Informal coercion in psychiatry: a focus group study of attitudes and experiences of mental health professionals in ten countries.

PURPOSE: Whilst formal coercion in psychiatry is regulated by legislation, other interventions that are often referred to as informal coercion are less regulated. It remains unclear to what extent these interventions are, and how they are used, in mental healthcare. This paper aims to identify the attitudes and experiences of mental health professionals towards the use of informal coercion across countries with differing sociocultural contexts. METHOD: Focus groups with mental health professionals were conducted in ten countries with different sociocultural contexts (Canada, Chile, Croatia, Germany, Italy, Mexico, Norway, Spain, Sweden, United Kingdom). RESULTS: Five common themes were identified: (a) a belief that informal coercion is effective; (b) an often uncomfortable feeling using it; (c) an explicit as well as (d) implicit dissonance between attitudes and practice-with wider use of informal coercion than is thought right in theory; (e) a link to principles of paternalism and responsibility versus respect for the patient's autonomy. CONCLUSIONS: A disapproval of informal coercion in theory is often overridden in practice. This dissonance occurs across different sociocultural contexts, tends to make professionals feel uneasy, and requires more debate and guidance.

VOLUNTAD ANTICIPADA. UNA INVESTIGACIÓN A PROFESIONALES DE LA SALUD.

The aim of this paper is to obtain the knowledge and attitudes in front of the advanced directives of the health staff of the Medical Center "Lic. Adolfo Lopez Mateos" of Toluca, state of Mexico. The sample consisted in 80 health professionals, who agreed to participate in the questionnaire complementing the previous instruction (Herreros, 2012). Which consisted of 11 closed questions. Being the first four of the last seven knowledge and attitudes. The results showed that there is little knowledge about the living will, and that you think the doctor is the social worker who must inform the patient on it. But a high percentage think it would be important to be held although also agrees that it should be performed in patients with terminal illness. It concludes that, although the reserve sample size, there is little knowledge on the subject, however the positive attitude tends to be performed so that the measures and diffusion, the living will become a acceptance document at least on the side of health professionals.

El objetivo de esta investigación es obtener los conocimientos y actitudes que sobre las voluntades anticipadas tienen los profesionales de la salud en el área de medicina interna del Centro Médico "Lic. Adolfo López Mateos" de Toluca, Estado de México. La muestra consiste en exponer las opiniones de ochenta profesionales de la salud que participaron, de manera voluntaria, para contestar el cuestionario sobre conocimiento y actitudes ante el Testamento Vital, el cual consta de 11 preguntas cerradas; las primeras cuatro cuestiones versan sobre conocimientos, y las últimas siete sobre la actitud ante la Voluntad Anticipada (VA).Los resultados obtenidos permiten observar que existe escasa noción respecto al tema. Se considera que el médico y la trabajadora social son quienes deben informar al paciente acerca de las VA. Sobresalen las observaciones para que los pacientes con enfermedad terminal deban tener elaborado el Testamento Vital (TV). Por lo que se concluye, aunque con la reserva del tamaño de la muestra, que existe poco conocimiento sobre las VA o TV, incluso cuando la inclinación es positiva para tomar las medidas pertinentes y la difusión necesaria; esto es, el TV se convertiría en un documento de aceptación, al menos por el lado de los profesionales de la salud.