Knowledge on types of treatment pressure. A cross-sectional study among mental health professionals.

Treatment pressure restricts patients' voluntary and autonomous decisions. Yet interventions involving treatment pressure are widely used in mental health and psychosocial services. This cross-sectional study explored whether mental health professionals' knowledge on five types of treatment pressure (no coercion, persuasion or conviction, leverage, threat, and formal coercion) was associated with sociodemographic, professional and contextual factors. A more positive attitude towards interventions involving treatment pressure was associated with underrating the level of those interventions compared with a predefined default value. The treatment setting and professional group played a minor role in 'leverage' and 'formal coercion' types of treatment pressure, respectively.

[Recovery Self Assessment: Translation and cultural adaption of a recovery oriented assessment instrument]. / Recovery Self Assessment - Übersetzung und kulturelle Anpassung eines recovery-orientierten Einschätzungsinstrumentes.

BACKGROUND: The recovery approach is becoming increasingly important in mental health services and research. In English-speaking countries, its practical implementation as well as the scientific discussion is far more advanced. To support the approach, assessment instruments are required. A widespread and recognised tool is the Recovery Self Assessment Scale {RSA}. This includes four versions of a questionnaire, which cover the perspectives of users, providers, family members and management. AIM/METHOD: In this article, the development of the instrument and the system atictranslation process are presented. Two independent research groups applied different translation. METHODS: The Swiss research group {AGS} used the ISOPR principles, the German research group (AGN} the Guidelines of the European Social Survey Programme for survey translations TRAPD. The methods differ in the fact,that TRAPD uses focus groups. The results of both groups were combined by means of a consensus process. RESULTS: Within the translation and cultural adjustment of the RSA-D, the the oretical framework of the RSA as well as the transferability into the German speaking context has been ensured. CONCLUSION: Before the RSA-D c~n beused in practice and research, further studies towards psychometric testing should be conducted.

[How do nurses in psychiatric institutions assess suicide risk? A survey in the German-speaking part of Switzerland]. / Wie schätzen pflegende die suizidalität von patient(inn)en ein? Erhebung in psychiatrischen institutionen der deutschen Schweiz.

In the interdisciplinary treatment process nurses play an important role, assessing suicide risk. To cope with this responsibility, the use of assessment instruments is recommended. Although a lot of instruments exist to assess the risk of suicide, nurses do not use them consistently. This cross-sectional study seeks to answer the following questions: How do nurses assess the suicidality of patients of psychiatric hospitals in the German speaking part of Switzerland? Do they use assessment instruments and if so, which ones? Ward nurses in every psychiatric hospital (n = 32) were asked about the state of the nursing practice in assessing the suicide risk by means of an electronic questionnaire. The following results emerged: Nurses use instruments to assess suicide risk on about half of the wards (n = 119, 50.63%). 13% of the mentioned instruments are research-based. Nurses mostly assess suicide endangerment in the case of a presumed danger, less often at admission and least often during the discharge process. As suicidality is assessed mostly when nurses assume a danger in this study, and due to the fact that suicides most frequently occur shortly prior to or during the discharge process, an expansion of or the introduction of the assessment is recommended before the discharge process.

[Roles and Work Content of Peer Workers and Experts by Experience in Mental Health Practice, Education, Research and Development - Results of a Survey in Switzerland]. / Rollen und Arbeitsinhalte von Peers und Expertinnen und Experten durch Erfahrung in Praxis, Bildung, Entwicklung und Forschung in der Psychiatrie.

AIM OF THE STUDY: To identify work contents, roles and tasks of peer workers in mental health services in the German-speaking part of Switzerland. METHODS: A survey was conducted among peers in the German-speaking part of Switzerland. RESULTS: Most respondents stated that they work mainly in specialized services in the treatment of people with psychoses and affective disorders and in direct contact with service users. "Building bridges" between service users and professionals, conveying hope and confidence, empowerment as well as support in symptom management was most frequently indicated as a work activity. The majority of respondents have job descriptions that correspond to their activities. CONCLUSIONS: For mental health services, the challenge is to integrate the new professional group of peers workers as well as possible without undermining their proximity to the service users or their possibly critical perspective with regard to the existing practice.

Psychometric evaluation of the German version of the Opening Minds Stigma Scale for Health Care Providers (OMS-HC).

BACKGROUND: Healthcare professionals can be a source of stigma and discrimination for people with mental illness, and anti-stigma programs are needed for this target group. However, there is no validated German language scale to assess attitudes of healthcare professionals towards people with mental illness. This study had the aim to validate the German language version of the Opening Minds Stigma Scale for Health Care Providers (OMS-HC), a self-report measure of stigmatizing attitudes. METHODS: Staff (n = 392) on general psychiatric inpatient wards (excluding child, forensic and geriatric psychiatry) at five psychiatric hospitals in Switzerland (n = 3) and Germany (n = 2) participated in the study. The internal consistency of the OMS-HC was examined as well as its factor structure using exploratory and confirmatory factor analyses. To assess the scale's concurrent validity, we used the Social Distance Scale. RESULTS: Internal consistency for the OMS-HC total score was good (α = 0.74), acceptable for the subscales Attitudes (α = 0.62) and Social Distance (α = 0.69), and poor for the Disclosure subscale (α = 0.55). The original three-factor structure fit our data well. The OMS-HC total score and the Social Distance subscale score were significantly correlated with the Social Distance Scale, supporting concurrent validity. CONCLUSION: The German version of the OMS-HC demonstrated satisfactory psychometric properties and can be recommended for future research and intervention evaluation.

Peer support in Switzerland - Results from the first national survey.

Peer work is now known in Switzerland for 10 years and has developed strongly. The aim of the study was to describe peer support specialists' (PSSs') work conditions and job satisfaction, as well as the challenges of integration into the workforce in Switzerland. A further aim was to identify possible development topics in the preparation of PSSs for working with peer support work (PSW) training and interventions within the working field. We launched a survey with a self-developed questionnaire for people with lived experiences with mental illness and recovery who were working as PSSs or experts by experience in education, research, politics, and other areas in the German-speaking region of Switzerland. The survey took place from 1 September 2017 to 15 November 2017. The results show that PSSs were working mostly in 1:1 contact with service users and in education and noticeably less in politics and research. Their work conditions and job satisfaction seemed good. Most PSSs had job descriptions matching their duties, were satisfied with their salaries, and indicated being satisfied or very satisfied with their work. Amongst other aspects, the greatest challenge reported was integration into the inter-disciplinary working team. PSS training should better consider the working areas of experts by experience in the fields of politics and research to reinforce employment opportunities in these work areas. To increase the impacts of PSSs and to improve integration into the workspace, the preparation of professionals and institutions should be improved by means of information sessions, trainings, and guidelines.

Effectiveness of Transitional Interventions in Improving Patient Outcomes and Service Use After Discharge From Psychiatric Inpatient Care: A Systematic Review and Meta-Analysis.

Background: The transition from psychiatric hospital to community is often hindered by challenges that influence community adjustment and continuity of care. Transitional interventions with bridging components are provided prior to discharge and continue beyond inpatient care. They provide continuity of care and may be effective in preventing readmission. We aimed to assess the effectiveness of transitional interventions with predischarge and postdischarge components in reducing readmissions and improving health-related or social outcomes of patients discharged from psychiatric hospitals. Methods: We conducted a systematic review by searching electronic databases (MEDLINE, Embase, Cochrane Library, CINAHL, PsycINFO, and Psyndex) and included randomized, nonrandomized, and one-group study designs. A random effects meta-analysis was conducted with randomized controlled trials (RCTs) reporting data on readmission rates. Other study designs were synthesized qualitatively. Results: After screening 2,673 publications, 16 studies (10 RCTs, three quasi-experimental, and three cohort studies) were included and nine RCTs were included in the meta-analysis. The tested interventions included components from case management, psychoeducation, cognitive behavioral therapy, and peer support. All studies with significant improvements in at least one outcome provided elements of case management, most frequently in combination with cognitive behavioral therapy and psychoeducation. Readmission rates during follow-up ranged between 13% and 63% in intervention groups and 19% and 69% in control groups. Overall, we found an odds ratio of 0.76 (95% confidence interval = 0.55-1.05) for readmission due to transitional interventions. Heterogeneity was low at only 31% (p = 0.17) and the funnel plot indicated no obvious publication biases. Conclusions: We observed that transitional interventions with bridging components were no more effective in reducing readmission than treatment as usual; however, these results are based on limited evidence. Therefore, additional high-quality research is required to conclude the effectiveness of transitional interventions. Nevertheless, transitional interventions with bridging components are preferred by service users and could be an alternative to strategies regularly employed.

Outcomes and feasibility of the short transitional intervention in psychiatry in improving the transition from inpatient treatment to the community: A pilot study.

Discharge from psychiatric inpatient care is frequently described as chaotic, stressful, and emotionally charged. Following discharge, service users are vulnerable to becoming overwhelmed by the challenges involved in readapting to their home environments, which could result in serious problems and lead to readmission. The short transitional intervention in psychiatry (STeP) is a bridging intervention that includes pre- and post-discharge sections. It aims to prepare patients for specific situations in the period immediately following discharge from a psychiatric hospital. We conducted a quasi-experimental pilot study to determine the feasibility of the intervention, and gain insight into the effects of the STeP. Two inpatient wards at a Swiss psychiatric hospital participated in the study, and represented the intervention and control arms. Patient recruitment and baseline assessment were performed 2 weeks prior to discharge. Follow-up data were collected 1 week subsequent to discharge. Questionnaires measured coping, admission and health-care usage, self-efficacy, working alliance, experience of transition, and the number of difficulties experienced following discharge. Fourteen and 15 patients completed the follow-up assessment in the control and intervention groups, respectively. The STeP did not affect primary or secondary outcomes; however, it was shown to be feasible, and patients' feedback highlighted the importance of post-discharge contact sessions. Further research is required to improve understanding of the discharge experience, identify relevant patient outcomes, and assess the effectiveness of the intervention in an adequately-powered randomized, controlled trial.

Informal coercion as a neglected form of communication in psychiatric settings in Germany and Switzerland.

AIMS: Informal coercion is a frequently used form of communication among mental health professionals to influence treatment outcomes. This study investigates the recognition, attitude, and application of different forms of informal coercion by mental health professionals. METHODS: Mental health professionals of five psychiatric institutions in Germany and Switzerland (n = 424) took part in an online survey assessing the recognition of, attitudes towards, and application of different forms of informal coercion. RESULTS: Mental health professionals did not recognize the extent of informal coercion adequately; especially stronger forms were underestimated. Recognition and application of informal coercion was predicted by attitudes towards coercion. Furthermore, there were differences between profession of participants regarding the recognition and application of informal coercion. CONCLUSIONS: It is important to realize that the extent of applied informal coercion in therapeutic communication is often not recognized by practitioners, although it might interfere with a sound therapeutic relationship.

Inter-rater reliability of the German version of the Nurses' Global Assessment of Suicide Risk scale.

In comparison to the general population, the suicide rates of psychiatric inpatient populations in Germany and Switzerland are very high. An important preventive contribution to the lowering of the suicide rates in mental health care is to ensure that the risk of suicide of psychiatric inpatients is assessed as accurately as possible. While risk-assessment instruments can serve an important function in determining such risk, very few have been translated to German. Therefore, in the present study, we reported on the German version of Nurses' Global Assessment of Suicide Risk (NGASR) scale. After translating the original instrument into German and pretesting the German version, we tested the inter-rater reliability of the instrument. Twelve video case studies were evaluated by 13 raters with the NGASR scale in a 'laboratory' trial. In each case, the observer's agreement was calculated for the single items, the overall scale, the risk levels, and the sum scores. The statistical data analysis was conducted with kappa and AC1 statistics for dichotomous (items, scale) scales. A high-to-very high observers' agreement (AC1: 0.62-1.00, kappa: 0.00-1.00) was determined for 16 items of the German version of the NGASR scale. We conclude that the German version of the NGASR scale is a reliable instrument for evaluating risk factors for suicide. A reliable application in the clinical practise appears to be enhanced by training in the use of the instrument and the right implementation instructions.

Raiders of the Lost Art: A review of published evaluations of inpatient mental health care experiences emanating from the United Kingdom, Portugal, Canada, Switzerland, Germany and Australia.

Forming interpersonal therapeutic relationships with mental health Service Users remains a key aspect of the practice of Psychiatric/Mental Health nurses. Given the omnipresence of the concept within the relevant literature the reader could be forgiven for asking: why would Psychiatric/Mental Health nurses opine about something so basic, so ubiquitous and so central to the theory and practice of our discipline? While the authors could locate no substantive argument that refutes the role or value of such relationships, a sizable, growing and reasonably consistent body of work has emerged, which appears to indicate that this centrality and value is not necessarily reflected in many clinical practice settings. Accordingly, we draw on the published evaluations of mental health care emanating from the United Kingdom, Portugal, Canada, Switzerland, Germany and Australia, compare these findings and highlight similarities or/and congruence and discuss a range of issues arising out of the findings. Alas, the findings seem to depict a mental health care inpatient experience that is often devoid of warm therapeutic relationships, respectful interactions, information or choice about treatment and any kind of formal/informal 'talk therapy'. Instead such care experiences are personified by: coercion, disinterest, inhumane practices, custodial and controlling practitioners and a gross over use of pharmacological 'treatments'.

Does adherence therapy improve medication adherence among patients with schizophrenia? A systematic review.

Non-adherence to medication is highly prevalent in patients with schizophrenia. Adherence therapy aims to improve medication adherence of these patients by applying techniques of cognitive behavioural therapy, psycho-education, and motivational interviewing. Even though adherence therapy is frequently discussed and researched, its effectiveness is still uncertain. This paper aims to review the effectiveness of adherence therapy on the medication adherence of patients with schizophrenia. To this end, six electronic databases were systematically searched for randomized, controlled trials on adherence therapy from January 2002 to March 2013. Four trials met the inclusion criteria and were incorporated into the review. The findings suggest that adherence therapy does not improve patients' medication adherence in comparison to treatment as usual or a control intervention. However, all the studies reviewed showed high-adherence ratings at baseline. Thus, further well-designed studies that target adherence therapy to patients who are non-adherent to their medication are needed for a more profound understanding of its effectiveness. In addition, if adherence therapy is aimed not only at improving medication adherence, but also to reach an agreement whereby the patient's decision not to take his medication is accepted, the shared decision-making process needs to be assessed as well.