Patients rate compulsory institutional care

Researchers at the Sahlgrenska Academy have asked patients with psychosis for the first time about how they want to be cared for in compulsory institutional care when they have a relapse. The study has led to a new cooperative plan that is used within the treatment of psychosis in Sweden.

Among patients with psychosis, relapse is very common. As people suffering from psychosis might lack awareness of their illness, it often becomes a matter of compulsory institutional care – a sometimes traumatic experience in which one is medicated and restrained against their will.

A cooperative plan built upon patient experience

Researchers at the Sahlgrenska Academy, in a study jointly with Sahlgrenska University Hospital, have interviewed people who have been committed for compulsory institutional care due to a psychotic illness. The study has resulted in the development of an “individual action plan” aimed at improving the commitment process, and which is now in place at two care pathways for psychotic illness in Western Sweden.

“This is a new way to work with patients in compulsory institutional care, via making use of their knowledge and experience with of the care and treatment,” comments Eva Andreasson, researcher at the Sahlgrenska Academy and psychiatric nurse at Sahlgrenska University Hospital.

The Individual Action Plan contains three parts. In the first part, which is occurs at the time a patient is discharged from compulsory institutional care and has recovered, the patient rates the various different elements of the care and treatment along with their experiences and perspectives which are then forwarded as feedback to the treatment unit.

In the next part, the patient describes how he or she would like to be dealt with in case of a relapse. In many cases, patients have very specific preferences, such as advice on how staff should get them to voluntarily take their medication. The third part deals with the patient evaluating and rating the care and treatment in the event of a relapse.

The results from the Cooperative Plan have not yet been evaluated, but the underlying study has revealed several themes which the patients who have been committed for compulsory institutional care consider to be particularly important, among other things the need to be actively involved as a participant, retain their independence, and to be “regarded as a fellow human being.”

However, not all patients are able to prepare an individual action plan.

“To carry out measures of compulsory institutional care is tremendously difficult, and despite good intentions, it does not always work out so well for the patient as one had hoped. The thought of perhaps needing compulsory care again in the future may be too difficult for some,” comments Eva Andreasson.

“Our hope is nevertheless that the Cooperative Plan will reduce the suffering of patients and contribute to increased knowledge about what support they need.”

The study “Patients Treated for Psychosis and their Perceptions of Care in Compulsory Treatment: Basis for an action plan,” was published in the Journal of Psychiatric and Mental Health Nursing.

Link to the article: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2850.2011.01748.x/pdf

FROM THE STUDY: Patients speak about their experience with compulsory institutional care:

“I think as I’ve said that they could speak to me a little more often. If you’re in your own psychotic thoughts, it can be good to get a little distracted. It could be about weather, sports, or whatever.”

“I had somehow thought that there was a gas chamber in the basement of the psychiatric clinic, that they gassed patients there(…). Then he told me that he had showered there, that there were staff showers there. I thought it was nice that he [told me] that. Some of the caregivers do not want to talk about delusions; they like to sweep them under the carpet.”

“I want company all of the time when I come in, because right then I’m awfully afraid.”

For further information, please contact:
Eva Andreasson, researcher at the Sahlgrenska Academy, University of Gothenburg, and Advanced Nurse in Psychiatric and Mental Health Care, with the NåUt Team, Sahlgrenska University Hospital
Telephone: +46 (0)31- 7433758
Mobile: +46 (0)707-855104
e-mail: eva.andreasson@vgregion.se

Presskontakt Krister Svahn
Sahlgrenska akademin vid Göteborgs universitet
0766-18 38 69
031-786 3869
krister.svahn@sahlgrenska.gu.se

Sahlgrenska akademin är Göteborgs universitets största fakultet, med undervisning och forskning inom farmaci, medicin, odontologi och vårdvetenskap. Här bedrivs alltifrån grundläggande studier av molekylers struktur, via patientnära forskning i samarbete med Västra Götalandsregionen, till studier på befolkningsnivå. Allt för att förebygga, lindra och behandla sjukdom och ohälsa.

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