Die Behandlungsabsprache als Partizipationsmethode in der Kinder- und Jugendpsychiatrie

Abstract

Background: Children’s participation in all matters affecting themselves is guaranteed by human rights documents such as the UN Convention on the Rights of the Child. Yet, patients in child and adolescent psychiatric hospitals suffer from double marginalisation as minors and mentally ill patients, thus, special care should be taken to safeguard their rights. So far, little research efforts have been invested into exploring the means and effects of children`s participation in psychiatric decision making. One form of advance care planning are treatment agreements which are already established in some adult psychiatric clinics. Child and adolescent psychiatry could follow this example. Objective: We investigated available options for child participation and developed an advance care document for child and adolescent psychiatric hospitals in collaboration with the Child and Adolescent Psychiatric Hospitals at the University of Göttingen. To this aim, we carried out explorative qualitative interviews with hospitalised children, their parents and staff members to explore the need for advance care planning, and we organised two workshops. Results: Children, parents and staff members stated several positive effects of a treatment agreement in psychiatry. It could increase child trust, reduce fear and help safeguard respect for the dignity of the child. Both parents and children would expect to profit from increased reliability of the hospital team. Doctors expect positive effects on transparency as well as crisis prevention. Based on this assessment, a treatment agreement document was developed together with staff members, including psychiatrists, a psychotherapist and a nurse, as well as ethicists and a law student. The document comprises an information and an agreement part. Conclusion: Supported by hospitalised child and adolescent psychiatric patients, their parents and staff members, we succeeded in developing a practicable treatment agreement. Once established, this form of advance care planning could contribute to safeguarding minors’ participation rights in healthcare decision making.