NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK.
NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
BMC Psychiatry. 2024 Jun 27;24(1):476. doi: 10.1186/s12888-024-05914-w.
Compulsory admissions occur in psychiatric hospitals around the world. They result in coercive and sometimes traumatic experiences for service users and carers. Legal and service reforms in various countries are intended to reduce rates of detention and improve service user experience. We aimed to inform policy and service delivery by providing an up-to-date synthesis of qualitative evidence on service users' and carers' experiences of assessment and detention under mental health legislation, updating previous reviews in which we searched for literature published up to 2018.
We searched five bibliographic databases for studies published between January 2018 and March 2023. We identified 24 additional studies reporting qualitative investigations of service users' or carers' experiences of assessment or detention under mental health legislation. A team including researchers with relevant personal experience analysed and synthesised data using a thematic synthesis approach.
Findings suggest that views on compulsory admissions and assessment varied: many reports highlighted its often negative, traumatic impacts on emotional well-being and self-worth, with fewer accounts of it as an opportunity to access help and support, accompanied by feelings of relief. Experiences of racial discrimination, inequality of access, and dissatisfaction with support before and after hospital stay were more prominent than in our previous reviews.
Increasing service user and carer involvement in treatment decisions, provision of timely information at key stages of the admission process, training of key personnel, addressing the issue of discrimination, and investing in community alternatives of inpatient care may contribute to and lead to better overall treatment experiences.
The study protocol has been registered in the PROSPERO database on 30th May 2023 (CRD42023423439).
在世界各地的精神病院中，都会发生强制入院的情况。这会给患者及其照顾者带来强制性的、有时甚至是创伤性的体验。各国的法律和服务改革旨在降低拘留率并改善患者的体验。我们旨在通过提供最新的定性证据综合分析，为政策和服务提供信息，这些证据涉及在精神卫生立法下，患者及其照顾者在评估和拘留方面的体验，对我们之前的综述进行了更新，之前的综述中我们仅检索了截至 2018 年的文献。
我们在五个文献数据库中检索了 2018 年 1 月至 2023 年 3 月期间发表的研究。我们还确定了另外 24 项研究报告，这些研究报告从定性角度调查了精神卫生立法下患者或照顾者的评估或拘留体验。一个包括具有相关个人经验的研究人员的团队使用主题综合分析方法对数据进行了分析和综合。
研究结果表明，人们对强制入院和评估的看法存在差异：许多报告强调了其对情绪健康和自我价值的负面影响，经常是创伤性的，很少有报告将其视为获得帮助和支持的机会，并伴有解脱感。种族歧视、获得服务机会不平等以及对住院前后支持的不满比我们之前的综述中更为突出。
增加患者及其照顾者在治疗决策中的参与度，在入院过程的关键阶段提供及时的信息，培训关键人员，解决歧视问题，并投资于住院替代的社区服务，可能有助于并导致整体治疗体验的改善。
该研究方案于 2023 年 5 月 30 日在 PROSPERO 数据库中进行了注册（CRD42023423439）。
