Women in higher education: exclusion, inclusion and seclusion

This literature review is conceptually rooted in intersectional feminism and Harding's (2004) standpoint theory. I assert and affirm my positionality as a black woman from the Global South as I unpack the literature on women in higher education. I use the concepts of inclusion and exclusion to illustrate that while women are unequivocally in higher education, they remain largely out of positions of power. The concept of seclusion is used to describe women's and institutions' obscured and hidden behaviors that reinforce gendered patterns of women's subsistence in higher education. The review also highlights two key persistent challenges, namely, that of the impossibility of work life balance, especially, but not only, for academic mothers;and of being a black woman in academia. I offer insight into the devastating impacts of covid-19 on women academics and academic mothers. The review also identifies strategies used to make qualitative shifts in women's occupation of higher education spaces. © 2023 Elsevier Ltd. All rights reserved.

A two-center pilot study on the effects of clinical ethics support on coercive measures in psychiatry.

BACKGROUND: The use of formal coercion such as seclusion, mechanical restraint, and forced medication is one of the most challenging and complex issues in mental health care, on the clinical, the legal, and the ethical level. Clinical ethics support aims at assisting healthcare practitioners in determining the morally most justifiable course of action in these situations. However, the effectiveness of clinical ethics support has hardly been studied so far. METHODS: Monthly moral case deliberation (MCD) was implemented in two acute wards of two different psychiatric hospitals in Switzerland. Frequency and intensity of coercion was measured on ward level (npatients = 405), and the Moral Attentiveness Scale, Knowledge on Coercion Scale, and Staff Attitudes towards Coercion Scale were applied on healthcare practitioner level (nHP = 46). Pre-post-comparisons were conducted using multi-level modeling where appropriate. RESULTS: After implementation of MCD, formal coercion was less frequent (particularly seclusion, small effect size; 9.6 vs. 16.7%, p = .034, Cramér's V = .105) and less intense (particularly mechanical restraint, large effect size; 86.8 ± 45.3 vs. 14.5 ± 12.1 h, exact p = .019, r = -.74), and approval for coercive measures among healthcare practitioners was lower when controlling for the number of MCD sessions attended. CONCLUSIONS: Clinical ethics support such as MCD may be a hitherto underutilized service for the reduction of coercion, complementing existing strategies and programs. Implementing clinical ethics support may help improve quality of care for persons suffering from severe mental illness.

Women in higher education: exclusion, inclusion and seclusion

This literature review is conceptually rooted in intersectional feminism and Harding's (2004) standpoint theory. I assert and affirm my positionality as a black woman from the Global South as I unpack the literature on women in higher education. I use the concepts of inclusion and exclusion to illustrate that while women are unequivocally in higher education, they remain largely out of positions of power. The concept of seclusion is used to describe women's and institutions' obscured and hidden behaviors that reinforce gendered patterns of women's subsistence in higher education. The review also highlights two key persistent challenges, namely, that of the impossibility of work life balance, especially, but not only, for academic mothers;and of being a black woman in academia. I offer insight into the devastating impacts of covid-19 on women academics and academic mothers. The review also identifies strategies used to make qualitative shifts in women's occupation of higher education spaces.

Restrictive interventions on a psychiatric admission ward before and after COVID-19.

OBJECTIVES: Restrictive interventions (seclusion, restraint and special observations) are used on psychiatric wards when there are no other means available to keep a patient or others safe. These measures can be traumatic, and the Mental Health Commission and the Health Service Executive are focused on minimising their use. We set out to determine whether, following a COVID related reduction in bed numbers on a high dependency psychiatric ward in St John of God Hospital in Dublin, there was a change in their incidence. METHODS: Data on restrictive interventions and challenging behaviours were gathered for 9-month periods before and after March 2020 when COVID related ward changes took place. Figures were also collected on seclusion and restraint for the previous 18 months for a longer-term view. Ward and hospital occupancy levels were also recorded. RESULTS: Between the two time periods, episodes of seclusion fell by 53% and episodes of restraint by 56%. The hours devoted to special observation declined by 30% and incidents of challenging behaviours fell by 26%. Ward occupancy levels fell by only 5%. The longer-term comparison of figures for seclusion and restraint point towards a downward trend from mid-2019 that was accentuated in the post-COVID period. CONCLUSIONS: The changes found may relate to reduced crowding on the ward or other COVID related factors such as the emphasis on social distancing and a shared sense of purpose on the ward. The longer-term trend points towards an emerging cultural shift. The challenge now is to sustain and build upon these changes.

Model projects according to 64 b SGBV in the Corona pandemic: care, structure and coercive measures

Background: Mental health care in Germany is being put to the test by the Corona pandemic, for example through the closure of day hospitals, bans on visits in hospitals, restrictions on community psychiatric services and chains of infection in old-age mental health wards. Model Region: In this context and exemplified in the psychiatric department of Heidenheim General Hospital, the "regional budget for psychiatry" as a cross-sectoral model project according to Sec. 64b SGB V (Germany's Code of Social Law) proves to be structurally and financially resilient. The regional budget works as a capitation system in which the provider of psychiatric care (Klinikum Heidenheim) agrees with the health insurance funds on a number of people from a defined catchment area who receive comprehensive inpatient and outpatient psychiatric care. Service description: Flexible treatment settings allow for low bed occupancy, outreach work, greater use of home treatment and more day hospital treatment. These options enable the provision of needs-based care while reducing the risk of infection. Use of coercion: Coercive measures were used less frequently in the model project than in previous years. Yet, during the corona pandemic in 2020 coercion was used more frequently compared to the previous year. Whether this is due to institutional or external factors is still an open question.

Silver linings: Observed reductions in aggression and use of restraints and seclusion in psychiatric inpatient care during COVID-19.

WHAT IS KNOWN ABOUT THE SUBJECT?: In a survey conducted by the World Health Organization (WHO) in the summer of 2020, 93% of countries worldwide acknowledged negative impacts on their mental health services. Previous research during the H1N1 pandemic in 2009 established an increase of patient aggression in psychiatric facilities. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Despite expected worsening of mental health, our hospital observed reductions in aggressive behaviour among inpatients and subsequent use of coercive interventions by staff in the months following Covid-19 pandemic restrictions being implemented. The downward trend in incidents observed during the pandemic has suggested that aggression in mental health hospitals may be more situation-specific and less so a factor of mental illness. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: We believe that the reduction in aggressive behaviour observed during the pandemic is related to changes in our organization that occurred in response to concerns about patient well-being; our co-design approach shifted trust, choice and power. Therefore, practices that support these constructs are needed to maintain the outcomes we experienced. Rather than return to normal in the wake of the pandemic, we are strongly encouraged to sustain the changes we made and continue to find better ways to support and work with the individuals who rely on or use our services. ABSTRACT: The global COVID-19 pandemic has dramatically changed the operation of health care such that many services were put on hold as patients were triaged differently, people delayed seeking care, and transition to virtual care was enacted, including in psychiatric facilities. Most of the media dialogue has been negative; however, there have been some silver linings observed. Coinciding with the pandemic has been a reduction in aggressive incidents at our psychiatric hospital, along with the decreased need to use restraints and seclusion to manage behaviour. In this paper, we are taking stock of the changes that have occurred in response to the pandemic in an attempt to share our learnings and offer suggestions so that health care does not necessarily return to "normal".

Isolation of patients in psychiatric hospitals in the context of the COVID-19 pandemic: An ethical, legal, and practical challenge.

Psychiatric inpatients are particularly vulnerable to the transmission and effects of COVID-19. As such, healthcare providers should implement measures to prevent its spread within mental health units, including adequate testing, cohorting, and in some cases, the isolation of patients. Respiratory isolation imposes a significant limitation on an individual's right to liberty, and should be accompanied by appropriate legal safeguards. This paper explores the implications of respiratory isolation in English law, considering the applicability of the common law doctrine of necessity, the Mental Capacity Act 2005, the Mental Health Act 1983, and public health legislation. We then interrogate the practicality of currently available approaches by applying them to a series of hypothetical cases. There are currently no 'neat' or practicable solutions to the problem of lawfully isolating patients on mental health units, and we discuss the myriad issues with both mental health and public health law approaches to the problem. We conclude by making some suggestions to policymakers.