Professor for psychiatric rehabilitation research
Dirk Richter is currently working as a researcher and professor of psychiatric rehabilitation research at Bern University of Applied Sciences and Bern University Hospital of Mental Health in Switzerland. He has conducted many empirical and theoretical studies and has published widely on topics such as housing and occupational rehabilitation, psychiatric epidemiology, aggression and coercion, psychiatric epistemology and the consequences of COVID-19 on mental health. He has been trained as a nurse in mental health care and holds a Dr. phil. doctorate and a subsequent habilitation (PhD) in sociology from the university of Muenster, Germany.
Medically legitimized coercion is ethically and legally justified by the simultaneous occurrence of a risk of self-harm or a risk to other people and a defined illness/mental disorder. The issue of the definition of a mental disorder has not yet become a topic for coercion-related research. A closer look into the latest neuroscience and taxonomic research reveals that the existence of mental disorders as defined by current classification systems (DSM/ICD) has come under much scrutiny. Main reasons for becoming sceptical about conventional notions of mental disorders are the extensive comorbidity of diagnostic entities and the dimensionality of mental phenomena which necessarily leads to arbitrariness when it comes to separate health from illness. Additionally, there is increasing uncertainty about the characteristics and even the existence of a human mind or consciousness in neuropsychology and neurophilosophy. This state of research suggests that we can no longer be confident about the definition and probably even about the existence of mental disorders and, therefore, can no longer justify coercion as a means of mental health care. Consequences and dilemmas of this conclusion need to be addressed.
Professor of Psychology and Mental Health
Paula Reavey is Professor of Psychology and Mental Health at LSBU. She is also a Lead Director of Research and Education for the Design in Mental Health Network UK.
She has co-edited a number of academic and commercial books, “New Feminist Stories of Child Sexual Abuse: Sexual Scripts and Dangerous Dialogues” (with Sam Warner, Routledge, 2003) and “Memory Matters: Contexts for Understanding Sexual Abuse Recollections” (with Janice Haaken, Psychology Press, 2009) and the Handbook of Mental Health & Space (with Laura McGrath, Routledge, 2018).
She is sole editor for the volumes, “Visual Methods in Psychology: Using and Interpreting Images in Qualitative Research” (Routledge, 2011) and A Handbook of Visual Methods in Psychology (Routledge, 2021). She has also published two monographs, “Psychology, Mental Health and Distress” (with John Cromby and Dave Harper, Palgrave, 2013 – winner of the British Psychological Society Book Award, 2014 – now being prepared for its second edition) and “Vital Memory and Affect: Living with a Difficult Past” (with Steven D. Brown, Routledge, 2015).
Paula has published numerous works on mental distress, social remembering and child sexual abuse, using a variety of qualitative and visual methodologies. Her passion is to understand lived experience in context, including social inequalities and class and her teaching at undergraduate and postgraduate level adopts this experiential and social justice approach. She has received funding from NIHR, ESRC, Wellcome, Mental Health First Aid England and is on the NHS England advisory committee for improving mental health environments.
People not places are violent, surely? But what if aspects of the environment create conditions where risk is increased and violence more readily ignited? In this presentation, I bring together evidence based insights from design, architecture and psychology, to create a system level appraisal of escalation, violence and seclusion use. This perspective I have termed ‘psycho-ecological’ to represent the theoretical and empirical synthesis of environments and people, to examine how environments ‘afford’ greater risk, through increasing anxiety, closing down relations between staff and patients and reducing a sense of agency and meaning. This theoretical aperture invites closer inspection on how to work collaboratively with experts by experience, architects and designers to create environments that are safer – both physically and psychologically.
Professor of Mental Health
Joy Duxbury is a mental health nurse and Professor of Mental Health at Manchester Metropolitan University. She has worked on numerous funded projects pertaining to mental health including the exploration of perspectives and implementation. Her national and international focus has been upon minimizing restrictive practices across varied settings.
Joy has written extensively on this subject over the past 20 years and secured several grants to examine coercion and social injustices using participatory and co-creation methods.
As a result of her profile in this area, Joy was Chair of the European Violence in Psychiatry Research Group and currently remains a board member. She is Trustee and Chair of the Restraint Reduction Network. In recognition of her work she was awarded the Eileen Skellern Award in 2014 and more recently an OBE in 2021.
The disproportionate use of force in mental health settings and beyond is a significant issue in the modern-day care of the most vulnerable individuals in society. A range of inequalities are evident and impact upon the quality of care that certain populations experience.
The disparities are extensive and include matters pertaining to ethnicity, age gender, and disorder. These clearly affect the experiences of those involved and need to be addressed. In order to do this, we need not only to understand the extent and nature of the problem in terms of accurate reporting but also how to understand the challenges faced by all parties. Clearly participatory action approaches such as experience based co-design can help drive the changes required going forward.
I will present the evidence base on the current position and highlight some research we have been working on to co-create new ways of working. Some examples include the experiences of Black Afro-Caribbean men about being detained and research on those with learning disabilities and autism around restrictive interventions. Both populations experience disproportionately in the use of force when engaging with mental health services. It’s time to flip the narrative.
Professor for psychiatric rehabilitation research
The Covid-19 pandemic has hit mental health care services unexpectedly in early 2020. Many services were shut down, inpatient capacities were reduced and services had to deal with outbreaks within their service user populations and staff. This Masterclass session will provide an overview on the impact of the pandemic on mental health issues in the general population and in mental health care service users. A particular focus will be made on critical incidents such as aggression and suicide attempts and how institutions have dealt with these issues under stressful circumstances.
The session will include a presentation and an interactive part with participants who are asked to share their personal and institutional experiences on how to deal with critical incidents during a pandemic and what can be learned for future infectious outbreaks.
Researcher, Head of care development
Anna Bjorkdahl works at a Swedish psychiatric clinic where she supports and initiates both large and small nursing- and interprofessional clinical improvement projects in acute psychiatry. Projects often relate to violence prevention and management, such as implementing sensory rooms, the Bergen model, rapid tranquillisation and Safewards. She is a researcher at the Karolinska Institute where she currently evaluates the effects of Safewards in a prospective Swedish multicentre study, mainly from the perspective of implementation science.
The bulldozer and the ballet dancer are metaphors for opposite ends of nurses’ different caring approaches that can often be observed on acute psychiatric wards. The bulldozer is recognized by a rather low level of interest in getting to know, understand and support patients but is often active and fearless in acute violent and controlling situations. The ballet dancer on the other hand is frequently seen interacting with patients, almost like a form of art, imagining the patient’s situation and constantly trying every option to building rapport. The ballet dancer, however, is rarely seen involved in violent and controlling situations since it is frightening and may challenge his or her values and beliefs.
In this interactive and maybe slightly provocative masterclass, we will dig deeper into nurses’ different caring approaches and specifically discuss the impact on violence prevention and management from a realistic as well as idealistic perspective. Are both bulldozers and ballet dancers needed in acute psychiatry? Or a hybrid nurse with a little bit of both?
Björkdahl, A., et al. (2010). The bulldozer and the ballet dancer: aspects of nurses’ caring approaches in acute psychiatric intensive care. J Psych Ment Health Nurs. 17:510-518.
Sidsel, 36 years old, health tech engineering and working as a consulting in pharma and med-tech industry. She is telling open about her past as a patient diagnosed with paranoid schizophrenia, deathly selfharming and a user of the psykiatric system for about 12 years.
She was 18 year old, the first time she was hospitalized, and at the age of 30, she was declared free of symptoms, medicine and didn’t need any care and help anymore.
Sidsel holds seminars and teaches professionals based on her own experiences – both the good and the bad. She wants to bring hope and show that there is a way, even when it doesn’t seems like it.
We want a psychiatry where we help the patients towards a better and more tolerable life, and therefore it is important to listen to them.
We want to reduce violence, coercion and increase the possibility of recovery, but is it even possible if we don’t know the person it’s all about?
Based on her own experiences, Sidsel talks openly and honestly about her many years in psychiatry, what helped and what hindered recovery.
Mental health nurse
Details will follow
Prof. Sabine Hahn
Prof. Sabine Hahn (PhD, CNS, RN) heads the School of Nursing and the Unit of Applied Research in Nursing at Bern University of Applied Sciences (CH). She is president of the Swiss Association for Nursing Science, visiting professor at Bournemouth University (UK) and board member of the EViPRG. After 15 years working in direct patient care as psychiatric nurse, she changed to the field of higher nursing education. Sabine has profound expertise in leadership, strategic development, and in promoting of young scientific talents. As P.I. of national and international research projects her topics are violence, de-escalation and reduction of coercion, staff retention as well as staff development and quality development in health care.
Dr. Kevin McKenna
Kevin has extensive healthcare experience in Ireland and US in roles which have included clinical practice, administration, education, and research. In addition to nursing qualifications he holds undergraduate and post graduate degrees in psychology and education.
Kevin has a special interest in conflict and aggression within healthcare, and in supporting organisations in providing trauma informed services free from restrictive practices. He has led a number of national and international educational, practice and research initiatives related to these subject areas.
Kevin is a lecturer in Dundalk Institute of Technology Ireland, part time practitioner, and remains research active in a number of practice related areas.
There is universal acknowledgement that the prevention and recognition, and the safe, effective and therapeutic management of conflict occurrences poses a serious challenge within mental health settings. Such occurrences, and the utilisation of emergency restrictive interventions, are associated with potentially serious physical and psychological risks for all concerned.
Beyond the immediate risks, evidence suggests that the impact of such occurrences endures beyond the incident, can impoverish the therapeutic environment, and diminish the quality of the care experience for both recipient and provider. Furthermore, witnessing such occurrences is distressing to others, and costly to services.
Professional and regulatory guidance impose explicit imperatives for some form of ‘post incident review’ to ameliorate potential distress and restore/preserve therapeutic relationships, while coercive minimisation initiatives consistently include ‘debriefing’ as one critical component of overall strategies (Huckshorn 2005 Colton and Xiong 2010; MHCI 2014; UK NICE (2015) Duxbury et al 2019).
Despite these mandates, there remains some confusion as to the specific purpose and function of ‘debriefing’ and/or ‘post incident reviews’, and considerable variance in practice reflects the paucity of evidence as to what constitutes evidence-based best practice.
During this highly interactive masterclass participants will:
Each stage of the masterclass will involve active engagement among participants.
Assistant professor and senior researcher
Yolande Voskes is a nurse and mental health scientist. She completed her PhD on the reduction of seclusion in psychiatry from a care ethics perspective. Currently she is working as an assistant professor at the department of ethics, law and humanities at the Amsterdam University Medical Centers. She is the coordinator of the program ‘ethics and psychiatry’ and is involved in studies on High and Intensive Care (HIC), Forensic High and Intensive Care (FHIC), Active Recovery Triad (ART) and the evaluation of the Compulsory Mental Healthcare Act.Moreover she is working as a senior researcher at mental health institute GGZ Breburg and is a board member of the HIC foundation.
From an ethical perspective coercion is a problematic issue. The autonomy of the patient has become more important. On the other hand coercion provided effective means for preventing injury. There is clearly a tension between autonomy on the one hand and safety on the other. The focus is on whether or not seclusion is justified at a certain moment. Little attention is paid to everyday ethical issues in contact with patients and the dilemmas involved, which may in the end result in recourse to coercive measures. Moreover, the morality of care relationships and the mutual expectations and moral obligations of the patient, the professional and other stakeholders are not addressed. In this presentation an argument will be made for an ethics that goes beyond the focus on autonomy and security: an ethics of care! This different way of looking at coercion gave the opportunity to develop some best practices in the Netherlands.
President of the Lisbon Institute of Global Mental Health
Professor José Caldas de Almeida is the President of the Lisbon Institute of Global Mental Health, Lisbon Nova Medical School, and Vice Chair of the EU Cost Action FOSTREN.
He was the Chairman of the Department of Psychiatry at the Lisbon Nova Medical School until 2017, the Coordinator of the Mental Health Unit at the Regional Office of WHO for the Americas (2000-2006) and the Leader of the EU Joint Action on Mental and Wellbeing (2013-2016).
His main research interests are focused on the areas of mental health policy and services, and mental health and human rights.
In the last decades, significant efforts have been made, both at national and international levels, to reduce the use of coercion in mental health services. New international human rights instruments were created, innovative strategies and interventions were developed to reduce the use of coercion, many countries promoted important changes in their mental health legislations, policies and services to scale up rights of persons with mental disorders, and in some places the active participation of people with lived experience of severe mental health problems was strengthened.
In this presentation, we will discuss the results of these efforts, based on the available evidence. We will analyze, with special attention, the data that can help us understand the real impact of new mental health legislation and policies on reducing compulsory treatment and the use of other coercive measures in mental health care, and we will present some examples of initiatives and programs that have shown encouraging results both in high- and low-income countries.
Finally, after discussing the main challenges we are currently faced with in promoting more human rights and recovery-oriented services, we will share some thoughts on how research could contribute to respond to these challenges.