Goulet Marie-Hélène, Sergerie-Richard Sophie, Dostie Mathieu, Drouin Jean-Simon, Vigneault Luc, Genest Christine
Faculty of Nursing, Université de Montréal, 2375 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1A8, Canada.
Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, 7401 Rue Hochelaga, Montréal, QC H1N 3M5, Canada.
Healthcare (Basel). 2024 Dec 16;12(24):2532. doi: 10.3390/healthcare12242532.
BACKGROUND/OBJECTIVES: Coercion in mental health is challenged, prompting reduction interventions. Among those, the Joint Crisis Plan (JCP), which aims to document individuals' treatment preferences in case of future de-compensation, regardless of the potential loss of discernment, has been identified as a key path to study. Identified challenges related to its implementation highlight the need to adapt this intervention to the local context. Considering that in Quebec (Canada), the JCP is not widely used, but the scientific literature supports its adoption and corroborates its potential impact on reducing coercion, this study evaluates the feasibility, acceptability, and preliminary outcomes of the JCP among psychiatric and forensic inpatient settings.
A pilot mixed-methods study was conducted through 16 individual interviews with inpatients and healthcare providers, combined with a pre-post analysis of seclusion and restraint use and the violence prevention climate (VPC) based on healthcare providers' (n = 57) and inpatients' perspectives (n = 53).
Although the challenging implementation of the JCP complicated the evaluation of its effects on seclusion and restraint use, a moderate change ( = 0.40) in the VPC was identified based on healthcare providers' perspectives. Qualitative findings are also insightful to understand the acceptability and feasibility of the JCP use. A tension emerged between the perspectives of inpatients and healthcare providers: while inpatients valued the reflective process of completing the plan, providers focused more on its technical aspects.
The results support the integration of the JCP into patient care pathways, as it provides a tool to amplify patients' voices, promote patient empowerment, facilitate open dialog on alternatives to coercion, and foster more collaborative and humane mental health care.
背景/目标：心理健康领域的强制手段受到挑战，促使人们采取减少强制的干预措施。其中，联合危机计划（JCP）旨在记录个体在未来病情复发时的治疗偏好，无论其是否可能丧失判断力，该计划已被确定为一项关键的研究路径。已发现的与该计划实施相关的挑战凸显了根据当地情况调整这一干预措施的必要性。鉴于在加拿大魁北克省，JCP并未得到广泛应用，但科学文献支持采用该计划，并证实其对减少强制手段具有潜在影响，本研究评估了JCP在精神科和法医住院环境中的可行性、可接受性及初步效果。
开展了一项试点混合方法研究，对16名住院患者和医疗服务提供者进行了个体访谈，并结合了基于医疗服务提供者（n = 57）和住院患者（n = 53）视角的隔离和约束使用情况以及暴力预防氛围（VPC）的前后分析。
尽管JCP实施过程中存在挑战性，使得评估其对隔离和约束使用的影响变得复杂，但基于医疗服务提供者的视角，发现VPC有适度变化（ = 0.40）。定性研究结果对于理解JCP使用的可接受性和可行性也具有启发性。住院患者和医疗服务提供者的观点之间出现了一种紧张关系：住院患者重视完成计划的反思过程，而医疗服务提供者则更关注其技术方面。
研究结果支持将JCP纳入患者护理路径，因为它提供了一种工具，可增强患者声音、促进患者赋权、推动就替代强制手段的方法展开公开对话，并促进更具协作性和人道性的精神卫生保健。
