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The Role of Ethics in Reducing and Improving the Quality of Coercion in Mental Health Care

Abstract

Coercion in mental health care gives rise to many ethical challenges. Many countries have recently implemented state policy programs or development projects aiming to reduce coercive practices and improve their quality. Few studies have explored the possible role of ethics (i.e., ethical theory, moral deliberation and clinical ethics support) in such initiatives. This study adds to this subject by exploring health professionals’ descriptions of their ethical challenges and strategies in everyday life to ensure morally justified coercion and best practices. Seven semi-structured telephone interviews were carried out in 2012 with key informants in charge of central development projects and quality-assurance work in mental health services in Norway. No facilities used formal clinical ethics support. However, the informants described five areas in which ethics was of importance: moral concerns as implicit parts of local quality improvement initiatives; moral uneasiness and idealism as a motivational source of change; creating a normative basis for development work; value-based leadership; and increased staff reflexivity on coercive practices. The study shows that coercion entails both individual and institutional ethical aspects. Thus, various kinds of moral deliberation and ethics support could contribute to addressing coercion challenges by offering more systematic ways of dealing with moral concerns. However, more strategic use of implicit and institutional ethics is also needed.

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Notes

  1. 1.

    The English name for “PET” is “mental health care, ethics and coercion”.

  2. 2.

    Some key informants held double positions.

  3. 3.

    Norwegian Social Science Data Service (NSD 2015), http://www.nsd.uib.no/personvern/en/notification_duty/meldeskjema?eng).

  4. 4.

    “Shielding” is the main kind of seclusion in Norway. It differs legally from isolation in that it requires the continuous presence of staff.

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Acknowledgments

We thank the informants who have participated in this study; Associate Professor Nina Olsvold at Diakonova University College and anonymous reviewers for valuable advices; and the Norwegian Directorate of Health for financial support.

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Correspondence to Reidun Norvoll.

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There are no conflicts of interest regarding financial support or relationships.

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Norvoll, R., Hem, M.H. & Pedersen, R. The Role of Ethics in Reducing and Improving the Quality of Coercion in Mental Health Care. HEC Forum 29, 59–74 (2017). https://doi.org/10.1007/s10730-016-9312-1

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Keywords

  • Coercion
  • Ethics
  • Clinical ethics support
  • Mental health policy
  • Quality improvement and research