减少精神卫生保健中的强制手段。
Reducing coercion in mental healthcare.
机构信息
Institute of Health & Wellbeing, University of Glasgow, Scotland.
Dipartimento di Salute Mentale, WHO Collaborating Centre for Research and Training, ASUI Trieste, Italy.
出版信息
Epidemiol Psychiatr Sci. 2019 Dec;28(6):605-612. doi: 10.1017/S2045796019000350. Epub 2019 Jul 9.
AIMS
To examine the extent and nature of coercive practices in mental healthcare and to consider the ethical, human rights challenges facing the current clinical practices in this area. We consider the epidemiology of coercion in mental health and appraise the efficacy of attempts to reduce coercion and make specific recommendations for making mental healthcare less coercive and more consensual.
METHODS
We identified references through searches of MEDLINE, EMBASE, PsycINFO and CINAHL Plus. Search was limited to articles published from January 1980 to May 2018. Searches were carried out using the terms mental health (admission or detain* or detention or coercion) and treatment (forcible or involuntary or seclusion or restraint). Articles published during this period were further identified through searches in the authors' personal files and Google Scholar. Articles resulting from searches and relevant references cited in those articles were reviewed. Articles and reviews of non-psychiatric population, children under 16 years, and those pertaining exclusively to people with dementia were excluded.
RESULTS
Coercion in its various guises is embedded in mental healthcare. There is very little research in this area and the absence of systematic and routinely collected data is a major barrier to research as well as understanding the nature of coercion and attempts to address this problem. Examples of good practice in this area are limited and there is hardly any evidence pertaining to the generalisability or sustainability of individual programmes. Based on the review, we make specific recommendations to reduce coercive care. Our contention is that this will require more than legislative tinkering and will necessitate a fundamental change in the culture of psychiatry. In particular, we must ensure that clinical practice never compromises people's human rights. It is ethically, clinically and legally necessary to address the problem of coercion and make mental healthcare more consensual.
CONCLUSION
All forms of coercive practices are inconsistent with human rights-based mental healthcare. This is global challenge that requires urgent action.
目的
检查精神保健中强制实践的程度和性质，并考虑当前该领域临床实践所面临的伦理和人权挑战。我们考虑了精神卫生中强制的流行病学，并评估了减少强制的尝试的效果，并为减少精神保健的强制性和提高一致性提出了具体建议。
方法
我们通过搜索 MEDLINE、EMBASE、PsycINFO 和 CINAHL Plus 来确定参考文献。搜索仅限于 1980 年 1 月至 2018 年 5 月期间发表的文章。使用以下术语进行搜索：精神健康（入院或拘留或拘留或强制）和治疗（强制或非自愿或隔离或约束）。通过作者个人文件和 Google Scholar 中的搜索进一步确定了在此期间发表的文章。审查了搜索结果以及这些文章中引用的相关参考文献。排除了不属于精神病患者、16 岁以下儿童以及专门针对痴呆症患者的文章和评论。
结果
各种形式的强制都存在于精神保健中。该领域的研究很少，缺乏系统和常规收集的数据是研究以及理解强制的性质和解决此问题的主要障碍。该领域的良好实践示例有限，几乎没有关于个别计划的普遍性或可持续性的证据。根据审查结果，我们提出了减少强制性护理的具体建议。我们认为，这将需要不仅仅是立法上的修补，还需要从根本上改变精神病学的文化。特别是，我们必须确保临床实践不会损害人们的人权。解决强制问题并使精神保健更具一致性在道德、临床和法律上都是必要的。
结论
所有形式的强制实践都不符合基于人权的精神保健。这是一个全球性挑战，需要紧急行动。
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