices. The aim of this study was to develop restrictive practice benchmarks for Australian and New Zealand FMHS.
Method:
A participatory action research methodology was used by conducting a Delphi study. FMHS experts provided de-identified service-specific restrictive practice data, which was used to stimulate reflection towards the development of restrictive practice benchmarks.
Results:
Consensus decision-making was reached on benchmarks for the rate, duration and frequency of seclusion and physical restraint. Mechanical restraint was found to be a rare event, requiring event specific review in each service.
Conclusions:
Benchmarking with FMHS may assist in working to reduce restrictive practices and encourage the scrutiny of service practice. Establishment of a FMHS network might assist to embed the proposed benchmarks.
The United Nations Subcommittee on the Prevention of Torture visits signatory nations to the Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or ...Punishment (OPCAT). Its role is to monitor and support signatory nations in implementing and complying with the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment (CAT). In October 2022, the United Nations Subcommittee on the Prevention of Torture visited Australia but was barred from visiting mental health wards in Queensland and all detention facilities in New South Wales leading to the termination of its visit. This breach of Australia’s obligations under the OPCAT presents a significant setback for the rights of people with mental illness and other involuntarily detained populations. This piece sets out to demonstrate the relevance of OPCAT to the mental health system in Australia. Individuals who are detained for compulsory treatment in locked facilities such as acute psychiatric inpatient wards and forensic mental health facilities are deprived of their liberty, often out of public view. Thus, it highlights the ethical and professional obligations of all mental health professionals, especially psychiatrists, to safeguard the human rights of individuals being detained in mental health facilities as enshrined in Australia’s international legal obligations under the OPCAT. Adhering to these obligations diminishes the risk of future human rights violations of people with mental illness.
In 2019, the Council of Europe agreed to urge member states to take steps toward total abolition of psychiatric coercive measures.
To test if this aspiration is perceived as realistic and what the ...alternative would be in the event of a total abolition, we surveyed members of the European FOSTREN network of mental health practitioners and researchers, which is specifically dedicated to exchanging knowledge on reducing psychiatric coercion to its minimum.
Web-based survey. Categorical responses were analyzed using frequencies, and free text responses were analyzed through thematic analysis.
In total, out of 167 invitations to FOSTREN network members, 76 responded to the survey (Response Rate 45.5%). A minority (31%) of participating experts dedicated to the reduction of psychiatric coercive measures believed a total abolition to be an achievable goal. A commonly held belief was that total abolition is not achievable because mental health disorders are difficult to treat and may cause violence, necessitating coercion, and there is a need to protect the involved persons from harm. Those responding that complete abolition is achievable argued that the consequences of coercion outweigh any gains and indicated that use of advance directives are sufficient as alternatives to coercion.
Of a European group of experts specifically dedicated to the reduction of psychiatric coercion who participated in this questionnaire study, a minority believed a total abolition be an achievable goal. The study adds to the empirical evidence of the feasibility of the aspiration to totally abolish involuntary measures in the mental health services from the perspective of experts.
WHAT IS KNOWN ON THE SUBJECT?: The use of restrictive interventions is described as a violation of patients' rights and autonomy. It must only be used as a last resort to manage dangerous behaviour, ...to prevent or reduce the risk of mental health patients harming themselves or others. International mental health policy and legislation agree that when restrictive interventions are applied, the least restrictive alternative should be chosen. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The results are ambiguous, as to which restrictive intervention is preferred over others, but there are tendencies towards the majority preferring observation, with mechanical restraint being the least preferred. To make the experience less intrusive and restrictive, certain factors are preferred, such as a more pleasant and humane seclusion room environment, staff communicating during the application and staff of same gender applying the intervention. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: When applying restrictive interventions, mental health professionals should consider environment, communication and duration factors that influence patient preferences, such as the opportunity to keep some personal items in the seclusion room, or, when using restraint, to communicate the reason and explain what is going to happen. More research is needed to clarify patients' preferences regarding restrictive interventions and their views on which are the least restrictive. Preferably, agreement is needed on standard measures, and global use of the same definition of restrictive interventions.
INTRODUCTION: The use of restrictive interventions is a violation of patients' rights that causes physical and psychological harm and which is a well-known challenge globally. Mental health law and legislative principles and experts agree that when restrictive interventions are applied, the least restrictive alternative should be used. However, there is no consensus on what is the least restrictive alternative, especially from the patient perspective.
To investigate the literature on mental health patients' preferences regarding restrictive interventions applied during admission to a psychiatric hospital.
An integrative review informed by the PRISMA statement and thematic analysis were undertaken.
There were tendencies towards patients preferring observation and, for the majority, mechanical restraint was the least preferred restrictive intervention. Factors such as environment, communication and duration were found to influence patients' preferences.
There is a lack of agreement on how best to measure patients' preferences and this complicates the choice of the least restrictive alternative. Nonetheless, our findings show that staff should consider environment, communication and duration when applying restrictive interventions.
More research on restrictive interventions and the least restrictive alternative is warranted, but agreement is needed on standard measures, and a standard global definition of restrictive interventions.
Objectives: A great deal of attention is being directed at the use of seclusion in adolescent inpatient psychiatric units due to its forceful nature and negative impact on inpatients and staff. This ...mixed methods study aimed to explore and compare the level of satisfaction with the services received and perspectives on seclusion in secluded and non-secluded adolescent inpatients.
Methods: This study included 188 participants, across three adolescent inpatient psychiatric units in Australia; 17% reported having experienced seclusion. A mixed methods approach was employed. Participants completed the Consumer Satisfaction Questionnaire-8 and Perceptions of Treatment and Seclusion Questionnaire shortly before or at discharge. Qualitative data was analysed using thematic analysis.
Results: Secluded participants were more likely to report issues with broader care experiences on the Consumer Satisfaction Questionnaire-8. Secluded individuals reported ongoing negative effects from seclusion but were more likely than non-secluded participants to believe seclusion is necessary. Qualitative analyses showed that both secluded and non-secluded individuals considered seclusion to be traumatic, many did not agree with its use.
Conclusions: Communication between inpatients and staff regarding seclusion needs to be improved and there needs to be ongoing support in relation to seclusion during and after discharge. Many adolescent inpatients acknowledge the necessity of seclusion whilst advocating for reduced seclusion.
Mental health professionals working in acute inpatient mental health wards are involved in a complex interplay between an espoused commitment by government and organizational policy to be ...recovery-oriented and a persistent culture of risk management and tolerance of restrictive practices. This tension is overlain on their own professional drive to deliver person-centered care and the challenging environment of inpatient wards. Safewards is designed to reduce conflict and containment through the implementation of 10 interventions that serve to improve the relationship between staff and consumers. The aim of the current study was to understand the impact of Safewards from the perspectives of the staff.
One hundred and three staff from 14 inpatient mental health wards completed a survey 12 months after the implementation of Safewards. Staff represented four service settings: adolescent, adult, and aged acute and secure extended care units.
Quantitative results from the survey indicate that staff believed there to be a reduction in physical and verbal aggression since the introduction of Safewards. Staff were more positive about being part of the ward and felt safer and more connected with consumers. Qualitative data highlight four key themes regarding the model and interventions:
This study found that from the perspective of staff, Safewards contributes to a reduction in conflict events and is an acceptable practice change intervention. Staff perspectives concur with those of consumers regarding an equalizing of staff consumer relationships and the promotion of more recovery-oriented care in acute inpatient mental health services.
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