Inger Beate Larsen

Coercion in a locked psychiatric ward Perspectives of patients and staff

Background: In spite of a national strategy for reducing coercion in the mental health services, Norway still has a high rate of involuntary treatment compared to other European countries. It is therefore crucial to study various parties involved in involuntary treatment in order to reduce coercion. Research question: How do patients and staff in a Norwegian locked psychiatric ward experience coercion? Research design: Participant observation and interviews. Participants: A total of 12 patients and 22 employees participated in this study. Ethical considerations: This study is accepted by the National Committee for Medical Health Research Ethics. Findings: The participants experienced coercion in different ways. Patients often felt inferior, while many of the staff felt guilty for violating patients’ dignity, although they ascribed responsibility for their actions to the “system.” The main themes are (1) corrections and house rules, (2) coercion is perceived as necessary, (3) the significance of material surroundings, and (4) being treated as a human being. Discussion: The discussion draws upon the concepts of vulnerability, guilty conscience, and ethical sensitivity, related to the staffs’ divergent views on coercion. Conclusion: Especially among staff, there are divergent views of coercion. Professionals being physically and emotionally close to the patient are more likely to understand him or her as a unique person with individual needs. If patients are kept at a distance, professionals as a group change to understand patients as members of a group with common needs and common restrictions.

Hell on earth: Textual reflections on the experience of mental illness

Background Some people who by themselves or by others are understood as having mental health problems have written autobiographies about their experiences. Aims The aim of this study is to explore how people write about their experiences of being mentally ill. Method Twelve Scandinavian autobiographies were studied using content analysis based on phenomenology and hermeneutics. Results Three themes were identified: feeling like a stranger in life and places, the transformation of life experiences into questions of disease and feeling ashamed. Conclusions Peoples experiences of being mentally ill might be understood as the result of medical constructions unsuitable for the persons themselves. We could instead say that mental problems are not diseases, but severe and painful phenomena in peoples lives.

Generating dialogical practices in mental health: experiences from southern norway, 1998-2008.

In Norway and many other countries, political guidelines prescribe the development of mental health strategies with both a service user’s perspective and a treatment system established by the local authority. The development of new strategies frequently involves challenges regarding procedures and treatment as well as a view of knowledge and humanity. Dialogical practices might provide a solution for these challenges not only because of its procedures but also due to its attitudes toward service users. The aim is to explore the implementation of three dialogical practice programs in Southern Norway from 1998 to 2008 and to critically analyze and discuss the authors’ experiences during the implementation process. Three different programs of dialogical practices were initiated, established, and evaluated within the framework of participatory action research. Sustainable changes succeed individually and organizationally when all participants engage as partners during the implementation of new mental health practices. Generating dialogic practice requires shared understanding of the Open Dialogue Approach (ODA) and collaboration between professional networks and among the leaders. Developing a collaboration area that includes service users in all stages of the projects was one of the essential implementation factors. Other factors involved a common vision of ODA by the leaders and the actors, similar experiences, and a culture of collaboration. However, ODA challenged traditional medical therapy and encountered obstacles to collaboration. Perhaps the best way of surmounting those obstacles is to practice ODA itself during the implementation process.

Fear, danger and aggression in a Norwegian locked psychiatric ward Dialogue and ethics of care as contributions to combating difficult situations

Background: Fear and aggression are often reported among professionals working in locked psychiatric wards and also among the patients in the same wards. Such situations often lead to coercive intervention. In order to prevent coercion, we need to understand what happens in dangerous situations and how patients and professionals interpret them. Research questions: What happens when dangerous situations occur in a ward? How do professionals and patients interpret these situations and what is ethically at stake? Research design: Participant observation and interviews. Participants: A total of 12 patients and 22 professionals participated. Ethical considerations: This study has been accepted by the Regional Committee for Medical and Health Research Ethics in Norway. Findings: (a) Both atmosphere and material surroundings were interweaved within dangerous situations, (b) the professionals applied stereotypes when interpreting dangerous situations and (c) the professionals and the patients had different interpretations of what triggered dangerous situations. Discussion: The discussion centres on how care ethics and a dialogical practice might contribute towards combating difficult situations and the ways in which change is an ongoing ethical process of becoming. Conclusion: The ethics of care and a dialogical approach are suggested as ethical frameworks for preventing fear, danger and aggression in psychiatric wards. Both frameworks can be understood as patient-driven, including the relational and contextual perspectives. It means a shift from professionally driven processes to patient-driven dialogue.

A place for the heart : A journey in the post-asylum landscape. Metaphors and materiality

Abstract The downsizing of psychiatric hospitals has created a new institutional landscape in the local community to support people with severe mental problems in their daily living. This study explores meeting places in Norway from the users’ perspectives. The users used four metaphors to describe these meeting places: “like a home”, “like a family”, “like a landing ground” and “like a trampoline”. The users have decorated the interiors of the meeting places with hearts made from various materials, and these could be considered as symbols of the places. The metaphors used: the hearts and the rooms and interiors, reflect old ideas about calmness and dignity rather than new ideas based on New Public Management. HighlightsVery little is known about the post‐asylum landscape in welfare countries.Users described meeting places as “like home/family”, “like a landing ground” and “like a trampoline”.Meeting places were places without goal‐directed interventions and scheduled changes.They were spaces offering time for just “being” (a landing ground).Just to be allowed to “be” could create an opportunity for change (a trampoline).

“Heaven and Hell on Earth” A critical discourse analysis of religious terms in Norwegian autobiographies describing personal experience of mental health problems

This article explores the use of religious terms in six Norwegian autobiographies written between 1925 and 2005 by people who themselves have been patients in the mental health services. Through a critical discourse analysis, we discuss the functions of religious discourse in the texts and its position in contrast to the medical discourse predominant in todays mental health services. It was found that religious (predominantly Christian) terms were used to varying degrees in all autobiographies as a means to capture the immensity and inherent ambivalence characteristic of mental health problems. Despite the “medical turn” in professional mental health discourse, there is no clear evidence of a decrease in the use of religious terms from the oldest to the most recent text. We propose that professional mental health workers to a larger extent take into account the religious dimension in therapy, and reflect on its larger historical and sociocultural context.

Textbook descriptions of people with psychosis – some ethical aspects:

Background: Textbooks are central for the education of professionals in the health field and a resource for practitioners already in the field. Objectives: This article focuses on how 12 textbooks in psychiatric nursing and psychiatry, published in Norway between 1877 and 2012, describe and present people with psychosis. Research design: We used qualitative content analysis. Ethical considerations: The topic is published textbooks, made available to be read by students, teachers and professionals, and no ethical approval was required. Findings: The analysis shows that all 12 textbooks describe and present people who are considered as psychotic from a ‘perspective from above’. In this perspective, the readers are learning about psychosis in the professional’s language and from the author’s viewpoint. Most often the textbooks communicate a universal image of people with psychosis, a description that fits with the diagnostic criteria. The analysis also shows that two textbooks in psychiatric nursing combined this perspective with a ‘perspective from within’. Here, the readers are learning about psychosis from the patients’ own viewpoint. The authors communicate a personal, psychotic universe that differs from various people, even if they have the same diagnosis, and the descriptions are focusing on the patient as a whole person. Discussion and conclusion: Drawing partly on Rita Charon’s writings about narrative knowledge in the health field, and partly on insights from Martha Nussbaum and her concept of narrative imagination, we argue that mental health professionals need to learn about, understand and fathom what patients go through by reading, listening to and acknowledging the patients’ own stories and experiences. Cultivating the capacity for empathy and compassion are at the very heart of moral performance in the mental health field. A valuable moral resource in that regard is leading textbooks and how they describe and present people with severe mental illness.

Small Things, Micro-Affirmations and Helpful Professionals Everyday Recovery-Orientated Practices According to Persons with Mental Health Problems

The aim of this study is to present concrete descriptions of the content in the construction of helpful relationships with staff, according to users. Starting with the re-occurring concept of the meaning of “little things” in recovery studies, a literature review was done. A thematic analysis shows that small things play an important role in improving a person’s sense of self. Small things seem to be an invisible but effective parts of a recovery-orientated practice, but they might be defined as unprofessional and their efficacy negated.

Fra behandling til recovery. En review-studie av forskning på dagsentra for mennesker med psykiske lidelser

This study reviews research publications topically related to day centres for people with mental health problems. The purposes are to give a general overview of the evidence-based knowledge in the field, to detect gaps of knowledge, and to throw light on the following research questions: (1) Which ideologies about day centres may be revealed in Scandinavian- and English-speaking research on day centres for people with mental health problems; and (2) What significance do the day centres have for the users? Both questions are answered by examining 34 research publications, printed in either Scandinavian or English languages during the period 1962-2015. An integrative literature review was used as method. The topical knowledge revealed is categorized under two headings: (a) the day centres’ organization, and (b) their materiality and internal life. The results and the discussion show that the day centres in the 1960s started out as arenas based on treatment ideology, dominated by psychiatric, medical knowledge. Slowly and gradually the ideology changed towards recovery approaches. However, this change in ideology does not mean that the day centres have succeeded in implementing the idea of integrating the users in the general society.

Materiell og profesjonell stigmatisering av mennesker med sykelig overvekt

The aim of this study is to show how people suffering from severe obesity might experience stigmatization. We interviewed 6 persons recruited from a Norwegian rehabilitation center, specialized in lifestyle intervention in severe obesity. We found that the participants suffering from severe obese experienced stigmatization and thus felt that they a) did not fit into the materiel world and b) experienced a lack of respect from health care professionals. The results are discussed according to how contemporary symbols are embedded in our surroundings and in our bodies. The conclusion underlines severe obesity as a complex problem which is strengthened by rooms and interior designed for ideal sizes. The prejudices that health care professionals express worsen these patients feeling of stigma. We refer to this as material and professional stigmatization.