Seclusion and restraint are frequent but controversial coercive measures used in psychiatric treatment. Legislative efforts have started to emerge to control the use of these measures in many countries. In the present study, the nationwide trends in the use of seclusion and restraint were investigated in Finland over a 15-year span which was characterised by legislative changes aiming to clarify and restrict the use of these measures.
The data were collected during a predetermined week in 1990, 1991, 1994, 1998 and 2004, using a structured postal survey of Finnish psychiatric hospitals. The numbers of inpatients during the study weeks were obtained from the National Hospital Discharge Register.
The total number of the secluded and restrained patients declined as did the number of all inpatients during the study weeks, but the risk of being secluded or restrained remained the same over time when compared to the first study year. The duration of the restraint incidents did not change, but the duration of seclusion increased. A regional variation was found in the use of coercive measures.
Legislative changes solely cannot reduce the use of seclusion and restraint or change the prevailing treatment cultures connected with these measures. The use of seclusion and restraint should be vigilantly monitored and ethical questions should be under continuous scrutiny.
The knowledge of the impact of coercion on psychiatric treatment outcome is limited. Multiple measures of coercion have been recommended. The aim of the study was to examine the impact of accumulated coercive incidents on short-term outcome of inpatient psychiatric care
233 involuntarily and voluntarily admitted patients were interviewed within five days of admission and at discharge or after maximum three weeks of care. Coercion was measured as number of coercive incidents, i.e. subjectively reported and in the medical files recorded coercive incidents, including legal status and perceived coercion at admission, and recorded and reported coercive measures during treatment. Outcome was measured both as subjective improvement of mental health and as improvement in professionally assessed functioning according to GAF. Logistic regression analyses were performed with patient characteristics and coercive incidents as independent and the two outcome measures as dependent variables
Number of coercive incidents did not predict subjective or assessed improvement. Patients having other diagnoses than psychoses or mood disorders were less likely to be subjectively improved, while a low GAF at admission predicted an improvement in GAF scores
The results indicate that subjectively and professionally assessed mental health short-term outcome of acute psychiatric hospitalisation are not predicted by the amount of subjectively and recorded coercive incidents. Further studies are needed to examine the short- and long-term effects of coercive interventions in psychiatric care.
Cites: Int J Law Psychiatry. 1997 Spring;20(2):227-419178064
Cites: Int J Law Psychiatry. 1996 Spring;19(2):201-178725657
Fear can be problematic for children who come into contact with medical care. This study aimed to illuminate the meaning of being afraid when in contact with medical care, as narrated by children 7-11 years old. Nine children participated in the study, which applied a phenomenological hermeneutic analysis methodology. The children experienced medical care as "being threatened by a monster," but the possibility of breaking this spell of fear was also mediated. The findings indicate the important role of being emotionally hurt in a child's fear to create, together with the child, an alternate narrative of overcoming this fear.
In recent years images of independence, active ageing and staying at home have come to characterise a successful old age in western societies. 'Telecare' technologies are heavily promoted to assist ageing-in-place and a nexus of demographic ageing, shrinking healthcare and social care budgets and technological ambition has come to promote the 'telehome' as the solution to the problem of the 'age dependency ratio'. Through the adoption of a range of monitoring and telecare devices, it seems that the normative vision of independence will also be achieved. But with falling incomes and pressure for economies of scale, what kind of independence is experienced in the telehome? In this article we engage with the concepts of 'technogenarians' and 'shared work' to illuminate our analysis of telecare in use. Drawing on European-funded research we argue that home-monitoring based telecare has the potential to coerce older people unless we are able to recognise and respect a range of responses including non-use and 'misuse' in daily practice. We propose that re-imagining the aims of telecare and redesigning systems to allow for creative engagement with technologies and the co-production of care relations would help to avoid the application of coercive forms of care technology in times of austerity.
Compliance-enhancing organizations such as the military and police are characterized by guiding and controlling employees, and they increasingly tend to control and restrict employees' behavior when exposed to external uncertainty. Restrictions on employees' behavior are intended to increase efficiency, safety, and combat readiness through reducing misunderstandings and conflicts. However, many writers have argued that the most natural reaction to external unpredictability and uncertainty is internal flexibility and utilizing the entire range of employees' qualifications. The question raised in this study is whether restrictions imply that employees feel they are subject to incompatible work conditions and are deprived of resources and opportunities to execute their everyday responsibilities and thereby experience role conflict. Hierarchical regression analyses performed on data from 71 police and 71 army officers showed that rules and routines that were perceived as restrictive or coercive better explained role conflict among employees than either leadership loyalty, commitment, and rules or routines that were perceived as enabling.
Scientists agree on the need for robust public health safeguards to accompany the imminent introduction of xenotransplantation--clinical transplantation of animal tissue into humans. To protect society in the event of emerging infectious diseases, governments must devise a legally effective means of ensuring compliance with such safeguards. Neither consent law, the law of contracts, nor existing public health legislation can adequately enforce such compliance. Consent law serves as a mechanism of communicating the momentary waiver of legal rights, not as a durable enforcement doctrine. Because it would be essential for recipients personally to comply with public safety measures, the law of contracts would also be unable to compel compliance. Existing public health legislation would also likely be ineffective because it would need to be substantially amended to incorporate the heightened powers necessary for the periodic examination of asymptomatic xenotransplant recipients. Xenotransplantation-specific legislation would be a legally effective means of enforcing public health safeguards since it could require conforming behaviors and could impose monetary fines on those recipients who, having benefited from life-saving intervention, fail to comply. This Article argues that legislation implementing a post-xenotransplantation surveillance system should withstand constitutional scrutiny because it would not be discriminatory and because, although it would violate fundamental rights of recipients, such violations would be justified under existing constitutional doctrines.