[Involuntary treatment under guardianship law in psychiatric hospitals in Germany: results of an online survey].

Aim Of The Study: To determine the circumstances of involuntary treatment under the German Civil Code (BGB) in psychiatric hospitals serving a catchment area.

Method: Medical directors of psychiatric hospitals in Germany, including psychiatric departments at general hospitals and university clinics, were interviewed by means of an online survey.

Results: The response rate among the N=397 institutions addressed was 43%.

Treatment Pressures and the Predicament of Family Care: A Grounded Theory Study With Relatives of People With a Serious Mental Health Condition.

Relatives are increasingly recognized as important in the care of people with a serious mental health condition, such as major depressive disorder, bipolar disorder, or schizophrenia. Research indicates that in providing care, relatives use so-called treatment pressures, such as persuasion, interpersonal leverage, inducements, or threats, to promote the treatment compliance of their family member. This grounded theory study investigated why relatives use treatment pressures by analyzing the experiences of relatives of people with a serious mental health condition before, during, and after mental health crises of their family member.

[Theoretical foundations of clinical ethics consultation in psychiatry].

Background: Clinical ethics consultants support mental health professionals in identifying and analyzing moral problems in clinical practice.

Objective: Presentation of key ethical concepts and normative theories that are relevant for clinical ethics consultation in mental healthcare.

Material And Methods: Conceptual and ethical analyses.

Electroconvulsive Therapy in Forensic Psychiatry: A Systematic Review.

Patients with schizophrenia are the largest population in forensic hospitals, and treatment-resistant psychosis is associated with length of stay. For patients with severe and treatment-resistant psychotic disorders, electroconvulsive therapy (ECT) is a potentially effective treatment. Data regarding the use of ECT in forensic psychiatry are scarce.

Strategies to promote treatment compliance: a grounded theory study with relatives of people with a serious mental health condition.

Background: Treatment pressures encompass communicative strategies that influence mental healthcare service users' decision-making to increase their compliance with recommended treatment. Persuasion, interpersonal leverage, inducements, and threats have been described as examples of treatment pressures. Research indicates that treatment pressures are exerted not only by mental healthcare professionals but also by relatives.

Intersectional Discrimination in Mental Health Care: A Systematic Review With Qualitative Evidence Synthesis.

Objective: Discriminatory practices in mental health care undermine the right to health of marginalized service users. Intersectional approaches enable consideration of multiple forms of discrimination that occur simultaneously and remain invisible in single-axis analyses. The authors reviewed intersectionality-informed qualitative literature on discriminatory practices in mental health care to better understand the experiences of marginalized service users and their evaluation and navigation of mental health care.

[Advance directives and mental disorders: a practice recommendation of the Commission for Ethics and Law of the German Association for Psychiatry, Psychotherapy and Psychosomatics].

Background: Since the creation of legal requirements for advance directives by the legislator in 2009, special aspects of their application in the treatment of people with mental illnesses have been discussed.

Goal Of The Paper: Important questions on dealing with advance directives in everyday life will be answered in a practice-oriented manner.

Results: Among other things, this document answers the question of the conditions under which a patient can refuse or consent to hospitalization and treatment in advance, and in particular how to deal with advance directives whose implementation would also affect the rights of third parties.

Intersectionality as a tool for clinical ethics consultation in mental healthcare.

Bioethics increasingly recognizes the impact of discriminatory practices based on social categories such as race, gender, sexual orientation or ability on clinical practice. Accordingly, major bioethics associations have stressed that identifying and countering structural discrimination in clinical ethics consultations is a professional obligation of clinical ethics consultants. Yet, it is still unclear how clinical ethics consultants can fulfill this obligation.

Open-door policy versus treatment-as-usual in urban psychiatric inpatient wards: a pragmatic, randomised controlled, non-inferiority trial in Norway.

Background: Open-door policy is a recommended framework to reduce coercion in psychiatric wards. However, existing observational data might not fully capture potential increases in harm and use of coercion associated with open-door policies. In this first randomised controlled trial, we compared coercive practices in open-door policy and treatment-as-usual wards in an urban hospital setting.

Self-binding directives in psychiatric practice: a systematic review of reasons.

Self-binding directives (SBDs) are an ethically controversial type of advance decision making involving advance requests for involuntary treatment. This study systematically reviewed the academic literature on psychiatric SBDs to elucidate reasons for and against their use in psychiatric practice. Full-text articles were thematically analysed within the international, interdisciplinary authorship team to produce a hierarchy of reasons.

Research ethics in practice: An analysis of ethical issues encountered in qualitative health research with mental health service users and relatives.

The ethics review of qualitative health research poses various challenges that are due to a mismatch between the current practice of ethics review and the nature of qualitative methodology. The process of obtaining ethics approval for a study by a research ethics committee before the start of a research study has been described as "procedural ethics" and the identification and handling of ethical issues by researchers during the research process as "ethics in practice." While some authors dispute and other authors defend the use of procedural ethics in relation to qualitative health research, there is general agreement that it needs to be supplemented with ethics in practice.

When Treatment Pressures Become Coercive: A Context-Sensitive Model of Informal Coercion in Mental Healthcare.

Treatment pressures are communicative strategies that mental health professionals use to influence the decision-making of mental health service users and improve their adherence to recommended treatment. Szmukler and Appelbaum describe a spectrum of treatment pressures, which encompasses persuasion, interpersonal leverage, offers and threats, arguing that only a particular type of threat amounts to informal coercion. We contend that this account of informal coercion is insufficiently sensitive to context and fails to recognize the fundamental power imbalance in mental healthcare.

Opportunities and challenges of self-binding directives: A comparison of empirical research with stakeholders in three European countries.

Background: Self-binding directives (SBDs) are psychiatric advance directives that include a clause in which mental health service users consent in advance to involuntary hospital admission and treatment under specified conditions. Medical ethicists and legal scholars identified various potential benefits of SBDs but have also raised ethical concerns. Until recently, little was known about the views of stakeholders on the opportunities and challenges of SBDs.

Situational vulnerability within mental healthcare - a qualitative analysis of ethical challenges during the COVID-19 pandemic.

Background: Mental healthcare users and patients were described as a particularly vulnerable group in the debate on the burdens of the COVID-19 pandemic. Just what this means and what normative conclusions can be derived from it depend to a large extent on the underlying concept of vulnerability. While a traditional understanding locates vulnerability in the characteristics of social groups, a situational and dynamic approach considers how social structures produce vulnerable social positions.

Opportunities and risks of self-binding directives: A qualitative study involving stakeholders and researchers in Germany.

Purpose: Self-binding directives (SBDs) are a special type of psychiatric advance directive in which mental health service users can consent in advance to involuntary hospital admission and involuntary treatment during future mental health crises. This study presents opportunities and risks of SBDs reported by users with bipolar disorder, family members of people with bipolar disorder, professionals working with people with bipolar disorder and researchers with expertise in mental health ethics and law.

Methods: Seventeen semi-structured interviews with users, family members and professionals, and one focus group with five researchers were conducted.

[Shared Decision-Making for Patients with Mental Disorders or Cognitive Impairments].

Shared Decision-Making for Patients with Mental Disorders or Cognitive Impairments Shared Decision-Making (SDM) describes a model of collaborative decision-making that combines the expert knowledge of health professionals and the experiential knowledge of patients. This allows patients to play a more active role in the decision-making process. SDM is also becoming increasingly important in the treatment of persons with mental disorders or cognitive impairments.

Mental Health Service Users' Perspectives on Psychiatric Advance Directives: A Systematic Review.

Objective: Psychiatric advance directives (PADs) are documents that allow users of mental health services to express their preferences for treatment in future mental health crises. To increase the use of PADs in psychiatric practice, it is helpful to consider how service users view PADs and the factors that facilitate or hinder PAD creation and implementation. A systematic review of the empirical literature on this topic may help inform evidence-based policy making.

[The combined supported decision making model : A template for an ethically justifiable implementation of Article 12 of the UN Convention on the Rights of Persons with Disabilities in psychiatry].

Background: The interpretation of Article 12 of the United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD) by the UN Committee on the Rights of Persons with Disabilities led to a controversy over the implementation of the article in psychiatry.

Objective: How can Article 12 CRPD be implemented in psychiatry in an ethically justifiable way?

Material And Method: An empirically and legally informed conceptual and ethical analysis was carried out.

Results: The suggested combined supported decision making model ensures the recognition of people with mental disorders as persons before the law, their equal treatment in the informed consent process and the provision of supported decision making.