ABSTRACT
This study describes and explores the application of no-restraint policies in General Hospital Psychiatric Units (GHPUs) in Italy, a country pioneering in deinstitutionalization and psychiatric reform. The research aims to assess the organizational characteristics and effectiveness of no-restraint practices, contributing to the global discourse on humane psychiatric care. Following a purposive sampling approach, a nationwide descriptive study was conducted involving a detailed online survey distributed to 24 GHPUs actively engaged in or aspiring toward no-restraint practices. The survey, comprising 60 items across seven sections, gathered comprehensive data on the structural, organizational, and operational dimensions of the units, along with the prevalence and management of restraint episodes. Results reveal a significant commitment to no-restraint policies, with 14 GHPUs reporting zero restraint incidents in 2022. Despite variations in infrastructure and staffing, a common thread was the implementation of systematic procedures and risk management training aimed at reducing coercive practices. The study identified a correlation between the use of exclusive garden spaces and an increased incidence of restraints, suggesting nuanced factors influencing restraint practices. The findings underscore the viability and ethical alignment of no-restraint practices within psychiatric care, highlighting the crucial role of organizational protocols and training. This research adds empirical weight to the advocacy for restraint-free environments in mental health settings, signaling a paradigm shift toward more humane and rights-respecting psychiatric care.
ABSTRACT
Objective: This cross-sectional study investigates the characteristics and practices of mental health care services implementing Open Dialogue (OD) globally. Methods: A structured questionnaire including a self-assessment scale to measure teams' adherence to Open Dialogue principles was developed. Data were collected from OD teams in various countries. Confirmatory Composite Analysis was employed to assess the validity and reliability of the OD self-assessment measurement. Partial Least Square multiple regression analysis was used to explore characteristics and practices which represent facilitating and hindering factors in OD implementation. Results: The survey revealed steady growth in the number of OD services worldwide, with 142 teams across 24 countries by 2022, primarily located in Europe. Referrals predominantly came from general practitioners, hospitals, and self-referrals. A wide range of diagnostic profiles was treated with OD, with psychotic disorders being the most common. OD teams comprised professionals from diverse backgrounds with varying levels of OD training. Factors positively associated with OD self-assessment included a high percentage of staff with OD training, periodic supervisions, research capacity, multi-professional teams, self-referrals, outpatient services, younger client groups, and the involvement of experts by experience in periodic supervision. Conclusion: The findings provide valuable insights into the characteristics and practices of OD teams globally, highlighting the need for increased training opportunities, supervision, and research engagement. Future research should follow the development of OD implementation over time, complement self-assessment with rigorous observations and external evaluations, focus on involving different stakeholders in the OD-self-assessment and investigate the long-term outcomes of OD in different contexts.
ABSTRACT
Empirical evidence from the COVID-19 pandemic shows that women carried the major burden of additional housework in families. In a mixed-methods study, we investigate female and male remote workers' experiences of working from home (WFH) during the pandemic. We used the free association technique to uncover remote workers' representations about WFH (i.e., workers' reflection of subjective experiences). Based on a sample of 283 Austrian remote workers cohabitating with their intimate partners our findings revealed that in line with traditional social roles, men and women in parent roles are likely to experience WFH differently: Mothers' representations about WFH emphasize perceived incompatibility between the work and non-work sphere whereas fathers' representations highlight work-family facilitation of WFH. However, gender differences were also prevalent for women and men without children: Women seem to particularly benefit from more concentration at home, whereas men consider WFH as more efficient, practical and leading to less work. Thus, our findings imply that gender affected perceptions of WFH during the pandemic independently from children, but children seemed to increase the existing burden, in particular for women. To conclude, WFH can generally be seen as an enabler to reduce work-life/family conflict for both women and men, but bears different challenges based on the contextual (family) situation.
ABSTRACT
This study investigates the differences between a co-produced experimental mental health centre and traditional day centres. For this purpose, we used a collaborative and mixed-method approach in two complementary studies: (i) a quantitative cross-sectional study designed to compare users' hospitalization rates and their use of psychiatric medications and (ii) a qualitative study designed to explore and document the experienced differences between co-produced and traditional services. In the quantitative cross-sectional study, surveys were administered to 37 users of one co-produced mental health service and to 40 users of traditional mental health services. A negative binomial regression analysis was performed to examine the relationships between predictors and users' hospitalization rates. After adjusting for the potential confounders, users of the co-produced centre reported a 63.2% reduced rate of hospitalizations compared with users of traditional mental health services (P = 0.002). Furthermore, 39% of users of the co-produced centre reported a reduction or even withdrawal from psychiatric medications against 22% of the comparison group (P = 0.036). In the qualitative study, six main differences emerged from a thematic analysis of a large user-led focus group. In the participants' experiences, the co-produced service focused on (i) parity and respectful relationships, (ii) people's strengths, (iii) freedom, (iv) psychological continuity, (v) social inclusion, and (vi) recovery orientation. Our research provides empirical evidence concerning the 'preventive aspect' of co-produced mental health services. Additionally, new insights into how different stakeholders, particularly users of co-produced mental health services, experience the differences between co-produced and traditional mental health services are provided.
