The relationship between the services available to patients in primary care and at local psychiatric clinics and the use of coercion: recent findings from Northern Norway
Introduction: Psychiatric patients may be subjected to coercion in many different forms, including involuntary admission to psychiatric hospital, involuntary outpatient treatment, and involuntary treatment with medications [1]. The use of coercion in the psychiatric services involves a range of ethi...
Published in: | International Journal of Integrated Care |
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Language: | English |
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Ubiquity Press
2016
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Online Access: | https://www.ijic.org/jms/article/view/2796 https://doi.org/10.5334/ijic.2796 |
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International Journal of Integrated Care (IJIC) |
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English |
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psychiatry services coercion integration primary care |
spellingShingle |
psychiatry services coercion integration primary care Wynn, Rolf Henrik Myklebust, Lars The relationship between the services available to patients in primary care and at local psychiatric clinics and the use of coercion: recent findings from Northern Norway |
topic_facet |
psychiatry services coercion integration primary care |
description |
Introduction: Psychiatric patients may be subjected to coercion in many different forms, including involuntary admission to psychiatric hospital, involuntary outpatient treatment, and involuntary treatment with medications [1]. The use of coercion in the psychiatric services involves a range of ethical, clinical, and legal issues [2,3]. The Norwegian authorities have stated that it is a goal to reduce the use of coercion in the psychiatric services, as it is believed that this will improve the services and increase the quality of care [4].Purpose and methods: We review and discuss findings from studies on coercion in North Norway, focusing on the relationship between the services available to patients in primary care and at local psychiatric clinics and the use of coercion.Results and discussion: A lack of services at the municipal level might increase the use of coercion. For instance, approximately half of the involuntary admissions had been referred from doctors working at municipal out-of-hours clinics [5]. These doctors often felt pressured to commit patients to psychiatric hospital, as few other options were available at nights and week-ends [5-7]. The increased availability of other services at nights and week-ends could therefore possibly result in reduced levels of coercion. Having sufficient resources available at the secondary level might also reduce the amount of coercion patients are subjected to. For instance, an area that had beds available for emergencies at local psychiatric clinics had significantly fewer (95% CI for EXP(B)=1.133-2.206, p=0.005) involuntary admissions than a comparable area without such beds [8]. While much of the coercion of psychiatric patients takes place at the tertiary/hospital level, this study suggests that the availability of services at the primary and secondary levels might influence the level of coercion at the tertiary/hospital level.Conclusion: The present study suggests that increasing the availabilty of voluntary psychiatric services at the primary and secondary levels might represent one way of achieving the goal of reducing coercion in the psychiatric services. This relationship should be examined further in future research involving the North Norwegian psychiatric health services. References:1. Wynn R, Myklebust LH, Bratlid T. Psychologists and coercion: decisions regarding involuntary psychiatric admission and treatment in a group of Norwegian psychologists. Nordic Journal of Psychiatry 2007;61:433-437.2. Wynn R. Coercion in psychiatric care: clinical, legal, and ethical controversies. International Journal of Psychiatry in Clinical Practice 2006;10:247-251.3. Wynn R. The use of physical restraint in Norwegian adult psychiatric hospitals. Psychiatry Journal 2015; 2015: 347246.4. Stuen HK, Rugkåsa J, Landheim A, Wynn R. Increased influence and collaboration: a qualitative study of patients’ experiences of community treatment orders within an assertive community treatment setting. BMC Health Services Reserach 2015;14:409.5. Røtvold K, Wynn R. Involuntary psychiatric admission: Characteristics of the referring doctors and the doctors' experiences of being pressured. Nordic Journal of Psychiatry 2015;69:373-379.6. Røtvold K, Wynn R. Involuntary psychiatric admission: how the patients are detected and the general practitioners’ expectations for hospitalization. An interview study. International Journal of Mental Health Systems 2016; 10: 20.7. Myklebust LH, Sørgaard K, Røtvold K, Wynn R. Factors of importance to involuntary admission. Nordic Journal of Psychiatry 2012;66:178-182.8. Myklebust LH, Sørgaard K, Wynn R. Local psychiatric beds appear to decrease the use of involuntary admission: a case-registry study. BMC Health Services Research 2014;14:64. |
format |
Article in Journal/Newspaper |
author |
Wynn, Rolf Henrik Myklebust, Lars |
author_facet |
Wynn, Rolf Henrik Myklebust, Lars |
author_sort |
Wynn, Rolf |
title |
The relationship between the services available to patients in primary care and at local psychiatric clinics and the use of coercion: recent findings from Northern Norway |
title_short |
The relationship between the services available to patients in primary care and at local psychiatric clinics and the use of coercion: recent findings from Northern Norway |
title_full |
The relationship between the services available to patients in primary care and at local psychiatric clinics and the use of coercion: recent findings from Northern Norway |
title_fullStr |
The relationship between the services available to patients in primary care and at local psychiatric clinics and the use of coercion: recent findings from Northern Norway |
title_full_unstemmed |
The relationship between the services available to patients in primary care and at local psychiatric clinics and the use of coercion: recent findings from Northern Norway |
title_sort |
relationship between the services available to patients in primary care and at local psychiatric clinics and the use of coercion: recent findings from northern norway |
publisher |
Ubiquity Press |
publishDate |
2016 |
url |
https://www.ijic.org/jms/article/view/2796 https://doi.org/10.5334/ijic.2796 |
long_lat |
ENVELOPE(9.934,9.934,63.921,63.921) |
geographic |
Landheim Norway |
geographic_facet |
Landheim Norway |
genre |
North Norway Northern Norway |
genre_facet |
North Norway Northern Norway |
op_source |
International Journal of Integrated Care; Vol 16: Annual Conference Supplement 2016; A248 1568-4156 |
op_relation |
https://www.ijic.org/jms/article/view/2796/3612 10.5334/ijic.2796 https://www.ijic.org/jms/article/view/2796 doi:10.5334/ijic.2796 |
op_rights |
AuthorsStarting in 2009 the International Journal of Integrated Care applies the Creative Commons Attribution 4.0 Internaltional License (CC-by, http://creativecommons.org/licenses/by/4.0/) to all articles, submitted in or after January 2009, that are published in IJIC. Authors retain ownership of the copyright for their articles, but they permit anyone unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. After it has appeared in IJIC authors may republish their text in any way they wish (electronic or print) as long as they clearly acknowledge IJIC as its original publisher with the correct citation details and copyright notice, independent of whether the article is used in whole or in part.Authors of accepted manuscripts assign IJIC the right to publish and distribute their text electronically and to archive it permanently retrievable electronically.Authors retain the copyright of the article. After it has appeared in IJIC authors may republish their text in any way they wish (electronic or print) as long as they clearly acknowledge IJIC as its original publisher with the correct citation details and copyright notice (see below), independent whether the article is used in whole or in part.IJIC may change the appearance of the article, both layout and technical format, to ensure consistency and readability. Under no circumstance will the content of the article be altered.The author warrants to IJIC that the article is original, does not infringe any existing copyright, and does not infringe the rights of any third party. This warrant concerns the entire manuscript, text as well as pictures, sound, video, data sets etc. The author also warrants to us that he has full authority to enter into this agreement and that the rights he is granting to IJIC are done so without breaching any obligations he may have.Acceptation:ReadersStarting 2009 Utrecht the International Journal of Integrated Care applies the Creative |
op_rightsnorm |
CC-BY CC-BY-NC |
op_doi |
https://doi.org/10.5334/ijic.2796 |
container_title |
International Journal of Integrated Care |
container_volume |
16 |
container_issue |
6 |
container_start_page |
248 |
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1766140203816189952 |
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ftjijic:oai:ojs.www.ijic.org:article/2796 2023-05-15T17:39:26+02:00 The relationship between the services available to patients in primary care and at local psychiatric clinics and the use of coercion: recent findings from Northern Norway Wynn, Rolf Henrik Myklebust, Lars 2016-12-16 application/pdf https://www.ijic.org/jms/article/view/2796 https://doi.org/10.5334/ijic.2796 eng eng Ubiquity Press https://www.ijic.org/jms/article/view/2796/3612 10.5334/ijic.2796 https://www.ijic.org/jms/article/view/2796 doi:10.5334/ijic.2796 AuthorsStarting in 2009 the International Journal of Integrated Care applies the Creative Commons Attribution 4.0 Internaltional License (CC-by, http://creativecommons.org/licenses/by/4.0/) to all articles, submitted in or after January 2009, that are published in IJIC. Authors retain ownership of the copyright for their articles, but they permit anyone unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. After it has appeared in IJIC authors may republish their text in any way they wish (electronic or print) as long as they clearly acknowledge IJIC as its original publisher with the correct citation details and copyright notice, independent of whether the article is used in whole or in part.Authors of accepted manuscripts assign IJIC the right to publish and distribute their text electronically and to archive it permanently retrievable electronically.Authors retain the copyright of the article. After it has appeared in IJIC authors may republish their text in any way they wish (electronic or print) as long as they clearly acknowledge IJIC as its original publisher with the correct citation details and copyright notice (see below), independent whether the article is used in whole or in part.IJIC may change the appearance of the article, both layout and technical format, to ensure consistency and readability. Under no circumstance will the content of the article be altered.The author warrants to IJIC that the article is original, does not infringe any existing copyright, and does not infringe the rights of any third party. This warrant concerns the entire manuscript, text as well as pictures, sound, video, data sets etc. The author also warrants to us that he has full authority to enter into this agreement and that the rights he is granting to IJIC are done so without breaching any obligations he may have.Acceptation:ReadersStarting 2009 Utrecht the International Journal of Integrated Care applies the Creative CC-BY CC-BY-NC International Journal of Integrated Care; Vol 16: Annual Conference Supplement 2016; A248 1568-4156 psychiatry services coercion integration primary care info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion 2016 ftjijic https://doi.org/10.5334/ijic.2796 2022-03-22T09:19:41Z Introduction: Psychiatric patients may be subjected to coercion in many different forms, including involuntary admission to psychiatric hospital, involuntary outpatient treatment, and involuntary treatment with medications [1]. The use of coercion in the psychiatric services involves a range of ethical, clinical, and legal issues [2,3]. The Norwegian authorities have stated that it is a goal to reduce the use of coercion in the psychiatric services, as it is believed that this will improve the services and increase the quality of care [4].Purpose and methods: We review and discuss findings from studies on coercion in North Norway, focusing on the relationship between the services available to patients in primary care and at local psychiatric clinics and the use of coercion.Results and discussion: A lack of services at the municipal level might increase the use of coercion. For instance, approximately half of the involuntary admissions had been referred from doctors working at municipal out-of-hours clinics [5]. These doctors often felt pressured to commit patients to psychiatric hospital, as few other options were available at nights and week-ends [5-7]. The increased availability of other services at nights and week-ends could therefore possibly result in reduced levels of coercion. Having sufficient resources available at the secondary level might also reduce the amount of coercion patients are subjected to. For instance, an area that had beds available for emergencies at local psychiatric clinics had significantly fewer (95% CI for EXP(B)=1.133-2.206, p=0.005) involuntary admissions than a comparable area without such beds [8]. While much of the coercion of psychiatric patients takes place at the tertiary/hospital level, this study suggests that the availability of services at the primary and secondary levels might influence the level of coercion at the tertiary/hospital level.Conclusion: The present study suggests that increasing the availabilty of voluntary psychiatric services at the primary and secondary levels might represent one way of achieving the goal of reducing coercion in the psychiatric services. This relationship should be examined further in future research involving the North Norwegian psychiatric health services. References:1. Wynn R, Myklebust LH, Bratlid T. Psychologists and coercion: decisions regarding involuntary psychiatric admission and treatment in a group of Norwegian psychologists. Nordic Journal of Psychiatry 2007;61:433-437.2. Wynn R. Coercion in psychiatric care: clinical, legal, and ethical controversies. International Journal of Psychiatry in Clinical Practice 2006;10:247-251.3. Wynn R. The use of physical restraint in Norwegian adult psychiatric hospitals. Psychiatry Journal 2015; 2015: 347246.4. Stuen HK, Rugkåsa J, Landheim A, Wynn R. Increased influence and collaboration: a qualitative study of patients’ experiences of community treatment orders within an assertive community treatment setting. BMC Health Services Reserach 2015;14:409.5. Røtvold K, Wynn R. Involuntary psychiatric admission: Characteristics of the referring doctors and the doctors' experiences of being pressured. Nordic Journal of Psychiatry 2015;69:373-379.6. Røtvold K, Wynn R. Involuntary psychiatric admission: how the patients are detected and the general practitioners’ expectations for hospitalization. An interview study. International Journal of Mental Health Systems 2016; 10: 20.7. Myklebust LH, Sørgaard K, Røtvold K, Wynn R. Factors of importance to involuntary admission. Nordic Journal of Psychiatry 2012;66:178-182.8. Myklebust LH, Sørgaard K, Wynn R. Local psychiatric beds appear to decrease the use of involuntary admission: a case-registry study. BMC Health Services Research 2014;14:64. Article in Journal/Newspaper North Norway Northern Norway International Journal of Integrated Care (IJIC) Landheim ENVELOPE(9.934,9.934,63.921,63.921) Norway International Journal of Integrated Care 16 6 248 |