Find the sessions of your interest in the schedule below
During the congress there are paper presentations, poster presentations, creative contributions and interactive workshops to choose from, spread over six concurrent sessions of 90 minutes and one posters session:
- Paper presentation: Presentation of 30 minutes, including at least 5 minutes for questions/discussion. Three, sometimes two, paper presentations are grouped together in one session.
- Interactive workshop: Workshops are informative interactive sessions in which the focus is on a specific methodology or instrument in which the participants actively work during the workshop. It could also be a session in which the participants are engaged in demonstrations, hands-on activities and/or discussion. A workshop lasts 90 minutes with at least 50% of the time structured around active participant involvement.
- Creative contribution: This type of presentation lasts 30 mins, followed by 15 minutes for discussion. It may include a video presentation, animation, art and design project or an interactive TED-like talk showcasing research-informed creative contributions advancing our understanding of any aspect of violence within the congress themes.
- Poster presentation: Posters will be on display during the congress. The programme will include a one hour session where the presenters are available at their poster for questions and/or discussion.
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Session schedule
Thursday 6 October 2022
11:30 - 13:00 Concurrent sessions 1
Co-production, reduction and rights -Developing a best practice model for restraint training
Interactive workshop21Sarah Leitch, Restraint Reduction Network, United Kingdom; Alexis Quinn, Restraint Reduction Network, Birgmingham, United Kingdom
Hudig ZaalThu 11:30 - 13:00
The Restraint Reduction Network (RRN) training standards (2019) were developed in response to concerns about quality and safety of physical restraint training in the UK. They have a human rights and prevention focus.The standards support co-production through Standard 1.5 which states that people with lived experience of being restrained must be involved in the development and delivery of training. Before staff are taught any restraint techniques they must hear what it is like to be restrained.An independent evaluation by Manchester Metropolitan University (MMU) revealed that most training organisations believed this standard would lead to less restraint. However they felt that this was a challenging standard to meet.As a result of this feedback the RRN is developing a toolkit to help training organisations and people with lived experience work together effectively, equally and safely. The tool will be developed over two workshops and will be available in 2023
20. Staff training and education
Co -production, Restraint reduction, Rights, Training
Prevention of psychotic murders: consider severre bipolar disorders; a role for psychiatry
Paper presentation12C. Ray Lake, University of Kansas Health System, United States
Schadee ZaalThu 11:30 - 13:00
Mental health professionals are at high risk for violence, even murder, by their psychotic clients. Psychotic perpetrators also commit mass murders of unknowns as well as killing their family and friends. These perpetrators differ from non-psychotic murderers, killing innocent strangers in volume, seemingly at random; act alone; attack during daylight; remain, often suiciding on site; are not intoxicated, radicalized, or gang members; give prior warnings of their plans; have prior psychiatric contact; sometimes prior successes, even exceptional; and are motivated by paranoid, grandiose, delusional logic. Non-organic psychoses are caused by severe Bipolar Disorders. Details from the media show that psychotic murderers suffer with severe mania or depression. The current paper presents an epidemiology of such murders and exemplary cases to support this contention that a psychotic Bipolar Disorder is responsible. Prior mental health attention typically produces misdiagnoses of Schizophrenia. Correct diagnosis results in more effective pharmacologic treatment and, potentially, prevention.
1. Epidemiology and nature of violence against staff in mental health
BIPOLAR, FAMILICIDE, MASS MURDERERS, PSYCHOTIC
Association between characteristics of nursing teams and patients’ aggressive behaviour in closed psychiatric wards
Paper presentation24Paul Doedens, Amsterdam University Medical Centers, the Netherlands
Schadee ZaalThu 11:30 - 13:00
AIM To estimate the effect of nursing, shift and patient characteristics on patients’ aggression in clinical mental health care.DESIGN AND METHODS A follow-up study was performed to estimate the effect of nursing characteristics at shift level and patient characteristics on the incidence of aggression.FINDINGS The incidence of aggression was higher in teams with only female nurses. Teams scoring high on extraversion experienced more verbal aggression and teams scoring high on neuroticism experienced more physical aggression. Younger patients and/or involuntarily admitted patients were more frequently aggressive.IMPLICATIONS FOR PRACTICE Our study is, to our knowledge, the first to investigate the influence of Big Five personality traits of nurses and aggressive behaviour of patients. These findings should stimulate support for nursing teams in order to prevent aggression on psychiatric wards. Information of their personality might serve useful for training purposes.
Aggression, Mental Health Care, Nursing, Personality
Staff and ward factors associated with aggression development: an experience sampling method study
Paper presentation54Irene Weltens, Maastricht University, the Netherlands
Schadee ZaalThu 11:30 - 13:00
Through using the Experience Sampling Method for nurses working on a High Intensive Care Unit in a large psychiatric hospital in the Netherlands different factors from the staff and the ward were studied to establish their association with the development of aggression within a naturalistic setting. With this study the following factors were found to contribute to the development of inpatient aggression: less availability of the nurse, more working experience, a more negative interaction between the nurse and the patient (such as in setting a limit or discussion about privileges) and an occupancy rate of the beds above 100%. Protective for aggression is a more positive atmosphere on the ward.In knowing this, it is possible to develop more specific strategies to prevent inpatient aggression and more is learned on the nature of violence against staff in mental health (Theme 1).
Aggression, Development, Experience Sampling Method, Violence
WITHDRAWN - Pilot study on the Management of Aggression Program (MAP) in primary health care
Paper presentation165Gunilla Maria Berg Kristiansen, Helse Bergen, Norway; Øyvind Lockertsen, Oslo University Hospital, Norway
Van Beuningen ZaalThu 11:30 - 13:00
Service user aggression and violence are associated with great costs and can cause injuries, absence, dissatisfaction and high turnover, and hence negatively influence quality of services.The MAP is a comprehensive staff education programme developed to help prevent and manage aggression and violence. The pilot study aims to investigate whether the implementation of MAP municipal version in primary health care can have an impact on registered deviations, sick leave and staffs experienced degree of safety and security.The pilot study takes place in two municipalities in Norway and includes departments within mental health, substance abuse, nursing homes and intellectually disabled. The target group is employees in departments which have a particularly high frequency of challenging behavior.Preliminary findings show that the project organization, management anchoring, and organization of education, impacts the participants perceived usefulness, transfer value, relevance and their experience of safety and security when facing aggression and violence.
Aggression, Prevention, Primary health care, Violence
Evaluation of a training program to manage patients‘ aggression – the modified Thackrey Scale
Paper presentation166Jaroslav Pekara, Medical College in Prague, Czech Republic
Van Beuningen ZaalThu 11:30 - 13:00
The most frequently used evaluating instrument for evaluation training in psychiatry is the Thackrey Scale (1987) that focuses on coping with violent patient in psychiatry. There is no such official evaluation scale for this problem in the Czech Republic. We wanted to examine the internal consistency of 3 questionnaires (Thackery scale self confidence, A global measure of perceived stress and Modified Thackery scale Vevera-Pekara) and to verify the convergent validity of Adapted Thackery scale Vevera- Pekara with the original Thackery scale. We measured internal consistency was assessed with Cronbach’s alpha, Guttman’s lambda and McDonald’s omega and the the correlation of Adapted Thackery scale with Thackery scale. We verified that our modified Thackrey scale (by Vevera & Pekara) is a reliable tool for measuring the effectivity and positive impact of our training program aimed at coping with aggressive and violent patient when we exclude the questions about frequent of violent incidents.
Evaluation, Psychiatry, Training, Violence
The experiences with the Simulation Education in psychiatry on prevention of violence
Paper presentation172Jaroslav Pekara, Medical College in Prague, Czech Republic
Van Beuningen ZaalThu 11:30 - 13:00
The studies indicate that simulation method with real actors is an effective and appropriate education tool for these purposes. The main aim of the study is to describe the effect of the simulation training of psychiatry staff utilising simulation scenarios with actors and to evaluate the impact of the course on the confidence of psychiatry staff when dealing with violence. The participants (120 psychiatric nurses) answered the questionnaire (Confidence in coping with patient-initiated aggression was measured with the scale developed by Thackrey) at the beginning of the course, immediately after the course (paper questionnaire). The participants achieved the most significant progress in the areas of physical intervention during the contact with a violent patient and in their perceived self-confidence when facing a violent patient.
Education, Evaluation, Psychiatry, Simulation
I Feel Your Pain: violence prevention through shared body-state facilitated by the insula
Interactive workshop35Kellie Rhodes, Limbic Legacy, United States; Aisland Rhodes, Limbic Legacy, United States
Van Weelde ZaalThu 11:30 - 13:00
The aim of the research was to assess the applicability and efficacy of a practice that aligns the instruments and methods used within the mental health community to prevent and treat violence, with those employed by the human body to initiate and inhibit violence. Presenters assayed the applicability and efficacy of this practice through a feasibility study with mental health staff (n=750), and a pilot study with males in residential treatment with primary diagnoses associated with violence (n=10). Pilot data were subjected to Chi-square and ANOVA testing revealing statistically significant impact on violence-related outcome measures with 99% certainty. Capitalizing on homoeostatic processes honed over millennia invites the potential to join with biology to prevent violence at its origin and transform treatment. We are on the cusp of a revolution as interdisciplinary research and practitioner experience collide into a vanguard response to the age-old challenge of violence prevention and treatment.
care and treatment
Dopamine, Homeostasis, Insula, Limbic
Developing a designed safety intervention for acute mental health wards: An evaluation
Paper presentation224John Baker, University of Leeds, United Kingdom
Van Weelde ZaalThu 11:30 - 13:00
The safety of patients and staff on acute mental health wards is a significant issue. Safety incidents (self harm, violence, coercion) occur frequently. These cause harm and trauma to patients and staff. We think we can predict when incidents are more likely to occur through real time monitoring of the ward milieu. Intervening early may prevent incidents and social contagion. We have co-designed a monitoring tool which asks patients on mental health wards to input their perceptions of safety into a tablet. This provide real time data on the ward to both patients and staff. The technology interface has been co-designed with people who have lived experience by our design (Thrive by Design) and industry (Ayup) partners and is in open source code. The study used focused ethnography to explore how the technology was implemented on the wards, and routine data to examine its effect on safety.
3. Violence prevention, care and treatment
Milieu, Patient safety
The role of forensic vigilance in maintaining safety in forensic psychiatric institutions
Paper presentation225Maartje Clercx, Forensic Psychiatric Center de Rooyse Wissel, Netherlands
Van Weelde ZaalThu 11:30 - 13:00
Forensic vigilance indicates a central competency that forensic professionals need to work in the highly specialized and complex field of forensic psychiatric settings. The term originated in the Netherlands as “forensische scherpte”, but represents an internationally relevant construct (Clercx et al., 2021). Forensic vigilance is often considered pivotal in maintaining safety and preventing incidents in forensic psychiatric settings. However it is unknown precisely how forensic vigilance relates to incident prevention, and whether different types of incidents (e.g. aggression towards others, suicide, absconsions, unprofessional relationships with patients) require different aspects of forensic vigilance.The current study utilized a combination of thematic and interpretative analyses of incident reports on incidents that occurred in 8 high secure forensic psychiatric hospitals. We developed a model of forensic vigilance, and identified key attributes and differences in these between different types of incidents, and refined this model in expert meetings with forensic psychiatric professionals.
Forensic psychiatric professionals, Forensic vigilance, Incidents in forensic psychiatric institutions
14:00 - 15:30 Concurrent sessions 2
Implementation and use of Clinical Joint Crisis Plans in acute psychiatry; a nurse-led seven-step method
Interactive workshop80Robert Eijpe, Altrecht, the Netherlands; Marlies van der Pas, Altrecht, the Netherlands; Suzanne Verschueren, HU University of Applied Sciences Utrecht, the Netherlands
Hudig ZaalThu 14:00 - 15:30
A Clinical Joint Crisis Plan (CJCP) aims to empower patients and strengthen the therapeutic relationships while preventing degeneration of a psychiatric crisis and reducing coercive measures. It contains personal and patient tailored interventions that are linked to personal characteristics of the various phases of a psychiatric crisis. The use of CJCPs is strongly recommended or mandatory by coercion guidelines in western countries. However, it is a challenge to consistently implement and design a CJCP in acute inpatient psychiatric wards.We developed a seven-step-method (KSP7s – “Naar een Klinisch Signaleringsplan in 7 stappen”) that guides the multidisciplinary team in designing a CJCP for patients admitted in acute psychiatric wards. We will present the KSP7s method that transforms a standardized CJCP into a personalized CJCP by using the input of peer workers, family members, in- and outpatient practitioners and the patient.
Acute inpatient psychiatry, Clinical Joint Crisis Plan, Nurse led interventions, Reduction coercive measures
What can we learn from registries of violent incidents and coercive measures in clinical psychiatry?
Paper presentation98Tilman Steinert, Zentrum für Psychiatrie Südwürttemberg, Germany
Jurriaanse ZaalThu 14:00 - 15:30
Background: Registries for coercive measures, and, to a smaller extent, for violent incidents, have been established in several European countries and in the US. In the German State of Baden-Wuerttemberg, such a registry based on Mental Health Law is available since 2015.
Objectives: To answer relevant research questions from these large-scale observational data.
coercion, epidemiology, SOAS-R
A Study of Aggression and Violence as Experienced by Doctors in Psychiatry in Ireland
Paper presentation186Israa Elkashif, HSE, Ireland; Kevin Mc Kenna, Ireland
Jurriaanse ZaalThu 14:00 - 15:30
Background: A compelling body of evidence consistently identifies aggression and violence as a complex hazard within the health sector. Despite universal recognition, the problem remains understudied, particularly in relation to psychiatrists.
Psychiatrist, Qualitative, Violence
Domestic violence against children and adolescents in the Covid-19 pandemic in Brazil: a qualitative approach
Paper presentation143Diene Carlos, Federal University of São Carlos - UFSCar, Brazil
Schadee ZaalThu 14:00 - 15:30
The aim of this study is to understand the perceptions of schools´ professionals and families from a high social vulnerability area in Brazil about violence against children and adolescents in the COVID-19 pandemic. Qualitative study, conducted in a Brazilian high social vulnerability area with 17 participants between September, 2020 and April, 2021. Data collection took place through semi-structured interviews and the data were thematically analyzed. Two final themes emerged: “Violence and Covid-19 times: a new enemy” and “(Non)accessibility”. Due to the specificities that occur more frequently in families, the life changes imposed by the pandemiccan lead to an increase in the number of cases and a greater difficulty identifying violence against this population and accessing services to protect them. The families and communities should be empowered and mental health practices for them must be improved to support the care of the child and youth population.
coercion, confined environments, deprivation of treatment, domestic violence, suicide and self-harm)
Adolescents, Children, Domestic violence, School health
Stigma and violence against healthcare workers during the COVID-19 pandemic and their mental health
Paper presentation167Jaroslav Pekara, Medical College in Prague, Czech Republic
Schadee ZaalThu 14:00 - 15:30
We describe the relationship between exposure to stigmatization, and violence against healthcare workers during the COVID-19 pandemic in the Czech Republic and their mental health. Our respondents (in summer 2020 was n=929; in the spring 2021 was n=1206) experienced stigma/discrimination and violence due to being healthcare worker in the pandemic. Experiences of violence were slightly higher at a later wave (wave 1: 4.5%; wave 2: 5.1%). In both waves, exposure to stigma/discrimination was reliably associated with substantially increased risk of at least moderate level of psychological distress (wave 1 OR: 2.72 & wave 2 OR: 1.71), moderate depressive symptomatology (wave 1 OR: 3.44 & wave 2 OR: 2.38), and suicidal ideation (wave 1 OR: 3.55 & wave 2 OR: 2.02). The strongest observed association was between exposure to violence and suicidal ideation in the second wave, suggesting 3.5 times increased risk (OR= 3.63; 95%CI: 1.83 to 7.22).
coercion, confined environments, deprivation of treatment, domestic violence, suicide and self-harm)
association, COVID-19, stigma
Coercion in inpatient psychiatric treatment during the Covid-19 pandemic in the Rhineland region, Germany
Paper presentation184Euphrosyne Gouzoulis-Mayfrank, LVR institute of research and education (IFuB), Germany
Schadee ZaalThu 14:00 - 15:30
We performed a retrospective analysis of the use of coersive measures in a large psychiatric hospital association in Northrhine-Westphalia (NRW), Germany, before and during the Covid-19 pandemic. We found an overall decrease in case numbers, but increases of cases with involuntary hospitalisation according to the Mental Health by 5% and cases with seclusion by 20%. Rates (relative numbers) increased from 12% for restraint and 22% for involuntary hospitalisation to almost 40% for seclusion. These trends may reflect poorer mental health of the general population and/or deficits in outpatient mental health care during the Covid-19 pandemic. However, they may also reflect changes in inpatient mental health care including the impact of the need to inforce hygiene measures in acute psychiatric wards. Understanding the reasons for these trends may help us organize inpatient mental healthcare services in such a way that the quality of care returns to the pre-pandemic level.
coercion, confined environments, deprivation of treatment, domestic violence, suicide and self-harm)
coercion, Covid-10 pandemic
Consultations for refractory cases in mental health services: a descriptive study
Paper presentation2Barbara Stringer, Centre for Consultation and Expertise, the Netherlands
Van Beuningen ZaalThu 14:00 - 15:30
The Dutch Centre for Consultation and Expertise (CCE) is available to support refractory cases in Mental Healthcare Services.This descriptive mixed methods study gains insight into the commonalities underlying the reasons of 472 consultations and the solutions proposed that play roles in (the reduction of) refractory cases for which consultation has been requested.83% cases in the sample could be explained with four exemplary situations involving self-harm (24.2%), aggression (21.8%), self-neglect (24.4%), and socially unacceptable behavior (12.5%), respectively.The main conclusion is that refractory situations involve interaction patterns that inadvertently perpetuate or even exacerbate them.Professionals’ adoption of an interpersonal behavioral style with attention to daily routines and meaningful activities was an essential part of all possible solutions to the refractory situations in this study. This behavioral style can be challenging for professionals because they are sometimes counterintuitive. The presented solutions to refractory situations imply profound relevance for clinical practice.
care and treatment
challenging behavior, consultation, disharmonic developmental profiles, refractory cases
Validation of the dynamic appraisal of situational aggression (dasa) instrument in estonian psychiatric inpatient care
Paper presentation47Margit Lenk-Adusoo, Tartu Health Care College, Estonia
Van Beuningen ZaalThu 14:00 - 15:30
Rather than continue a debate largely based on professional or personal opinion, this presentation aims to introduce an evidence-based taxonomy of risk which has been developed to enhance an organisation's ablilty to make decisions regarding which restrictive interventions (restraint) are suitable for use within their settings so that effective governance can be enacted so that front line staff authorised and approved to use restraint fully understand the risks and are aware of any mitigating factors that need to be used to maximise patient safety.
care and treatment
Aggression, Inpatient, Management, Risk assessment
The development and status of the Norwegian staff-training program “Management of Aggression Program” (MAP)
Paper presentation107Thomas Nag, Haukeland University Hospital, Norway; Lone Viste, Haukeland University Hospital, Norway
Van Beuningen ZaalThu 14:00 - 15:30
Background: In the time period from 2015-2019, a national collaborative effort took place between all the health regions in Norway. The project resulted in the staff-training program “MAP”.Aims: The projects intention was to achieve a national standard for teaching violence prevention to mental health staff. Prior to this work, all the different health regions had their own unique training programs, and there was a high degree of unnecessary variation.Methods: Evidence was systematically gathered from both theory, clinical expertise and from the patient perspective, and integrated to make sure the program had a solid knowledge-based foundation.Results: The program was officially launched in 2019, and since then all the different health regions has implemented «MAP» in their mental health sector.Conclusions: The projects aim of achieving a Norwegian national standard of violence prevention in the mental health sector has been successful.
care and treatment
Developing a national standard, Implementation of staff-training programs, Staff-training program, Violence prevention
Ethnicity and the use of restrictive practices in mental health inpatient settings: a scoping review
Paper presentation57Martin Locht Pedersen, Forensic Mental Health Research Unit Middelfart, University of Southern Denmark, Denmark
Van Cappellen ZaalThu 14:00 - 15:30
Aim: To identify and summarise existing knowledge about patient ethnicity and use of restrictive practices in adult mental health inpatient settings. Methodology: A scoping review was conducted using the methodological framework recommended by Arksey and O’Malley (2005), Levac and colleagues (2010) and the JBI (2020). Findings (selected): Altogether 38 studies, mostly European, were included. Ethnicity was mostly divided by migrant/national status in primary studies but not comparable across reviews. Categorising the reported restrictive practices, seclusion was widely reported across studies, followed by multiple concurrent restrictive practices. Significance for practice: Mental health practice needs to focus on patient ethnicity as evidence suggests that some ethnic minorities were more likely to experience restrictive practice than others. Relevance for theme: This review summarises knowledge about ethnicity and use of restrictive practices.
culture and ethnicity), race
Coercive measures, Ethnic disparities, Hospitalised patients, Psychiatry
A taxonomy of risk for restrictive physical interventions
Paper presentation270Chris Stirling, Crisis Prevention Institute, United Kingdom
Van Cappellen ZaalThu 14:00 - 15:30
Notwithstanding the potential for restrictive practices to be misused and abused, there is a specific concern related to manual restraint and the potential for adverse physiological and psychological impacts including pain, injury, and, in some rare cases, fatal consequences.
prevention and protective factors
Manual restraint, risk taxonomy
Challenging the perspective that wrist flexion techniques are not pain-inducing
Paper presentation271Chris Stirling, Crisis Prevention Institute, United Kingdom
Van Cappellen ZaalThu 14:00 - 15:30
An Investigation into the Range of Movement and Forces Involved by the Application of Wrist Flexion Restraint Techniques - P
prevention and protective factors
Pain inducing techniques, risk mitigation
Hearing the Silences: Putting lived experience at the heart of mental health research
Interactive workshop28Kim Heyes, Manchester Metropolitan University, United Kingdom; Abiola Brodrick, Manchester Metropolitan University, United Kingdom
Van Weelde ZaalThu 14:00 - 15:30
This interactive workshop discusses the co-produced findings of a systematic review for the NIHR funded project ImprovE-ACT. The focus of the review was to find out about the lived experiences of Black males who have been detained under Mental Health legislation. Through our partnership with experts by experience, we have identified some of the ‘silences’ that do not currently feature in the academic literature. During the workshop, we will: introduce you (by video) to some of our Experts by Experience, encourage you to think about the silences we have identified, and support you to identify issues within mental health detention that need to change.
culture and ethnicity), race
Black experiences, Black male mental health, Inequality, Mental Health Detention
Friday 7 October 2022
11:00 - 12:00 Poster session
Implementing the German Clinical Practice Guidelines - Preliminary Results of a nationwide RCT
Poster presentation10Sophie Hirsch, ZfP Suedwuerttemberg / Ulm University, Germany
Jurriaanse FoyerFri 11:00 - 12:00
The PreVCo study (Prevention of Violence and Coercion) is a nationwide RCT on the implementation of German Clinical Practice Guidelines “Prevention of Coercion – Prevention and Treatment of Violent Behavior in Adults”. 12 implementation recommendations were derived from the guidelines. These were presented with the help of external consultants in multidisciplinary workshops on 55 wards throughout Germany. Implementation then took place in a randomized matched-pair design with an intervention and a waiting list group over a total of 2 years. The main outcome is coercive measures per month and bed. Secondary outcome will be cumulative duration of seclusion and restraint per bed and year as well as the change before and after the intervention in the waiting list group. Aggressive incidents are also reported. Degree of implementation of the single recommendations is assessed by Likert Scales.
care and treatment
Clinical Practice Guidelines, Complex Intervention Programmes, RCT
Ranking Psychiatric Formal Coercive Measures – Patients’ and Staffs’ Perspectives of the Least Restrictive Alternative
Poster presentation25Camilla Lindekilde, Department of Clinical Sciences, University of Southern Denmark, SDU, Denmark
Jurriaanse FoyerFri 11:00 - 12:00
Aim: To investigate which formal coercive measures, (described by law), mental health patients and staff experience as least restrictive and how patients and staff rank various types of coercive measures.Methodology: The project consists of three sub studies: 1) a systematic review; 2) translation and validation of the CES questionnaire followed by a questionnaire study using the CES; and, 3) an interview study with staff.Findings (preliminary): Preliminary findings from the systematic review will presumably be available for presentation at the conference.Significance for practise: Knowledge of patients’ experiences with different coercive measures - and which of these are least restrictive - is fundamental to practicing the essence of the least restrictive alternative principle. It may also be crucial in formulating future legislation.Relevance for theme:The least restrictive alternative is a principle of health legislation. Psychiatric coercive measure use is an important human rights concern.
human rights and legal perspectives
Coercive measures, Least restrictive alternative, Patients' perspective
Application of the Good Lives Model to street gang membership: New framework for violence intervention
Poster presentation30Jaimee Mallion, London South Bank University, United Kingdom
Jurriaanse FoyerFri 11:00 - 12:00
With high levels of violence and mental distress, street gangs have been classified as a global public health problem requiring immediate attention. However, current interventions suffer from poor theoretical foundations and risk focus. As such, the applicability of an innovative and strengths-based approach to gang intervention (termed Good Lives Model [GLM]) was explored. The GLM assumes offending results when limited prosocial alternatives prevent attainment of 11 universal human needs (e.g., inner peace and community). This study examined the GLM’s etiological assumptions through interviews with 17 gang members; exploring how gangs provide a space to enable attainment of universal needs and factors preventing these being achieved through prosocial means. Findings supported the GLM’s etiological assumptions: participants aimed to achieve all universal needs, with gang membership occurring when prosocial methods were unavailable (e.g., lack of employment opportunities, poor emotion regulation). This supports implementing GLM-consistent interventions to prevent, care, and treat gang-related violence.
care and treatment
Gangs, Good Lives Model, Intervention, Violence
Preventing and reducing restrictive practices on adults with learning disabilities: A realist review
Poster presentation33Alina Haines-Delmont, Manchester Metropolitan University, United Kingdom; Tella Lantta, Manchester Metropolitan University, United Kingdom
Jurriaanse FoyerFri 11:00 - 12:00
This poster will present the methodology and early findings of a realist review of approaches to prevent and reduce the use of restrictive practices on adults with learning disabilities in healthcare organisations. A realist synthesis encompasses a theory-driven interpretation to make sense of complex approaches. The review iteratively progressed through four steps: step 1 – locate existing theories and approaches; step 2 – a systematic search of evidence; step 3 – data extraction and organisation; and step 4 – synthesising the evidence. A project stakeholder group and patient and public involvement were convened to advise throughout. An initial programme theory (IPT) consisting of four subcomponents including interpersonal interactions, service user involvement, carers’ role and invested organisation were outlined that postulated the reduction in restrictive practice use. Fifty-three relevant articles, thus far, have been identified that will be used to refine the IPT. Findings will provide recommendations for practice and policymaking.
Realist review, Reducing restrictive practices
Self-harm on a closed psychiatric ward
Poster presentation38Nienke Kool, Fivoor, the Netherlands
Jurriaanse FoyerFri 11:00 - 12:00
Aim: In this study, we aim to gain insights in the self-harming behavior and in the relation with other aggressive behavior of patients admitted to a closed ward in a psychiatric hospital.Method: Data were gathered between September 2019 and January 2021. The Self-Harm Scale and Social Dysfunction and Agression Scale were used to gather the data. Descriptive analysis, Chi-square tests and Mann-Whitney test were used for the analysis of the data.Findings: Twenty of 27 patients examined (74%) showed 470 incidents of self-harming behavior. Head banging (40.9%) occurred most, while tension/stress as triggering factor was mentioned most (19.1). No significant difference was found in the degree of aggressive behavior towards others or objects between the group of patients harming themselves and the group that didn't.Conclusion: This study delivers insights in self-harming behavior of patients admitted to closed psychiatric departments that can be used for prevention and treatment.
Aggression, Closed ward, Self-harm
Safe skill station in de-escalation. Sociological and practical training approaches
Poster presentation42Lene Lauge Berring, Region Zealand Psychiatry, Denmark; Lise Bachmann Østergaard, Region Zealand Psychiatry, Slagelse, Denmark
Jurriaanse FoyerFri 11:00 - 12:00
Frequent staff exposure to violence and aggression can be a traumatic experience and may cause several problems in patients and in the workforce. For all parties it can lead to secondary traumatic stress.The aim was to develop and test a skill-station in de-escalation and explore how this can improve the safety in hospitals By means of the Co-operative Inquiry method a skill station was developed and tested at three wards (Psychiatry, Emergency department and Neurology). Focus groups with participants were used to refine the different parts before it was released for general use.Safe skill-station in de-escalation is helpful in regards of gaining knowledge of how to cope with agitated behavior among patients and their relatives.ConclusionThe skill station replaces classroom teaching and apply a way of learning familiar to clinical staff. We anticipate that skill-station in de-escalation will prevent the use of coercive measures and staff injuries.
care and treatment
Deescalation, Liason, Safety, Violence and restraint reduction
Development of interventions catalogue to reduce mechanical restraint in forensic mental health services
Poster presentation52Ellen Boldrup Tingleff, Mental Health Services in the Region of Southern Denmark, Denmark
Jurriaanse FoyerFri 11:00 - 12:00
Aim: To develop and validate a targeted interventions catalogue based on previous research for use in the reduction of mechanical restraint in forensic mental health services (FMHS).
Methodology: The methodology of American pragmatism will be applied as the overall research approach, using the following sub-studies: 1. Develop interventions catalogue draft by qualitative analysis of existing data published in Tingleff et al. 2019a; Tingleff et al. 2019b; Gildberg et al. 2021; 2. Develop interventions catalogue by systematic literature searches of evidence-based interventions to reduce coercive measures; 3. Content validation of the interventions catalogue in interviews with patients, carers and staff.
care and treatment
Interventions, Interviews, Qualitative study
What makes the difference? Reduction of restrictive interventions in an adolescent psychiatric ward.
Poster presentation55Sanne Lemcke, Aarhus University Hospital, Child and Adolescent Psychiatry, Denmark
Jurriaanse FoyerFri 11:00 - 12:00
The aim of the study is to investigate the significance of the different changes made to the environment in an adolescent psychiatric ward for the prevalence of restrictive interventions.
In a retrospective study, information is being collected from documents on interventions targeted reduction of the use of restrictive practices in the ward. In the same period, incidence of restrictive practices was registered in the region's electronic register. A comparison of interventions and the incidence of restrictive practices will be performed using descriptive statistic and time series analysis.Preliminary inspection of data suggests that the interventions have had a significant effect. In connection with COVID-19, some of the interventions were suspended, which appears to have had a negative impact on the incidence of restrictive practice in the ward.
reduction of restrictive interventions
Clinical decision-making in cases of rapid tranquillisation in mental health inpatient settings: an integrative review
Poster presentation56Martin Locht Pedersen, Forensic Mental Health Research Unit Middelfart, University of Southern Denmark, Denmark
Jurriaanse FoyerFri 11:00 - 12:00
Aim: To advance our understanding of nurses’ clinical decision-making concerning use of rapid tranqullisation in adult mental health inpatient settings. Methodology: An integrative review was conducted using the methodological framework described by Whittemore and Knafl (2005). Findings (preliminary): Altogether 151 meaning units were ed from 10 included studies; 11 categories were generated. Of these categories, five were related to the clinical decision-making process; six, to factors influencing and/or associated with nurses’ clinical decision-making. Significance for practice: Nurses play a crucial role in decisions regarding the use of rapid tranquillisation. Therefore, increased understanding of their clinical decision-making can inform interventions aimed at reducing use of rapid tranquillisation. Relevance for theme: This study synthesises knowledge about nurses use of rapid tranquillisation and thus how they use it in their daily nursing care and treatment.
care and treatment
Chemical restraint, Clinical judgment, Nurse, Psychiatry
Ethical issues in co-creating research on coercion in mental health care
Poster presentation68Deborah Aluh, Nova University of Lisbon, Portugal
Jurriaanse FoyerFri 11:00 - 12:00
The co-production of knowledge by diverse stakeholders, including experts, researchers, and service users, is becoming of increasing interest in mental health care. The paper highlights potential ethical dilemmas that arise in research involving service users as co-producers of knowledge. Prior to the research study, issues of tokenism, the dual role of health care researchers as researchers, and inclusivity in recruiting service users as co-researchers may arise as ethical dilemmas. During the research, service user co-researchers who have experienced coercion may be at risk of being retraumatized. There may be difficulties with authorship in academic publications and presentations at conferences. The issue of full payment of service user co-researchers could also be problematic. After the research study has ended, there may be an ethical dilemma on how to end the relationship created because of the research collaboration without causing harm.
human rights and legal perspectives
Co-creating, coercion, Ethics, Service users
Treating women in forensic mental health care: a profession in its own right?
Poster presentation72Vivienne de Vogel, Van der Hoeven Kliniek, the Netherlands
Jurriaanse FoyerFri 11:00 - 12:00
Substantial differences have been found between female and male forensic psychiatric patients, relating to trauma, offense history and mental health needs. However, not many clear policies or gender-responsive treatment programs are currently available for working in gender-mixed forensic mental health settings. In the present project, practical guidelines were developed for treating women in gender-mixed forensic mental health care. The literature into gender-responsive working was studied and experiences of both practitioners and forensic psychiatric patients were collected and analysed by means of an online survey (N = 295) and interviews with 22 professionals and 8 female patients and 3 male patients. Based on these results, the guide Treating women in clinical forensic mental health care was written. This guide was subsequently presented in several expert meetings and its revision was tested for usability in a pilot study.
forensic mental health care, gender, gender-responsive, gender-sensitive
Staff perspectives on an extended Safety-Training-Program at four Forensic Psychiatric Wards in Region Zealand, Denmark
Poster presentation92Demi Erik Pihl Hansen, Region Zealand, Denmark
Jurriaanse FoyerFri 11:00 - 12:00
Background: Forensic Psychiatry in Region Zealand has four medium secured wards, all located in the psychiatric hospital in Slagelse. In order to deliver care and treatment, it is necessary to train staff in a specific way. We have revitalized our previous training and developed an extended Safety Training Program lasting 12 days targeting our patients. The program includes interaction between practice in the clinic and the acquired theory and training obtained during the education. The Staff members will gain knowledge within topics such as psychopathology, psychopathy, ethics - ethics in everyday life and ethical dilemmas, mentalizing as well as legal material, rules, legislation and guidelines and through theory in combination with casework, the students will learn to Risk assess a patient. The Program has a strong ethical foundation where attitudes such as empathy, equality and respect are central concepts in our philosophy of effective violence prevention and management.
De-escalation, Risk assess, Staff safety training, Violence prevention
Preliminary results of cross-validating the MR-CRAS in Danish general psychiatry
Poster presentation122Jonas Harder Kerring, Forensic psychiatric research unit Middelfart (RFM), Psychiatry in the Region of, Denmark
Jurriaanse FoyerFri 11:00 - 12:00
The Mechanical Restraint Confounders Risk Alliance Score (MR-CRAS) assesses readiness to be released from mechanical restraint. MR-CRAS was developed and validated in 2018 in forensic psychiatry in Denmark. However, the scale has not been validated on other clinical samples or in other cultural contexts. The current study aimed to examine the content validity of the MR-CRAS in a general psychiatric setting.An interdisciplinary expert panel (N=8), representing four psychiatric wards in the Region of Southern Denmark, rated the relevance and comprehensiveness of MR-CRAS items and sub-scales for a general psychiatric context.All items were considered relevant (I-CVI≥0.78), with the exception of two items (I-CVI=0.75 and 0.38). The item with the lowest I-CVI value is being refined. All subscales had excellent content validity (S-CVI/Ave≥0.90), apart from one (S-CVI/Ave=0.82).Overall, preliminary results suggested that MR-CRAS is applicable in the assessment of the readiness of general psychiatric patients to be released from MR.
prevention and protective factors
Cross-validation, MR-CRAS
Preventing aggression: Evaluation of prevention and support measures on aggression incidents in high-security forensic psychiatry
Poster presentation156Sophie Verschueren, FPC Antwerpen, Belgium
Jurriaanse FoyerFri 11:00 - 12:00
The current study aimed to recognize the needs of health care staff in avoiding violent incidents and to identify areas of improvement in the current violence prevention policy and the policy regarding a safe transfer of the patient to a seclusion room. Four focus group interviews were conducted with 26 employees of the two high-security forensic psychiatric centers in Flanders, consisting of nursing staff members, department heads, psychologists, psychiatrists, and in-house trainers of aggression prevention techniques resilience. Inductive content analysis was applied to analyze the focus group transcriptions. Health care staff emphasizes the importance of self-confidence in one's own abilities to detect, prevent and act appropriately on violent incidents. Different measures are suggested that could improve self-confidence, which can be subdivided into different prevention levels. Practical interventions were formulated that respond to the existing gaps in violence prevention policy and to the needs of the employees.
care and treatment
forensic psychiatry, policy
Barriers and facilitators for Assertive community treatment (ACT) implementation in Latvia
Poster presentation161Ksenija Baidina, University of Latvia, Latvia
Jurriaanse FoyerFri 11:00 - 12:00
Assertive community treatment (ACT) is an integral part of the mental health care in many countries for providing treatment to individuals with severe mental illness (SMI) to prevent their hospitalization in case of mental illness exacerbation. In Latvia, measures to implement community based psychiatric care have been adopted, however there is no ACT and the problem of continuity of treatment for persons with SMI has not been resolved. The aim of study to determine the current level of preparedness in implementation of ACT in Latvia. The largest outpatient departments in Latvia were evaluated according to the ACT criteria of the Dartmouth assertive community treatment scale. The study revealed insufficient preparedness of mental health centres to implement ACT in Latvia. The need to amend the mental health policy, plans and strategies to ensure the continuity of treatment for persons with SMI and to implement of ACT was identified.
ACT, mental health policy, outpatient department, severe mental illness
The relationship of substance use and abuse issues with students in Inclusive Higher Education program
Poster presentation178Chrisann Schiro-Geist, University of Memphis Institute on Disability, United States
Jurriaanse FoyerFri 11:00 - 12:00
Presenters will provide a poster on the qualitative research done on this topic. The issue is well substantiated in the literature,but no intervention literature or studies exist. the researchers will be creating an intervention program based on the findings
prevention and protective factors
Inclusive, program, substance abuse, substance use
Pilot explore of implementation of music intervention in mood disorder adolescents.
Poster presentation193Hsu Chia-Wei, Toayuan Psychiatric Center, Ministry Health and Welfare, Taiwan
Jurriaanse FoyerFri 11:00 - 12:00
Due to the COVID- 19 pandemic, isolation and distance learning are more likely to cause mood disorder in adolescents. Several literatures found listening music is the most commonly stress management strategy, and it can improve mood status and increase well-being. However, there is a lack of systematic empirical research in adolescents. According to the steps of evidence base research, it forms the basis for clinical implementation. To deliver music intervention to mood disorder adolescents, could in benefits in mood disorder and well-being. Participants can focus more on activities; it shows that music intervention may more suitable for mood disorder adolescents.
adolescent, mood disorder, music intervention
Use of assessment instruments in forensic evaluations of criminal responsibility in Norway
Poster presentation194Pia Jorde Løvgren, Oslo University Hospital, Norway
Jurriaanse FoyerFri 11:00 - 12:00
We aimed to explore the use of instruments in 500 Norwegian reports of forensic evaluations of criminal responsibility from 2009-2018, in cases with serious violent crimes; specifically, whether this use was associated with diagnostic and forensic conclusions.
The first author coded data from all reports. Two co-authors then coded a random sample of 50 reports, for inter-rater reliability. We present descriptive measures and associations between use of instruments and diagnostic and forensic conclusions.
Instruments were used in 50.0% of reports. The Wechler’s Adult Intelligence Scale (WAIS), Historical Clinical Risk-20 (HCR-20), and the Structured Clinical Interview for DSM disorders (SCID I), were used in 15.8, 13.8, and 9.0% of reports, respectively. The use of instruments increased over the years. Instruments were more often used by teams with both psychologists and psychiatrists. The use of instruments was strongly associated with both diagnostic and forensic conclusions.
Assessment instruments, Criminal responsibility, Forensic evaluations, Violent crimes
A Randomized Clinical Trials of Cognitive-Behavioral versus Supportive Psychotherapy for Intermittent Explosive Disorder
Poster presentation213Michael McCloskey, Temple University, United States
Jurriaanse FoyerFri 11:00 - 12:00
Despite its prevalence, chronicity, and clinical impact few clinical trials have evaluated the efficacy of psychotherapy for Intermittent Explosive Disorder (IED). In this randomized clinical trial, participants with IED completed twelve 50-minute individual sessions of either a multi-component cognitive behavioral intervention for IED (n=19) or a time equated supportive psychotherapy (n=25). At baseline, post-treatment and three-month follow-up, all participants received the Overt Aggression Scale–Modified. During these visits, participants also completed self-report measures of relational aggression, anger, cognitive biases, and associated symptoms. Primary study outcomes were aggressive behavior and anger. Though participants in both treatments tended to improve over time, the cognitive behavioral intervention was superior to supportive psychotherapy in decreasing aggressive behavior and relational aggression. These findings support the efficacy of a multi-component cognitive behavioral intervention in treating aggression in IED.
Cognitive behavioral therapy, Intermittent Explosive Disorder, Randomized Controlled Trial, Supportive therapy
A study of associations between lack of information on risk factors and future violence
Poster presentation216Bjørn Magne S. Eriksen, Oslo University Hospital, Norway
Jurriaanse FoyerFri 11:00 - 12:00
We aimed to explore associations between risk items scored Don’t know, indicating lack of information, and subsequent violence when using a 10 item risk screen (Violence risk screening - 10; V-RISK-10) in a sample from three acute psychiatric wards (N = 1435). V-RISK-10 was scored at admission and before discharge. Violence was recorded during hospital stay and three months post - discharge. For most items, a significant proportion of patients were scored Don’t know at admission, and Don’t know scores at admission were significantly associated with inpatient and post-discharge violence. Substantially fewer risk items were scored Don’t know before discharge, and for most items, Don’t know scores were not significantly associated with post-discharge violence. These preliminary findings are relevant for acute psychiatric admissions when information on risk factors may be sparse and indicate that lack of information at time of admission should be taken into consideration in violence risk assessments.
Acute psychiatry, Screening tool, Uncertainty, V-RISK-10
“Unplugged”: Exploring benefits of wireless headphones and music streaming services in acute inpatient psychiatry.
Poster presentation220Shoni Taylor, Resnick Neuropsychiatric Hospital at UCLA, United States
Jurriaanse FoyerFri 11:00 - 12:00
Exposure to relaxing music has shown positive results among a variety of populations including elderly people with dementia, post-traumatic patients and patients diagnosed with schizophrenia or mood disorders. The aim of this study is to decrease anxiety, agitation and other psychiatric symptoms through the use of wireless headphones and music streaming services in an adult inpatient psychiatric unit. Patients used wireless headphones and music streaming services at designated intervals throughout the day. Pre and post use questionnaires were complete by each patient that used the wireless headphones. Anxiety, agitation and self-identified symptom levels were tracked before and after headphone use. Restraint and seclusion data was tracked. Survey results suggest a significant positive association between listening to music and decrease in self-report level of agitation, anxiety/ distress, and level of symptoms (p-value: .000054). Restraint and seclusion rates significantly declined the 3 quarters following implementation (3Q2020, 4Q2020 and 1Q2021).
Together on psychiatry – More extended collaboration in the most complex courses
Poster presentation258Jens Peter Hansen, Mental Health Services in Esbjerg, Denmark
Jurriaanse FoyerFri 11:00 - 12:00
Aim: To improve the citizens' life situation through strengthened cooperation and coherent effortsIn more countries in Europe, community-based care is a substantial part of mental health. In the past decades, more efforts have been initiated in incorporating community-based care to decrease involuntary admissions. Few projects focus on the most complex mental health situations.Methods:The project includes a collaboration between five hospitals and 22 communities. The included sectors meet regarding patients with the most complex situations over one year. The consent was to create a common understanding, goals and solutions based on a holistic understanding of the patient/citizen.Results:The number of involuntary seclusions decreased and the number of admissions decreased significantly in the project period compared to the historic period.Implications:The results support additional efforts in preventing involuntary admissions through better collaboration between sectors. More research is needed on effect and economy in collaboration models.
Common understanding, Community care, Involuntary admissions, Solution based
Efforts to reduce coercion in Mental Health Services of Denmark by organizing and training staff
Poster presentation266Louise Krossing Hansen, Region Hovedstadens Psykiatri, Denmark
Jurriaanse FoyerFri 11:00 - 12:00
The poster illustrates efforts to prevent and reduce coercion by organizing and training of staff. Three different kind of staff instructors, all with a great experience in clinical psychiatry, teach and train new staff in how to prevent and reduce coercion.New staff members participate in a mandatory course, in how to prevent and reduce conflicts and the use of restraint consisting of 5 days split over a period of 6 months, from the beginning of their employment.The staff instructors train the new staff through bedside teaching from day one in the wards and continuously on the mandatory course. The instructors contribute to the content and dialogue on the mandatory course, based on the latest research and knowledge on reducing coercion, best practice and recent identified challenges in the work to reduce coercion.
20. Staff training and education
Staff training
Health professionals` experiences when community treatment order was revoked following capacity-based mental health legislation
Poster presentation282Nina Camilla Wergeland, University Hospital of North Norway and UiT The Arctic Univeristy of Norway, Norway
Jurriaanse FoyerFri 11:00 - 12:00
In 2017 Norway introduced capacity-based legislation in mental health care with the aim of increasing patient autonomy and legal protection, and reducing the use of coercion. The aim of the study was to explore health professionals’ experiences of how capacity-based legislation affects healthcare services for patients whose community treatment order (CTO) was revoked as a result of having capacity to consent. Nine health professionals from specialist and primary healthcare services were individually interviewed in 2019-2020. We used a hermeneutic approach to the interviews and analysis of the transcripts. The participants found that capacity-based legislation raised their awareness of their responsibility for patient autonomy and involvement in treatment and care. The study shows that personnel now focus more on adapting care and treatment to patients` wishes and condition to enable them to maintain their capacity to consent and prevent a new CTO. This requires close collaboration between primary and specialist level.
human rights and legal perspectives
Capacity-based legislation, Community treatment order, Health professionals, Increased autonomy
14:00 - 15:30 Concurrent sessions 3
Coercion registration: 15 years of Dutch experience. Learning how to feed back findings.
Interactive workshop241Eric Noorthoorn, GGNet Centre of Mental Health, Netherlands
Hudig ZaalFri 14:00 - 15:30
Violence and agression occur frequently at admission wards. In the last 20 years a vast body of literature was developped showing the effect of risk assessment, ward environment, personell, law and many other factors determining ward policy contribute to the reduction of coercion. In the workshop we wil present the main prinicples of a tool, which is currently used at all wards throughout the country. The registration tool argus covers all coercive measures in a way the subsitution of one measure by another can be investigated. Date of time of strart and end contribute to a precise cacluation of the time patients are subject to any form of coercion. In the workshop we present the main caculation techniques. We show how to tap into hospital registration systems. We also show how the data of these systems are included in a relational database allowing a standardised calculation of coercion use.
Calculation principles, Mental Health Law, Registration definition
Community of Practice in implementing High and Intensive Care (HIC): Lessons Learned and Perceived Effects
Paper presentation108Laura van Melle, GGZ inGeest; Amsterdam UMC, the Netherlands
Jurriaanse ZaalFri 14:00 - 15:30
In the Netherlands, the High and Intensive Care (HIC) model has been developed as a national approach to improve quality of care of acute psychiatric admission wards and to reduce coercion. To support the implementation of this approach throughout the Netherlands, a Community of Practice (CoP) was created consisting of auditors from participating institutions. Audits served as an important vehicle to activate the CoP, and stimulated the implementation of HIC. The CoPs stimulated quality improvement and reduction of coercive measures. Moreover, audit results show that wards that obtain a higher audit score use less coercion than lower scoring wards. The findings may help others in creating a CoP when it comes to the implementation of best practices and improving healthcare: lessons learned and perceived effects of the CoP will be presented.
care and treatment
community of practice, high and intensive care, implementation science, reduction of coercion
Another psychotic maniac kills – why do they let them out
Paper presentation210Stål Kapstø Bjørkly, Molde University College, Norway
Jurriaanse ZaalFri 14:00 - 15:30
Background. Individuals with psychotic disorders face profound challenges as they attempt to maintain identity through the course of illness. A small proportion of them commits violence. This presentation will address some challenges and discuss the violence stigma attached to persons with psychosis.
Aims. The first aim is to present the main groups of risk factors of violence: Dispositional, Historical, Contextual and Clinical. I will address the three last main risk assessment groups. First, I will focus on one historical and contextual factor, criminality, that often is ignored in risk assessment research. In the second aim I will scrutinize what dynamic aspects of psychosis that are empirically associated with risk of violence.
Methods. This is results from a structured literature review of the empirical research concerning the psychosis – violence link with focus on emotional catalysts in imminent violent hallucinations and delusions. If the review is published when the congress starts, I will present the results in detail.
Results and Conclusion. Focus on criminality appears to be a strong risk factor, even stronger than psychosis alone. Still, persons with psychosis have a higher risk for being victim than perpetrator. Psychosis at the diagnosis level is not enough to predict violence. Specific psychotic symptoms, such as persecutive delusions and violent auditive command hallucinations appear not to be automatically associated with violent acts. However, the strongest catalyst for perpetrating violence appears to be negative emotional distress.
5. Assessment of risk, prevention and protective factors
‘’My past will not dictate my future’’ Short-term trauma treatment for a forensic psychiatric patient
Paper presentation81Annabel Simjouw, De Forensische Zorgspecialisten, the Netherlands
Van Beuningen ZaalFri 14:00 - 15:30
Prevalence of trauma exposure is high within the forensic psychiatric population, making it a relevant factor for the treatment of forensic patients. The present study focuses on the implementation of an intensive short-term trauma treatment within a Dutch forensic psychiatric hospital, using both quantitative and qualitative research methods. Insights from this study show that trauma treatment could be an essential part of forensic mental health care in promoting patients’ resilience and responsivity.
4. Trauma informed practice
forensic mental health care, mental health, trauma, trauma-informed care
Aggressive behaviour of psychiatric patients with Mild and Borderline Intellectual Disabilities
Paper presentation126Jeanet Nieuwenhuis, GGNet Centre of Mental Health, the Netherlands
Van Beuningen ZaalFri 14:00 - 15:30
Purpose Little is known about the associations between Mild Intellectual Disability (MID) and Borderline Intellectual Functioning (BIF) and aggressive behaviour in general Mental Health Care.Aim. To establish the association between aggressive Behaviour and MID/BIF, analysing patient characteristics and diagnoses.Method 1174 out of 1565 consecutive in-and outpatients were screened for MID/BIF with the Screener for Intelligence and Learning Disabilities (SCIL) in general mental health care in The Netherlands. During treatment, aggressive behaviour was assessed with the Staff Observation Aggression Scale-Revised (SOAS-R). Results Forty-one percent of participating patients were screened positive for MID/BIF. Patients with assumed MID/BIF showed significantly more aggression at the patient and sample level (Odds Ratio of 2.50 for aggression and 2.52 for engaging in outwardly directed physical aggression). Conclusions We found an increased risk for aggression and physical aggression in patients with assumed MID/BIF. We recommend screening for intellectual functioning at the start of treatment.
14. Specific populations: intellectually disabled / learning disabilities
Aggression, Analysis, Risk factors
Patient experiences of victimization during mandatory psychiatric treatment
Paper presentation154Nienke Verstegen, Van der Hoeven Kliniek, the Netherlands
Van Beuningen ZaalFri 14:00 - 15:30
Forensic psychiatric inpatients are frequently exposed to aggression from fellow patients during their treatment, but research on how this impacts patients’ well-being and treatment progress is lacking.
In this study, we interviewed nine patients on their experiences of victimisation during mandatory psychiatric treatment. The interviews were analysed using a Grounded Theory approach in consensus between three researchers. Three main themes emerged from the data, namely situational descriptives, intrapersonal and interpersonal consequences. Patients were not only exposed to both physical violence and verbal aggression by other patients, but also to a more ubiquitous flow of micro-aggressive comments. Options to escape these situations were limited, resulting in fear, hypervigilance, avoidance, reactive aggression, flashbacks, and increased power differences between patients and staff. Victimization processes are not always timely noticed in an environment that focuses on risks and treatment of delinquent behavior. Recommendations for the implementation of trauma informed care are provided.
forensic psychiatry, inpatient aggression, justice-involved persons, victimization
How training with actors, can help psychiatric staff in Denmark achieve non-technical skills
Interactive workshop128Stine Horn Gade, Center for Kompetenceudvikling, Denmark
Van Weelde ZaalFri 14:00 - 15:30
In the congress workshop, we will briefly talk about the background for choosing to use actors for achieving de-escalation skills, and report our findings from this work. Hereafter the workshop will consist of video-clips of actors and psychiatric staff from training sessions, exercises where workshop participants try some of the exercises we use in our de-escalation courses, video-filmed testimonials from both course-participants, course-facilitators, actors and peer co-workers. The workshop will end with an open debate, about the benefits of using actors when training non-technical skills.
Actors, De-escalation, Non-technical skills, Training
16:00 - 17:30 Concurrent sessions 4
Preserving a therapeutic environment within inpatient mental health settings during COVID-19. Lessons learned.
Interactive workshop179Kevin McKenna, Dundalk Institute of Technology, Ireland; Lene Berring, Region Zealand Psychiatry, Denmark; Roland van de Sande; Eric Noorthorn
Hudig ZaalFri 16:00 - 17:30
In response to COVID-19, an international group of mental health professionals and service managers collaborated to mitigate the potential conflict anticipated as being inherent in enacting restrictive public health measures.The group utilised a Delphi approach of four iterative stages to develop a strengths based, person-centred and recovery-oriented framework to support services in preserving a therapeutic milieu specifically within inpatient mental health settings during situations of pandemic.The framework incorporated the core principles of ‘therapeutic community’, Safewards, recovery, and trauma informed care with emphasis placed on preserving a safe supportive environment, while promoting the principles of trust, safety, collaboration, choice and empowerment.The lessons learned from this pandemic-imposed initiative have the potential to enrich the quality of the care experience, for both care recipients and providers, within inpatient settings beyond the pandemic.
6. Humane safe and caring approaches to coercive practices
Co-created, Delphi, Milieu, Therapeutic
Enhancing risk assessment and intervention: Linking the DASA risk assessment to an Aggression Prevention Protocol
Paper presentation22Tessa Maguire, Centre for Forensic Behavioural Science/Forensicare, Australia
Jurriaanse ZaalFri 16:00 - 17:30
There are several short term risk assessment instruments used in mental health inpatient settings designed to assess imminent aggression. While the assessment of risk is important, it is equally important that following assessment, efforts are focused on intervening to prevent aggression and use of restrictive interventions. While there has been considerable research investigating the predictive accuracy of these instruments, there has however, been limited focus on intervention following prediction of risk. By assessing the level of risk, this can assist nurses to identify who might be likely to engage in aggression, and prompt coordination of strategies to reduce risk by intervening appropriately. Against this background, this paper will discuss a program of research designed to enhance risk assessment using the Dynamic Appraisal of Situational Aggression (DASA), and a linked Aggression Prevention Protocol designed to reduce aggression and use of restrictive interventions.
prevention and protective factors
nursing intervention, restrictive interventions
FOSTREN: building a European network to help prevent coercion in mental health services
Paper presentation155Richard Whittington, St. Olav's University Hospital, Norway
Jurriaanse ZaalFri 16:00 - 17:30
FOSTREN is a network of mental health service stakeholders funded by the European Cooperation in Science and Technology (COST) framework for the period 2020-2024. The network is focused on bringing together experts with understanding and experience of successful methods for reducing coercion and restrictive practices in mental health services. There are representatives from 32 European countries and the work programme is organised along five interconnected themes within an implementation science paradigm. The network organises and supports a number of international collaborative activities in line with its objectives. These include Training Schools for early-career researchers and innovators, and short-term scientific missions (STSMs) involving international visits between research teams. This presentation will outline the FOSTREN programme and review progress at the midway point.
Restrictive practices
The evolution in managing aggressive episodes in an Italian acute psychiatric ward
Paper presentation183Rosaria Di Lorenzo, AUSL-Modena, Italy
Jurriaanse ZaalFri 16:00 - 17:30
Aims: To evaluate the frequency of mechanical restraints and all the variables which can have significantly influenced its use in an acute psychiatric ward during the last 9 years.Methods: This retrospective analysis was conducted in an Italian Service of Psychiatric Diagnosis and Care.Results: A significant reduction of mechanical restraints was observed after the application of more restrictive guidelines on its use in 2015. Concomitantly, an increase of incident reports was reported in 2015 (n= 68) and 2019 (n=71). Successively, a regular 12-hour work shift of hospital guards was implemented inside the ward and, in 2021, mechanical restraints decreased to zero and incident reports reduced by 87%.Conclusions: Our results suggest that alternative procedures in managing aggressive behaviour can be applied after a cultural change, initially imposed by guideline and successively accepted by staff, who can apply safe no-restraint treatment, only delegating to others the task of controlling violence.
care and treatment
Acute psychiatric ward, Aggressive behaviour, Health guidelines and hospital guards, Mechanical restraint reduction
Informal coercion and psychological pressure in mental health care: a contextual model
Paper presentation64Christin Hempeler, Ruhr-University Bochum, Germany
Van Beuningen ZaalFri 16:00 - 17:30
Although informal coercion is very present in the everyday life of service users, it is neither conceptually clear nor sufficiently represented in research. To gain insight from multiple perspectives, we conducted semi-structured qualitative interviews with 14 people with mental illness who have experienced coercive measures and 11 relatives of people with mental illness. We analyzed the data using grounded theory methodology and performed an empirically informed conceptual analysis.The analysis shows that the various communicative means subsumed under informal coercion cannot be considered in isolation, but that diverse contextual factors must be taken into account. For example, power imbalances and the possibility of the use of formal coercion play a crucial role in the perception of informal coercion. The inclusion of these contextual factors as well as non-verbal and implicit modes of interaction into our concept allows for a more comprehensive understanding and recommendations on how to reduce informal coercion.
9. Service users and family perspectives
informal coercion, psychological pressure, qualitative mental health research, voluntariness
The role of carers in reducing restrictive practices for people with learning disabilities
Paper presentation75Rachel Whyte, Manchester Metropolitan University, United Kingdom
Van Beuningen ZaalFri 16:00 - 17:30
Restrictive practices are often used in response to a breakdown in communication. Despite carers having unique insight into what their loved ones are attempting to express, closed service cultures mean they are often silenced. The aims of this project were to understand why carers’ involvement is important in the care of people with learning disabilities, what it means for them to be involved and how can their involvement lead to the reduction/prevention of restrictive practices. An online focus group was conducted with 25 carers of people with learning disabilities, exploring their direct involvement in reducing restrictive practices on their loved one. Findings showed that the vital role of carers in reducing restrictive practices is underrepresented and undervalued within systems of care. This in turn, raises critical questions around the quality of fully informed provision and support. Significantly, this project highlights that carers’ play a direct role in reducing restrictive practices.
Behaviour that challenges, Carers, Learning Disabilities, Restrictive practices
Parental Sense of Coherence, Dispositional Optimism, and Quality of Life in Children with Intellectual Disability
Paper presentation259Ram Kumar B V, National Institute for the Empowerment of Persons with Intellectual Disabilities, India
Van Beuningen ZaalFri 16:00 - 17:30
Families and caregivers of children with intellectual disabilities have to deal with both the typical struggles that every household faces and those adjustments unique to these children including greater challenges in caregiving, more health problems, and feelings of isolation which results in poor quality of life (QOL). This study examines the relationship between a sense of coherence, dispositional optimism, and quality of life among parents of children with intellectual disability. Study used purposeful sampling with 30 parents who attend general services at NIEPID, Secunderabad, Telangana, India. The results indicated that a positive correlation was found between a sense of coherence and dispositional optimism, and coherence also correlated positively with parents of children with intellectual disabilities' psychological well-being. As a result, it suggested that a sense of coherence has an impact on quality of life and that a high sense of coherence correlates with a higher level of quality of life.
Intellectual Disability, Optimism, Quality of Life, Sense of Coherence
Feasibility of a violence risk screening in adolescent psychiatric inpatient care, a pilot study
Paper presentation174Carina Chudiakow Gustavsen, Oslo University Hospital, Norway
Van Cappellen ZaalFri 16:00 - 17:30
To our knowledge there are no validated instruments for violence risk screening among adolescents. Therefore, a new screening instrument, Violence Risk Screening for Youth (VRISK-Y) was developed for emergency settings to help assess the risk for violence among adolescents aged 12-18 years. The present study aimed to investigate the feasibility of the VRISK-Y in a Norwegian adolescent emergency psychiatric Inpatient Unit. The study had a naturalistic prospective design. For a year all admitted adolescents was scored with V-RISK-Y at admission, and compared with recorded episodes of threats or violence during hospitalization. The healthcare professionals (N= 16 ) filled out an evaluation form regarding the instrument. Fifteen out of sixteen healthcare professionals found the instruments utility either good or very good. They found it difficult to score each items relevancy to the violence risk. The results provides a basis for further testing of a revised version.
Adolescents, Feasibility, Risk assessment, Violence
BoevenBeesten! Stimulating forensic vigilance in outpatient forensic settings through persuasive gaming
Creative contribution209Rosalind van der Lem, Fivoor, Netherlands; Rens Kortmann, TU Delft | Delft University of Technology, Netherlands; Doris Boschma, TU Delft | Delft University of Technology, Netherlands;
Van Cappellen ZaalFri 16:00 - 17:30
Fivoor Ambulant (a large forensic outpatient facility with several locations throughout the Netherlands) offers an extensive educational programme for therapists. Part of the programme contributes to improving the forensic vigilance of Fivoor staff. By forensic vigilance (Clercx et al.,2021) we mean the ability of therapists to recognise risks that patients pose to others (like aggressive behaviour) and respond to these risks appropriately. Most of the forensic vigilance training aims to improve individual knowledge and skills. However, forensic outpatient care is mostly provided by teams of therapists who depend on each other’s expertise and knowledge of the patient. Therefore, forensic vigilance has collective aspects too. To raise awareness in teams about their collective forensic vigilance and motivate them to participate in our forensic vigilance educational programme, we developed the persuasive card game BoevenBeesten. Fivoor Ambulant developed the game in close collaboration with the Gamelab at Delft University of Technology.
forensic outpatient settings, persuasive games
Evaluating restraint positions
Interactive workshop138Torill Storhaug, Helse Fonna HF and Helse Bergen HF, Norway; Lone Viste, Helse Stavanger HF and Helse Bergen, Norway; Marius Krogdal Engen, St.Olavs hospital - avd. Brøset, Norway
Van Weelde ZaalFri 16:00 - 17:30
There is a broad international consensus that where any form of coercion is used, preference should be given to the least restrictive and least dangerous measure. Coercive interventions exist in a dynamic clinical context, where the availability of one intervention may have an impact on the frequency and nature of other interventions. (Sethi et.al, 2018). Since 2014, extensive work has been done to prepare a new norwegian mental health staff training program for prevention and management of aggression and violence in the mental health sector. ). The aim of the project was to standardize and quality assure such training to staff in the mental health sector. The project resulted in the staff-training program “MAP”. (Management of Aggression Program). MAP has been a collaborative project between the SIFER network, the four regional high security forensic units, Helse Stavanger and Helse Fonna.
MAP, physical techniques, Restraint position, standardization
Saturday 8 October 2022
09:00 - 10:30 Concurrent sessions 5
Trauma-informed care vs coercion and violence_x000D_
Interactive workshop223Stijn van Griensven, GGZ inGeest, Netherlands; Laura van Melle, GGZ inGeest, Netherlands
Hudig ZaalSat 09:00 - 10:30
The High and Intensive Care (HIC) model is a Dutch approach for high quality care of acute psychiatric admission wards with minimal use of coercion. Central to working according to HIC principles is the focus on making contact with clients and between colleagues. Making contact can be challenging in times of crisis and failure to do so can result in agression and coercion. We are developing a best practice and training to work with trauma-informed care on HIC wards and in particular during crisis situations. We suggest a change of view to integrate trauma-informed care and de-escalation techniques as a key chance to make a connection with clients in crisis to avoid violence and to minimize coercive measures. This workshop will adress the theory behind the best practice and provide the opportunity to practice. We aim to integrate input from the workshop to refine the practice and training.
Best-practice, Connection, Trauma-informed, User-based
The implementation of mandatory training standards in mental health/ learning disability settings in the UK
Paper presentation89Katie Goodall, Manchester Metropolitan University, United Kingdom; Alina Haines-Delmont, Manchester Metropolitan University, United Kingdom
Jurriaanse ZaalSat 09:00 - 10:30
In 2020, the first national mandatory standards for training in restrictive practices were launched in England. The Restraint Reduction Network (RRN) Training Standards apply to any organisation delivering training on restrictive practices (including restraint) in mental health and learning disability settings. This presentation will outline the findings of a research study funded by the Burdett Trust for Nursing, examining the views and experiences of organisations who implemented the Standards. A sequential mixed method design was used, involving an online survey, in-depth interviews, and consultation workshops. Quantitative data were analysed using descriptive statistics, while qualitative data were analysed in Nvivo using thematic analysis. In this session, we will outline key findings and implications for future training and practice. Mandatory standards are one piece of the puzzle towards reducing restraint – we will reflect on challenges and advantages of such standards and how they could be transferred to other settings or countries.
Reducing restrictive practices, Training standards
The patients’ view on mechanical restraint in Austrian adult psychiatry
Paper presentation90Florian Wostry, University of Vienna - PhD Student / Wiener Gesundheitsverbund, Austria
Jurriaanse ZaalSat 09:00 - 10:30
This study explored with qualitative methodology the experience of mechanical restraint from the patients’ perspective and their suggestions for improvement. In 2020 in Vienna twelve guided individual interviews were conducted with inpatients.Three prototypes were identified, which are characterised by physical and psychological stress as well as the perception of a great benefit. Eight general categories describe a lack of understanding, disregard for basic needs, experiences with medication, unpleasant atmosphere, loss of trust, relief from falling asleep, empathic care and calm, protection, safety and understanding. Patients described important improvements by reflexing and breaking up old structures, the mechanism of control and communicative de-escalation techniques. Calming touch and participatory decision-making were mentioned as alternatives to break restrictive practices.The description of the prototypes allows nurses to better reflect their role and actions during coercive treatment. A new finding of this research is the calming touch experienced by patients during mechanical restraints.
experience, mechanical restraint, patients
An ethnography of coercion: capturing the processual dynamics
Paper presentation125Malene Clemmensen, Roskilde University, Denmark
Jurriaanse ZaalSat 09:00 - 10:30
This paper presentation draws on data from the presenter’s PhD project: “Coercion in psychiatry: a negotiative practice of autonomy?”. The methodology is qualitative ethnographic fieldwork, comprising of participant observation and interviews. The findings suggest that there are conflicts in the meaning making of interpersonal relationships between patients and professionals in the psychiatric practice, which challenges efforts to reduce coercion. This project and paper presentation is relevant for the chosen theme for two reasons. First, participant observation allows for the involvement of the patients’ and professionals’ ongoing reflections about the research, which qualifies the approach. The general interdisciplinarity of the ECVCP-conference will enable further co-creating research and practice within contemporary mental health. Second, the presentation is relevant for theme 6, in that the aim of the PhD-research is a humane and relationship-oriented approach to coercive practices in mental health care.
coercion, ethnographic fieldwork, institutionalized processes, qualitative research
The influence of mental health professionals’ attitudes on decision-making around coercion.
Paper presentation88Simone Agnes Efkemann, LWL University Hospital Bochum, Germany
Mees ZaalSat 09:00 - 10:30
Research on coercion in mental healthcare has recently shifted to the investigation of subjective aspects, both on the side of the people with mental disorders affected and the staff members involved. In this context, the role of personality traits and attitudes of staff members in decision-making around coercion is increasingly being assessed. We developed and validated a German version of the Staff Attitudes towards Coercion Scale and then used it in an experimental case vignette study. Results from both studies showed that attitudes towards coercion – ranging from rejecting to approving the use of coercion – significantly influenced decisions around coercion in individuals cases, resulting in a greater likelihood to approve of the use of coercion. Strategies to reduce coercion in mental healthcare institutions should focus more on the role of staff attitudes and encourage staff members to reflect on them critically.
personality traits, SACS
Seclusion and restraint: an online education platform designed to promote the integration of care standards
Paper presentation235Geneviève Chouinard, CIUSSS-EMTL, Canada; Sophie Sergerie-Richard, CIUSSS-EMTL, Canada; Catherine Hupé, CIUSSS-EMTL, Canada
Mees ZaalSat 09:00 - 10:30
Healthcare professionals feel the pressure of the responsibility to provide the best possible care when using seclusion and restraint as a last resort safty measure in mental health settings. They face various obstacles to continuous learning and improvement, from the theory-practice gap to the shortage of time, staff and facilities (Safazadeh, Irajpour, Alimohammadi & Haghani, 2018; Shadadi, Sheyback, Balouchi & Shoorvazi, 2018). The complexification of learning environments around the globe forces nursing leaders to think of new strategies to maintain and improve the quality of care. This presentation describes an online care assessment platform developed to give nurses the opportunity to declare and reduce seclusion and restraint while learning how to apply standards of care to real life clinical situations. This innovation in healthcare education effectively promotes seclusion and restraint reduction in addition to enhance the learning experience of the nursing staff.
Education, Innovation, Restraint, Seclusion
Practical application of machine learning in forensic psychiatric research and its clinical implications
Paper presentation102Johannes Kirchebner, University Hospital of Psychiatry Zurich, Switzerland; Lena Antonia Hofmann, University Hospital of Psychiatry Zurich, Switzerland; Steffen Lau, University Hospital of Psychiatry Zurich, Switzerland; Andrea Aemmer, University Hospital of Psychiatry Zurich, Switzerland
Schadee ZaalSat 09:00 - 10:30
Research: The work of the research group was based on a comprehensive analysis of offender patients with a schizophrenia spectrum disorder (SSD) regarding different difficult treatment courses via machine learning (ML). Based on these findings, a prognostic tool for their occurrence is currently under development.Methodology: A database of 370 offender patients with SSD with over 500 variables was created and analyzed via ML for different adverse treatment events.Findings: The different difficult treatment courses were based on similar predictors: biographical information, severity of illness according to PANNS, and antisocial behaviors in the past. The models achieved notable AUC above 0.75.Practice and Relevance: Psychiatric illnesses and resulting behavioral problems are complex phenomena driven by various, often interdependent factors. ML offers the possibility of an according analysis. The identified predictors of difficult treatment courses in forensic psychiatry are currently compiled in a screening tool.
Augmented Reality, Virtual Reality)
machine learning, schizophrenia spectrum disorder, screening tool development
Forensic High and Intensive Care: lessons learned from the implementation of a new care model
Paper presentation148Sylvia Gerritsen, Amsterdam University Medical Center (UMC), the Netherlands
Schadee ZaalSat 09:00 - 10:30
Several years ago, a new care model was developed in Dutch forensic psychiatry called Forensic High and Intensive Care (FHIC). FHIC aims to foster the transition from control-based care, including the seclusion of patients, to contact-based care in forensic psychiatry. The core elements of the FHIC model are; care ethics, stepped care, the premise that a crisis is relational, safety in contact, and the inclusion of (family) peer providers in the team. In this presentation, the focus will be on the development and implementation of FHIC. A mixed methods study was performed at a large number of forensic care wards. Among others, challenges in and lessons learned for daily practice and the implementation process of the FHIC model are identified. These lessons are relevant to initiate such change in a complex healthcare practice such as forensic psychiatry.
complex care practice, contact-based care
Restorative justice in mental health services: Systematic review
Paper presentation280Nutmeg Hallett, University of Birmingham, United Kingdom
Schadee ZaalSat 09:00 - 10:30
Background: Mental health services can be coercive and this means a risk of harm. Patient violence can cause harm and some interventions can be harmful (e.g. seclusion, restraint). Restorative justice (RJ) provides a framework for addressing such harm.Aim: To identify how RJ is being used within mental health services, where the current research gaps are and potential future developments.Methods: Systematic review using bidirectional citation searching. Studies describing/discussing RJ patient interventions within mental health services were included and findings were narratively synthesised.Results: Nine papers were included in this review. All described RJ in forensic mental health settings and used to address patient assaults or index offences.Conclusions: RJ has been successfully implemented in forensic settings. Further research is needed to explore the wider potential benefits.
Patient violence, Restorative justice, Secure mental health
Co-creating a comprehensive intervention for primary mental health care to reduce involuntary admissions
Paper presentation91Irene Wormdahl, NTNU Social Research, Norway
Van Beuningen ZaalSat 09:00 - 10:30
Internationally there has been a call for a shift in mental health services towards a decrease in involuntary treatment and an increase in community-based care. So far, most research on reducing coercion has focused on services at the specialist health care level, and knowledge on how primary health care can facilitate and contribute to such a decrease is lacking. Through dialogue conferences and feedback meetings in five mid-sized municipalities in Norway, we have developed a comprehensive intervention for primary mental health care aimed at reducing involuntary admissions. Representatives from primary mental health care, specialist mental health care, GPs, police, persons with lived experience, and family carers participated in the co-creation of the intervention together with the research team. In this presentation, the process of developing the intervention will be presented.
17. Specific populations: community and outreach care
Co-creation, Involuntary admission, Primary health care, the ReCoN intervention
Compulsory psychiatric admission: geographic variation and opportunities for prevention
Paper presentation104Jorun Rugkåsa, Akershus University Hospital, Norway
Van Beuningen ZaalSat 09:00 - 10:30
There is significant variation in the levels of compulsory psychiatric admission between countries and also between different geographical areas within countries. This suggests that some areas use more compulsory care than is necessary. By exploring the international literature and reporting on the RECON register study that included all compulsory admissions in Norway between 2014-18, this presentation argue that even if the observed variation is not fully explained, inventions at the primary care level hold potential for reducing coercion.
coercion, Compulsory admission, geographic variation, RECON study
User involvement in an intervention to reduce compulsory admissions (ReCoN)
Paper presentation120Solveig Kjus, NTNU social research, Norway; Trond Hatling, NTNU social research, Trondheim, Norway
Van Beuningen ZaalSat 09:00 - 10:30
In this presentation we will describe the role and experiences of user involvement in developing and realizing the ReCoN intervention to reduce the level of compulsory admissions. User involvement was present throughout the process; in planning and writing the application, in the steering group, as peer researcher employed part-time, and direct involvement of persons with lived experience and carers in interviews, dialogue conferences and meetings to develop and monitor the compliance of the intervention. Our ambition was to make the intervention relevant for those receiving mental health services. We will describe and discuss the recruitment of persons with lived experiences and carers, the methods we applied and the challenges we met. The peer researcher’s experiences of participating in the project are described and discussed. The strengths and challenges of having lived experience with coercion are elaborated, including how the peer researcher is met in the project, making these challenges manageable.
Mental Health services, User involvement in research
The first five minutes in conflict situation: a collaborative development of a European Training Program
Interactive workshop135Lene Lauge Berring, Region Zealand Psychiatry/ University of Southern Denmark, Denmark; Eric Noorthoorn, Ggnet Community Mental Health Centre, the Netherlands; Kewin Mc Kenna, School of Health and Science Dundalk Institute of Technology, Ireland
Van Weelde ZaalSat 09:00 - 10:30
There is little consensus regarding the content or teaching methodology, of training for frontline personnel in the management of aggression within mental health. The fidelity of translation of classroom teaching to practice is uncertain, as is the effectiveness of the training in improving safety of all concerned.This paper will describe the development and practice of a collaboration of trainers, researchers, and educators from Denmark, Netherland and Ireland in a pragmatic action research study. The collaboration will develop a shared model of best practice interventions in the ‘first five minutes’ of a potential crisis, which will emphasize psychological and physical safety, and minimize risk for staff and patientsThis international co-creation of theoretically underpinned training will advance the state of knowledge, and enhance the practice effectiveness of engagement during the opening ‘first five minutes’ of a potentially difficult encounters in everyday practice. The workshop will include proposed evaluation strategies.
care and treatment
Co-production, Safety, Training, Violence
11:00 - 12:30 Concurrent sessions 6
Fear of losing control – Practical guidance towards forced tube feeding patients with eating disorders.
Interactive workshop217Chantal Verhoef, Amsterdam UMC, Netherlands; Panos Tamtakos, Amsterdam UMC, Netherlands; Paul Doedens, Amsterdam UMC, Netherlands
Hudig ZaalSat 11:00 - 12:30
A small sample of patients with severe eating disorders are at acute risk of adverse outcomes due to critical somatic condition. An intervention of last resort for these patients is forced tube-feeding. In the Netherlands, most patients that receive this highly complex en intrusive intervention are admitted at medical psychiatric units. If forced tube-feeding is deemed necessary, staff members face an omission of clear guidelines or best practices on the utilization of this intervention.In this workshop, we discuss the absence of clinical guidelines and introduce a stepped-care approach to reduce the use of force during forced tube feeding. The workshop starts with an outline on the population, setting, necessary tools and skills for forced tube feeding, focused on clinical practice. We demonstrate our stepped-care approach (both theoretical and physical) and invite participants to elaborate on their experience and practice on de-escalation, reduction of force, attitude and safe physical interventions.
Eating disorders, Forced tube feeding, Stepped care, Trauma informed care
An RCT of a co-created open-door policy versus usual-treatment in acute psychiatric ward care
Paper presentation133Nikolaj Kunøe, Lovisenberg Diaconal Hospital, Norway
Jurriaanse ZaalSat 11:00 - 12:30
Open-door policy (ODP) is a flexible framework for acute psychiatric hospital care that emphasises patients’ recovery and personal freedom to reduce coercion. Evidence is debated as RCT data is lacking. Researchers, managers, staff and service user representatives co-created a Nordic ODP and evaluation project, the Lovisenberg Open Acute Door Study (LOADS). The aim of the RCT evaluation was to investigate whether ODP was non-inferior or superior to usual treatment (TAU) ward care by randomly allocating n=550 admissions to either arm for 12 months. Two ODP wards were open 09-21 daily, but closed in case of acute crises. Preliminary analyses suggest no difference between ODP and TAU in violent events or coercive practices. LOADS is relevant to ‘Humane, safe and caring approaches’ by being the first RCT on ODP in 25+ years, with results suggesting acute psychiatric wards can reduce door-locking, an informal type of coercion, without compromising on safety.
Acute psychiatric ward treatment, Coercion prevention, Open-door policy, Violent events
High and intensive care in psychiatry: a care model in motion
Paper presentation175Isa de Jong, Amsterdam UMC, the Netherlands
Jurriaanse ZaalSat 11:00 - 12:30
Previous research has shown progression in implementation of the High and Intensive Care (HIC) model and a decline of compulsory care by the level of implementation. Securing implementation has proven to be challenging, among others by national shortage of mental health care staff. Systematic evaluation of compulsory care is necessary. This follow-up research aims to optimize the development and implementation of the HIC model in the current mental health care context. Focus will be on 1) developments of influence on the HIC monitor, 2) developments in compulsory care, aggression incidents and complex cases, 3) experiences of clients, family and professionals on previous topics, and 4) professionals’ motivation to work at HIC wards. Both qualitative and quantitative methods will be used, including interviews, focus groups, case studies, questionnaires and an arts-based method. This presentation highlights the research design and how creative methods can be used in research to optimize HIC care.
complex cases, compulsory care, developments in acute psychiatry, HIC model
Monitoring the implementation process of psychiatric High and Intensive Care in Belgium.
Paper presentation190Hella Demunter, UPC KU Leuven, Belgium
Jurriaanse ZaalSat 11:00 - 12:30
The psychiatric High and Intensive Care (HIC) model is an innovative healthcare program in Belgium for inpatient treatment for severely disturbed psychiatric patients, focusing on intensive patient-centered integrated care with minimal coercive measures (van Mierlo et al., 2013). Our study is a multi-method approach of the implementation process of HIC across Belgium, as well as a longitudinal clinical-epidemiological approach to study patient profiles, changes in clinical outcomes during treatment, and after 6 and 12 months. Data are weighted to represent general patient profiles admitted in HIC units across Belgium. We present preliminary results on epidemiological profiles and clinical outcomes (aggression, suicide risk, psychiatric crisis, (perceived) coercion ) among the first 240 participants. We discuss implementation processes and generate hypotheses on factors related to decreases in clinical symptomatology and the use of coercive measures. We add to the knowledge on organizing services for severely disturbed psychiatric patients from innovative patient-centered perspectives.
epidemiological profiles, high and intensive care, implementation process, patient-centered clinical outcomes
Towards patient engagement in violence risk assessment and management: a patient perspective
Paper presentation37Tella Lantta, University of Turku, Finland
Mees ZaalSat 11:00 - 12:30
The aim of this research was to describe inpatients’ ideas on how they would develop current violence risk assessment and management practices. The data collection took place in one PICU unit specialized in the treatment of patients with psychosis and violent behavior. A qualitative descriptive design was adopted with individual interviews (n=13). Patients’ views centered on concrete ideas for developing patient engagement in care and violence risk management methods. Developing patient engagement involved noticing patients’ individuality and collaboration between a patient and staff. Developing violence risk management methods included themes about providing alternative risk management methods and developing nursing staff’s work. Patients had clear ideas on how violence risk assessment and management methods could be developed further. They also want to be involved in both practices. These findings indicate, that patients need to be given a more active role in their care related to violence risk assessment and management.
Interview, Participatory research, Service user, Violence
Service users’ perceptions of Safewards implementation fidelity on an acute psychiatric in-patient ward
Paper presentation51Veikko Pelto-Piri, University Health Care Research Center, Örebro University, Sweden
Mees ZaalSat 11:00 - 12:30
Safewards is a model that aims at reducing conflict and containment on psychiatric wards. Fidelity of implementation is often assessed by using the Safewards Fidelity Checklist (SFC). However, SFC does not include the perspective of service users. The aim of this study was to investigate the service users’ perceptions of Safewards implementation fidelity on an acute psychiatric ward.The ward had, according to its own follow-ups, succeeded well with the implementation of Safewards. An independent fidelity assessment using SFC was made along with a detailed ward walk-though. Ten service users were interviewed about their observations of manifest signs of Safewards as well as quality aspects of the interventions.Preliminary findings indicate that there was a high implementation fidelity, both according to the SFC and the service users’ observations of Safewards and its implementation. Some interventions were perceived as demanding by some service users and several suggestions were made about improvements.
Implementation, Prevention, Safewards, Service users
Aggression management training in a Malaysian academic hospital: a Low-and-Middle Income setting cased-based model
Paper presentation244Choon Leng Eu, National University of Malaysia Medical Centre (UKMMC), Malaysia; (UKMMC), Malaysia
Mees ZaalSat 11:00 - 12:30
Violence and aggression in healthcare settings within and beyond psychiatric units are critical incidents that require proactive strategies. Early career aggression management training for all healthcare workers should start at the undergraduate level. Targeted training aims to equip healthcare workers in managing aggression and preventing violence. The National University of Malaysia Medical Centre (UKMMC) runs a training program for undergraduate medical students, postgraduate psychiatry trainees and mental health clinicians since 2015. The undergraduate training is a half day Team-based-learning (TBL) workshop, conducted 4 times per year. The postgraduate/mental health clinician workshop is a 2-day workshop conducted annually. The training is knowledge and skills-based. ‘De-escalation’ techniques are emphasised to reduce physical restraint. Main challenges include translation of training hours into effective clinical practice. Future goals for sustainable implementation of aggression management training in a resource-challenged setting include engagement of institutional stakeholders and formal evaluation of violence prevention and cost-effectiveness.
Education, Hospital, Managing aggression, Training
The effectiveness of Transcranial Direct Current Stimulation as an intervention to reduce aggressive behavior
Paper presentation221Josanne van Dongen, Erasmus University Rotterdam, Netherlands
Schadee ZaalSat 11:00 - 12:30
Aggression posed by violent individuals is a major public health concern and to date, interventions to reduce aggression are found to be insufficient in doing just that. Aggressive behavior is associated with dysfunctions in the prefrontal cortex, of which the Dorsolateral Prefrontal Cortex (DLPFC) and Ventromedial Prefrontal Cortex (vmPFC) are two of the most studied areas. There has been a growing interest in using Transcranial Direct Current Stimulation (tDCS) as an intervention to modulate brain regions of interest and increasing activity in damaged brain areas that show blunted activity.In this presentation, I will discuss the current state-of-the-art with respect to studies on tDCS and aggression. Moreover, I will discuss our recent findings that have not only shown that tDCS can be effectively used to modulate brain activity and aggression, it also has shown that it is effective in increasing synchronization of neural activity in the brain of violent offenders.
7. Neurobiological and pharmacological interventions
Aggression, Forensic Patients, Neuromodulation, tDCS
Effects of multivitamins, minerals and n-3 PUFAs on aggression among long-stay psychiatric in-patients: randomised trial
Paper presentation229Nienke de Bles, LUMC, Netherlands
Schadee ZaalSat 11:00 - 12:30
Background: Aggression is a major concern in psychiatric in-patient care. Nutritional supplementation has been found to reduce aggressive incidents in forensic populations and children with behavioural problems.
Aims: To assess whether multivitamin, mineral and n-3 polyunsaturated fatty acid supplementation would reduce the number of aggressive incidents among long-stay psychiatric in-patients.
Method: Data were collected at eight local sites for mental healthcare in The Netherlands and Belgium. Participants were randomised to receive 6-month treatment with either three supplements or placebo. The primary outcome was the number of aggressive incidents, determined by the Staff Observation Aggression Scale – Revised (SOAS-R).
Results: In total, 176 participants were randomised. The primary outcome of SOAS-R incidents was similar in supplement and placebo groups, with a rate ratio of 1.08 (95% CI 0.67–1.74, P = 0.75).
Conclusions: Six months of nutritional supplementation did not reduce aggressive incidents among long-stay psychiatric in-patients.
Aggression, n-3 polyunsaturated fatty acids, nutrition, psychiatric in-patients
The Compulsory Care Act: early observations and expectations of in- or outpatient involuntary treatment
Paper presentation118Eric Noorthoorn, GGNet Centre of Mental Health, Warnsveld, the Netherlands
Van Beuningen ZaalSat 11:00 - 12:30
Background. On January 1st, 2020, the Dutch Compulsory Care Act (WvGGZ) replaced the Special Admissions Act (BOPZ). Whilst the old law only allowed compulsory treatment in hospital, the new law allows it both in inpatient and outpatient settings. Methods. We studied the seclusion and enforced medication events before and after January 1st 2020 using coercive measures monitoring data. Results. The mean number of hours of seclusion between 2012 and 2019 was 27,124 per year, decreasing from 48542 in 2012 to 21,133 in 2019, and to 3,844 hours in 2020. The mean incidence of enforced medication events between 2012 and 2019 was 167, increasing from 90 in 2012 to 361 in 2019, and dropping to 294 in 2020. Discussion. There was a reduction in number of seclusion hours after the introduction of the Compulsory Care Act (2020). Conclusion. We observed a significant increase of enforced medication and a decrease of seclusion.
Community treatment orders, Mental Health Law, Trend data
Recovery-oriented prevention and management of staff-directed aggression in community mental health services
Paper presentation145Erlend Rinke Maagerø-Bangstad, University of South-Eastern Norway, Norway
Van Beuningen ZaalSat 11:00 - 12:30
Little is known of how recovery can be utilized in the prevention and management of staff-directed aggression in community mental health settings. The paper presents results from two studies of competence development among staff in community mental health services partaking in education and training in the prevention and management of staff-directed aggression afforded by the Agency of Health in the Municipality of Oslo. In the studies we found that the most competent and ‘powerful’ conceptions of practice corresponded to a large extent with principles of practice known from the recovery and person-centred approach. The findings add to the existing knowledge of staff’s perceptions and experiences of violence in community mental health services. Additionally, the findings describe recovery as a particularly promising route to decrease workplace violence in mental health services. The findings will also have practical use for practitioners in devising applicable and effective practices in handling staff-directed aggression.
Community mental health services, Practitioners, Recovery-oriented practice, Staff-directed aggresseion
Impact of assertive community treatment on the use of coercive measures: a French study
Paper presentation159Mael Pulcini, CHU Saint Etienne, France; Yvonne Quenum, CHU Saint Etienne, Saint Etienne, France
Van Beuningen ZaalSat 11:00 - 12:30
The aim of this research was to assess the impact of assertive community treatment (ACT) team on length of stay in full time hospitalization units. We also evaluated the impact on days spent with coercion (seclusion and physical restraint) and emergency services use. We used a pre-post study model, comparing a same cohort of patients one year before introduction of the ACT intervention, with one year after the ACT team was launched. We observed a significant diminution of days spent in full time hospital services, no modification on emergency services use and a significant diminution on use of coercion. These results confirm that community based mobile team is a good alternative – in the French healthcare system – to full time hospitalizations services in regards to benefits on quality of life and autonomy procured by such intervention for users and their relatives.
coercion, community, hospitalization, mobile team