Domenico Giacco1, Maev Conneely2, Tumseela Masoud3, Erin Burn2, Stefan Priebe2. 1. Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, United Kingdom. Electronic address: d.giacco@qmul.ac.uk. 2. Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, United Kingdom. 3. East London NHS Foundation Trust, United Kingdom.
Abstract
BACKGROUND: Observational research has found that involuntary treatment provides limited benefits in terms of long-term clinical outcomes. Our aim was to review literature on existing interventions in order to identify helpful approaches to improve outcomes of involuntary treatment. METHODS: This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Seven databases (AMED, PsycINFO, Embase Classic, Embase 1974-2017, CINAHL, MEDLINE, and BNI) were searched and the results were analysed in a narrative synthesis. RESULTS: Nineteen papers describing fourteen different interventions were included. Using narrative synthesis the interventions were summarised into three categories: a) structured patient-centred care planning; b) specialist therapeutic interventions; c) systemic changes to hospital practice. The methodologies used and outcomes assessed were heterogeneous. Most studies were of low quality, although five interventions were tested in randomised controlled trials (RCTs). Preliminary evidence supports structured patient-centred care planning interventions have an effect on long-term outcomes (such as readmission), and that specialist therapeutic interventions and systemic changes to hospital practice have an effect on reducing the use of coercive measures on wards. CONCLUSIONS: This review shows that it is possible to conduct rigorous intervention-testing studies in involuntary patients, including RCTs. Yet, the overall evidence is limited. Structured patient-centred care planning interventions show promise for the improvement of long-term outcomes and should be further evaluated.
BACKGROUND: Observational research has found that involuntary treatment provides limited benefits in terms of long-term clinical outcomes. Our aim was to review literature on existing interventions in order to identify helpful approaches to improve outcomes of involuntary treatment. METHODS: This systematic review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Seven databases (AMED, PsycINFO, Embase Classic, Embase 1974-2017, CINAHL, MEDLINE, and BNI) were searched and the results were analysed in a narrative synthesis. RESULTS: Nineteen papers describing fourteen different interventions were included. Using narrative synthesis the interventions were summarised into three categories: a) structured patient-centred care planning; b) specialist therapeutic interventions; c) systemic changes to hospital practice. The methodologies used and outcomes assessed were heterogeneous. Most studies were of low quality, although five interventions were tested in randomised controlled trials (RCTs). Preliminary evidence supports structured patient-centred care planning interventions have an effect on long-term outcomes (such as readmission), and that specialist therapeutic interventions and systemic changes to hospital practice have an effect on reducing the use of coercive measures on wards. CONCLUSIONS: This review shows that it is possible to conduct rigorous intervention-testing studies in involuntarypatients, including RCTs. Yet, the overall evidence is limited. Structured patient-centred care planning interventions show promise for the improvement of long-term outcomes and should be further evaluated.
Authors: Emma Bainbridge; Brian Hallahan; David McGuinness; Patricia Gunning; John Newell; Agnes Higgins; Kathy Murphy; Colm McDonald Journal: BJPsych Open Date: 2018-11-16
Authors: J Hamann; F Holzhüter; S Blakaj; S Becher; B Haller; M Landgrebe; M Schmauß; S Heres Journal: Epidemiol Psychiatr Sci Date: 2020-06-16 Impact factor: 6.892