InvolvE Outcomes of Involuntary Admissions in Hospitals In England Newham Centre for Mental Health Institute of Psychiatry Liverpool University Bristol University Department of Health Funded MHRN Dr Diana Rose and Rajinder Sidhu

Background Psychiatry is the only medical speciality that treats significant numbers of patients against their will and many patients get admitted to hospital involuntarily. Empirical Evidence about practice, outcome and processes of coercive treatment is limited

The Study - One Principle Investigator at each site - One Principle Investigator from the MHRN - One Service User Researcher/Investigator at the IOP involved in drawing up project proposal

RESEARCH QUESTIONS What is the outcome of hospitalisation for legally involuntary patients after 4 weeks of treatment, 3 months of treatment, and 12 months of treatment What patient characteristics and process variables are associated with more or less favourable outcomes? Compare findings from 11 other European Countries With different legislation (EUNOMIA) ?

The Project 4 sites around the UK, IOP covers 4 Trusts One Service User Researcher age able to give informed consent Questionnaires and some In depth interviews Paid LARGEST GEOGRAPHIC AREA Sections 2 and 3

Section 2: Admission for assessment Up to 28 days. It isn't renewable. You can only be given treatment with consent unless, under extreme circumstances, it's considered necessary to save your life. Section 3: Admission for treatment Up to six months for treatment in the first place. It can then be renewed for another six months. Any renewals after this would be for one year. Up to three days in a place of safety. In exceptional circumstances, this can include a police station. It isn't renewable. Section 136: Removing a mentally ill person from a public place to a place of safety

What happens during the sectioning and Admission process Patients own perceptions of their mental health/ability to be at ‘risk’. Brief Psychiatric Assessment Scale Respected and Understood Experiences of Tribunals MANSA ? At the Zoo, Hannah Brookes, 2004 The Consultant…… M.A. Graham, 2004 SERVICE USERS PERCEPTION OF:

Perceptions of treatment/medication and after care Level of ‘coercion’ felt and actual coercive measures used (how pressured/forced felt) RETROSPECTIVE SERVICE USERS PERCEPTION OF:

Who suggested you go to hospital? Did you feel free to do what you wanted? Did you have A lot of control….? Perceived Coercion Perceived Coercion 1 10 MacArther Maximum use Of Coercion Minimum use of Coercion

10 days 4 weeks 12 weeks 12 months FOLLOW UP Community Treatment Was Sectioning Justified Pressure to Adhere to Treatment Any Coercive Measures

Qualitative Interviews Process in detail from the moment the patient is sectioned What lead to this, what happened, what do they think was the reason for this Treatment and Care Retrospect – necessary? What changes need to be made? The One that got Away, Linda Hart 2004 One Service User Analysing

( Continuity of Care and InvolvE and Partnership Working and Gendep) Importance,Experience and Satisfaction Users Priorities Scales are combined with qualitative materials and a range of questions and measures to gain the true meaning to experience – e.g, treatment/care/respect separated Empowering by feedback to the participant and the service Dissemination to user groups and other services InvolvE: Is more than an audit of one service – looks at a process (sectioning) and its impact on the patient Shared Experiences

277 participants at the IOP Approx 870 participants nationwide Retained at 48% at One Year follow up NOW