Variation in use of coercive measures in psychiatric hospitals.

PURPOSE: The use of coercive measures in psychiatry is still poorly understood. Most empirical research has been limited to compulsory admission and to risk factors on an individual patient level. This study addresses three coercive measures and the role of predictive factors at both patient and institutional levels. METHODS: Using the central psychiatric register that covers all psychiatric hospitals in Canton Zurich (1.3 million people), Switzerland, we traced all inpatients in 2007 aged 18-70 (n = 9698). We used GEE models to analyse variation in rates between psychiatric hospitals. RESULTS: Overall, we found quotas of 24.8% involuntary admissions, 6.4% seclusion/restraint and 4.2% coerced medication. Results suggest that the kind and severity of mental illness are the most important risk factors for being subjected to any form of coercion. Variation across the six psychiatric hospitals was high, even after accounting for risk factors on the patient level suggesting that centre effects are an important source of variability. However, effects of the hospital characteristics 'size of the hospital', 'length of inpatient stay', and 'work load of the nursing staff' were only weak ('bed occupancy rate' was not statistically significant). CONCLUSION: The significant variation in use of coercive measures across psychiatric hospitals needs further study.

Do mental health professionals stigmatize their patients?

OBJECTIVE: Assessing stereotypes towards people with mental illness among mental health professionals, comparing their view to the Swiss general population and analysing the influence of demographic factors, profession and work place variables (type of ward, employment time and professional experience). METHOD: Conducting a representative telephone survey (n = 1073). Factor analysis was used to achieve one-dimensional scales, which were analysed by regression analysis. RESULTS: Most positive depictions were regarded as less characterizing people with mental illness, whereas most negative descriptions were viewed as more typing these people. Compared with the Swiss general population, mental health professionals have not consistently less negative or more positive stereotypes against mentally ill people. Of the 22 stereotypes five factors were detected: 'social disturbance', 'dangerousness', 'normal healthy', 'skills' and 'sympathy'. Stereotypes about people with mental illness are influenced by the professional background and if at all only slightly affected by gender, age, ward type, participation rate of the hospital, weekly working hours or years of professional experience. CONCLUSION: Mental health professionals must improve their attitudes towards people with mental illness. Different ways, e.g. improving their professional education or their quality of professional contacts by regular supervision to prevent burn-out, are discussed.

Lay beliefs about causes of depression.

OBJECTIVE: Assessing lay beliefs about causes of depressive behaviour and analysing the influence of labelling and demographic factors on causal attributions. METHOD: In Switzerland we conducted a representative telephone survey with 873 interviewees. A vignette depicting a man with depression satisfying the Diagnostic and Statistical Manual (DSM)-III-R criteria was presented. Content analysis of up to three answers about assumed causes was conducted. RESULTS: For more than half the respondents (56.6%) difficulties within the family or the partnership are causal for depression. Occupational stress is the second most-mentioned cause (32.7%), whereas unspecified further stress is in third place (19.9%). Traumatic events (17.9%), depressive disorder (14.1%) and further unspecified illnesses (11.6%) follow. Few correlations were found between causal attributions, labelling and demographic factors. CONCLUSION: The respective causal attributions are mainly independent of demographic factors, thus generalizable for the population. The attributions are shaped primarily by psychosocial ideas about aetiology. Nevertheless, one-third of the interviewees holds biological or disease-related beliefs about causes of depression. The respective illness models cannot be neglected in the therapeutic relationship.

Public attitude to compulsory admission of mentally ill people.

OBJECTIVE: Assessing the public attitude to compulsory admission of mentally ill in Switzerland and analyzing the influence of demographic, psychological, and sociological factors. METHOD: We conducted a representative telephone survey with 1737 interviewees. In a logistic regression analysis compulsory admission was used as the dependent variable. RESULTS: More than 70% of the respondents display a positive attitude to compulsory admission. Education, negative stereotypes, and living in the French speaking part of Switzerland are predictors for accepting compulsory admission whereas older age, extreme political opinion, and rigid personality traits show an inverse effect. Negative emotions, anomie, social distance, and contact to mentally ill have no significant influence. CONCLUSION: The mostly positive attitude to compulsory admission suggests that the public trust in psychiatry to deal with the assigned responsibility.

Lay recommendations on how to treat mental disorders.

BACKGROUND: Beliefs about the helpfulness of interventions are influencing the individual help-seeking behavior in case of mental illnesses. It is important to identify these beliefs as professional helpers are asked to consider them in their treatment recommendations. OBJECTIVE: Assessing lay proposals for an appropriate treatment of mental illnesses. METHODS: We conducted a representative opinion survey in Switzerland. Eighteen treatment proposals were presented with respect to a vignette either depicting schizophrenia or depression. Respondents were asked to indicate the proposals considered to be helpful for treatment and those considered to be harmful, respectively. RESULTS: 'Psychologist,' 'general practitioner,' 'fresh air, and 'psychiatrist' were mostly proposed as being helpful. Among several psychiatric treatment approaches 'psychotherapy' was favored, while psychopharmacological treatment and electroconvulsive therapy were only proposed by less than one-fourth of the interviewees. Especially psychotropic drugs were considered to be harmful. Treatment by a psychiatrist was regarded as being more helpful for schizophrenic individuals than for depressive persons. For a person experiencing a life crisis, treatment by a psychiatrist and psychological treatment were viewed as being harmful, and non-medical interventions were preferred. However, for persons thought to be mentally ill, psychiatric and psychopharmacological treatments were recommended. CONCLUSION: Mental health professionals are regarded as being helpful although their treatment methods are seen as being less helpful. A clear distinction is made between lay proposals for depression and schizophrenia. However, the perception of whether a condition is considered to be an illness or a life crisis has significantly more influence on lay treatment proposals than the cited diagnosis in the vignette.

[Volunteering in psychiatry: determining factors of attitude and actual commitment]. / Bürgerhilfe in der Psychiatrie: Determinanten von Einstellung und tatsächlichem Engagement.

OBJECTIVE: To assess public attitude, actual working commitment and the respective influence of demographic, psychological and sociological variables on voluntary help in psychiatry. METHODS: Multiple logistic regression analysis of the results of a representative population survey in Switzerland. RESULTS: Public attitude is mostly positive, but the respective working commitment is small. Attitude depends on gender, psychological factors (social distance, stereotypes), and on attitude to community psychiatry. For the working commitment, clearly distinct predictors are found: age, emotions, participation, and perceived discrimination to the mentally ill. For both attitude and commitment, having a social profession and interest in mass media are predictors. CONCLUSIONS: Internationally compared, Switzerland has a positive attitude and a big commitment in lay helping in psychiatry. But attitude is different from actual commitment. Lay helpers' work must be limited to realizable tasks and they need professional recruitment, instruction, and supervision otherwise they tend to be over-burden. The unused potential of voluntary helpers has to be opened specifically, e.g. by involving mass media and opinion-makers.

Public acceptance of restrictions on mentally ill people.

OBJECTIVE: To assess the influence of demographic, psychological, sociological and cultural variables on the public acceptance of restrictions on mentally ill people. METHOD: Multiple logistic regression analysis of the results of an opinion survey conducted on a representative sample in the German, French and Italian-speaking part of Switzerland. RESULTS: Public acceptance of restrictions depends on age, education and gender. The influence of demographic variables is reduced when including rigidity, anomie, social distance and contact with mentally ill people in the analysis. The cultural influence of the language region is significant. All these factors predict acceptance. Stereotypes and emotional reactions have no influence. CONCLUSION: Attitudes to mentally ill people are shaped on three distinct levels, the psychological, social and cultural, respectively. Demographic variables partly play the role of placeholders covering the underlying relationships.