Wild Kimbali, Sawhney Jappan, Wyder Marianne, Sebar Bernadette, Gill Neeraj
School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia; Division of Mental Health, Metro South Health, Brisbane, Queensland, Australia.
Mental Health and Specialist Services, Gold Coast Health, Gold Coast, Queensland, Australia.
Int J Law Psychiatry. 2025 Jan-Feb;98:102061. doi: 10.1016/j.ijlp.2024.102061. Epub 2024 Dec 9.
Despite legislative reform to promote less restrictive treatment options, the rates of involuntary psychiatric treatment in Queensland, Australia continue to rise. This paper aims to investigate mental health clinicians' perspectives of reasons behind the high and increasing rates of involuntary psychiatric treatment in Queensland.
Qualitative methodology was used to explore clinician perspectives by facilitating two face-to-face focus groups. Purposive sampling was used to select clinicians of multiple disciplines from inpatient and community adult mental health teams. Reflexive thematic analysis was utilised to analyse and interpret data.
The findings suggested a broad consensus that involuntary treatment is over-utilised in public mental health services. Six main themes were identified, including risk aversion, systemic service deficiencies, lack of voluntary alternatives, increased substance use in the community, legislative and policy shortcomings, and barriers to enacting criteria in the legislation.
This paper highlights that legislative reform alone will be ineffective in reducing involuntary psychiatric treatment, and adequate resources, training, policy and culture change are necessary for successful implementation of less restrictive practices. The reforms require reorientation of the implementation of policy, as well as legislation to align the Queensland mental health system within a human rights framework.
尽管进行了立法改革以推广限制较少的治疗方案，但澳大利亚昆士兰州非自愿精神科治疗的比例仍在持续上升。本文旨在调查昆士兰州非自愿精神科治疗比例居高不下且不断上升的背后，心理健康临床医生的看法。
采用定性研究方法，通过组织两次面对面焦点小组来探讨临床医生的观点。采用目的抽样法从住院部和社区成人心理健康团队中选取多学科的临床医生。运用反思性主题分析法对数据进行分析和解读。
研究结果表明，人们普遍认为非自愿治疗在公共心理健康服务中被过度使用。确定了六个主要主题，包括规避风险、系统性服务缺陷、缺乏自愿替代方案、社区药物使用增加、立法和政策缺陷以及立法中标准实施的障碍。
本文强调，仅靠立法改革在减少非自愿精神科治疗方面将是无效的，充足的资源、培训、政策和文化变革对于成功实施限制较少的做法是必要的。改革需要重新调整政策的实施方向，以及立法，以使昆士兰州的心理健康系统符合人权框架。
