Attitudes of mental health professionals towards the use of coercion are highly relevant concerning its use coercion in mental healthcare, as mental health professionals have to weigh ethical arguments and decide within a legal frame in which situations to use coercion or not. Therefore, assessment of those attitudes is relevant for research in this field. A vital instrument to measure those attitudes towards the use of coercion is the Staff Attitude to Coercion Scale. This scoping review aims to provide a structured overview of the advantages and limitations in the assessment of attitudes toward coercion. We conducted a scoping review in Medline, PsycINFO, CINAHL, and Web of Science, based on the PRISMA-ScR. Inclusion criteria were empirical studies on the attitudes of mental health professionals. We included 80 studies and systematically mapped data about the main results and limitations in assessing attitudes toward coercion. The main results highlighted the relevance and increased interest in staff attitudes towards coercion in mental healthcare. Still, the majority of the included studies relied on a variety of different concepts and definitions concerning attitudes. The data further indicated difficulties in developing new and adapting existing assessment instruments because of the equivocal definitions of underlying concepts. To improve the research and knowledge in this area, future studies should be based on solid theoretical foundations. We identified the need for methodological changes and standardized procedures that take into account existing evidence from attitude research in social psychology, nursing science, and other relevant research fields. This would include an update of the Staff Attitude to Coercion Scale based on the limitations identified in this review.
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4.1 IntroductionThe use of coercive measures generally has negative effects on patients. To help prevent its use, professionals need insight into what nurses believe about coercion and which staff determinants may influence its application. There is need for an integrated review on both attitude and influence of nurses on the use of coercion.4.2 AimTo summarize literature concerning attitude of nurses towards coercive measures and the influence of staff characteristics on the use of coercive measures.4.3 MethodSystematic review.4.4 ResultsThe attitude of nurses changed during the last two decades from a therapeutic to a safety paradigm. Nurses currently view coercive measures as undesirable, but necessary to deal with aggression. Nurses express the need for less intrusive interventions, although familiarity probably influences its perceived intrusiveness. Literature on the relation between staff characteristics and coercive measures is inconclusive.4.5 DiscussionNurses perceive coercive measures as unwanted but still necessary to maintain safety on psychiatric wards. Focussing on the determinants of perception of safety might be a promising direction for future research.4.6 Implications for practiceMental health care could improve the focus on the constructs of perceived safety and familiarity with alternative interventions to protect patients from unnecessary use of coercive interventions.
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Background: While the interest of health promotion researchers in change methods directed at the target population has a long tradition, interest in change methods directed at the environment is still developing. In this survey, the focus is on methods for environmental change; especially about how these are composed of methods for individual change ('Bundling') and how within one environmental level, organizations, methods differ when directed at the management ('At') or applied by the management ('From'). Methods: The first part of this online survey dealt with examining the 'bundling' of individual level methods to methods at the environmental level. The question asked was to what extent the use of an environmental level method would involve the use of certain individual level methods. In the second part of the survey the question was whether there are differences between applying methods directed 'at' an organization (for instance, by a health promoter) versus 'from' within an organization itself. All of the 20 respondents are experts in the field of health promotion. Results: Methods at the individual level are frequently bundled together as part of a method at a higher ecological level. A number of individual level methods are popular as part of most of the environmental level methods, while others are not chosen very often. Interventions directed at environmental agents often have a strong focus on the motivational part of behavior change. There are different approaches targeting a level or being targeted from a level. The health promoter will use combinations of motivation and facilitation. The manager will use individual level change methods focusing on self-efficacy and skills. Respondents think that any method may be used under the right circumstances, although few endorsed coercive methods. Conclusions: Taxonomies of theoretical change methods for environmental change should include combinations of individual level methods that may be bundled and separate suggestions for methods targeting a level or being targeted from a level. Future research needs to cover more methods to rate and to be rated. Qualitative data may explain some of the surprising outcomes, such as the lack of large differences and the avoidance of coercion. Taxonomies should include the theoretical parameters that limit the effectiveness of the method.
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Background Prevention of coercion in mental health care is a major, international challenge for mental health professionals. The Dutch government aims to diminish seclusion of psychiatric inpatients by 2018. Since the main reason for seclusion is violent behaviour, there is a need for understanding aggressive behaviour.
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The demographics of the homeless population in many countries are currently shifting, and this cannot be explained by the different welfare systems to be found in these countries. Nevertheless, there is some evidence that the homelessness policies of some countries are converging, and we observe a combination of decentralisation, housing first, and a taylor-made, individualised approach. However, what is interesting is the question as to what extent these policies are based on a punitive dimension or on a justice dimension.
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Wijkagenten en jongerenwerkers in de Rotterdamse wijk Delfshaven krijgen in toenemende mate te maken met meiden die slachtoffer (dreigen te) worden van ‘exposen’: het online verspreiden van seksueel getint (beeld)materiaal met het doel iemand reputatieschade toe te brengen. Om meer zicht te krijgen op deze ontwikkeling heeft de gemeente Rotterdam het lectoraat Publiek Vertrouwen in Veiligheid gevraagd onderzoek te doen naar de rollen die meiden tussen de 10-23 jaar spelen binnen het fenomeen exposen in Delfshaven. Uit het onderzoek blijkt dat meiden naast slachtoffer, ook omstander en dader zijn. Meiden exposen zelf, om zo andere meiden naar beneden te halen en in een positief daglicht (bij jongens) te komen. Verder valt op dat áls meiden reageren op exposen, zij dat alleen doen richting het slachtoffer, en niet richting de dader. De schuld van het exposen wordt veelal bij het slachtoffer neergelegd. Exposen heeft verregaande consequenties voor slachtoffers. Ze krijgen te maken met seksuele intimidatie, geweld door familieleden, trekken zich terug uit het sociale verkeer uit schaamte en kunnen een negatief zelfbeeld ontwikkelen. Geconcludeerd wordt dat exposen in Delfshaven plaatsvindt binnen een complex systeem van elkaar versterkende en deels overlappende contexten; straat-, wijk- en schaamtecultuur. Daar waar sprake is van een overlap is de kans op verregaande vormen van exposen met verregaande consequenties (en dus verstrekkende schade voor meiden en hun familie) het grootst. Geadviseerd wordt een aanpak in de eerste plaats te richten op meiden die zich in deze overlap bevinden, waarbij aandacht wordt besteed aan het objectieve én het subjectieve veiligheidsprobleem dat rond exposen in Delfshaven is ontstaan.
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From January 2011 until December 2012, forty Family Group Conferences (FGCs) will be studied in the public mental health care (PMHC) setting in the province of Groningen, the Netherlands. Research should yield an answer to whether FGCs are valuable for clients in PMHC as a means to generate social support, to prevent coercion and to elevate the work of professionals. The present study reports on two case studies in which shame and fear of rejection are designated as main causes for clients to avoid contact with their social network, resulting in isolated and marginalised living circumstances. Shame, on the other hand, is also a powerful engine in preventing clients from relapse into marginalised circumstances for which one needs to feel ashamed again. An FGC offers a forum where clients are able to discuss their shameful feelings with their social network; it generates support and helps breaking through vicious circles of marginalisation and social isolation. Findings of these case studies confirm an assumption from a previous study that a limited or broken social network is not a contraindication, but a reason for organising FGCs.
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Since the introduction of Family Group Conferences (FGCs) in the Netherlands, there has been a steady growth in conferences being organised each year. Government policy emphasises the importance of empowering families to strengthen their ability to take responsibility for their own well-being. A recently adopted amendment in the Dutch Civil Code reflects this commitment and designates FGC as good practice. However, there is little knowledge on the application of FGCs in mental health care, let alone in a setting even more specific, such as public mental health care (PMHC). Clients in PMHC often have a limited network. The starting point of this study is the assumption that conferences promote involvement, expand and restore relationships and generate support. Over the next two years, we will research the applicability of FGCs in PMHC by evaluating forty case studies. The aim of our study is to provide an answer to the question of whether Family Group Conferencing is an effective tool to generate social support, to prevent coercion and to promote social integration in PMHC. Although making contact and gaining trust is a goal of PMHC, it is an aim to study whether FGCs can elevate or replace the work of professionals.
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Lezing gehouden tijdens congres "Wie beslist er over wat: congres over subsidiariteit en het middenbestuur in de 21e eeuw" op 19 december 2005.
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Background. Violent criminal offenders with personality disorders (PD’s) can cause immense harm, but are often deemed untreatable. This study aimed to conduct a randomized clinical trial to test the effectiveness of long-term psychotherapy for rehabilitating offenders with PDs. Methods. We compared schema therapy (ST), an evidence-based psychotherapy for PDs, to treatment-as-usual (TAU) at eight high-security forensic hospitals in the Netherlands. Patients in both conditions received multiple treatment modalities and differed only in the individual, study-specific therapy they received. One-hundred-three male offenders with antisocial, narcissistic, borderline, or paranoid PDs, or Cluster B PD-not-otherwise specified, were assigned to 3 years of ST or TAU and assessed every 6 months. Primary outcomes were rehabilitation, involving gradual reintegration into the community, and PD symptoms. Results. Patients in both conditions showed moderate to large improvements in outcomes. ST was superior to TAU on both primary outcomes – rehabilitation (i.e. attaining supervised and unsupervised leave) and PD symptoms – and six of nine secondary outcomes, with small to moderate advantages over TAU. ST patients moved more rapidly through rehabilitation (supervised leave, treatment*time: F(5308) = 9.40, p < 0.001; unsupervised leave, treatment*- time: F(5472) = 3.45, p = 0.004), and showed faster improvements on PD scales (treatment*- time: t(1387) = −2.85, p = 0.005). Conclusions. These findings contradict pessimistic views on the treatability of violent offenders with PDs, and support the effectiveness of long-term psychotherapy for rehabilitating these patients, facilitating their re-entry into the community
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