Coercive Measures
Conditions
Keywords
Coercion, Post-coercion review, Mental health, Seclusion, Mechanical restraint
Brief summary
The present study aims at exploring the impact of a standardized post-coercion review session of coercive measures that took place in the psychiatric inpatient setting in reducing the use of coercive measures and the subjective perception of coercion. It is well known that coercive measures have a major negative impact on the health, well-being and the course of treatment of patients suffering from mental health issues. Many interventions have been implemented in the last years to reduce the use of coercion and limit its consequences. The investigators developed a standardized post-coercion review intervention. This session takes place as soon as possible after the concerned coercive measure and is moderated by a member of staff who has not been involved in the use of coercion. Other persons involved are the patient, a staff member who took the decision leading to the use of the coercive measure, and a one of the patient's relatives. Hypothesis is that the use of this standardized intervention can reduce the use of subsequent coercive measures and level of perceived coercion, prevent the development of post-traumatic symptoms, help preserving a trustful therapeutic relationship and positively change the attitude of staff regarding the use of coercion. This intervention has been proven to be well accepted by patients and staff members in a previous pilot study. The present study is designed as a randomised-controlled study investigating the effect of post-coercion review.
Detailed description
The present study aims at exploring the impact of a standardized post-coercion review session of coercive measures that took place in the psychiatric inpatient setting in reducing the use of coercive measures and the subjective perception of coercion. It is well known that coercive measures have a major negative impact on the health, well-being and the course of treatment of patients suffering from mental health issues. Many interventions have been implemented in the last years to reduce the use of coercion and limit its consequences. The investigators developed a standardized post-coercion review intervention. This session takes place as soon as possible after the concerned coercive measure and is moderated by a member of staff who has not been involved in the use of coercion. Other persons involved are the patient, a staff member who took the decision leading to the use of the coercive measure, and a one of the patient's relatives. The guidelines define important themes and questions that should be addressed during the review session. These guidelines have been developed with the help of psychiatrists, nurses and a peer worker. Hypothesis is that the use of this standardized intervention can reduce the use of subsequent coercive measures and level of perceived coercion, prevent the development of post-traumatic symptoms, help preserving a trustful therapeutic relationship and positively change the attitude of staff regarding the use of coercion. This intervention has been proven to be well accepted by patients and staff members in a previous pilot study. The methods combine quantitative and qualitative evaluations. The present study is designed as a randomised-controlled study investigating the effect of post-coercion review.
Interventions
OTHERStandardized debriefing session of coercive measures
Debriefing session following the developed guidelines including setting and themes.
Sponsors
Federal Ministry of Health, Germany
Charite University, Berlin, Germany
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
Eligible participants are randomly assigned either to the intervention arm (standardized post-coercion review session session) or to the Treatment-as-usual (TAU) arm.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Inpatient * Subject to coercive measure (seclusion, restraint, forced medication) * Diagnosis of a psychotic disorder (ICD-10: F1x.5, F2x, F31.x). * Written and informed consent.
Exclusion criteria
* Inability to provide informed consent * Hospital stay \< 24h
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Objective coercive measures | At the time of discharge from the hospital by every included patient, up to 6 months | Number of coercive measures (seclusion, restraint, forced medication) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Subjective experience of coercion (2) | At the time of discharge from the hospital by every included patient, up to 6 months | Subjective experience coercion assessed by the Coercion Ladder (CL). The CL is an analog scale ranging from 1 to 10 and assessing the level pf perceived coercion. Higher values indicate a higher level of perceived coercion. |
| Subjective experience of coercion (3) | At the time of discharge from the hospital by every included patient, up to 6 months | Subjective experience coercion assessed by the German version of the Coercion Experience Scale (CES). The CES is a scale used to measure the impact of coercive measures. It comprises 29 items related to perceived stressors during a coercive intervention with a 5-point Likert-scale. A total score is used with higher values indicating higher perceived coercion. |
| Subjective experience of coercion (1) | At the time of discharge from the hospital by every included patient, up to 6 months | Subjective experience coercion assessed by the German version of the Perceived Coercion Subscale (PCS) of the MacArthur Admission Experience Survey (AES). The AES comprises 16 dichotomous items (yes-no answers) divided in 4 subscales. The PCS comprises 5 items. A higher score (range 0-5) indicates a high level of perceived coercion. |
| Post-traumatic symptoms (1) | At the time of discharge from the hospital by every included patient, up to 6 months | Development of post-traumatic symptoms assessed by the German version of the Peri-Traumatic Distress Inventory (PDI). The PDI assesses the reactions during the traumatic event. It comprises 13 items with a 0-4 Likert-scale. Scores of all items are summed up and so the total score ranges from 0 to 52. A score higher than 26 indicates a high risk of developing a post traumatic stress disorder. |
| Post-traumatic symptoms (2) | At the time of discharge from the hospital by every included patient, up to 6 months | Development of post-traumatic symptoms assessed by the German version of the Impact of Events Scale Revised (IES-R). The IES-R comprises 22 items with a Likert-scale ranging from 0 to 5. Items are divided into 3 sub scales (Intrusion (7 items), Avoidance (8 items), and Hyperarousal (7 items)). Scores for each sub scales are built by adding the answers to each item. Higher scores indicate a higher level of symptoms. The probability of post traumatic stress disorder (PTSD) is assessed using a formula developed by the German translators: X = (-0,02 x intrusion) + (0,07 x avoidance) + (0,15 x hyperarousal) - 4,36. Scores \>0 indicate the probable presence of PTSD. |
| Quality of the therapeutic relationship | At the time of discharge from the hospital by every included patient, up to 6 months | Evaluation of the quality of the therapeutic relationship assessed by the German version of the Work Alliance Inventory-Short Form (WAI-SR). The WAI comprises 12 items divided into 3 subclass (goal, task, bond). each subscale comprises 4 items with a 5-point Likert-scale. The score range for each subscale ranges from 5 to 20. Higher scores indicate a better therapeutic alliance. |
Countries
Germany
Outcome results
None listed