Cowman Seamus, Björkdahl Anna, Clarke Eric, Gethin Georgina, Maguire Jim
Royal College of Surgeons in Ireland- Bahrain, P.O. Box 15503, Adliya, Bahrain.
Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institute, Stockholm, Sweden.
BMC Health Serv Res. 2017 Jan 19;17(1):59. doi: 10.1186/s12913-017-1988-7.
In mental health services what is commonplace across international frontiers is that to prevent aggressive patients from harming themselves, other patients or staff, coercive measures and foremost, violence management strategies are required. There is no agreement, recommendations or direction from the EU on which measures of coercion should be practiced across EU countries, and there is no overall one best practice approach.
The project was conceived through an expert group, the European Violence in Psychiatry Research Group (EViPRG). The study aimed to incorporate an EU and multidisciplinary response in the determination of violence management practices and related research and education priorities across 17 European countries. From the EVIPRG members, one member from each country agreed to act as the national project coordinator for their country. Given the international spread of respondents, an eDelphi survey approach was selected for the study design and data collection. A survey instrument was developed, agreed and validated through members of EVIPRG.
The results included a total of 2809 respondents from 17 countries with 999 respondents who self-selected for round 2 eDelphi. The majority of respondents worked in acute psychiatry, 54% (n = 1511); outpatient departments, 10.5% (n = 295); and Forensic, 9.3% (n = 262). Other work areas of respondents include Rehabilitation, Primary Care and Emergency. It is of concern that 19.5% of respondents had not received training on violence management. The most commonly used interventions in the management of violent patients were physical restraint, seclusion and medications. The top priorities for education and research included: preventing violence; the influence of environment and staff on levels of violence; best practice in managing violence; risk assessment and the aetiology and triggers for violence and aggression.
In many European countries there is an alarming lack of clarity on matters of procedure and policy pertaining to violence management in mental health services. Violence management practices in Europe appear to be fragmented with no identified ideological position or collaborative education and research. In Europe, language differences are a reality and may have contributed to insular thinking, however, it must not be seen as a barrier to sharing best practice.
在精神卫生服务领域，跨越国际边界的普遍情况是，为防止有攻击行为的患者伤害自己、其他患者或工作人员，需要采取强制手段，首先是暴力管理策略。欧盟对于在欧盟各国应实施哪些强制手段没有达成一致意见、提出建议或给出指导方向，也没有一种总体上最佳的实践方法。
该项目由一个专家小组，即欧洲精神病学暴力研究小组（EViPRG）构思而成。该研究旨在纳入欧盟及多学科的应对措施，以确定17个欧洲国家的暴力管理实践以及相关的研究和教育重点。EViPRG的成员中，每个国家有一名成员同意担任本国的国家项目协调员。鉴于受访者分布在国际范围内，研究设计和数据收集选择了电子德尔菲调查方法。通过EViPRG的成员开发、商定并验证了一份调查问卷。
共有来自17个国家的2809名受访者参与，其中999名受访者自行选择参与第二轮电子德尔菲调查。大多数受访者在急性精神病科工作，占54%（n = 1511）；门诊部，占10.5%（n = 295）；法医部门，占9.3%（n = 262）。受访者的其他工作领域包括康复、初级保健和急诊。令人担忧的是，19.5%的受访者未接受过暴力管理方面的培训。管理暴力患者时最常用的干预措施是身体约束、隔离和药物治疗。教育和研究的首要重点包括：预防暴力；环境和工作人员对暴力程度的影响；暴力管理的最佳实践；风险评估以及暴力和攻击行为的病因及触发因素。
在许多欧洲国家，精神卫生服务中与暴力管理相关的程序和政策问题令人震惊地缺乏明确性。欧洲的暴力管理实践似乎分散无序，没有确定的意识形态立场或协作性的教育与研究。在欧洲，语言差异是现实存在的，可能导致了狭隘的思维方式，然而，绝不能将其视为分享最佳实践的障碍。
