Lickiewicz Jakub, Efkemann Simone Agnes, Husum Tonje Lossius, Lantta Tella, Pingani Luca, Whittington Richard
Department of Psychology, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland.
LWL University Hospital Bochum, Ruhr University Bochum, Bochum, Germany.
Front Psychiatry. 2024 May 29;15:1403094. doi: 10.3389/fpsyt.2024.1403094. eCollection 2024.
Coercion is frequently used in mental health practice. Since it overrides some patients' fundamental human rights, adequate use of coercion requires legal and ethical justifications. Having internationally standardised datasets to benchmark and monitor coercion reduction programs is desirable. However, only a few countries have specific, open, publicly accessible registries for this issue.
This study aims to assemble expert opinions regarding strategies that might be feasible for promoting, developing, and implementing an integrated and differentiated coercion data collection system in Europe at national and international levels. A concept mapping methodology was followed, involving 59 experts from 27 countries in generating, sorting and rating strategies regarding relevance and feasibility. The experts were all researchers and/or practitioner members of an EU-COST-Action focused on coercion reduction Fostering and Strengthening Approaches to Reducing Coercion in European Mental Health Services (FOSTREN).
A hierarchical cluster analysis revealed a conceptual map of 41 strategies organized in seven clusters. These clusters fit into two higher-order domains: "Advancing Global Health Research: Collaboration, Accessibility, and Technological Innovations/Advancing International Research" and "Strategies for Comprehensive Healthcare Data Integration, Standardization, and Collaboration." Regarding the action with the higher priority, relevance was generally rated higher than feasibility. No differences could be found regarding the two domains regarding the relevance rating or feasibility of the respective strategies in those domains. The following strategies were rated as most relevant: "Collection of reliable data", "Implementation of nationwide register, including data on coercive measures", and "Equal understanding of different coercive measures". In analysing the differences in strategies between countries and their health prosperity, the overall rating did not differ substantially between the groups.
The strategy rated as most relevant was the collection of reliable data in the nationwide health register, ensuring that countries share a standard understanding/definition of different coercive measures. Respondents did not consider the feasibility of establishing a shared European database for coercive measures to be high, nor did they envision the unification of mental health legislation in the future. There is some consensus on the most suitable strategies that can be adopted to enable international benchmarking of coercion in mental health settings.
强制手段在精神卫生实践中经常被使用。由于它凌驾于一些患者的基本人权之上，因此合理使用强制手段需要法律和伦理依据。拥有国际标准化数据集来对减少强制手段的项目进行基准测试和监测是很有必要的。然而，只有少数国家有针对这个问题的具体、开放且公众可访问的登记册。
本研究旨在收集有关在欧洲国家和国际层面促进、发展和实施综合且有差异的强制数据收集系统可能可行的策略的专家意见。采用了概念映射方法，邀请了来自27个国家的59位专家就相关性和可行性生成、分类和评估策略。这些专家都是欧盟COST行动“促进和加强欧洲精神卫生服务中减少强制手段的方法”（FOSTREN）的研究人员和/或从业者成员。
层次聚类分析揭示了一个由41项策略组成的概念图，这些策略分为七个类别。这些类别可归入两个更高层次的领域：“推进全球卫生研究：合作、可及性和技术创新/推进国际研究”以及“综合医疗保健数据整合、标准化和合作策略”。关于优先级较高的行动，相关性的总体评分通常高于可行性。在这两个领域中，就各自策略的相关性评分或可行性而言，未发现差异。以下策略被评为最相关：“收集可靠数据”、“实施全国登记册，包括强制措施数据”以及“对不同强制措施的统一理解”。在分析各国及其卫生繁荣程度之间策略的差异时，各群体的总体评分差异不大。
被评为最相关的策略是在全国卫生登记册中收集可靠数据，确保各国对不同强制措施有标准的理解/定义。受访者认为建立一个共享的欧洲强制措施数据库的可行性不高，也没有设想未来精神卫生立法的统一。在可采用的最适合策略上达成了一些共识，以便能够对精神卫生环境中的强制手段进行国际基准测试。
