Involuntary hospitalization, stigma stress and suicidality: a longitudinal study.

People with severe mental illness and a history of involuntary hospitalization may experience stigma-related stress and suffer negative consequences as a result. However, the long-term impact of stigma stress on suicidality in this population remains unknown. This longitudinal study therefore examined stigma stress, self-stigma, self-esteem and suicidal ideation among 186 individuals with mental illness and recent involuntary hospitalization. After adjusting for age, gender, diagnoses and symptoms, more stigma stress at baseline predicted suicidal ideation after 2 years, mediated by increased self-stigma and decreased self-esteem after 1 year. Anti-stigma interventions that reduce stigma stress and self-stigma could therefore support suicide prevention.

Preventing compulsory admission to psychiatric inpatient care using psycho-education and monitoring: feasibility and outcomes after 12 months.

The aim of this study was to evaluate an intervention programme for people with severe mental illness that targets the reduction in compulsory psychiatric admissions. In the current study, we examine the feasibility of retaining patients in this programme and compare outcomes over the first 12 months to those after treatment as usual (TAU). Study participants were recruited in four psychiatric hospitals in the Canton of Zurich, Switzerland. Patients were eligible if they had at least one compulsory admission during the past 24 months. Participants were assigned at random to the intervention or to the TAU group. The intervention programme consists of individualised psycho-education focusing on behaviours prior to illness-related crisis, crisis cards and, after discharge from the psychiatric hospital, a 24-month preventive monitoring. In total, 238 (of 756 approached) inpatients were included in the trial. After 12 months, 80 (67.2%) in the intervention group and 102 (85.7%) in the TAU group were still participating in the trial. Of these, 22.5% in the intervention group (35.3% TAU) had been compulsorily readmitted to psychiatry; results suggest a significantly lower number of compulsory readmissions per patient (0.3 intervention; 0.7 TAU). Dropouts are characterised by younger age and unemployment. This interim analysis suggests beneficial effects of this intervention for targeted psychiatric patients.

Emotional reactions to involuntary psychiatric hospitalization and stigma-related stress among people with mental illness.

Compulsory admission to psychiatric inpatient treatment can be experienced as disempowering and stigmatizing by people with serious mental illness. However, quantitative studies of stigma-related emotional and cognitive reactions to involuntary hospitalization and their impact on people with mental illness are scarce. Among 186 individuals with serious mental illness and a history of recent involuntary hospitalization, shame and self-contempt as emotional reactions to involuntary hospitalization, the cognitive appraisal of stigma as a stressor, self-stigma, empowerment as well as quality of life and self-esteem were assessed by self-report. Psychiatric symptoms were rated by the Brief Psychiatric Rating Scale. In multiple linear regressions, more self-stigma was predicted independently by higher levels of shame, self-contempt and stigma stress. A greater sense of empowerment was related to lower levels of stigma stress and self-contempt. These findings remained significant after controlling for psychiatric symptoms, diagnosis, age, gender and the number of lifetime involuntary hospitalizations. Increased self-stigma and reduced empowerment in turn predicted poorer quality of life and reduced self-esteem. The negative effect of emotional reactions and stigma stress on quality of life and self-esteem was largely mediated by increased self-stigma and reduced empowerment. Shame and self-contempt as reactions to involuntary hospitalization as well as stigma stress may lead to self-stigma, reduced empowerment and poor quality of life. Emotional and cognitive reactions to coercion may determine its impact more than the quantity of coercive experiences. Interventions to reduce the negative effects of compulsory admissions should address emotional reactions and stigma as a stressor.

[Crisis Cards for the Prevention of Compulsory Hospitalization]. / Krisenkarten zur Prävention von Zwangseinweisungen.

OBJECTIVE: To assess early signs of mental-health crises, treatment-specific demands and individual coping strategies from the subjective patients' perspective, and to categorize these specifications on the patients' crisis cards. METHODS: A sample of 108 psychiatric patients with severe mental disorders is currently taking part in an intervention programme targeting the reduction of compulsory re-admission to psychiatry. As part of the programme, patients fill in a crisis card. Data are analysed by a qualitative approach using content analysis. RESULTS: A variety of early signs of a crisis was specified by the psychiatric patients, most often negative emotions/thoughts (48 %). Likewise, the analysis revealed a wide range of treatment-specific preferences and individual strategies to cope with mental-health crises. CONCLUSIONS: Drawing up a crisis card in collaboration with a patient and discussing its contents might be used as a treatment resource and be beneficial to increase the patient's empowerment. Essential for the long-term prevention of mental-health crises and relapses is the regular reflection of the contents of a patient's crisis card.

Preventing Compulsory Admission to Psychiatric Inpatient Care: Perceived Coercion, Empowerment, and Self-Reported Mental Health Functioning after 12 Months of Preventive Monitoring.

OBJECTIVE: To evaluate the effects of a preventive monitoring program targeted to reduce compulsory rehospitalization and perceived coercion in patients with severe mental disorder. We analyze patient outcomes in terms of perceived coercion, empowerment, and self-reported mental health functioning at 12 months. METHODS: The program consists of individualized psychoeducation, crisis cards and, after discharge from the psychiatric hospital, a 24-month preventive monitoring. In total, 238 psychiatric inpatients who had had compulsory admission(s) during the past 24 months were included in the trial. T1-assessment 12 months after baseline was achieved for 182 patients. RESULTS: Study participants reported lower levels of perceived coercion, negative pressures, and process exclusion, a higher level of optimism, and a lesser degree of distress due to symptoms, interpersonal relations, and social role functioning (significant time effects). However, improvements were not confined to the intervention group, but seen also in the treatment-as-usual group (no significant group or interaction effects). Altered perceptions were linked to older age, shorter illness duration, female sex, non-psychotic disorder, and compulsory hospitalization not due to risk of harm to others. CONCLUSION: Our findings suggest that changes in the subjective perspective were fueled primarily by participation in this study rather than by having received the specific intervention. The study contributes to a better understanding of the interaction between "objective" measures (compulsory readmissions) and patients' perceptions and highlights the need for treatment approaches promoting empowerment in individuals with a history of involuntary psychiatric hospitalizations.