[Data-guided learning from suicidal incidents by using KEHR SUICIDE. A practice example in a Dutch mental health care facility]. / Datagestuurd leren van suïcidale incidenten met KEHR SUICIDE: GGz Eindhoven als praktijkvoorbeeld.

BACKGROUND: Specific and systematic data on health care providers' behaviour is needed to futher improve the care provided to suicidal patiënts in mental health care facilities.
METHOD: Explorative observational study of all suicidal incidents (n=50) that occurred in a Dutch mental health care facility over a one year period. Incidents were evaluated using KEHR SUICIDE, a questionnaire that assesses to what extent health care providers' conduct was compliant to the suicide practice guideline in the context of patients' suicidal behaviour. Associations between health care providers' and patients' features and guideline compliant behaviours of health care providers were calculated by logistic regression models.
RESULTS: Health care providers showed less guideline compliant behaviour when the patient had a psychotic, substance abuse or development disorder or had no axis 1 disorder. A positive association was found between guideline compliant behaviour and the extent to which the incident had been expected. CONCLUSION Guideline compliant behaviour of mental health care providers appears to be related to the axis 1 disorder of patients in a Dutch mental health care facility. Still, the application of guideline compliant behaviour concerning suïcide incidents shows room for improvement. KEHR SUICIDE is shown to be a helpful tool for multidisciplinary evaluation of suicidal incidents as it provides specific, ready-made information by which mental health care facilities can guide, examine and adjust suicide prevention policy. The outcomes provide hypotheses that may be examined in future research.

[High and intensive care three years later; an evaluation of the experiences of patients and employees and the effect on coercive measures in psychiatry]. / Drie jaar high en intensive care; evaluatie van ervaringen van cliënten en medewerkers en effect op gebruik van dwang en drang.

BACKGROUND: As part of the national campaign against the use of coercive measures in psychiatry, the Mental Health Service in Eindhoven set up the first modern high and intensive care centre (HIC) in Eindhoven in 2012. AIM: To study the progress of the numbers on coercive measures, and to evaluate the experiences of patients and treatment team members after working for three years according to the HIC model. METHOD: We analysed the registration data, carried out a short survey and conducted interviews. RESULTS: We found that the number of coercive measures used between 2012 and 2015 had declined by 42%. Patients generally had a positive attitude to the treatment they had received. They appreciated the role played by the team and were pleased to have had access to modern technology. Team members had a positive attitude to working with the HIC model. CONCLUSION: The main goals of working according to the new HIC model have been achieved. However, it should be possible to increase cooperation with mobile teams, develop more links with patients' next-of-kin and make wider use of modern technology.

The confusion about epistemology and "epistemology"--and what to do about it.

The epistemology debates within the field of family therapy have become relatively infrequent in the last year or so, perhaps as a consequence of the confusion they have generated for many family therapists. This article maintains that the primary reason for the confusion is a failure to distinguish clearly between the conventional meaning of the term epistemology, which concerns the nature of knowledge, and the unconventional meaning given the term in family therapy, which concerns the nature of what we know. It is proposed that the confusion can be diminished by understanding the relationship between the two meanings, which are here distinguished as epistemology (meaning 1) and epistemology (meaning 2) respectively. Particular attention is given to the logical consequences of adopting a position on epistemology (meaning 1)--e.g., is the knower capable of knowing an independent reality, or does the act of knowing make its own reality?--or on epistemology (meaning 2)--e.g., is causality linear or nonlinear?. The relevance and implications of these problems for the theory and practice of family therapy are discussed.