Use of a proforma to aid in reducing coercion into informal admission for acute adult psychiatric inpatients in the U.K. (February 2019)

• Record Type: Journal Article
• Authors: Perry, Benjamin I.; Ayadurai, Nirmalan; Hess, Emily; Harmer, David; Curry, Thomas; Broom, Rebecca; White, David
• Is Part Of: Legal medicine. Volume 36(2019)
• Page Start: 103
• Page End: 109
• Publication Date: 2019-02
• Subjects: Coercion -- Psychiatry -- Mental health act -- Informed consent -- Capacity; Medical jurisprudence -- Periodicals; Forensic Medicine -- Periodicals; Médecine légale -- Périodiques; Medical jurisprudence; Periodicals; 614.1
• DOI: 10.1016/j.legalmed.2018.11.011
• Languages: English
• ISSNs: 1344-6223

Abstract

Highlights: Patients with mental illness are at risk of coercion. We implemented a proforma to reduce risk of coercive informal psychiatric admission. The proforma successfully reduced risk of coercive informal psychiatric admission. Younger patients were most at risk of coercive informal psychiatric admission. Part of our results may be explained by poor documentation. Abstract: Background: People with acute psychiatric illness may be at risk of coercion into informal admission. A lack of capacity assessment (CA) and provision of adequate information (PAI) for informal patients may constitute a risk of coercive admitting practice, resulting in increased use of the mental health act (MHA) in the days following admission. We developed and tested a proforma to aid in ensuring CA and PAI for informal admissions. Method: A pilot case-study was conducted in 2015 at a U.K. NHS trust (n = 50), analysing the prevalence of CA & PAI for adult psychiatric inpatient admissions, alongside the prevalence of MHA use in the next 72 h. Case-note audits were completed in 2016 & 2017 (n = 100 each), to assess the impact of the proforma in improving documented CA & PAI, alongside the prevalence of MHA use in the next 72 h. We tested for any demographic associations with CA & PAI using logistic regression. Results: CA improved from 39% (2015) to 60% (2017). PAI improved from 9% (2015) to 45% (2017). Use of the MHA in the 72 h following admission fell from 32% (2015) to 7% (2017). Most informal admissions detained within 72 h had no record of CA & PAI. People under the age of 26 years were significantly less likely to have documented CA & PAI. Implications: Use of the proforma was successful in improving CA & PAI in a U.K. population. Further improvements could be made. Future research should seek to further examine demographic differences in informal coercion.