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Interventions to reduce the use of coercion in mental health care - an introduction

Interventions to reduce the use of coercion in mental health care - an introduction. HOLMEN FJORDHOTEL 23-24 MAI 2013. The search for evidence: Paper identification. SEARCH STRATEGIES SCREENING OF IDENTIFIED REFERENCES QUALITY ASSESSMENT INCLUDED PAPERS RESULTS.

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Interventions to reduce the use of coercion in mental health care - an introduction

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  1. Interventions to reduce the use of coercion in mental health care - an introduction HOLMEN FJORDHOTEL 23-24 MAI 2013

  2. The search for evidence: Paper identification SEARCH STRATEGIES SCREENING OF IDENTIFIED REFERENCES QUALITY ASSESSMENT INCLUDED PAPERS RESULTS Inclusion and exclusion criteria Selection of databases Exclusion of the majority of papers, usually based on title and abstract Papers rejected because of poor quality Analysis of included papers, grading of quality

  3. The Norwegian Knowledge Center Cohrane Library

  4. The norwegian Knowledge Center • Intervention for reducingseclusion and restraint in mental health for adults (PublishedOctober 2012, last search June 2012) • 13 papersincluded, thereof 11 usingcivilcommitment as a primaryoutcome (alone or in combination withotheroutcomes) Interventionnumberof studiessignificantreduction ACT-Teams/Community teams 2 0 AcuteCrisis Teams/Crisis plan 3 1 Community Network 1 1 Communitytreatment order 1 0 Treatmentcontract 1 0 In-patient training/rehab 1 0 Personal suport (Lawyer) 1 0 TreatmentAdherenceTherapy 1 0 • In additiontwopapersontheuseofcoercivemeasurewereincluded, oneshowed a signficantreduction (Abderhalden et al 2008) whiletheotherdid not (Van de Sande 2011)

  5. Crisis teams/Crisis inteventions The Norwegian knowledge center (2012)Cohrane Library (2012) Henderson et al. 2004 (UK) Johnsen et al. 2005 (UK) Johnsen et al. 2005 (UK) Fenton et al. 1979 (CA) Tyrer et al. 2010 (UK) Fentom et al. 1998 (CA) Hoult et al, 1983 Howard et al. 2010 Muijen et al 1992 Pasamanick et al 1964a Stein et al 1975 Assessment pending: Bindman et al. 2008 (UK)

  6. ACT Teams The Norwegian knowledge center (2012)Cohrane Library (2012) Davidson et al. 2007 (UK) 20 studies (18 US, 1 UK, 1 SE) Oelenschlaeger et al. 2007 (DK) (Davidson and Oelenschlager not included). (Review withdrawn)

  7. Community Mental Health Teams The Norwegian knowledge center (2012)Cohrane Library (2010) Davidson et al. 2007 (UK) Burns et al 1993 (UK) Murson et al. 1992 Tyrer et al. 1998 (UK)

  8. Advanced Directives The Norwegian knowledge center (2012)Cohrane Library (2012) None Henderson et al. 2004a (UK) Papageorgiou et al, 2002 (UK) Assessment pending Thornicroft et al. 2010 (UK) Henderson et al 2004b (UK)

  9. Community treatment order The Norwegian knowledge center (2012)Cohrane Library (2010) Polack et al. 2005 (US) Steadman et al 2001 (US) Swartz et al. 1999 (US)

  10. Effect measures I • Death • Compliance: Studycompliance, treatmentcompliance, program compliance • Satisfactionwith services • (Re)Admission rates • Durationofreadmissions • Useofemergency services • Contactwithprimarycare • Contactwithsocial services • Mental state • Socialfunctioning CohranereviewofCommunityMental Health Teams 2010

  11. Effect measures II • Primary outcomes: Compulsory admissions, involuntary treatment, mechanical/physical restraint, involuntary medication • Secondary outcomes: Social functioning, Quality of life, satisfaction with care, peceived coercion, number of inpatient days, readmission, crime and asdverse events (e.g. suicide, injuries to staff and episodes of violence

  12. Effect measures III Crisis interventions studies (Cohrane 2012): Eight studies used 18 different measures for mental state/function. Only 9 of them provided useful data for the review: BPRS, Client Satisfaction Quiestionnaire, GAS, HoNOS, MANSA, Life Skills Profile, PSE, Psychiatric evaluation form. Social Adjustment Scale, EuroQual.

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