InvolvEInvolvE

Outcomes of Involuntary Outcomes of Involuntary Admissions in Hospitals Admissions in Hospitals

In EnglandIn England

Newham Centre for Mental Health Institute of PsychiatryLiverpool UniversityBristol University Department of Health Department of Health FundedFunded MHRNMHRN

Dr Diana Rose and Rajinder SidhuDr Diana Rose and Rajinder Sidhu

BackgroundBackground

Psychiatry is the only medical speciality that treats significant numbers of patients against their will and many patients get admitted to hospital involuntarily.

Empirical Evidence about practice, outcome and processes of coercive treatment is limited

The StudyThe Study

- One Principle Investigator at each site

- One Principle Investigator from the MHRN

- One Service User Researcher/Investigator at the IOP involved in drawing up project proposal

RESEARCH QUESTIONSRESEARCH QUESTIONS

What is the outcome of hospitalisation for legally involuntarypatients after 4 weeks of treatment, 3 months of treatment,

and 12 months of treatment

What patient characteristics and process variables are associated with more or less favourable outcomes?

Compare findings from 11 other European Countries With different legislation (EUNOMIA)

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The ProjectThe Project

4 sites around the UK, IOP covers 4 Trusts

One Service User Researcher

age 18-65 able to give informed consent

Questionnaires and someIn depth interviews Paid

LARGEST GEOGRAPHIC AREA

Sections 2 and 3

Section 2: Admission for assessment

Up to 28 days. It isn't renewable.You can only be given treatment with consent unless, under extreme circumstances, it's considered necessary to save your life.

Section 3: Admission for treatment

Up to six months for treatment in the first place. It can then be renewed for another six months. Any renewals after this would be for one year.

Up to three days in a place of safety. In exceptional circumstances, this can include a police station. It isn't renewable.

Section 136: Removing a mentally ill person from a public place to a place of safety

What happens during the sectioning andAdmission process

Patients own perceptions of their mental health/ability to be at ‘risk’.

Brief Psychiatric Assessment Scale

Respected and Understood

Experiences of Tribunals

MANSA

??At the Zoo, Hannah Brookes, 2004

The Consultant……M.A. Graham, 2004

SERVICE USERS PERCEPTION OF:

Perceptions oftreatment/medication

and after care

Level of ‘coercion’ felt and actual coercive measures used

(how pressured/forced felt)

RETROSPECTIVE

SERVICE USERS PERCEPTION OF:

Who suggested you go to hospital?

Did you feel free to do what you wanted?

Did you have A lot of

control….?

Perceived CoercionPerceived Coercion

1

10

MacArtherMacArtherMaximum useOf Coercion

Minimum use of Coercion

10 days

4 weeks

12 weeks

12 months12 months

FOLLOW UPFOLLOW UP

Community TreatmentWas Sectioning Justified

Pressure to Adhere to TreatmentAny Coercive Measures

Qualitative InterviewsQualitative Interviews Process in detail from the moment the patient

is sectioned What lead to this, what happened,

what do they think was the reason for this Treatment and Care Retrospect – necessary?

What changes need to be made?

The One that got Away, Linda Hart 2004

One Service User Analysing

( Continuity of Care and InvolvE and Partnership Working and Gendep)

Importance,Experience and SatisfactionImportance,Experience and Satisfaction

Users PrioritiesUsers Priorities

Scales are combined with qualitative materials and a range of questions and measures to gain the true meaning to experience – e.g, treatment/care/respect separated

Empowering by feedback to the participant and the serviceDissemination to user groups and other services

InvolvE: Is more than an audit of one service – looks at a

process (sectioning) and its impact on the patientShared Experiences

277 participants at the IOPApprox 870 participants nationwide

Retained at 48% atOne Year follow up

NOW