This symposium brings together perspectives on how to prevent coercive events from happening, thus contributing to policy aims of reduced coercion and improved quality of mental health services. Different settings and approaches will be discussed.
Dr. Roaldset’s presentation, entitled “Preventing violence by risk assessment checklists” takes as a starting point that assessing the risk of violent incidents is needed to put preventative measures in place, and that such checklists should be easily accessible for use. However, there has been a lack of validated checklists for young people. This study aimed to adapt the V-RISK-10 checklist for adults to the population aged 12-18. This was a multicentre project, involving four emergency adolescent psychiatric wards, and four child welfare emergency institutions, which tested out the adapted V-RISK-Y tool. Results were overall good, but performed better in adolescent psychiatry compared with child welfare. Based on secondary data analysis and expert consultation, a V-RISK-YPs tool, tailored for child welfare services, was therefore also developed. The scales are short and easy to use by staff even without training. The presentation will emphasise their practical use in daily clinical work, as well as challenges of risk assessments.
In his talk “Changing our narrative towards ‘aggressive behaviour’”, Dr Doedens directs focus to the narrative surrounding aggressive behaviour, which not only suggests that total abolishment of aggressive behaviour in healthcare is possible. Healthcare deals with vulnerable, highly emotional individuals, and the abolishment of all aggressive behaviour seems highly unlikely. Furthermore, presenting professionals as victims and service users and visitors as perpetrators of aggressive behaviour does not consider the fact that most aggressive behaviour takes place during their interactions. As policies primarily aim to control the behaviour of service users, these strategies might not be optimal. If, instead, we change the narrative to one that focuses on the interactions in which aggressive behaviours occur, this could provide an opportunity for professionals to control and adjust their own behaviour, thereby potentially de-escalate situations. Such a change can empower mental health professionals by enhancing their skills and resilience when dealing with aggressive behaviour. Doing so, could potentially prevent aggressive behaviour and, thereby coercive measures, but also improve the safety of everyone involved in health services.
In the last talk, “Preventing coercion by strengthening primary mental health care”, Prof Rugkåsa argues that because governmental policies and action plans for reducing coercion are directed towards specialist services, to which people come when they are in crisis, this can make it hard to achieve the intended impacts on coercion rates. Instead, interventions earlier in the pathway might hold more potential to prevent crises from happening, thus both promoting better mental health and reduce the use of coercion. This would mean changing, at least part of, the attention on coercion reduction from acute wards to community services. The Reducing Coercion in Norway (RECON) project will be used as an example of such an approach, which both in its process evaluation and cluster-RCT, have shown promising results regarding reducing the level of involuntary admissions through making it part of the agenda of primary mental health care. Such approaches are in line with the WHO’s overall approach to healthcare that seek to achieve better alignment with human-rights based care.
Jorun Rugkåsa
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