Berge Torkil, Bjøntegård Kjersti Sunniva, Ekern Petter, Furan Martin, Landrø Nils Inge, Larsen Grete J Sølvberg, Osnes Kåre, Selvaag Inger, Vedlog Anne Helene
Tidsskr Nor Laegeforen. 2018 Aug 21;138(12). doi: 10.4045/tidsskr.17.0338.
The use of coercive mental healthcare contravenes the principle of voluntary examination and treatment. However, it should be possible for persons at acute risk to receive imperative health assistance.
After evaluating 37 emergency interviews in psychiatric outpatient clinics where the use of coercive mental health care was considered, interviews were conducted with emergency assistance staff.
The study includes interviews that resulted in involuntary hospitalisation (n = 15), coerced observation (n = 2), voluntary hospitalisation (n = 14) and follow-up by the outpatient clinic (n = 6). Important factors in assessing the use of coercion were the severity of psychotic symptoms, suicide risk and risk for others, and difficult social circumstances. Three-quarters of emergency assistance staff were in some degree of doubt, and 16 out of 37 experienced uneasiness during the assessment. With a view to enhancing the patient's perception of having been met with respect, the emergency assistance staff emphasised the need for the patient's opinion to be heard. Where the emergency assistance staff were in doubt, a number of professional and ethical issues were highlighted in the process of reaching a decision.
Latitude should be given for ethical and professional reflection in relation to assessing the use of coercion in daily clinical practice, as well as training in measures to reinforce patients' experience of participation during the interview.
强制精神卫生保健的使用违背了自愿检查和治疗的原则。然而，处于急性风险中的人应该有可能获得必要的医疗救助。
在评估了37例在精神科门诊进行的紧急访谈后（这些访谈涉及强制精神卫生保健的使用情况），对紧急救助人员进行了访谈。
该研究包括导致非自愿住院治疗的访谈（n = 15）、强制观察的访谈（n = 2）、自愿住院治疗的访谈（n = 14）以及门诊随访的访谈（n = 6）。评估强制手段使用情况的重要因素包括精神病症状的严重程度、自杀风险以及对他人的风险，还有艰难的社会环境。四分之三的紧急救助人员在某种程度上存在疑虑，37人中有16人在评估过程中感到不安。为了增强患者被尊重的感受，紧急救助人员强调需要听取患者的意见。当紧急救助人员存在疑虑时，在做出决定的过程中会凸显出一些专业和伦理问题。
在日常临床实践中评估强制手段的使用时，应给予伦理和专业反思的空间，同时要进行相关培训，以加强患者在访谈过程中的参与体验。
